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HomeMy WebLinkAbout0418 MITCHELL'S WAY - Health 4WMitchQll s W' ay -f Hyannis A 291 .024002 � J yA� �I I is o P r b e r tr. . YOU WISH TO OPEN A BUSINESS? ^For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you, must do 6y M.G.L.-it does not give you permissiori'bo operate.) You mu'stfirst obtain the necessary signatures on this form'at 200 Main St., Hyannis; Take the completed form to the Town Clerk's Offiee,' 1st FL, 367 Main St., Hyannis, MA 02601 (Town-Hall) and get'the Business Certificate that is required by law. f��a.�oo ::. DATE: I � Fill in please: APPLICANT'S YOUR NAME%S: � Cc' le �i;S4iyt1 /Uei/'c�� ��IGi+c/el C���F� ''fir"b' J1 ��' 1 " BUSINESS / YOUR HOME ADDRESS: U . TELEPHONE # Home Telephone Number C W pp L D IO NA ME: E CORPORAT N . u . . 'L-.TYPE..OF.:BUSINESS. C'o.S .✓ .a - O • US NESS �' ., ,�- r• Cc��• •�U�s .✓c�, y� . ... . . .. .. NAME. F NEW B I .... .'.-• orb � .. . . .. . ...:_... .... . ...:.y. ..;:, , .. YES : ...... :..... . .- CC : . O ••• '•' hI "' 'emu - - �. `•.71.. , t... .. .. : ., _ %AR':PARCEL:NUMB�R:;.' A.PPRESS:.O.F,,BL�5WESS1+;•; c<<'�:. Cs - - . M When starting a new business there are several things you must do in order to be in compliance with the rules aifd re ation�s of he To nn o Barnstable. This form is intended to assist you in obtaining the information you.may need. You MUST GO TO 200 Maim St. - he 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 CO 1SSIO ER'S OF ACE - This Individ of h s i o %ay e i r uire tints that ertainto this e of business: MUST COMPLY WITH HOME.00CUF�/aTrOI q P type RULES AND REGULATIONS-' .FAIL.UR15.TO ut oriz i ett7 ** Cl)h/IFL .sVIAY RESULT.-IN-FINES: M NT � % k. 2. BOARD r H LTH Ln�s This indivl ual has bee f m d` th e it r u' mhat pertain to this type of business: MUST COMPLY WITH TALL WARDbUS MATERIALS REGUUlT10�IS �w prized Signature COMMENTS: / B. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** ' COMMENTS: TOWN OF BARNSTABLE Date: /l 1 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: Cofle_ CcAp� Coy( L fi�G BUSINESS LOCATION: 14 to M;t _/V_1I w INVENTORY MAILING ADDRESS: (-((q) Pfl; .fcl'e► C S TOTAL AMOUNT: TELEPHONE NUMBER: qg-7- -C i 1- CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: 500--L 00 4q f z, 6/t,s�,Q 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 material 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) Miscellaneous 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 Miscellaneous 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 Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform,formaldehyde, # Paint&varnish removers, deglossers- ' _ hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) ' Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removersWindshield wash wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap li nt's Signature Staff's Initials Town ofBastable Paul a. Abcoonald police Department Chief of Police Craig A. Tamesh Depaty Chief P.O.BOXB Main: (501) 775-0387 Fax: (508)790-6317 Hyanids,MA0201 www.bemsiablepolice.com 508-778-3820 (Det. Division) 50$-778,3822 (fax) DETECTIVE DIVISION FAX COVER SKEET DATE: August 27, 2014 TIME: 2:43 PM TO: Ellen Health Department FAX, 508-790-6304 FROM: Sgt. Mellyn REF: Jorge Olydenez NUMBER OF PAGES INCLUDING COVER SHEET: 3 NOTE/MESSAGE: Thank you Tbis fax is intended only for the use of the individual or entity to which it is addressed,and may contpin information, which is privileged,confidential and exempt from disclosure under applicable lave. If the reader of this message is not responsible for delivering the message to the intended recipient,you are hereby notified that any copying,dissemination or distribution of this communication is strictly prohibited. if you have received this communication in error,please notify us by telephone and return the original to us at the above address via US Postal Service. " �• 7 1da s of S'antstr(blle.C iie teIN-lie.C:ataut,FJ[vrrxujis,,t 'Iti,rsto11.1 lbI7ills,4.sdex-k' i lc. acid West$0mita ale r - Barnstable police Department Page: ] Summons Report 0 8/11/2 014 Summons #: 14-2071-AR Call Mks 14-39863 ate/Time Reported= OB 10T014 @ 0453 ,Arrest Date/Time: 08/10/2014 C 0526 OeTN: TEAR201402071 Reporting officer: ptl. JOSHUA bA.LONEY Assieting OffiCex: PTL. NELSON SOUVE ApprOV'ng Of'f-i_cer: SGT. THOMAS TWOMEY Signature: Signature: L ORDEMZ, JORGE M LP 26 NOT AVAIL 418 MITCHELL'S WAY HYANNIS MA 02601 ilitary Active Duty: N COMPI�F3CION: NOT AVAIL,BODY: NOT AVAIL. DOE: 10/27/1987 PLACE OF BIRTH: VOT AVAIL. ,LICEN5F NUMBER: NOT AVAI:,- 9THNICITY: HISPANIC WNIP LOCATION TYPE: Res idence/Home/Apt-/Con.do Zane: HYA1 CALLE, LUIS 9. 