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HomeMy WebLinkAbout0147 MELBOURNE ROAD - Health '147 Melbourne Rd 267- 163 Hyannis I F i P J YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to ope.rate.) Business Certificates are available at the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis, MA.02601 [Town Hall) a �S n Fill in plaase: TS 1 y' x� APPLIGANT'S YOUR NAME: .l AIV 4 t.5.a;,,.,� st :,•R �;.�• r� ` � • BUSINESS � YOUR HOME ADD RESS:�J.� �- MGt% �o�lU(� R•P i<: .. . .,.;. ..�- ;moLin • w lu � TELEPHONE # Home Telephone Number NAME OF NEW BU IIVESS N/ t✓ �' yt r,, TYPE OF BUSINESS PA r'All IS THIS A HOME OCCUPATION? YES N.o Have you been given ap.p o �.., E- _...._:NO. ADDRESS OF BUSINESS = :MAP/PARCEL NUMBER: When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you [nay need. You MUST GO TLNain St. — (corner of Yarmouth Rd. & Main Street).to,make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed-of any permit requirements that pertain to,this type of business. Authorized Signature* COMMENTS: 2..BOARD OF HEALTH This individual has en infiq-96qed of th ermit req nents that pertain to this type of business. uth rized Signatur ** MUSTCOMPLYWITHA11 COMMENTS: . HAZARDOUS MATERIALS REGULATIONS 3: CONSUMER AFFAIRS fLICENSING AUTHOR This individual h on inf d of the s �uements that pertain to this type of business. Authorized Signature.* COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:(V L �y S f� BUSINESS LOCATION: 2 '4 L L 4_c/41 c 2 (a INVENTORY MAILING ADDRESS: 1 94 S. (_ Qv tt/ L R h TOTAL AMOUNT: TELEPHONE NUMBER: �o 3 '� 3 O _ -2 A; CONTACT PERSON: = r EMERGENCY CONTACT TELEPHONE NUMBER: D C,2 MSDS ON SITE? TYPE OF BUSINESS:�,�.._/� CV Cl: P 4( t4JrV r� Q INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's X Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) AIL6jkfs Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Civv'6 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS "//•- _�. v r .-<. . +c ...-'t,_ .40.,, I - - Date: 6 TOWN OF BARNSTABLE i TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 6ryr`� Ly2S �� i BUSINESS LOCATION: N `C 4 y�l `_ 2 INVENTORY MAILING ADDRESS: A TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER:(5 C'2 OW MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined.that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants i Motor Oils Pesticides NEW USED (insecticides,,herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car.waxes and polishes Fertilizers Asphalt & roofing tar PCB's x Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride):_ = r NEW USED Any other products with "poison" labels K Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor& furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers., (including bleach) co t 0eys t/\.D %\m( Zf Spot removers &cleaning fluids (dry cleaners) Y—�- ,. Other cleaning solvents Bug and tar removers ,� �3 ` 01 Windshield wash WHITE COPY-HEALTH DEPARTMENT]CANARY COPY'-BUSINESS C) COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF.ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROT CT EIVED MAR.2 2 2004 TOWN OF BARNSTABLE. HEALTH DEPT.. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICA T ION- Property Address: /v A MAP G `? Owner's Name: d Owner's Address: PARCEL LOT Date of Inspection: ? Name of Inspect r• please print Company Name: ' Mailing Address: Vol Telephone Number: 7-21. � CERTIFICATION STATEMENT 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: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority / ails Inspector's Signature: Date: �� N 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. Notes and Comments ° ****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. Title 5 Inspection Form 6/15/2000 page I -Page 2 of 1 I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: CAL OWa l Owner., Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. ystem Passes: I have.not found any information which indicates that any of the failure 3criteria adescribed 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. Answer yes,no or not determined(Y,N,ND).in the . 