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HomeMy WebLinkAbout0362 LINCOLN ROAD - Health (2) _ j62 Lincoln Road Hyannis _ = A = 271 - 064 -- =-- • � r F{ 1_ ii TOWN OF BARNSTABLE LOCATION ' ��U f iy1Cni i.�_ SEWAGE # VILLAGE �� s`� ` S ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. ��P4)(C_- Gc.�' �w V0_a,- SEPTIC TANK CAPACITY 5"6 d "B� LEACHING FACILITY: (type) 7 /'?�,.�T6'c/�e,�' (size) /n Y r�0 NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: ,� Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility •VO /f) 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 U � � V`i � W L9 q Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 362 Lincoln Road Property Address i"4W t.b Our Child LLC ..Y Owner Owner's Name Tf information is required for every Hyannis _ Ma 02601 9-13-17 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:When filling out forms A. General Information St.* lzzo(e on the computer, use only the tab 1. Inspector: key to move your cursor-do not Brett Hickey use the return Name of Inspector key. . Excavation Company r� Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code (508)477-0653 SI 13747 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 ❑ Needs Further Evaluation by the Local Approving Authority 9-13-17 Inspector's Signature Date 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis Ma 02601 9-13-17 -- page. City(rown State Lip Code Date of Inspection B. Certification (coot.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15i303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: §tem was in working order at time of inspection. 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 of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal.System Form - Not for Voluntary Assessments M , ' 362 Lincoln Road Property Address Our Child_LL_C Owner Owner's Name information is H annis _Ma 02601 9-13-17 required for every —�_ _.---_._________ _ page. CityrTown State Lip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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 broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: j .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 15ins•3/13 Title 5 Officisl Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Nante information is H annis _Ma C2601 9-13-17 required for every �_— _——.____ _ —_ page. Citylrown State Lip Code Date of Inspection B. Certification (cont.) 2e 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 to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and 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 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 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 El ® 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 1/z day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 362 Lincoln Road Property Address Our Child LLC_ Owner Owner's Name information is Hyannis- Ma 02.601 9-13-17 required for every _Y--_ __ page. Citylrown State Zip Code Date of Inspection B. Certifications (cont.) Yes No El ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. Li z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Z 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. �i 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.] V z The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ Z The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, 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" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply El 0 the system is within 200 feet of a tributary to a surface drinking water supply the system+ is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts = Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 362 Lincoln Road_ Property Address Our Child_LLC Owner Owner's Name information is required for every Hyannis__ _ _ _ _ _Na C2601 9-13-17 page. Cityrrown 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 Na E ❑ Purnping information was provided by the owner, occupant, or Board of Health Z Were any of the system components pumped out in the previous two weeks? Z ❑ 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? Zi ❑ there 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? Z F-1 Was the site inspected for signs of break out? Z ❑ Were all system components, excluding the SAS, located on site? BSI G 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, dirriensions, depth of liquid, depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner) provided with C' 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: Z ❑ 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): Ldu !ex' Number of bedrooms(Actual) 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 443GPD t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w„ 362 Lincoln Road Property Address Our Child_LLC Owner Owner's Name information is Hyannis------- Ma G260_1 _ 9-13-17 required for every —�_____.___ ._.__.__ _._ page. Cityrruwn State Lip Gude Date of Inspection D. System Information Description: Number of current residents: 6-8 Does residence have.a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter,readings, if available last 2 ears usage d See below 9 ( Y 9 (9P ))� Detail: 2015.- 1 18,932gallons 2016- 140,624gallons Surrip pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? El Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water mei:er readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name - ---- -- -—----- information is required for every H anrns Nia 02601 . 9-13-17 �._ ______.—___._._ _ —_ page. Cityrrown 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: Owner-last pumped in June 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: z Septic tank, distribution box, soil absorption system LJ Single cesspool Overflow cesspool ❑ Privy [; Shared system (yes or no) (if yes, attach previous inspection records, if any) E; 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. Lj Other(describe): t5ins•3/13 Tille 5 Offc al Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 362 Lincoln Road Property Address Our Child LLC _ Owner Owner's Name information is required for every Hyannis ——____—___--_____ _Ma _ 02601 9-13-17 page. City/Town State Zip Code Date of Inspection D. Systems Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2007 -- -- ---------- Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron E 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Colriments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 1 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: 1500gallons Sludge depth: 6" t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LL_C _ Owner Owner's Name information is H annis _Ma 02601 9-13-17 required for every �__�� —______._____—__ _._._ ___ page. Cityrrown 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 30" Scum thickness 4 .Distance from top of scum to top of outlet tee or baffle 6 Distance"rom bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in need of pumping at this time but should be pumped every two years for maintenance. — I Grease Trap(locate on site plan): Depth below grade: NAfeet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: 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 Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 362 Lincoln Road Property Address Our Child LLC Owner Owners Name information is H ann s _Ma C2601 9-13-17 required for every �_I _. —._ page. City/Tuwn State Lip 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: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Fiow: - gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Dale of last pumping: Date Cornments(condition of alarm and float switches, etc.): ' Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child_LLC Owner Owner's Nairle — -- — information is H _Mta_ 02601 _ 9-13-17 required for every ��ams i —.