418 MITC'8ELL'S WAY HYANNZS MA D2601 1 TOE Or$is1,sRca Violation, NOISE ORDINANCE N misdemeanor 901C 3 23, 1 CALLE, JORGE L PARTICIPANT M 06 20 075-86-6349 508-737-0627 418 MITCHELL'S WAY T--IyANNIS MA 02601 DOE: 05/3-0/1994 EMPLOYER: BLACK CAT CONTACT INFOVXM\TION: 508-737-0627 Home Phone (primary} 2 CALLE, JOSS D PARTICIPANT M @P 33 NOT ,AVAIL ***UNKNOWN*** HYANNIS MA 02601 1iOB: 01/26/1981 3 CALLE, MA ]EL J PARTICIP&NT M w 2 9 NOT AVAIL 418 MITCHELL'S WAY HYANNIS MA 02601 DOA: 05/09/1985 EMPLOYER: BUCK MILLER ROOFING T Barnstable Police Department Page: c. MRRAT:CVT FOR PTL. JOSHUA J MALONSY stet: 14-2071-AP, Entered: 08/10/2014 0 0621 Entry ID: 272 Noditied: 08/11./2014 @ 1747 ModifXed ID: 198 ,Approved: 08/10/2014 @ 0737 Approval ID: 185 _ 5n A-dg st 10, 2014, at approximately 0453hrs, I was on patrol. in Hyannis sector in narked. cruiser E227. Ptl Souve and I were dispatched 'to 4.18 Pitchers Way for aaz unknown disturbance. Dispatch, advised that there was a language barrier and the reporting party just kept saying, "My friends are being problems, 418 Pitchers." As we walked the driveway .looking for the residence, we heard yelling coming from the direction of Mitchells way. As we arrived at 418 Pitchers we observed the house was all quiet and no one was around. We Continued to hear a disturbance in the same direction. When asked, dispatch advised that the call came over wireless and was centered over 41.8 Mitcbells Way. This address is known to me as I have had several. dealing with 'this location as a, late night party house. When we arrived at the home we could hear approximately four males screaming at each other on the front porch. As we approached, three of them ran inside . I -asked, the one who stayed, Jose Calle, to get me the homeowners. Several minutes later they came to the door. The residents were identified as Norge Calle, Manuel Calle and Jorge ordenea . The three stated that they were having a family party and that their father is the owner of the home—All three are being mailed mailed citations for TOS noise ordinance. I observed the home and yard to be in complete disazay. There were bottles and broken glass about the yard; a dumpster, seemingly used for household trash, in the front yard along with piles of trash. The inside of the house was filthy. It also appeared.that there are too many people living in this home. I request this report be forwarded to the health department.. 3 Map Page 1 of 1 Town of Barnstable Geographic Information System New Search Home Help Parcel Viewer Custom Map Abutters Map Size 13 ❑ Zoom OutA111111181n r = _ Turn map layers on/off by JPG selecting check boxes below -" 'i (✓I Town Boundaries ri IX - ,. k; ���.... _... Road Names voter Precincts c ^�r13 ni f Map&Parcel Numbers � - - Fv�, Parcels FEMA Q3 Flood Zones(Current Maps) it Not for official flood hazard determination. AE(100 yr flood) AO(100 yr flood) yLi VE(100 yr flood w/wave action) 'ti , X500(500 yr flood) ��' F FEMA Preliminary May 2013 Zones(subject to change)+, Expected Adoption Summer 2014 AE-100 year flood 58 Feet ' AO-100 year flood ' '�� ' q " �i VE-Velocity Zone v)ti t �r 0.2%Annual Chance Flood Open Water lip Set Scale 1' = 58 I Aerial Photos il� I MAP DISCLAIMER Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.5122[ProduCtionj i 7 Z-0 V J http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=291024002 6/17/2014 R g aO TOWN OF !' t i d l i PPP • ! - .. I g d a t CA^' I i I _ j r ))j a :... _ TOWN OF BA Q=:STABLE. s DIVISION I j -TOWN OF BARNSTABLE L*4'ATION SEWAGE # 0 0,,LAGE .4�ZIVA n/ S ASSESSOR'S MAP& LOT ?/ p? ,. V 4 INSTALLER'S NAME&PHONE NO. ( '��I P �c�i('� Ln 2 S- V02 gr SEPTIC TANK CAPACITY K LEACHING FACII,ITY: (type) 7 /n l � �— (size) lU•2r 3 y� NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 3, COMPLIANCE DATE: Separation Distance Between the: ® / Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet off Leaching facility) Feet Furnished by r> / 1 Q _ r No. 00 /U � =,; � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplitation for.Migo!5al fpp5tem ConElruction Permit Application for a Permit to Construct(W Repair( ) Upgrade( ) Abandon( ) &Complete System ❑Individual Components Location Address or Lot No. q18 n°"rCi e-1lf war Owner's Name,Address,and Tel.No. Assessor'sMap/parcel ?,ej( 2 bZ yeF °1 " eG.e//S uy hot Installer's Name,Address,and Tel.No. �p c�a K. 7 b? Designer's Name,Address and Tel.No. yyra av6Jc_ 5-617 --/ 70 o-IY4—sn,3 r+,R Type of Building: Dwelling No.of Bedrooms - Lot Size I r, *,3 + sq.ft. Garbage Grinder Other Type of Building S,IiS e_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 336 gpd Design flow provided gpd' Plan Date 3-!o-20 o b Number of sheets / Revision Date Title L/lY hw,0 eb/s 11_ ) i Size of Septic Tank /S-0 6 Type of S.A.S. rtc?oCA. P 'K2 Description of Soil �1�yn Nature of Repairs or Alterations(Answer when applicable) f e,g/uT " Aw o 5,41 7-�y 4 1-11,/1 /J 0A )U&V 9AS. Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date 3- 1 3 2,a Application Approved by 'PLAP. Date 3 "A O—Q& Application Disapproved by: Date for the following reasons Permit No. a V O G _A)L Date Issued 3 r.20,-O f r Ida THE COMMONWEALTH OF MASS ACH.U'SETTS Entered mkcomputer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABL�E, MASSACHUSETTS Yes r 0[ppYication for 0"fgPoga1 1p5tem Cow5truction?Permit Application for a Permit Ue to Construct(tRepair O Upgrade O Abandon O Com lete S stem ❑Individual Components ,. g P Y P Location Address or Lot No. N��/7/�+r Tc4<</s t✓"j� Owner's Name,Address,and Tel.No. F{yAnn.'i '� Lvr'f GA//.F' • .Assessor's Map/Parcel 7 u,q y.Asse Ma /P _._. ,m..P,.. �.9�1/ aZ�-bi l-l.y✓/��,s /"4 azt.or Installer's Name,Address,and!