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. . ND explain: 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 obstruction is removed distribution box is.leveled or,replaced ND explain: 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 obstruction is removed ND explain: 2 Page 3 of 1'1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: 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: _ 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 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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: 3 Page 4 of 11 OFFICIAL.INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACKSMAGE DISPOSAL SYSTEM INSPECTION:FORM PART A CERTIFICATION(continued) Property Address: X-P Owners Date of I spection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes N _ 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 V Liquid depth in cesspool is less than 6"below invert or available volume is.less than %day flow 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. Z/I Any portion of a cesspool or privy is within a Zone 1 of a public well. 7J Any portion of.a cesspool or privy is within 50.feet of a private water supply well. t/ An onion of a cesspool— _ y p p 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility 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.] (Yes/No)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. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in.addition to the criteria above) 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 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 15.30.4.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART.B CHECIaIST Property Address: (1 ` Owner: i O� Date of nspection: Check if the following have been done.You must indicate`yes"or"►io"as to each of the following: _ Yes �o 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:? -t-4 Was the site inspected for signs of breakout V 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 o the affles or tees material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? _I_ 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: Z no 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(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION-FORM.. NOT FOR VOLUNTARY°ASSES8MENTS 'SUBSURFACE''SEWAGE`DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: �C7W Owner: L l�r Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310.Cv1R 15.203 (for example: 11:0 gpd x#of bedrooms): Number of current residents: _ Does residence have.a garbage grinder(yes or no Is laundry on a separate sewage system (yes or n✓ -[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no Water meter readings, if available(last 2 years usage(gpd)):0) Sump pump(yes or no. Last date of.occupancy� � I X/0� COMMERCIAL/INDUSTRIAL Type of establishment: Design flow.(based on 310 CMR 15.203): gpd Basis of design flow(seats% ersons/s ft� )etc. P q Grease trap present(yes or no):— Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to'the Title 5 system(yes or no):-_ Water meter readings, if available: Last date of occupancy/use: . OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the tnspec ' n(yes or no If es ,volume. um ed: *,- ' ,. y p... p , n - Y P P gallons--How was uant�t uin ed determined. Reason'for pumping: T E 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) Tight tank Attach.a copy of the DEP.approval —Other`(describe): . proximate a e o all components, d to in tall (if known)and source 61f information: Were sewage odors detected when arriving at the site(yes or no):/ 6 f Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 0 Owner: Date of Inspection: BUILDING SEWER(locate on site planVAT Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage, etc.): SEPTIC TANK: (locate on site plan) Depth below grade. 0 a Material of construction: concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) Dimensions: d _ Sludge depth: Distance from op of sludge to bottom of outlet tee or baffle: `d Scum thickness: ' _ j� Distance from top of scum to top of outlet tee or baffle: y ewe Distance from bottom of scum to bottom f�tl:�teq,�r baffle: /OHow were dimensions determined: � -4o�n�,l1 �l�CF Comments(on pumping recommend`tions, ' let and outlet tee or baffle condition, structural integrity, liquid levels related to outlet invert, evi ence of leakage etc.): J� &ca GREASE TRAP(locate on.site plan) Depth below grade:_ 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: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION.FORM PART:C /l SYSTEM.INFORMATION(continued) Property Address: y 2�� az Owner. (/ Date of Inspection: A T TIGHT or HOLDING TANKv/ (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene. dther(explain); Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: 'Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTIONhBOX:/(if present must be opened)(locate on..site plan) . q Depth of liquid levelabov'e outlet invert Comments(note if box is level and distribution to'outlets equal, any evidence of solids=carryover,any evidence of akage intq jor out of box, etc.): OT tj?