__--------------..—_-- _ — page. CityfTown 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 0" Cernmenks(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.): D-bax is in working order at time of inspection with liquid level equal to outlet invert. D-box did not show sins of back up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 362 Lincoln Road. Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis annis Ma 02601 9-13-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 7 infiltators 10'x50'x1' ❑ 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.): Leaching was in working order at time of inspection with no sign of hydraulic failure. Leaching was 3/ full when viewed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis Ma _02601, 9-13-17 required for every y page. Cityrrown 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.): Privy(locate on site plan): Materials of construction: NA Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis _Ma 02601 9-13-17 ' required for every y _ _ page. Cityrrown 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 Al-53' A2-36' A3-58' A4-55'4" B1-48' A B 1132-4T'5" B3-5,V B4-56'9" 3❑ t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis _Ma 02601 9-13-17 required for every y _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow S a ow wells No GW @132" 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: Date 7 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: You must describe how you established the high ground water elevation: Plan on file with BOH. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 9 p Y rY ,M 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis _Ma 02601 9-13-17 required for every �_ page. City/Town State "Lip 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form 61 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityrrown 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:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael Kellett l use the return Name of Inspector key. Aardvark Environmental Inspections �y Company Name PO Box 896 Company Address East Dennis MA 02641 Cityrrown State Zip Code 50&M5-7608 S13742 Telephone Number License Number B. Certification 1 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 ❑ Needs Further Evaluation by the Local Approving Authority 0923/13 Irtsp or's Signature Date 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. �d 110/15/b i3 t5ins•11/10 Title 5Offcial Inspectio F :Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 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 any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 of the replacement or repair,as approved by, the Board of Health,will pass. Check the box for"yes","non or"not determined"(Y,N, ND)for the following statements.If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration ortank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the flank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11/10 Title 50trcial Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923113 page. Cityfrown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes (cunt.): ❑ 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 broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required 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): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)thatthe system is not functioning in a mannerwhich 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 wins 11f10 11ue:,LYricial inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis MA 02601 0923/13 required for every y page. Cityrrown 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 to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and 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 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 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 El ® Liquid depth in cesspool is less than 6°below invert or available volume is less than%day flow t5ins-11/10 Title 5Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments sY 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis MA 02601 0923/13 required for every y page. City/Town state Zip Code Date of Inspection B. Certification (font.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® 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 e)dst as described in 310 CMR 15.303,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"nd"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered`yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Idle 5 official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is Hyannis MA 02601 09/23/13 required for every page. Cityfrown 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 15203(for example: 110 gpd x#of bedrooms): 440 t5ins-11/10 Idle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityrrown state Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Current Date CommerciaMndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): canons 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 the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: t5ins•11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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 VA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityfrown state Zip Code Date of Inspection D. System Information (cunt.) Approximate age of all components,date installed (If known)and source of information: 0123/07 per BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3.1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: eel Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain) If tank is metal,list age: yeas Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1,500 gal Sludge depth: 3" t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y� 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was sound and tight with tees in place and liquid at outlet invert Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 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 Date of last pumping: Date t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 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): Dimensions: 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.): "Attach copy of current pumping contract(required).Is copy attached? ❑ Yes ❑ No t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 09/23/13 page. Cityrrown 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 even 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.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System(SAS) (locate on site plan,excavation not required): If SAS not located,explain why: t5ins•11/10 We 5 Official Inspection Form:Subsurface Sewage Disposal Syslern•Page 12 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessmentsgo, 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. City1rown state Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ® leaching chambers number: 7 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc): This system has seven infiltrators in a 10'x50'field of stone.There was no sign of ponding or failure in the stones. 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 inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "t 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityrrown 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.): Privy(locate on site plan): ra` Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.): t5ins•11/10 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Fora K Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 page. Cityfrown state Zip Code Date of Inspection D. System Information (font.) 