>Tel.No. ,�,K 6? Designer's Name,Address and Tel.No. # - �eMrEn...vlC rhq ott,3� 61S.0 G�wnS 6� 6 9ZT O i ?5 Type"of Building: S qS3+ Dwelling No.of Bedrooms 73 Lot Size / sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers;,( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided SSA. gpd Plan Date 3-/L)- Zo o 6 Number of sheets Revision Date -Title t//$iwk4e6/S Size of Septic Tank /,SO d Type of S.A.S. irtL.�r✓�!v/ r�wtC-��'7 ��),F13/X yt�'x� ' Description of Soil ,4aa Q/arl Nature of Repairs or Alterations(Answer when applicable) eP//4c.e Aou ;,,a/ L-//'% • "Date last inspected: Agreement: : The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board-of H_ealt_h r,._ Signed Date 3- 1 3- Zov` Application Approved by �f S, Date 3 - a o-06o Application Disapproved by: Date for the following reasons i Perm"it tl r�O Date Issued 3 20- — ———————————— ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed (v .) Repaired ( ) Upgraded ( ) Abandoned( )by (1OMAIi J L l��c/�I rst� C C L at LfCls ✓h tae/(j tw d y �AOwr n/,S has been constructed in accordance r With the provisions of Title5 and the for Disposal System Construction Permit No. - 00 -'0 �/ dated Installer C,6i4,y.-4e Designer .SA NO h< #bedrooms 3 Approved design flow r3 3U gpd The_issuance of this permit shall+nowt be co ''styued as a guarantee that the system will O tin adesigned. Date. 75 ,f/ gj Inspector —————————————————————— ————— —————————— No. �006r��y Fee /00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS 0igpogar *g5temY Construction Permit Permission is hereby granted to Construct ( Vl Repair ( ) . Upgrade ( ) Abandon ( ) System located at qd 41/f64C1/S wood y H40",n,, > ( 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. 4 Provided: Construction must be completed within three years of the date of thi pe7i Date �>' 0 - (� Approved by ��- v i f .f\ / 5/25/01 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM hereby certify that the engineered plan signed by me dated ID O(�. ,concerning the property located at meets all of the following criteria: • 'This failed system is connected to a residential dwelling.only. There are no commercial or, business uses associated.with the dwelling. The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch: The applicant may use historical data to.conclude this fact or may conduct. preliminary tests at the site without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed: • The bottom of the proposed leaching facility.will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W.Elevation +adjustment for high G.W. DIFFERENCE BETWEEN A and B 44 SIGNED : DATE:, Z)` NOTICE Based upon the above information, a repair permit will be issued for bedrooms maximum. No.additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:perci mp FORM 30 C1W HoBBsa WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I,^s _ CITY/TOWN�� W � b DE ART ENT Aq C5D �yl � _ P7✓t✓!i ADDRE \^7Q Xr' //��/� VY//1/y r -' LEPHO E Address `9 7�� 14'QW-II f W f-y f4 Ar4 Occupant t 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 1 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Li z Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: � Dual Egress:and Obst'n.: L,1V "^ ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: _ Chimney: BASEMENT Gen.Sanitation: ¢ vU^ Dampness: Stairs: lollH Li htin 5 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: Sup ly Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents V { ELECTRICAL Panels, Meters,Cir.: ink' ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: -J) _ 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 PENALTIE RJURY." 7 �f � INSPECTOR � 1 TITLE DATE_ TIME JrL� P.M n A.M. THE NEXT SCHEDULED REINSPECTION L P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shali be deemed conditions which may endanger or impair the 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 withir 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 sys-em 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, c-umbled 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 w-ich 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 infestatio-is 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. FORM'30 HAW HoeesaWnaaeN'" THE COMMONWEALTH OF MASSACHUSETTS � F BOARD OF HEALTH CITY/TOWN a DEPARTMENT ADDRES �/ � _l//�j� [[ � ff f 1 TELEPHONE Address `+/ (__" L✓ r � _ Occupant__ S l 5 I•r C 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 _ a MU"; � Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: 1 Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters; Drains: Walls: ! NV, a�✓ j171 J1 4 Foundation: Chimney: �.: �- , r, r BASEMENT Gen.Sanitation: 1 h'''"' Dampness: Stairs: r✓I� t .� Li htin STRUCTURE INT. Hall,Stairway: !U " Obst'n.: Hall, Floor,Wall, Ceiling: Hall Lighting: Hall Windows: �. HEATING Chimneys: a Central ❑ Y ❑ N E ui . Repair c-3 TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ST ❑ P Waste Line: r ��, tlplr+• H.W.Tanks Safety and Vents w ELECTRICAL Panels, Meters,Cir.: " `- ❑ 110 ❑ 220 Fusing,Grnd.: N N" ✓ AMP: Gen.Cond. Distrib. Box: Gen..Basement Wiring: `gyp t r )) DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroorn 2 Bedroom 3 Bedroom 4 Hot Water Facil. . Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Tollet.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 w 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." tI. �1 r INSPECTOR ` I tA/S TITLE—u f A.M. DATE I � I� TIME �,� (P.M.) THE NEXT SCHEDULED REINSPECTfON""'P. �_ 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 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. ' -.. •rw.•'7-•.✓`.,-. "r.,..r�r••1„.^_ar''_'P"]�,�`n�•+,x=-r7.e '`.• .`\�wtiti„�.•...,rv��4.S1r.-fit.-. ...Y.'. 'a,r..n ,. •�., ., n •- .- ... - -^!At l� FORM30 H&W HOBBS&WARRENTM THE COMMONWEALTH OF MASSACHUSETTS {BOARD OF HEALTH CITY/TOWN W hr t 41-1 DEPARTMENT uD54. ADDRES Sy`0 TELEPHONE r Address k , 1/t ,% t1w Occupant tau' Floor Apartment No. No.of Occupants_77 No.of Habitable Rooms No.Sleeping Rooms _-- No. dwelling or.rooming units No.Stories -- Name and address of owner i Remarks Reg. Vio. 'YARD Out Bld s.: Fences: Qt •°' Garbage and Rubbish { Containers: 1 I 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: k Chimney: BASEMENT Gen.Sanitation:Dampness: r , Stairs: y Lighting: 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 Vents 1 air,; % eJ ELECTRICAL Panels, Meters,Cir.: ` 11110 11220 Fusing, Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: 'V r 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 PENALTIES OF PERJURY." INSPECTOR ' `'J L TITLE DATE ? k ' ` TIME I 0 'P.M.3 r A.M. �e 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 tc 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 powderec, 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 -equired 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 infestaticns and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 135 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. d.- LOCATION ! s _�i SEWAGE # 0 VILLAGES n ASSESSOR'S MAP& LOT �/ a INSTALLER'S NAME&PHONE NO. C 1,c/,& S-� 6' SEPTIC TANK CAPACITY /SOU �//h LEACHING FACILITY: (type) „� /r► l_J� � (size) lU•23 NO, OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 1 Separation Distance Between the: �. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ND Feet J g ty 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 caching facility) Feet within 300 feet of �— Furnished by4 .I a ly.s C 3 3s,y C � SF3 . a W Certified Mail#7003 1680 0004 5458 2322 �t Town of Barnstable Regulatory Services s MtABIFw Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �1VIay 25, 2005 Luis G. Calle .___ 418 Mitchell's Way Hyannis, MA 02601 J i J NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE rl The property owned by you located at`418 Mitch�_11's Way, Hyannis was inspected on January 18, 2006 by David W. Stanton R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violation of the State Environmental Code was observed: 310 CMR 15.214: Nitrogen Loading Limitations: 5 bedrooms were observed at said location which is located within a Zone 2, Wellhead Protection Area with less than one acre of land. On September 8, 1994, Septic repair permit 94-528 was issued for three bedrooms. You may have no more than three bedrooms total at said location. .f You are directed to correct the violation listed above within thirty (30) days of your receipt of this notice, by eliminating the two extra bedrooms so that a total of only three bedrooms are present at said location. The Town of Barnstable Health Department has a policy to eliminate the privacy of being considered a bedroom by installing a minimum five (5) foot cased opening with no doors, and no beds or people sleeping are allowed in the room. The other option is to eliminate a wall between two bedrooms and make it into one large bedroom. It is noted that there were three rooms observed in the basement. These rooms in the basement cannot be used as bedrooms, as they do not have adequate windows or means of egress. Please call Health Inspector David W. Stanton, RS to schedule a re- inspection of the property when the two extra bedrooms have been eliminated at (508) 862- 4647. 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. Q:\Order letters\Sewage violations\418 Mitchells Way.doc I PER ORDER OF THE BOARD OF HEALTH omas . Mc ean, R.S. Director of Public Health Town of Barnstable r QAOrder letters\Sewage violations\418 Mitchells Way.doc f--� yo�nn�'s � ,� • DzGo� 77 1 2°f 3� L L) �eVr) Qa) �� z Tw ISS S o r�2 Cq /le-- �Y +'ar� fl7hey, . �0 1Q h Fl o SBoues One k,•�, C �11t & )o ��e✓ �cxl/� January 11, 2006 The following people are declared to be residents of 418 Mitchell's Way, Hyannis: Name: Relationship • 3 ' Town of Barnstable Regulatory Services Thomas F.Geiler,Director rsutxsrABt.e. *. �0a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 3-7_3-2uo(- Sewage Permit# Zoo(.