/Ilyj 7�/pnn J�9 jil- 014 1 PUMP CHAMBE/ /4— (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: '�r 7 Date of I spection: SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type�' • eaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number, dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding; damp soil; condition of vegetation, CESSPOOL !}Ut(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 or no): Comments(note condition of soil, signs of hydraulic failure,_level of ponding, condition of vegetation,etc.): PRIVY/c &(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of,vegetation, etc.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM•INFORMATION(continued) Property Address: h A' Zr-w-'It )C,44 Owner• ){,{� ' Date of Inspection: AE5 L6A 9-1'goo y SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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., �g to Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C . SYSTEM INFORMATION(continued) Property Address: Owner: t�LO Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design plan reviewed: Observed site(abutting property/observation hole within ISO 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: 11 Permit Number: Date: Completed by: � HIGH GROUND-WATER LEVEL COMPUTATION Site Location: � 7 �, � ��� Id Lot No. Owner: (' %�J�J/` S Address: Contractor: � /1�If74 �`!l Address: Notes: STEP 1 Measure depth to water table _ to nearest 1/10 ft. .............................................................................. .Date month/day/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: y 0. OA Appropriate index well...............................!.`.`.l.J.�...... .Z © Water-level range zone ..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to water level for index well ........................... month/year STEP 4 Using Table of Water-level Adjustments for index well (STEP 2A), current depth to water level for index well (STEP 3), and water-level zone (STEP 213) �Jr determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by.subtracting the water- level adjustment (STEP 4) from measured depth to water levelat site (STEP 1) ............................................................................................................... Figure 13.--Reproducible computation form. 15 _ a t 3 E 7 F¢ h P • wa'a3 �-y-�� r" CO OFFICIAL. USE 'n Postage $ 7 zr C3 Certified Fee qO1 0PostmCReturn Receipt Fee FKW:9V Here(Endorsement Required) y�yO Restricted Delivery Fee =3O (Endorsement Required) CI1Total Postage&Fees $ fL Sent To k leeP7 /Oc G,,741 s ---------------------- ------------------------- N or PO Box No.Street,Apt. o. O/c/ �05 L �0 4 7,(j T - ----'-------------------------------------------------------------------------------------- City State,ZIP+4 / fU I U'e �/� /� 0 2 0 3 i Certified Mail Provides: o A mailing receipt 13 A unique identifier for your mailpiece o A signature upon delivery n A record of delivery kept by the Postal Service for two years important Reminders: t ' o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. o NO INSURANCE-COVERAGE IS PROVIDED with Certified Mail. For valuables,!please consider.Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery..tTo obtain Return Receipt service,please complete and attach a Return Receipt;(PS;Form 381,10o the article and add applicable postage to cover the fee.Endorse mailpiece 'Return Receipt Requested".To receive a fee waiver for a duplic,\te return receipt, a'USPS postmark on your Certified Mail receipt is required. +�yy, n For an add@fona delivery may be restricted to .the addressee or addressee's authadzed agent.Advise the clerk or mark the mailpiece with the enderement"Restricted Delivery". -1 n If'a p�stmark on the Certified Mail receipt is desired,please present the arti- cle at,3hg,post office for postmarking. If a postmark on the Certified Mail- receipt'is'npt needed,detach and affix label with postage and mail. IMPORTANT'"Ve this receipt and present it when making an inquiry. ' PS Form 3800,April 2002(Reverse) 102595-02-M-1133 I i SECTIONIt SENDER: COMPLETE THIS SECT16N COMPLETE THIS ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si'na re s item 4 if Restricted Delivery is desired. �� ,� ❑Agent X ■ Print your name and address on the reverse �+'` ❑Addressee so that we can return the card to you. B. R ceived by(Printed N e) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If> ES,enter delivery address below: ❑ No 1-eery Mc `II $ old �df� 966( (D c .41 rvice Type +' , , 1, i W e,1 p o)e1 M 4 0,203,2 Se (ed Mail ❑Express Mail E r�- I,Registered IX Return Receipt for Merchandise —`❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) 7002. 