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 rear i 36 48 50 54 55 57 t5ins•11/10 Me 5 Official Inspection Form:Subsurface Sewage D4osal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 09/23/13 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: 20.0 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: Date ❑ Observed site(abutting properly/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: You must describe how you established the high ground water elevation: USGS maps show an elevation of over 20.0 feet Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y< 362 Lincoln Road Property Address Our Child LLC Owner Owner's Name information is required for every Hyannis MA 02601 0923/13 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-11/10 Title e 5 Official inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 RtUer Vrope* fie "Cape Cod's Tuff Service Realty Company" 150'Main Street West vennis, 'MA 02670 Office(508)394-4446 Far(508)394-4819 11onday Friday, 9:00 am to 4:00 pm August 30, 2012 Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 RE: 362 Lincoln Road Dear Tim O'Connell: As per the Barnstable Health Departments request, all of the work as instructed by the Barnstable Health Department has been completed at 362 Lincoln Road, Hyannis. Specifically 105CMR410.500—the cabinets in the kitchen had bases that were in disrepair from water damage. Observed areas under said cabinets that contained dirt, debris and mold like substance along the sub-flooring not in good repair. The bases have been repaired, see July 20, 2012 invoice enclosed. Thank you for your attention. While Mr. Ortiz has had some legitimate complaints, which we immediately fixed, it is his way of trying not to pay the rent. Sincerely, Ronald D. Bourgeois (508) 394-4446 Monday — Friday, 9:00 am to 4:00 pm ron(aD-bassriverproperties.com C.C. Thomas McKeen Director Barnstable Health Department Edwin Ortiz and Maureen-Jones RDB/sh "No one kandfes tenant occupied properties better! F r "Cape Cod's TuffSerUice Realty Company" 150 Main Street West Tennis, T,4 02670 Office(508)394-4446 'Fax(508)394-481.9 ,14onday - Friday, 9:00 am to 4:00 pm August 28, 2012 Barnstable Health Department 3195 Main St Barnstable, MA 02630 RE: 362 Lincoln Road Dear Tim O'Connel: I just wanted to formally let you know that Joe did not get in yesterday, Monday August 27, 2012 as scheduled at 8:00 am as the tenants did not allow access as agreed to on Thursday July 23, 2012. After three trips to the property, Joe asked for a specific date for access of which the tenants would not give him a date to return. If you could get a specific appointment we will accommodate that time. We can not fix anything if we do not have access. Joe did buy materials in preparation to do work there for yesterdays appointment, which he had to then return resulting in a lot of wasted time. As always, please do not hesitate to call if you have any questions. Sincerely, Ronald D. Bourgeois (508) 394-4446 Monday - Friday, 9:00 am to 4:00 pm ron a(�.bassriverproperties.com C.c. Barnstable Health Department Edwin Ortiz and Maureen Jones RDB/sh "No one handfes tenant occupiedproperties better!" r t- Certified Mail#7008 3230 0002 5178 0509 t"B to Town of Barnstable Regulatory Services EARN 3TABM g Y MAW 639 163q. Thomas F. Geiler, Director �0 A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Our Child LLC August 28, 2012 c/o Ronald Bourgeious 150 Main Street West Dennis, MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 362 Lincoln Road (Unit B), Hyannis, MA was inspected on August 28, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following viblation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed paneling near bedroom and utility closet that was pealing and in need of repair. Observed multiple tiles cracked in kitchen area. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: Observed water filling bucket at the bottom of the drip pipe on hot water heater. You are directed to correct the violations listed above within fourteen (14) days of your receipt of this notice by making repairs on tile and paneling; by installing an expansion tank on hot water heater. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. i PER ORD OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Cc: Edwin Ortiz, Tenant QAOrder letters\Housing violations\Rental ordinance\362 lincoln rd apr B.doc 7-18-12 / INVOICE NO. ?�42 -4 gy INVOICE BILL TO r SERVICE PERFORM AT �+ 1 © p Q ADDRESS ADDRESS ADDRESS CITY,STATE,ZIP CITY,STATE, I �. CUSTOMER'S ORDER.# SALESPERSON TEAMS:" D ^' Fi T l,.41p lam` o u i Is 9Q NCT8745 ST- More saving. - Moir saving. More doing"' o More doin 9- 65 INDEPENDENCE DRIVE. INDEPENDENCE DRIVE HYANNIS, MA 02601 (508) 778-8948 ;y {tVW15: MA 02601 (508) 778-8948 2612 00056 40057 07/20/12 01:47 PM i6 40032` 07/20/12 01:42 PM CASHIER SELF CHECK OUT - SCOT56 F (N�CK OUT - SCOT56 037155991785 SHOWERHEAD -A- 7.47 SHOWERAP,M MOUNT CH U3.1LO ;; D 1G ORK 1G 1.38 LOW � � ,. i!L t,.,'URK 1G SUBTOTAL 7.47 0784772118jj WP, 4, •-A> 0.46 SALES TAX 0.47 1G WHT NYL MIDWAY OUTLET WALLPLT TOTAL $7.94 CASH 5.00 SUBTOTAL 1.84 CASH 1.00 SALES TAX 0.12 CASH 1.00 T!1i,t_ $1.96 CASH 1.00 CASH 5.00 CHANGE DUE 0.06 CHANGE DUE 3.04 I Illlllllllllllllilllllllllllillllllllll��lllillll I III li i�lllillll�IIII it IIIIIII�II�IIIIIII�IIIIIIIIIIIIIIii 2612 56 40057 07/20/2012 2667 2612 56 40032 07/20/2012 2667 RE1t1RN POLICY DEFINITIONS RETURN POLICY DEFINITIONS Pot-[0 [D DAYS POLICY EXPIRES ON P(i[.I(,Y ID DAYS POLICY EXPIRES ON A 1 90 10/18/2012 A 1 90 10/18/2012 THE HOME DEPOT RESERVES THE: kll: 10 THE HOME DEPOF RESERVES THE RIGHT TU DENY RETURNS. PLEASE SEE THE LIMIT / DENY RETURNS. PLEASF !+E t !M17 ! RETURN POLICY SIGN .IN STORES I-tw :L:TURP! Pi)1 ICY SIGN IN STORES FOP DETAILS. DETAILS. BUY ONLINE PICK-UP IN `-)RE Lii1Y )Il! .INE PICK-UP IN STORE AVAILABLE NOW ON HOMEf OM. AVAILABLE NOW ON HOMEDEPOT.COM. CONVENIENT, EASY AND ERS �'ONVENIENT, EASY AND MOST OR!.�EP) I I DCAfi Tnl RFAnv TKI I F4Q THAN[ aA n� INVOICE NO. ` INVOICE BILL TO ` SERVICE PERFORMED AT �a ADDRESS ADDRESS, \ CITY,STATE,ZIP CITY,STA ZIP i CUSTOMER'S ORDER# SALESPERSON TERMS D E t as k_ Cols l lA�crr'� U`n S �-� o ®an -ok 1co NCT8745 .r w a 4 rA 9 1 -------------- i yes v c.� 4P c4� �'U1,Ul c5 _ F k THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA ZI Joe Elliott Home Improvements 125 Webbers Path West Yarmouth, MA 02673 (508)221-0067 .To: Name Address City, State For Services at: !,MATION WORK DE MPTION y-a- t g f A? k '"� a -u=A�ieY� -LL ��«✓, t �. r 9 w /� am_....._.._.. - �. Ile, r - k ��� � �{ � � C E'.t� �� � + et�.���__Le..✓ 4',1 •- 3�....:_._-E' L(-� r a b a d �• t t x. "` "' F 2 V Ij' � � •. •$' ,��� n 1;.A E�. 4 k.. ��JV�� �.��,�-�'�,iy��'—'T-...w..��. ..��.���.,t ��`Q ois c� 4100 i j e q n3 wh' r k' d r �� - 6F a1 r �r�[fi' ('T h. j } F.,R s 1. d VIC, _ ....c , hr'r , r. ia ffi �,,J v V,V ftr rd i7 INVOICE N0. 