- to ro Assessor's Map\Parcel L9( zy-a 2 Designer: �-JSP 1-yO-ASS Installer: C= tg" Address: P(./Ovn✓Yt, e71(' 6 - Address: Wfo-7 641mgjr4- eawd �ar�� Co��, r �nr� oZ63S On 3"Zo - OG 64e j i' �'� Ferp.;seg was issued a permit to install a (date) p (installer) septic system at 4qQj m)-rcki!5i4_`S WtqV', /'&l wi=,based on a design drawn by (address) '�— L-YM S dated (designer) AC I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. oF Nk _ Ste: LISA 6. Installer's t ature) ;c a LIONS N S C ^� ,. t • LIt. 41.1.43� BASS �`Q�� 9iJu � T6ED SANS `V (Designer' i e) (Affix DRiVWri Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc 1 v Certified Mail#7003 1680 0004 5458 2322 EVE A Town of Barnstable ' Regulatory Services nnxxsraBIM Thomas F. Geiler, Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 20, 2006* Luis G. Calle 418 Mitchell's Way Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 310 CMR: 15.000 THE STATE ENVIRONMENTAL CODE TITLE V: MINIMUM REOUIREMENTS FOR THE SUBSURFACE DISPOSAL OF SANITARY SEWAGE The property owned by you located at 418 Mitchell's Way, Hyannis was inspected on January 18, 2006 by David W. Stanton R.S., Health Inspector for the Town of Barnstable, because of a complaint. The following violation of the State Environmental Code was observed: 310 CMR 15.214: Nitrogen Loading Limitations: 5 bedrooms were observed at said location which is located within a Zone 2, Wellhead Protection Area with less than one acre of land. On September 8, 1994, Septic repair permit 94-528 was issued for three bedrooms. You may have no more than three bedrooms total at said location. You are directed to correct the violation listed above within thirty (30) days of your receipt of this notice, by eliminating the two extra bedrooms so that a total of only three bedrooms are present at said location. The Town of Barnstable Health Department has a policy to eliminate the privacy of being considered a bedroom by installing a minimum five (5) foot cased opening with no doors, and no beds or people sleeping are allowed in the room. The other option is to eliminate a wall between two bedrooms and make it into one large bedroom. It is noted that there were three rooms observed in the basement. These rooms in the basement cannot be used as bedrooms, as they do not have adequate windows or means of egress. Please call Health Inspector David W. Stanton, RS to schedule a re- inspection of the property when the two extra bedrooms have been eliminated at (508) 862- 4647. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. + QAOrder letters\Sewage violations\418 Mitchells Way.doc Y n .tf a'1 PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable *Date corrected by DS on 2/3/06, wrong date on original order. QAOrder letters\Sewage violations\418 Mitchells Way.doc f I ILA i �, i ( ! l 7 n l 1oo ! i i t I • I " `I _ I - - - - - 147-- Fl — -- --- — —-- — e � r t _ -- -- - f 4 i - rA oo p� AO - -- ------- -- --- -El -- -- —,---- 1 � � I , i , I I I f I I I� I , 1 1 ; i C I i I-- ,• I I I _ I I i , i ""�` I I i• I -t ' I ' 1. _ l_ .-_I __� _ .. : I I i i. I I I. I I : 1 I • � � �I I I '7 _T_"e � f j I , I i �! I I I I i I ! T I I I I ! 1� 1 Ii I l I 1 I t , I ! I I i i I I I i i , i i - � � f t f' P' � I � l V f �. �� ':P. . I' e . �y f � �_4 ».( o i £e �� �.. _ �.. .�„.. �. I. . : �, i � � I . . . . � _ . � � � . . . �, � i . � � . � _ . e L u .. ., �, I � � r . m pf,ll � ; • l ' I 11 I I' 1 � - Q � n � � � o u � _ � \i a `o O 47� � z a r - D $ D __ .. L u m . . 2 - . .. L - . . � � _ ! .. v Eq� � f - - � �o o � x i V e ,Z � C _. F a • 1 M 71 R FLI v y �4 •� e y e t. iI I x +T n - - 7.S.a• n � Mtn It Pr el I - D O 8�y rtl a, ^ pl y.x w c 0 1 0 � a T n F I as's.a�Qna� = 6>mO a $ P o � 4aaraj. Z a c.ITN L1 0 70 ' _ O C , Oe D 1� P .Z /fios sspc � n 6'p Z .C `'- Tw � �y ( I kLi n E lz u ,� O y pq� �• o 5 , ro r BORTOLOTTI 'CONSTRUCTION, INC. P. O. 130�Y:704, MAIZSTONS MILLS, 1V1A 02648 508-771-9399 508-428-8926 508-428-9399/FAX SEWAGE DISPOSAL SYSTEM EVALUATION Inspected By: Date: CAddrI s: i�, of#: ner ,cyer:. C '7 77-d�16 Mailing Addres : NOTE: A satisfactory evaludtion does norguarWnfee that the system will continue to function. A Sketch of the proper-ty and sewage disposal components must accompany this form. :: - RESIDENTIAL` COMMERCIAL USE,. :-.. Lot Size: P 'Lot Size: No. of Bedrooms: oonzs: Type o fTusuiess. Garbage Grinder: Water,So te,zer: " Sq. Ft. of Bldg.: Othe,• kVater Use:(A plia,ices)L t,�`� No. of Employees: ` . • r {Vater Use Activity: Year Routzd: ;Seasonal: Water So,irce:' � Water Source: \j ` Septic System Installed(Date). v 'Title V Yes (° ) No`( ) W , No .Size Length 'Type 'Ft. to Ft. to Condition, .. Well Weiland Buil&4'Se►ver t Septic Tank IJ/4 /,4 „ Efflize�tt Pipe _ Dist. Box JA- - Dist. Pipe-- Leach - Pit Flow:Diffussor Leach Trench;. Stone ` Cesspool w. Pzunp/ChaniGer ~Evidence of Gro,ind Stain Yes ( ) No (✓� Unknow,z Evideice of Breakout/Ovei•loacl i, . } ry Yes._ ( ') No' ( j Unknofvn.( ) Evidence of Overflow to Surface Yes O No,(o Unkhotv,i (` ) Evidence of Lush-Growth around Pit/Cesspool Yes O No (;� Unkizow,z (• ) ' Standing Liquid in Pit 1/2 or More Tull Yes ( No (4 Unkhowm( Evidence of Excessive Pumping Rerluirezl Yes O No ( ✓f Unknown ( ) Co,rc ,zents. , a 0�3, ��6 � .� '� � � «� � �a � ,` - e,1 � — !