1000 0004 6683 1488 PS Form 3811,August 2001 Domestic Return Receipt 102595-02-M-1540 UNITED STATES POSTAL.SERVICE ON First-Class Mail P M. -IJ *.Sender: Please print yodr- E(ddress, and ZIP+4 in this box Public Health Division Town of Barnstable 200 Main St. Hyannis, Massachusetts 02601 R Town of Barnstable BIA1;�N9�A�i�, Regulatory Services 0r � Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 4, 2003 Kathleen McGinnis 46 Old Post Road Walpole, MA 02032 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND ARTICLE 51 OF THE TOWN RENTAL ORDINANCE. The property owned by you located at 147 Melbourne Road, Hyannis, was inspected on November 03, 2003 by David.Stanton R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. (Free from chronic dampness) Mold was observed in several locations throughout the basement. Mold was observed in the following locations: On the ceiling of the finished room, on the couch, and on the chair. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. The bulkhead was observed rusted through and not watertight. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. The windows are difficult to open and close. 105 CMR 410.500: Owner's Responsibility to Maintain Structural Elements. Tears were observed in the bathroom window screen. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice, by removing the mold and the source of chronic dampness causing the mold to grow in the dwelling, repairing the bulkhead so it is watertight, lubricating or repairing the windows so they can be easily opened or closed, and by replacing or repairing the bathroom window screen so there are no tears in the screen. 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. Q:Health/Order letters/Housing violations/147 melboume.doe w Non-compliance could result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. ;PERORDER OF- BOARD OF HEALTH W as A. McKean, R.S. Director of Public Health Town of Barnstable Q:Health/Order letters/Housing violations/147 melboume.doc 147 Melbourne. Mold spores on the ceiling,,. , in the basement room . DS .. s,r s.,, .$A- .. _,. •-. � `�` ..: re,. '- a„ rep� a e i� a � b , c ' , r e ` F a Y ., Pyy3p A 7 , Y 147 Melbourne. Mold on the k ceiling, in the bas.ement .room . . ®Soe < < T a Y `�.«s �w� •,„ +. .. > -. a ,ast _ u f s ! k .- a + {g �+'• s # s x rr y j ' s x t* - ' };J x rm g �♦ R "'�'Aie'�L�sue•'Fi � :psi .��• '� .,` x ,,, ♦a 4 �.s- f,* � �J - t S t Cr7 j s� � e- � " �.y ..fryer+, _ '�.''i [�t.,,d�i{. ♦�. t m,�-`1 '�-'�♦ ,� t� � '�3 ♦`�{� ' fir_ >!�Y.• V+" � i- e�+"�C'� w .`x F } 11 Ave- `!t '♦F �t .yam ~ ru ly 1.,� t ��t 1 t? +Y-4 x� h + '• -.ir,._ L .., �T SSS� ':s .'+5`,r•s.'` ate. ix rr ���•.�``' l� cFy .. r 't _ "is '♦.'. S J1> � " ,5• yy.p1 M 1 W T�� Svc - ��'� � x...�`,p, �` L �, _ '�.-• Ili •. .Ya t �♦ !, x ti � � `f t ,��;:�4 ��"+��� ram-,,� `�,+.A , • � 1 A .M�d .Y' �y .. 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'r .. raft yI -�eq• .` a 1�� 5 a r- Ilk e F t-. t, r` �` �i. xf �.r1. .r,�3 s���J��`h ���.`�r�t{�j•. '44 n,Ya •:', ,� � a,�� '� ., ft' ,x i x +1��5iY� � � '��tj J{ .p R��w ark '� Lw sygt♦ �" ,� 'r' s y �'� c ,�, A�ta .+ r1M.l t'cy,.'sF., .:q, �►'/ i V pI fI h.3 r u ,a rxr t +a a M r MON, 1' as Y �• ntt W t r W 11 � r - o' y An s� Cg 1 rl.. ,.. .ti h . •tea _ y.a.�^��� M+. i � II I 7^ .� .M �4 . � F ra .•y e1 C # r r� �• �. 1-4 IL Wl CD y r r,� r �• .� y;.a �. �,..ti�vs till '� � -.-� r .i }: e , e r.. e y a , � e " '� t ' t N r ' �_ Oi 1 * f{ y. t, � .an, {, x',�-far.,, 3 r�"' . � �. by„• II' "ol ,€ G - d.' P' r*•d..,x w ,'y, iCa ..9� '�° ..".ri s. + ,r.. j {rr(4 �} 1•� - erro.