22376.1 BILL TO k A SERVICE PERFORMED AT ADDRESS ADDRESS Cam- C�L,c�! �-- CITY,STATi,ZIP CITY,STATEPIP CUSTOMER ORDER NO, I SOLD BY TERMS DATE IL f qq , Cho , 9?::adams- NCT8745 01-11 hr�-o��► �en"T Ilk More saving. More saving® iciye saving. �,, t Q More doing. More doings" 9 r �k 65 INDEPENDENCE DRIVE 1� Rio i ng r 65 LNDEPENDENCE DRIVE: HYANNIS, MA 02601 (508) 778-89418 E>5 INDEPENDENCE I11?lU►: I HYANNIS), MA 02601 (508) 77;3 8948 hIYANIJTS, MA PENDE (` 11 I11 <>J I;1 2612 00002 83838 08/05/12 02:49 PM 2i;1:' 00001 490541 08/0(1/12 10:38 AM CASHIER CURTIS - CVH2883 261 ' 00001 `.i22z1'.) ;•, � "1:' "_):`1" AM CASHIER LUANNE - L.FML"1; 079340686663 PL ADHESIVE <A> 4.67 i C,aSFEIER LUANNE - l+M1:11' i 717185382653 WHT IRON ON �A- 5.41 PL PREMIUM ADHESIVE 10 OZ -111 A- 2.2`- `1/4"X27' WHf IRON ON EDGE 051136000051 PHENOSEAL <A> 5.28 (731i2505CO6U ROOF CEMI ?C PLASTIC ROUE CI:.MI::ldl ltl.ai)! 0851004100059 2X6-8 H1 PT =A1 4l.97 PHENOSEAL ALL PURPOSE WHITE 2X6-81--T MI. PT WEATHERSHTEI_D 099167673103 23 3/4X48 WH <A> SL113T( fAL '` 3/4"X23-3/4"X4' WHT MELAMINE SHELVNG SALES fAA (i.I ZI SUBTOTAL. 10. 14 2@13.56 27.12 TOTAL $2.39 SALES TAX 0.65 CASH 3.00 TOTAL. $11.09 SUBTOTAL 37.07 CHANGL. T)OF 0.61 CASH 22.00 SALES TAX 2.32 CHANGE DUE 10.91 TOTAL $39.39 XXXXXXXXXXXX4497 VISA 39.39 AUTH CODE 105805/2024954 TA - .� ,1>,,7 I���IIIiI:Ill�i,sly.II�III�IIJ�I��I!(IIII, II�I�I�ill:l 2612 01 52249 08, 07, 201` 261:' 01 49054 08/06/2012 5132 ( I RE f URN POL Ii;Y (lE1 IN I.11(iI i)N Ri.I1JRN POLICY DEFIN.111ON5 I!IIhIII�I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII((I III POLICY ID DAY. I OI.I L 7 I.Xf 111 g0 . 11i05/2U12 POLIi.Y 1f: DAYS POLICY EXPIRES ON �, 02 83838 ' '05/2012 1841 A 1 A 1 90 11/04/201.2 THE HOME DEF'0f RFSI_RVhS Itif: !:I(;h;I IO K 11NITIONS_r... POLICY lU I f.TMIT / CENY RETURN:;. PLIA:,i. Lf Illk. TFIt_ HUI'IE DLPUI RESER'JES THE RIGHT TU A 1 - /2('12 RF-TURN PUL_ICY S LGN IN ,I ORE ; FOR L I RETURNDPOL.I.ENY CY I U1NN rN STORES. PLEASE SEFO SHE DE i AIL_5. DEaAILS. THE HOME DE '' ' t , ._ • c tdG11T BUY ONLINE PICK-UP IN10RE: LIMIT'/ DES'. W 't�kN , t h i SF SEE T HE AVAILABLE NOW ON HOMEUtf'OT.COM. BUY ONLINE PICK-UP IN STORE RETURN •�L:N :N '.1ORES FOR AVAI CC)NVI:NIENT, EASY AND Mi)I f (A)DI RS LABLE .NOW ON Hi)MEDEPOT.COM: Ut I NTI_:; READY IN LESS THAN 2 HOURS! CONVENIENT, EASY AND MOST ORDERS 'A'A K:t A'.AA'K XK,,%A:X A'A'A A A A'K A"r'•"�'•""' AA n A'A'A READY IN LESS THAN '? HAtI S! Bt 1" ONLINE PICK JP.IN SPORE AVA1i-ABLE NOW ON HOMEDEPOT.COM. CONVENIENT_, EASY AND MOST ORDERS READY IN LESS THAN 2 HOURS! Certified Mail#7008 3230 0002 5178 0509 EVE r, �. Town of Barnstable } Regulatory Services IARNSUBM � MAas. Thomas F. Geiler, Director �fD MA'S A�0 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 28, 2012 Our Child LLC c/o Ronald Bourgeious 150 Main Street West Dennis, MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 362 Lincoln Road (Unit B), Hyannis, MA was inspected on August 28, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed paneling near bedroom and utility closet that was pealing and in need of repair. Observed multiple tiles cracked in kitchen area. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: Observed water filling bucket at the bottom of the drip pipe on hot water heater. You are directed to correct the violations listed above within fourteen (14) days of your receipt of this notice by making repairs on tile and paneling; by installing an expansion tank on hot water heater. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORD . OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Cc: Edwin Ortiz, Tenant QAOrder IettersUiousing violations\Rental ordinancel362 lincoln rd apr B.doc 7-18-12 :r= „~ THE COMMONWEALTH OF MASSACHUSETTS FORM 30 (\&w HOBBS S WARREN'" BOARD O�HELTH TY/TOW W DEPARTMENT ADDRESS 1M SVe"0 ✓ 6_ H a Address _ Occupan Floor Apartment No. No.of Occupants No. of Habitable Rooms No.Sleeping Rooms _ No. dwelling or rooming units No.Stories f Name and address of owner Ly 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: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: l Hall, Floor,Wall,Ceiling: (S Hall Lighting: 'r 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.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE5i P R AY." INSPECTOR ,TITLE DATE r TIME /0 ` o A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s)pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person 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. «�^ " TM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 H&W HOBBS&WARREN ' BOARD OF HEALTH CITY/TOWN � W DEPARTMENT vJsVsA1V i_ vGv►- ac ADDRESS GSM SVey`0W HONE Address J — Occupant Floor Apartment No. No. of Occupants__ No. of Habitable Rooms, No.Sleeping Rooms No.dwelling or rooming¢units No.Stories Name and address of owner L Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage / Infestation Rats or other. STRUCTURE EXT. Steps,Stairs, Porches: Y / '- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: ` atr „ (� O Roof ` Gutters, Drains: Walls: 1 r Foundation: ( ` Chimney: ✓ BASEMENT Gen.Sanitation: r Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: �' An /, HEATING Chimneys: ^ 1 Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: s H.W.Tanks Safety and Vents" ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: Y AMP: 1 Gen.Cond. Distrib. Box: Ei '.A -.Gen. Basement Wirin.• :,` DWELLING UNIT . _ Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks 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:_ I _;!r or r./ t. + Stove f t ' Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR -410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIESAF PER URY."°. INSPECTOR7 TITLE )-- DATE TIME D` i_ 5 `�1M• A.M. THE NEXT SCHEDULED REINSPECTION P.M. "' r 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 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. (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. ,..-,,,.,.... �r`°:'�4+w..�w,.r �•'^ 'c!.Y.,�..�.•�'t^J+�nf'm"'�*,sf�,4�,it'*"'T'R'...w^y'rt°,n•Sys.+irtaJ�.i,r�^err^Ct.: '.:...�,Yw-.,.+'o^er'"'�%c•�.'�.-... ':)k TM THE COMMONWEALTH OF MASSACHUSETTS FORM30 Caw HOBBS&WARREN BOARD OF HEALTH 7ZWNTODEPARTMENT ADDRESS W,y Sey`0 - ` PHONE AddressLt _ Occupant i' Floor Apartment No. No.of Occupants. No. of Habitable Rooms No.Sleeping Rooms _ No.dwelling or rooming units_ No.Stories 1 Name and address of owner 4�� G, LL C I 1z7 pk- Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: _ Drainage i CI Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches.- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: r i Roof / v Gutters, Drains: Walls.- Foundation.- /o f Chimney: BASEMENT Gen.Sanitation: f Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: ,' Hall, Floor,Wall,Ceiling: Hall Lighting: �. ...C1 A),,g r,t Ci4 Hall Windows: -1 e -/r} A rt HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair j _ u TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: i H.W.Tanks Safety and Vents, ; ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: 't" AMP?:-r t Gen.Cond. Distrib. Box: "} s —Gen. Basement Wirin : t 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 Sinker � -_;� Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND P,ENALTIES.OF`PERJ-UAY." INSPECTOR '` ~ TITLE DATE r l TIME V `, t (P P A.M.THE NEXT SCHEDULED REINSPECTION P.M. "` 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. Certified Mail#7008 3230 0002 5178 0509 °Ftro Town of Barnstable BA"SrABLE, ; Regulatory Services `1 ��� Thomas F. Geiler, Director ,ado MA'1 a Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Our Child LLC August 28, 2012 C/o Ronald Bourgeious 150 Main Street West Dennis, MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 362 Lincoln Road (Unit B), Hyannis, MA was inspected on August 28, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed paneling near bedroom and utility closet that was pealing and in need of repair. Observed multiple tiles cracked in kitchen area. 105 CMR 110.351: Owner's Installation and Maintenance Responsibilities: Observed water filling bucket at the bottom of the drip pipe on hot water heater. You are directed to correct the violations listed above within fourteen (14) days of your receipt of this notice by making repairs on tile and paneling; by installing an expansion tank on hot water heater. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORD OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Cc: Edwin Ortiz, Tenant QAOrder IetterMousing violations\Rental ordinancel962 lincoln rd apr B.doc 7-18-12 jpao Rthe r- VropertieS "Cape Cod's Tuff Service Reafty Company" 150 liain.Street West 4Dennis, VIA 02670 Office(508)394-4446 'Fa.X(508)394-4819 9donday ~ Friday, 9:00 am to 4:00 pm August 30, 2012 Town of Barnstable Public Health Division 200 Main Street Hyannis, MA 02601 RE: 362 Lincoln Road Dear Tim O'Connell: As per the Barnstable Health Departments request, all of the work as instructed by the Barnstable Health Department has been completed at 362 Lincoln Road, Hyannis. Specifically 105CMR410.500-the cabinets in the kitchen had bases that were in disrepair from water damage. Observed areas under said cabinets that contained dirt, debris and mold like substance along the sub-flooring not in good repair. The bases have been repaired, see July 20, 2012 invoice enclosed. Thank you for your attention. While Mr. Ortiz has had some legitimate complaints, which we immediately fixed, it is his way of trying not to pay the rent. Sincerely, Ronald D. Bourgeois (508) 394-4446 Monday- Friday, 9:00 am to 4:00 pm 5 ron ,bassriverproperties.com , o C.C. Thomas McKeen Director Barnstable Health Department '� o Edwin Ortiz and Maureen Jones h RDB/sh '' 'No one han&s tenant occupied properties better!" t "Cape Cod's EuITSeruice 12eafty Company" 150 Wain Street Nest.Tennis, W ,4 02670 Office(508)394-4446 'Fa.X(508).394-4819 'Tonday ~ Friday, 9:00 am to 4:00 pm August 28, 2012 Barnstable Health Department 3195 Main St Barnstable, MA 02630 RE: 362 Lincoln Road Dear Tim O'Connel: I just wanted to formally let you know that Joe did not get in yesterday, Monday August 27, 2012 as scheduled at 8:00 am as the tenants did not allow access as agreed to on Thursday July 23, 2012. After three trips to the property, Joe asked for a specific date for access of which the tenants would not give him a date to return. If you could get a specific appointment we will accommodate that time. We can not fix anything if we do not have access. Joe did buy materials in preparation to do work there for yesterdays appointment, which he had to then return resulting in a lot of wasted time. As always, please do not hesitate to call if you have any questions. Sincerely, Ronald D. Bourgeois (508) 394-4446 Monday - Friday, 9:00 am to 4:00 pm ron(a)-bassriverproperties com C.C. Barnstable Health Department Edwin Ortiz and Maureen Jones RDB/sh No one handles tenant otcup' roperties better!" Certified Mail#7008 3230 0002 5178 0509 Town of Barnstable Regulatory Services " =nPtvsTnst,E, " g y 9� 1639. , Thomas F. Geiler, Director A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Our Child LLC August 28, 2012 c/o.Ronald Bourgeious 150 Main Street West Dennis, MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 362 Lincoln Road (Unit B), Hyannis, NIA was inspected on August 28, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Observed paneling near bedroom and utility closet that was pealing and in need of repair. Observed multiple tiles cracked in kitchen area. 105 CMR 410.351: Owner's Installation and Maintenance Responsibilities: Observed water filling bucket at the bottom of the drip pipe on hot water heater. You are directed to correct the violations listed above within fourteen (14) days of your receipt of this notice by making repairs on tile and paneling; by installing an expansion tank on hot water heater. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORD OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Cc: Edwin Ortiz, Tenant r QAOrder letters\Housing violations\Rental ordinance\362 lincoln rd apr B.doc 7-18-12 CWT,,Xr�/96m, (2e-� vINVOICE NO. �< INVOICE BILL TO SERVICE PERFORM AT ro e ADDRESS _ ADDRESS L>, ki CITY,STATE,ZIP CITY,STATE, I I CUSTOMER'S ORDER y SALESPERSON, TERMS D TE , o WW-UA6 Dt 6 4�- L,3(-,L,4 i LA�©LA& V.O* 5T ,90 NCT8745 More saving. o :" Moi, saving. More doing • � o More doing:' 65 INDEPENDENCE DRIVE INDEPENDENCE DRIVE HYANNIS, MA 02601 (508) 778 8948 +Y„tvw15. MA .02601 (508) 778-8948 2612 00056 40057 07/20/12 01:47 PM .,)6 40032` 07/20/12 01:42 PM CASHIER SELF CHECK OUT - SCOT56 F t N!CK (iUT -- SCOT56 037155991785 SHOWERHEAD -A- 7.47 SHOWERARM MOUNT CH O:i-I-fps 1G LuW <A� 1.38 : ;:. 0 LOW V ;)L 1, 'ORK 1G ' SUBTOTAL 7.47 07847721189J WP, 4 =A� 0.46 P, SALES .TAX 0.47 1G WHT NYL MIDWAY OUTLET WAI-.LPLT TOTAL $7.94 c UB 1.84 TOTAL CASH 5.00 SALES TAX 0.12 CASH 1.00 $1.96 C CASH 1.00 ATS • CASH 1.00 CASH 5.00 CHANGE DUE 0.06 CHANGE DUE 3.04 � I Ililll�ll llllll�lllllillllllllll I IIIIIIIIIIIIIIIIIIIIIIIilllllllillllllll�lllllllllllil I���II III!I III I I II I 2612 56.40057 07/20/2012 2667 2612 56 40032 07/20/2012 2667 kFTURN POLICY DEFINITIONS RETURN POLICY DEFINITIONS Pik fCY ID DAYS POLICY EXPIRES ON PUf.IC ID U90 POLICY EXPIRES ON 1 A 1 90 10/18/2012 A 1 10/18/2012 THE HOME DEPOT RESERVES THE RTI,i To THE HOME f)EPOT RESERVES THE RIGHT 10 LIMIT / DENY RETURNS. PLEASF 1!IE t !MiT ! DENY RETURNS. PLEASE SEE THE RETURN POLICY SIGN .IN STORES Ftir? tq-jUkN Pill ICY SIGN IN STORES FOP, DETAILS. DETAILS. BUY ONLINE PICK-UP IN "ARE LwY )N! THE PICK-UP IN STORE. AVAILABLE NOW ON HOMEF 0M. AVAILABLE NOW ON HOMEDEPOT.COM. CONVENIENT, EASY P,ND ; 'ERS CONVENIENT. EASY AND MOST ORDER-) RFA114 1"nl I F¢c THA�� i oCnru, T� •• �.. INVOICE NO. y9 P:ewe INVOICE BILL TO ` SERVICE PERFORMED AT ADDRESS ADDRESS v1 h ff CITY,STATE,ZIP CITY,STA ZIP I CUSTOMER'S ORDER# SALESPERSON TERMS D TE 4�— -�u-AL4-re, 4 0 0 NCT8745 r Y Certified Mail#7006 0810 0000 3525 6733 �t rati Town of Barnstable - Regulatory Services LIRNSTABLL KAS& 1�$ Thomas F. Geiler, Director p'f039. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 17, 2012 Our Child LLC c/o Ronald Bourgeious 150 Main Street West Dennis, MA 02670 - &-6 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 362 Lincoln Road (Unit B), Hyannis, MA was inspected on May 16, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of a complaint. Th following violation(s) of the State Sanitary Code were observed: 01 5 CMR 410.351 —Owner's Installation and Maintenance Responsibilities. Open wiring observed within utility closet on left. 105 CMR 410.401 —Ceiling Height: Ceiling heights of 67' were observed in the f v 1� Vbathroom, kitchen, bedrooms and living room. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. The floor within utility closet on right has standing water, rotten floor boards and a mold like substance on interior walls and studs. CMR 410.500—Owner's Responsibility to Maintain Structural Elements. A leak was observed in water piping system from top unit which is leaking into both utility closets. /e following violation(s) of the Town of Barnstable Code were observed: 170-10—Maintenance of Smoke detectors and Carbon Monoxide Alarms. It was observed that there were NOT any operable carbon monoxide detectors within partment. 