_ i i � . ' Y i -\ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED MAR 2 1 2005 TITLE 5 TC ,ACHE OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM ' PART A CERTIFICATION If� Property jAhRCEL Owner's Name Owner's Address: j Date of Inspection: F Name of Inspector (please print) �.. Company Na Mailing Address: ' Telephone Number 9 - 2/ CERTIFICATION„STATEME��T � µ 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 a_ 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 MR 15.0.00). The system: Passes. Conditionally Passes Needs Further Evaluation by th--Local Approving Authority ' ails Inspector's Signature: ,' `"`,---- Date: 1 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shard 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 ar_d 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 1 Page 2 of I l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued.) Zi Property Address: � Owner: 1.(� Date of Inspection: r6 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. Svstem Conditional] Passes: _ Y 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,Hill pass. Answer yes,no or not determined(Y,NT.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 infiltratiott.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: Pap-6 3 of 11 OFFICIAL INSPECTION FORM =NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION-(continued) Property Address: , r t % AWA Owner: _ Date of Inspection: � _ ,,j& 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)ihaf 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 100rfeet ofa,'., 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 i of a public watersupply. 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 DAP certified.laboratory,.for coliform bacteria-and volatile•organic ccmpounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to Dr 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 3 Page 4 of 1 l OFFICIAL INSPECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: ' Date of Inspection: , y ' D. System Failure Criteria applicable to all systems: You must indicate"yes''or"no"to each of the following for all inspection Yes No Backup of sewage into facility or system compor_ent due to overloaded or clogged SAS or cesspool Discharge or ponding of efluent to the surface o:the ground of 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 availably volume is less than�7z 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. _. Any portion of a cesspool or privy is within a Zone 1 of a.publi: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 i CO 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 the form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15303,therefore the system fails. The System owner should contact the Board of Health to determine what will be necessary to correct the failur,. 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 i the system is located in a nitrDgen 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 operato-of any large system considered a significant threat under Section E or fazed under Section D shall upgrade tl_e system in accordance with 310 CMR 15.304..The system owner should contact the appropriate regional office of the Department. 4 I Pase 5.of I I - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B ,. CHECKLIST l (� Property Address: 7 r6 Owner: am—)4" Date of Ifispection: •� `�' r'� 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 ncrmal 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 breakout? _. 1 Were all sysiemcomponer:ts,excluding the SAS, located on site iWere'the septic tank manhDles uncovered, opened, and the in_erior of the tank inspected for the condition o�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 owne-)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: Yes ,. 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;Kb)] 5 Page 6 of 11 ' OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE-SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: .Date of Inspection: (II A FLOW CONDITIONS RESIDENTIAL 1/ ^� Number of bedrooms(design): Number of bedrooms(actual):�:�L DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x tt of bedrooms): ' Number of current residents: Does residence have a garbage grinder(yes or no):U"< Is laundry on a separate sewage system(y s or no):,L/O.(i=yes.separate in_pection required) Laundry system inspected(ye,s or no):A/() Seasonal use: (yes or no): Water meter readings, if av ilable (last 2 years usage (gpd)): Sump pump(yes or no):/L/ Last date of occupancy; COMMERCIAL/INDUSTRIAL / Type of establishment: Design flow(based on 310 CMR 15.20): . gpC Basis of design flow(seats/persons/sgffr,etc.).