+.m1 f Y ry TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date 1003 � Iee� Owner 0 C 6U AA.f c a iA),4Tenant Y VDMnn. S 1141 Address Address N7 [0• t e l 0 yue. Rd, 14A✓I✓1+,S Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities Le.,(, (P,ks, 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities Q$6 SG'ee,j Wi`A dt) 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural ucyr Pfo(G' Elements c1 1 Sdt�r-i0 c�C�/ tiS / 14. Insects and Rodents 0 15. Garbage and Rubbish Storage and Disposal ' 16. Sewage Disposal 17. Temporary Housing ALA PART II Ivl� 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Persons Interviewed 1/ / Inspector If Public Building such as Store or Hotel/Motel specify here Nov-07-03 10: 22A P .01 RICHARD A. GRIFFIN ATfOHNEY AT LAW NORWOOD AIRPORT UUSINESS PARK V y9 ACCcn!Ruud (In, 9 Nor-,x)d.N1:usA,:hwt:tu 02062 November 7, 2003 'r-i:(781)769•to6o F;ir.0811 769408 TO: TOWN ON BARNSTABLE VIA FAX NO. 508-790-6304 PUBLIC HEALTH DIVISION - Attn: Thomas McKean, Director FROM: RICHARD A. GRIFFIN RE: Estate cf Robert P. McGinnis, Jr./147 Melbourne Road, W. 11yannisport, MA THERE WILL BE A TOTAL OF Ci PAGES TO FOLLOW: MESSAGE: This office represents the captioned estate. I am in receipt of a copy of your November 4, 2603 .letter to Mrs. McGinnis relative to said property. The property was in the sole name of Robert P. McGinnis, Jr. , and Mrs. McGinnis has recently been appointed Administratrix of the estate. Mrs. McGinnis has been unaware of the circumstances of said property inasmuch as Mr. McGinnis was in complete control of the property. Only recently did Mrs. McGinnis become award that the tenant, Yvonne Silva, has not paid any rent since September 1, 2002 at a rental amount of $900.00 per month. Ms. Silva acknowledged this to me via telephone on or about October 21, 2003. After this information was received, Mrs. McGinnis initiated a eviction procedure for non payment of rent/as per Attorney Rugo's letter of October 29, 2003, a copy of which I enclose for your reference. Records of Mr. McGinnis reflect that Iiousing Assistance Corp, advised Mr. McGinnis that if Ms. Silva remained on the property after September 1, 2002, the tenant would be responsible for the full contract rent. Please call me when you have a chance. OU. cc: Mrs. McGinnis and Atty. Rilgo THE DOCUMENTS ACCOMPANYING THIS FACSIMILE TRANSMISSION CONTAIN INFORMATION FROM THIS OFFICE WHICH MAY BE CONFIDENTIAL AND/OR LEGALLY PRIVILEGED. THE INFORMATION IS INTENDED ONLY FOR THE: USE OF THE. INDIVIDUAL OR ENTITYNAMED ON THIS TRANSMISSION SHEET. IF YOU ARE NOT THE INTENDED INDIVIDUAL, OR ENTITEY RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISCLOSURE, COPYING, DISTRIBUTION OR THE TAKING OF ANY ACTION IN RELIANCE ON THE CONTENTS OF THIS INFORMATION IS STRICTLY PROHIBITEDd IN THIS REGARD, IF YOU HAVE RECEIVED THIS TRANSMISSION IN ERROR, PLEASE NOTIFY THIS OFFICE IMMEDIATELY SO THAT WE MAY ARRANGE FOR THE RETURN OF THE ORIGINAL DOCUMENTS TO THIS OFFICE AT NO COST TO YOU. Nov-07-03 10: 23A P .02 THOMAS R. RUGO ATTORNEY AT LAW 720 MAIN STREET HYANNIS, MA 02601 509 775 1171 October 29, 2003 Ms. Yvonne Silva 147 Melbourne Road West Hyannisport, MA 02672 Dear Ms. Yvonne Silva; This office represents the estate of Robert P. McGinnis, Jr., owner of the dwelling at 147 Melbourne Road, West Hyannisport, MA 02672 in which you currently occupy as a tenant. I have been contacted by attorney Richard A. Griffin to act as local counsel for the above named estate regarding this summary process action. Please be on notice that this letter shall serve as your 14 day notice to quit the promises you now occupy at 147 Melbourne Road, West Hyannisport, MA 02672. Your tenancy terminates at the end of the 14 day notice to quit. The reason for this notice is because of non-payment of rent for the months of September 1 2002 to the present date of October 29, 2003 at the ongoing rent amount of $900.00 per month for a total due of $12,600.00. if you remain in the premises after the 14 day notice co quit ends the landlord may only evict you by going to court and getting a judge's permission and that you have a right to defend yourself in court against the eviction. If you have not received a prior notice to quit in the last twelve months you may cure this arrears by paying the total amount due, $12,600.00. To revive your tenancy please contact this office immediately, in order to revive your tenancy the tender of cure is required within 10 days of receipt of this notice. This letter is intended to give you notice that the landlord seeks to take back the residence which you now occupy and give you notice of same in accordance with all Massachusetts laws relevant to summary process actions. Please quit the premises in accordance to Nov-07-03 