170-10 —Certificate of Registration. Apartment not registered with Town of Barnstable Health Division. QAOrder letterMousing violations\Rental ordinance\362 lincoln rd apr B.doc `i You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by pulling any required building permits (if applicable); by bringing ceiling heights up to code as stated in 105 CMR 410.401 of Massachusetts Sanitary Code; by repairing said leak; by repairing open wiring violations; by repairing floor boards in utility closet and removing mold like substance, all standing water and rot. You are directed to correct the violations listed above within twenty four(24) hours by installing carbon monoxide detectors in accordance to State Board of Fire Prevention(527 CMR). You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Cc: Edwin Ortiz, Tenant QAOrder letterMousing viol ati ons\Rental ordinance\362 lincoln rd apr B.doc y HOBBs&WARREN in THE COMMONWEALTH OF MASSACHUSETTS FORM3l) Caw BOARD OF HEALTH 41-A) SIC,b t-f— CITY/TOWN eC, DEPARTMENT Me, �G,M SVeyw ADDRES f TEEL�EP,HO-NE Address 3�°�'��� �" - Occupant 4 Floor Apartment N No. of Occupants _ 5 No.of Habitable Rooms No.Sleeping Rooms - No. dwelling or rooming units No.Stories —,L L Name and address of ow.Qer _ 5 W. � Remarks Reg. Vio. YARD Out Bld s.: Fences: U b Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: - Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: C / Hall, Floor,Wall,Ceiling: - ( Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: �l PLUMBING: Supply Line: ,Sv U ❑ 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: - -PP W I v'I .r- U I it o S ID Gen. Basement Wiring: oe- DWELLING UNrr 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.: h1 o d a p. Stacks, Flues,Vents,Safeties: 4a 6 Sf v eS� Kitchen Facilities Sink pf ! Gil k A/c Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Bu Idling 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 PERRJJJU INSPECTOR � TITLE— DATE 5-1(0 1 - TIME /19` $a P.M. �j A.M. THE NEXT SCHEDULED REINSPECTION 1 r P.M. r u 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person 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 `- (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.' - _ .,.w'k"""^"�..,..--'..., •-.;+...�. r"yY�.,,`e;..c"+�r"y�Mpr""y�r*.e•�.w+r...: r..,✓fir-..w-�+..tin1.+'sr+�watt�`�..'.�34ti.t..w-,--"�^*"�....... `FORnA'30' &W Hoses WARREN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j ...,. a DEPARTMENT ".yT od, IN ADDRESS ' TELEPHONE Address 3o-��� Occupant_`!i/Ww- Floor Apartment No. No.of Occupants" P P No.of Habitable Rooms_No.Sleeping Rooms__�!- No. dwelling or rooming units_ No.Stories_„___ L - Name and address of ow�r)er_ _( ,� W. Y Remarks Reg. Vio. YARD Out Garbage and Rubbish Containers: Drainage I , I nfestation Rats or other: STRUCTURE=EXT. Steps,Stairs, Porches: raD`ual E ress:and Obst'n.: ❑ B P-F OM `''"`Doors,Windows: Roof - - .,•'" '"tl.r 1 Gutters, Drains: Walls: �,.-�'. t- Foundatio�,; r .' Chimne : BA-SEMENT Gen.Sanitation: LAg Dampness: E :j Stairs: Lighting: STRUCTURE INT. Hall,Stairway: -Obst'n.: Hall, Floor,Wall,Ceiling: — Hall Lighting: r<_ yA \ i"l 1119 .1*1 i Hall Windows: Z. , Chimneys: , ! . Central ElY ❑ N Equip. Repair �YPE: Stacks, Flues,Vents: "PLUMBING: Supply Line: _ ❑ MS ❑ ST ❑ P Waste Line: 6 I Ij/"-' M-\ H.W.Tanks Safety and Vent(s)! ELECTRICAL Panels, Meters,Cir.: 110. ® 220 Fusing,Grnd.: / AMP J Gen.Cond. Distrib. Box: " o P eP NI Ir I 1 �- UtI !- l0 5 f W `110- 3S V Gen. Basement Wiring: 0^_ ' DWELLING UNIT Ventil. L to Outlets Walls "'Ceils. Wind. Doors Floors Locks 'Ki.tchen—— j I Bathroom t r �� f._ 3r ( t �' ► I� Pant 0vin Roo'ken Bedroom 1)/' -1 Tj , r -q Bedroom 2 r� K i. . A Y r` ►-+, va 1 Bedroom 3 f`V " Bedroom 4 - �. . Hot Water Facil. �� Sup.Ten.,Gas,Oil, Elect.: t6v%., IJ� ' `- o ` d 0 ,4 \ ,�,,1l Stacks, Flues,Vents,Safeties: a S (� c5 f 5�v 5 `! ! `� �lln �sVv Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.;Sanit'n.. Wash Basin,•Shower or Tub: t - ._ Infestation ,-'Rats, Mice,Roaches or Other ._ .-.- =-- Y� k Y°� ' "' _E ress .' - _ * Dual aril 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." _­fINSPECTOR TITLE % f M. DATE ��(�� Y TIME a` P M. THE NEXT SCHEDULED REINSPECTION �' P.M. 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- ditiori 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.' , "•°""w�",,^.'"",�R..'��.r+.,-.•-'".'tar,<o...,-t'!;�w:.^�+.-.+..•'",."^"t,.';5,,,�.w+�?7�46�-r+-."'.z'.•rm,+.n.+•;�nr^.34^'e,.'old*H'.rn�:r+ ...na.=n•+.�k:1',R`.*�1-*^�.�aR.e...sh.a;;;e,erv„a - _ -r.�.-,.,..*.. h ` TM THE COMMONWEALTH OF MASSACHUSETTS ��, • Yr_l7,RM'30 f CAW HOBBS&WARREN _. BOARD .OF HEALTH Q pp CITY/TOWN "* b DEPARTMENT Ob N1 C ew ADDRESS TELEPHONE A,, ' Address Occupant �`'�""''11'�""'Floor Apartment N No. of Occupants No.of Habitable Rooms_ No.Sleeping Rooms_ No.dwelling or rooming units No.Stories f —Name and address of owner 1� L �- '�G '�..-.0 Q► Ik11.6•.v /� Remarks Reg. Vio. YARD Out Bld s.: Fences: U 19 ` Garbage and Rubbish Containers: Drainage Infestation Rats or other: 1 STRUCTURE EXT Steps,Stairs, Porches: D ,Dual E ress: and Obst'n.: wr✓'' ❑ B ;❑.F ❑'M boors,Windows: r t c Roof *'` J i (� Gutters, Drains: " r , ' t Y Walls: �- �'�-'�' Chimney: BASEMENT ,/ Gen.Sanitation: AF`j'J `.�" Dampness: Stairs- Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: _. ' t _Q ' ti ,,l ,/ Hall Windows: .%'�b'•r'�s'"'�'.�� �.-;`''`' -HEXTIN"G'"" Chimneys: Central ❑ Y ❑ N Equip. Repair .. r /TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: I Vk--" rfcC" 7-1 1*1 ill) t ❑ MS ❑ ST ❑ P Waste Line: C " H.W.Tanks Safety and Vents' r r FELECTRICAL Panels, Meters,Cir.: �p 110.. ❑ 220 Fusing,Grnd.: J "Amp: Gen.Gen. Cond. Distrib. Box: Ar�t�l./ W r �}'�+ f t.P, (. 1+ r yrQ• "3S V/ Gen. Basement Wiring: 01� , DWELLING UNIT Ventil. L to . Outlets Walls- C,eils. Wind. Doors I Floors Locks Kitchen t Bathroom Pant k` N , . : f;�L.,K..> s .• .. , - Den../ _ uving Roomt,n .,'"ice + `"'�3 l r Bedroom 1 r" n n 1r a401 MAiAVAA%A,& rq, ! Bedroom 2 ` k � ""„— �' J-~ V_ A Ov r Bedroom 3 b Bedroom 4 h u ,✓` Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: 0- 4'+ - �} f�a f !!� 0 Stacks, Flues,Vents,Safeties: 4 A 5_ fit o f t &v% S•1 v cf i erg Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash.Basin,Shower or Tub Infestation Rats, Mice, Roaches�'o.r-�the`r - --- =E ress—"--- Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED'A•BOVE 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:" / 1 � f INSPECTOR ��. TITLE �1 � .M. DATE (0r. L' TIME 1 U� P.M. A.M. THE NEXT SCHEDULED REINSPECTION. - P.M. f r 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not 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. f � . i — Building DepartmentInspection Report r�� F Date Addres Referred By 12-S I Reported to Site with Purpose of Inspection("kk �` v� ✓ �,� Observations & Notes f At A tLLo -t— o n in � � oa i 1 In h Vh +0 r _ � C ^l t Certified Mail#7008 3230 0002 5178 0400 �t rati Town of Barnstable Regulatory Services WRNSTASM MAM Thomas F. Geiler, Director 1639. Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 17, 2012 Our Child LLC c/o Ronald Bourgeious 150 Main Street West Dennis, MA 02670 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 362 Lincoln Road (Unit B), Hyannis, MA was inspected on July 18, 2012 by Timothy O'Connell, R.S., Health Inspectors for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violation(s) of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. It was observed that cabinets in the kitchen had bases that are in disrepair from water damage. Observed areas under said cabinets that contained dirt, debris and mold like substance along with sub-flooring not in good repair. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by pulling any required building permits (if applicable); by replacing said bases of cabinets; by repairing sub flooring under cabinet so that it excludes chronic dampness and is in good repair. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will j result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. P ORDER OF THE BOARD OF HEALTH i as A. McKean, R.S., CHO Director of Public Health Cc: Edwin Ortiz, Tenant. Q:\Order letters\Housing violationskRental ordinance\362 lincolnrd apr B.doc 7-18-12 FORM30 C&w HOBBS&WARREN T" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H H � CITY TOWN W D PA MEN .. �� �G,M SVeyow ADDRESS TELOPHONE Address 3()- _Occupant — Floor Apartment No. No. of Occupants__ No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.Stories A n I , Name and address of owner 5(� N•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: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. Lgirn. Outlets W Its C ils. Win Doors Floors Lock Kitchen — Bathroom Pant 4 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: 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 ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES U INSPECTOR TITLE ` l DATE To — tj r TIME V M• .M. THE NEXT SCHEDULED REINSPECTION ( P.M. M 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person 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. • }.n^h.,r^r 1 yRa ,_y '.,.1 ''rv:.` 'bee i .rf`•-i..w.:.+.+'I.+•..d . -�.. •.+�•ir•'<.."� : ,.,.r...f`'+.•Mti..nwy,✓bw,�`...�."1.`v�•.,#''r`".�`".y"'rym�'�.'^.�"`z.r.-1..ra�}yF�"AC^�'[w °'ti,J"^'ti+P'k"'Fx.wnd`v*�wr.�,r••.TM.",r!'t*' # t M THE COMMONWEALTH OF MASS'ACHUSETTS�\ {fr{'fir{j�F 'M ;FORM C ,30 ,w— HOBBSB WARREN i 0 BOARD OF HE LTH CITY/TOWNtL DEPARIrM ENT Vt ADDRESS 0 TELEPHONE e Address , Occupant_ %2 �M �`' Floor Apartment No. No.of Occupants,— _ No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner • �%� , Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof V f Gutters, Drains.- Walls: Foundation: ...., ._.. Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs:.. Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows:, HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: "" AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: ' DWELLING UNIT � Ventil._ L g trip . Outlets Walls Its Ceils. Win . Doors Floors Locks �. ��-1 ,.�..c Den t ,(9'll- rn i 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: y Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTI�E.PERUURYo. INSPECTOR TITLE ` Y p C aM. (V /P.M. DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION i i J P.M. f. 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. I. .` w. �...�,...�-.r.,...•,,,...4-.-�'t,r�,.�.-.s.�� 1�'1'awry'r•.ii^+.-+^y.^w.>"awn..",,.+'.yew..-..M.:•FrL`���.F''+Y 1>�� +K.^V'11,�'�^" THE COMMONWEALTH OF MASS'ACHUSETTSFORM 30 C&w HOBBS 8 WARREN � _ BOARD. OF HEALTH CITY/TOWIt C a DEPA MENT ADDRESS ( f TELEPHONE Address — Occupant_- Floor Apartment No. No.of Occupants__ f No.of Habitable Rooms No.Sleeping Rooms-- No. dwelling or rooming units_ No.Stories ,r Name and address of owner ► �tn1'L. 1A) 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: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS , ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Gmd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. Lqtrjq. Outlets Walls I Ceils. i Wind, Doors Floors Locks 0 Kitchen �- >� ►"'� W 11 14aa' G - ? ...• } Bathroom_= _ 1 �� - � e,� .R� *.. iCn Den WZ (A }lr �' tom( A� > —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.: 1.. - -- =-- --- �11" Wash Basin,'Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH ' MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES O-F PER4R. Y " INSPECTOR - TITLE— AM l . DATE '�" TIME C� *M. A.M. THE NEXT SCHEDULED REINSPECTION b P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises,shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person 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. f "Cape Cod' s Full Service Realty Company" 150 Main Street West Dennis, MA 02670 Office (508) 394-4446 Fax (508) 394-4819 Monday - Friday, 9 : 00 am to 4 : 00 pm July 24, 2012 Edwin Ortiz and Maureen Jones 362 Lincoln Road, Basement Hyannis, MA 02601 Dear Edwin and Maureen, 4 M - � '� ...m I was disappointed to hear that you Twill not empty the dehumidifier we provided to help decrease the moisture in your basement�apartment. A lot of people would empty the dehumidifier-or,even:potentially rig a hose that dispensed the water out of the basement (whicWpotentially s yet,another ask/fix we could do). We did not have to provide a dehumidifier or pay,for the electricity that runs it, but we did. Basements have moisture. A-lot of,basements even have sump pumps. That is a fact. Again, I will sign a mutual termination`agreement-which would allow you to break the lease and move. We will prorate your rent accordingly which again we do not have to do. Please help us help you. Emptyingea`dehumidifier is not an unreasonable request, especially when the occupant (you) have 66m6laints abouCIthe moisture. Please simply empty it several times per week. Emptying the dehumidifier would probably fix the moisture problem. As always, please do not hesitate to call if youMave any questions. Sincerely, 5 Ronald D. Bourgeois (508) 394-4446 Monday - Friday, 9:00 am to 4:00 pm ron(aD-bassriverproperties.com C.C. Barnstable Health Department RDB/jm "No one handles tenant occupied properties better! " Rtber "Cape Cod's Tull Service Realty Company" 150 94ain Street West Dennis, 9W,4 02670 Office(508)394-4446 'Fa.X(508)394-4819 'T' onday —1Mday, 9:00 am.to 4:00 pm August 28, 2012 Barnstable Health Department 3195 Main St Barnstable, MA 02630. RE: 362 Lincoln Road Dear Tim O'Connel: I just wanted to formally let you know that Joe did not get in yesterday, Monday August 27, 2012 as scheduled at 8:00 am as the tenants did not allow access as agreed to on Thursday July 23, 2012. After three trips to the property, Joe asked for a specific date for access of which the tenants would not give him a date to return. If you could get a specific appointment we will accommodate that time. We can not fix anything if we do not have access. Joe did buy materials in preparation to do work there for yesterdays appointment, which he had to then return resulting in a lot of wasted time. As always, please do not hesitate to call if you have any questions. Sincerely, Ronald D. Bourgeois (508) 394-4446 Monday - Friday, 9:00 am to 4:00 pm ron bassriverproperties.com C.c. Barnstable Health Department - Edwin Ortiz and Maureen Jones RDB/sh "No one handles tenant occupied properties better!" a i r i ` EXCERPT FROM THE BOARD OF HEALTH MEETING MINUTES 6/12/12: I. Hearing - Housing: Ron Bourgeois representing Our Child LLC, owner— 362 Lincoln Road, Hyannis, Map/Parcel 271-064, variance for ceiling height. Ron Bourgeois was present. The property fell through cracks and was not registered. He has his other properties registered. The health inspector has said everything has been resolved with the exception of the ceiling height. One of the two units is.in the basement level and the whole basement has a ceiling of 67' and it can not be raised up. Mr. Bourgeois provided a letter from the prior owner who stated that she had two apartments in the building while she had owned since 1960's forward. Upon a motion duly made by Dr. Canniff, seconded by Mr. Sawayanagi, the Board voted to approve the ceiling variance. (Unanimously, voted in favor.) Town of Barnstable s r • l�tv.�/�l.T. f - .. f 59. Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-8624644 Wayne Miller,,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanagi November 26, 2012 Mr. Ronald D. Bourgeois Bass River Properties 150 Main Street West Dennis,.MA 02670 RE Variance Request to Maintain Ceiling Height at,362 Lincoln Road, Hyannis Dear Mr. Bourgeois, You are granted a variance, on behalf of your client Our Child LLC, from Section 105 CMR 410.401, of the State Sanitary Code, Chapter 2; Minimum Standards of Fitness for Human Habitation. This variance will allow you to continue to utilize the basement level at 362 Lincoln Road Hyannis for human habitation with the lower floor-to-ceiling height currently in existence there. The State Sanitary Code requires a minimum floor-to-ceiling height of 84-inches in every habitable room. However, at this dwelling, the existing floor-to-ceiling height is 79 inches within the basement level. You provided a letter from the previous owner, who owned it since the early 1960's. She indicated that she had two apartments in the structure. Although the lower ceilings could be a safety issue for taller individuals, the Board is of the opinion that the lower ceilings should not be a health issue for most individuals and it would be manifestly unjust to order you to raise the ceiling height in this dwelling constructed more than 50 years ago, considering the projected cost to raise the ceilings. Since ely yours, W yn iller, M.D. Chair n I Q:\WPFILES\BourgeoisLincoInRoadCeilingHeight.doc TOWN OF BARNSTABLE 4 LOCATION .! �; ,7 v► SEWAGE # � VILLAGE / i ASSESSOR'S MAP & LOT� CI INSTALLER'S NAME PHONE NO. , I .0 f,fi CD lI &L OL6 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) �rlt �q�Ca (size)--------------------------- �bD� NO. OF BEDROOMS 3 PRIVATE WELL O UBLIC WATER i BUILDER OR OWNER DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: ) Z VARIANCE GRANTED: Yes No Jc �%" r ASSESSORS MAP No: PARCEL NO.. 'No... 7 - Fes ............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .. OF > . `- 1 ................................ Y1es'j . Appliratiou for Dhgp ial Warkii Tomitrurtivit Prrutit Application is by made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ��� Li h�-�%r� K�e�� -•---- --....-•-•--•.....................•-------.. .....---•----•-------------------•------• —mooc1 hY�f S_. Location-Address or Lot No. ....!...�..., .. Owner Address a ;: .,p as.Lt,4.....................-................................................ 67 3..® Installer Address dType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___........`,.J.........................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building No. of persons.....\_3................ Showers (e:2.) — Cafeteria ( ) a' Other fixtures ----------- Design _ ___ Flow..•.......... .gallons per person per d Total daily ......... Septic Tank—Liquid capacity.-Ot4allons Length.. ,5.... Width.... Diameter................ Depth................ Disposal Trench—No. .................... Width---_------_------- Total Length.................... Total leaching area.-______---_----.--sq. ft. Seepage Pit No-------- ---------- Diameter........4�r..... 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........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_._..._.........._... 0 Description of Soil..........________________•_ .0-4 x V -------- -- W ------------------- U Nature of Repairs or Alterations—Answer when applicable------------- 57<!e-<<G__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1?I E� p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has en issue t oard of heal Signed.. . ate Application Approved By.............................. -tc-/l�'` Dat� Application Disapproved for the following reasons:-----•---------•--------------------------------------••-------------------------•-----•---•......------......_ ----------•---------•---------------------------------------•--------------------•---------•-------...----------•---•----------------•------•-•----•-----------•-------••--•••----------•-•-----------•- Date Permit No.......... ...........•- --------,-Z ---_.7.... Issued--•------•----------------------------------.'. ---- Date r No. —7 F.s..--� ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -----------------OF�I� �1 r`T%1 1 ------ -' Applirta#inn for Uh4poo al lforkg Tonstrurtinn rnmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at:3�[A// .......4.001h.•..------0.90......4VAMS.- --...•--------...-••------••-•-•••._..........••--•-----------------------------------------•--. 'c n.Address or Lot No. � . �TT r rvrer Address Installer Address PQ UType of Building Size Lot----------------------------Sq. feet �., Dwelling—No. of Bedrooms--- -------------------.-----__.--__-•Expansion Attic ( ) Garbage Grinder ( ) pa,,, Other—Type of Building c2 :_.AJD.V_C.No. of persons....._._3............... Showers (ram) — Cafeteria ( ) 0.' Other fixtures .................................. Design Flow........-•._ allons er erson er da Total dail w________________ W g � g P P P ��Y Y ��T' -dons. R� Septic Tank—.Liquid capacity/_2 )6.gallons Length_ _; . >..___ Width__ ._. _.._ Diameter................ Depth................ Disposal Trench—N?o..................... Width-•..._.._._..___-.-- Total Length.................... Total leaching area--------------------sq. ft. r Seepage Pit No-------/----------- Diameter-------�J'...... 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_-_-_---_____-______--.- Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O Description of Soil............................ x Nature of Repairs or Alterations—Answer when applicable.- _ W ----------------------- ---- /p A ` 51 ------------------------------------------------------------------------•--------------------............---...------------------------------------------------------------------------....•--•---•-•-•. Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of TiTI y 'g g p y 5 of the State Sanitary Code—The undersigned further reel not to lace the system in operation until a Certificate of :Compliance ha een issu y e board of I t Si fie Date Application Approved By............................--._....... .......... ;............................ ------- z y DaEe Application Disapproved for the following reasons---------------------------------•-----------•----------•-----------------------------------------------------•-- -•---•----------•-•-----------••......•-•..._._...-••••-----------•--•••.....................•---•-•--•-•--•------•--•----•--••------•--------••-•----•-----------------•-------------•---•---••-------- Date PermitNo............_. .......!Z—----- ... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Corrtgf grFatr of Tompliatta THIS TO CERTIFY the Individua�Sewage Disposal System constructed ( ) or Repaired '�) yi ...... S _� ...--------•-------------•-------•-----------------•-----......-•----------•-------••-----••-.....---------•-•- / Ins-taller y_ h 4; has been installed in accordance with the provisions of Ti TIE j 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 CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r � w -----------•-•....--•................ No.��___...........8 FEE........................ Dtsp1 nrk�ii_;o �ermtt = = Permission is hereby granted.., 'F�•........ .....••-.�.t.rwffott ) '•/' l'--•-------------------•-----•-••----------....._............_._.. to Construct ( ) pr Repair Sewage D' posal System at Noj.&. 14-21r' _04�ASJI..................... '1 1r11� ----•-----------------------•--•-•------------------------•--•-•--.••--- Street. �.-- as shown on the application for Disposal Works Construction Permit N6L✓_..j.7.97_ Dated......J------ - _M. alt ' • ` - Board of Health DATE. d�_-„ FORM 1255 HOBBS & WARREN, INC., PUBLISHERS