- 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 A Source of information:P1aj ,/)?f,61A,; Was system pumped as part of the mspdctio (yes or no): t If yes, volume pumped: gallons--How was quantiy pumped determined? Reason for pumping: TYPE OF SYSTEM t./Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system (yes or no)(if yes,zttach 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): r ximat age of all components, date installed(if known)and source o=information: Ms ,� 1 0 Were sewage odors detected when arriYing at the site(yes or 6 Page 7 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ;SYSTEM INFORMATION(continued) Property Address: r , Owner Date of'Inspection: r �. BUILDING SEWER(locate on site plan) 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: Material of construction: ncrete_metal_fiberglass_polyethylene _other(explain). If tank is metal list age:_ Is age con=armed by a Certificate of Compliance(yes or no): _(attach a copy of. certificate) , Dimensions: F•.j Sludge depth: Distance from top of sludge to.bottom o:outlet tee or baffle: as ; 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: How were dimens.ions determined- r G " Comments(on pumping recomm dation , inlet and outlet tee or baffle condition, structural integrity, liquid levels related to outlet``invert, evidence of leakage, etc.): e A 0//Xje, /,9 GREASE TRA49V(locate on site plan) /���' G;+/)j, v� 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 I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART-C SYSTEM INFORMATION(corxinued) z J Property Address: Owner: Date of I spection: �, ji �7, TIGHT or HOLDING TAN tank must be pumped at time of insoection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiber`lass_pollethylene other(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.): DISTRIBUTION BOX: (if present must be opened)(l.Dcate on site plan) n Depth of liquid level above outlet invert/ Comments note if box is level and distribution to outlets ` al, an evidence of solids carryover, any evidence of ( � Y kage.into or out of box, et ): ' / r311 I PUMP CHAMBEIjI) 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 Pau 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: , Date o Inspection:'LCUZ 7)') J a=5' , SOIL ABSORPTION SYSTEM (SAS):t (locate on site plan,excavation not required) If SAS.not located explain why:. Type leaching pits, number: .__...... leaching chambers, number: 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 ponying, damp soil, condition of vegetation, t c} I / ' [ n � CESSPOOL (cesspool must be;pumped as part of inspect ion)(]ocate 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 failtire, level of ponying, condition of vegetation,etc.): PRIV }' e) .(locate on site plan). Mate✓rials of construction:_ Dimensions: . Depth of solids: Comments(note condition of soil, sig,ns of hydraulic failure, level of ponying,,condition of vegetation,etc.): 9 Paae 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: O J¢ 11-11-14, ,f ! Owner 6T,/ . fI t Date Inspection: 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 T00 feet. Locate where public water supply enters the building. :0 i Page 1 l of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SELVAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of-lnspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated.depth to ground water feel 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 150 feet of SAS) Checked with local Board of Heath-explain: __ Checked with.local excavators, installers-(attach.documentation) '7 �/ Accessed USGS database-explain. e . You must describe how you established the high ground water elevatioll: • d % }`�,�'/.b�i'l"ice" < ' f�f� i 1I Permit Number: Date: Completed by: _ c5 HI.GH GRi.UND-WATER LEVEL COMPUTPTION Site Location: —71 � �(f �`" �;/�[ Lot No. Owner: Jam' % t�� Address, 9 S Contractor: �f f (� fi' _ t Address: 'Y; Notes: STEP 1 Measure depth to water tole J to nearest 1/10 ft. .............. .....:............. Date ( month,/day/year STEP EP 2 Using Water-Level Range =one and Index Well Map locata site and determine: OAppropriate index we":....................................................= B. Water-lever range zone ..................... , STEP 3 Using monthly report "Cu-rent Wate.r Resources Conditicr:s" determine current depth c i water level for index well ........................... month./year STEP 4 Using Table of Water-lever_ Adjustments I. .or index well (STEP 2A)_ current depth to water level for index "Pd (STEP 3), and water-level zone (STE" 2B) I i i. determine water-level adjustment ......:. STEP 5 Estimate depth to high water by subtracting the water- level adjustment (STEP 4= ,rom measured depth to -vater ow level at site (STEP 1)............................................................ Figure l3.--Reproducib1e Computation form, 15 +.5 b i _ -_a }1 1 i 1 i 1 � a 6 — F3 fl S t . e _ § 1 ' E ti R VA No.... Fas.......�c�. ....... THE COMMONWEALTH OF'�MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Diripoottl 3Vorko Tonitrnr#inn ramit Application is hereby made for a Permit to Construct ( ) or Repair (t,"<an Individual Sewage Disposal System at ....... 1. ... ,3 .. ..... ................. .... ------------------------•-...............-or No.--•-...._...............................- Lo ton-i� dress �` t ----------- Gi!! !!l` a er Address .. ca —•------- • ----•• .................. Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.__.��.---------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtu s ------------------------------• _ . Design Flow...........f��. ......................gallons per person day. Total da y flow... gallons. 