10: 23A P .03 the terms of this letter. Please 'Contact this office if I may be of assistance to you regarding this notice to quit. Very truly yours, Thomas R. Rugo Nov-11 -03 02 :09P P .01 RICHARD A. GRIFFIN ATTORNEY AT LAW NORWOOD AIRPORT HUSINE'SS PARK 81)Acce:a.I,oj-llnir I,) Nnru`r.d,NluelachusilbC2062 Tel.U81)769'I660 November 11, 2003 Ms . Yvonne Silva 147 Melbourne Road W. Hyannisport, MA 02647 Re 147 Melbourne Road Dear Ms . Silva: Please be advised that this office represents the -estate of Robert P. McGinnis, Jr. I am in receipt from the Administratrix of said estate, Kathleen A. McGinnis, of the November 4, 2003 letter issued by the Town of Barnstable Public Health Division relative to the captioned premises . Please advise this office as to what convenient times and dates entry may be made to the premises for confirmation and remedial action as to any violations which the Public Health Division letter addresses . Very. ruly your , i rd A. i fin RAG/tp CC: Atty. T. Rugo K. McGinnis L,.--Barnstable Public Health Division via fax 508-790-6304 TOWN OF BARNSTABLE LOCATION Z r :n� SEWAGE # 119 VILLAGE ASSESSOR'S MhP &LOT,2 AIC V-- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER C / PERMITDATE: COMPLIANCE DATE: '' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist wit40 hin 300 feet ofz1ch�g facility) Feet Furnished by L -_.._,_, ,� - �' ,� �� B� �► lv 7 ASSESSORS MAP NO; _2/ Z No. fs PARCEL NO: Fee �_-0-6 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zipprtcation for ;igpogal *pgtem Congtruction permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No.l./-' 7 97M Owner's Name,Address and Tel.No. Inst is Name,Address,and Tel.No. Designer's Name,Address and Tel.No. S75160, �— Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixturess�. Design Flow 17/ gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and wee of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Board of Hea th. Signed Date _9— .2 2 —94!� Application Approved by Application Disapproved for the following reasons Permit No. ge,�' Date Issued _Z�v x �. / No. 1 , �,i•, li(( �Ir%Li7 Fee THE COMMONWEALTH OF MASSACHUSETTS ,J PUBLIC HEALTH DIVISION -=TOWN OF BARNSTABLE., MASSACHUSETTS 01ppYication for Mi5pooal *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. _ Designer's Name,Address and Tel.No. Type of Building: g Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 1/1- .-- �?Iy gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date i Title Description of Soil i, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: l Agreement: . The undersigned agrees to ensure the construction and imem.t of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued this Bo d of Health. Signed Date �— Z Application Approved by Application Disapproved for the following reasons { i Permit No. �6 Date Issued V .147 - { _�--- -- .�— ——— —————— f— ---------^—�-- a THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS = f Certificate of Compliance THIS IS TO CER Y,t a the On- 'te Sewage Disposal System installed( )or repaired/repl ced on . '�� ak by for �C�-ta•� as / has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated;V,- !Z Use of this system is conditioned on compliance with the provisions set fA be ow: i 46 00 'i No. 9 Fee I � THE COMMONWEALTH OF MASSACHUSETTS F PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Migo.5a *p!tem Construction Permit Permission is hereby granted to to construct( repair( )an O -s' Sewage System located at 7 ` and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: mot49- ' __ _Approved y� i i i i ;1 4 CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL W01U0 CONS'I'RUGFION I'E[tNll'l' (IVI'I'IIOU'I' DESIGNED PLANS) hereby certify that the application for disposal works struction permit signed by me dated � — 2 z —�1L , concerning the property located at /117 4/," meets all of the following criteria: • There are no wetlands within 300 feet or(lie proposed septic system /There are no private wells within 150 feet of the proposed septic system /T,-C/"obscrvcd groundwater table is 14 feet or greater below the bottom of the leaching facility ! • There is no increase in flow and/or change in use proposed {•//There are no variances requested or needed. SIGNED: �%� DATE: LIC SE/SEP/1CSYSTEM INSTALLEJ169'TOWN OF BARNSTABLE NUMBER (Attach a sketch plan orthe proposed system. Also irthe licensed installer posesses a certified plot plan, 1 this plan should be submitted]. I