1:4 Septic Tank 4 Liquid capacity.`.f gallons Length-- ------ Width-- ------- Diameter................ Depth_-__.______-._.. Disposal Trench—No. .................... Width-------------------- Total Length_.__-._L_-'__7..._._. Total leaching area....................sq. ft. 3 Seepage Pit No.........I.......... Diameter---1�_.____. Depth below inlet-----7-__._....._. 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........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit______....-_____-__- Depth to ground water........................ pG ......-•--••---........-•----•...................•-••--•---.........----•-------•--••-•--•••.....---.......................--................................ ODescription of Soil................................................................................................................................................. ...................... W V .................•-•--..._......---•--•...•-•--•----•-•---------------•-•••--.....••------•---------._._.....---•-•-•-•-•...._...---------••---••--.._......-•-------•--•-••••-•••••--•----------•-••--- W -------------------------- ...............•......................................................................'------•-•-------.----- - U Nature of Repairs or A rations—Answer when applicable. ..��dt!.< P.f..............f�1.. 000 Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the.provisions of TITLE 5 of the State Environmental Code—The undersigned further aggrees not to place the system in operation until a Certificate of Com' lia s d by hheeUoal of Signe ......... . ..... .. ..........------ - ------- .................. --- ' re ApplicationApproved By --------- -------------------------------------------------------------------------n..... ........j.:.�� ..:. 1-f... Application Disapproved for the following reasons- --- ----------------- -------- -------------------------------------------------- ----------------- - -. . Date Permit No. ......... "' � � ............... Issued ..._.......................... Date F d No....�...... �.�... Z Es..............: THE COMMONWEALTH..O.F�MASSACHUSETTS _ BOARD O w.H E A LTH ` ``• „ ,. - 'TOW NOF BARN-STAB.LE',,-N lrttti>ait for tnttl19bxlt Cna�Btrt#iuriPrutt Application-is-hereby f madef for Prmit to Construct ( l ) or. epair (("ran Individual Sewage Disposal System at .................�.�.t. �,".S. .S.L/ C.v_•_•.r ___�n __............__.... ...................._......._......_.........__._.._..........__.............•.._............._.. Location-tlddress or Lot No. O eA... r 1 fig c��"" / [ c? ri4 �'1 `................ ........ ----•--- wner Address ay ---------------------------------------------------------------------------- Installer V Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___ _________________________.-__-Expansion Attic ( ) Garbage Grinder ( ) a`q Other—T e of Building No. of ersons___•_____________________. Showers YP g ---------------------------- P - ( ) — Cafeteria ( ) dOther fixturr_es ----------------------------------------------•---------------------------------------- ---------------------------------------•--------------------- W Design Flow.......... __'?______________________gallons per person .per day. Total daily flow..7 ��.__.___._.___._..._....gallons. R: _ Septic Tank Liquid capacit.. ..._gallcins Length_�-___--___ Width_..________ Diameter________________ Depth___.._______.... Disposal Trench—No_ ____________________ Width...........___.__. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No........../---------- Diameter._.,-._! ------- Depth below inlet.....y....._..._. 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..____-_--_--._.-----.-. (_, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �i .....-----••...................•---•---•----------•------•---......----------••......------.._................---•-----•----------------•--••-----...._...•-- Descriptionof Soil--- ------••--•••-•.....-••--------------------------------------------•-------------------------------------------------------------------------------------.....---•- x UW ----•------------------------------------------------------------- .........................---------------------------------------------=--------------------------•---•• .............. Nature of Repairs or Alterations—Answer when applicable_._ �7a.h1 ....k.ne _._.SP _f -t---- l( ---_-. 4 © 1 12 - -F- ......-.?`- 1: !�'�----!'t F- ,,---------�-------------"-=--------------------------------------------.........--•- . Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned,further a rees not to place the system in operation until a Certificate of Compliance has_been i sued by the board of hea`lh." Signed` �..� !........:...... .------- .............. .......... -;r J Dare Application Approved By --------- - ----- - -<.,� ",,',,— ----- r�'-r�.......------------------------------ �Dare Application Disapproved for the following reasons: .......... .................................. ..................................... .. . . ------------------------------------------------------------------------------------------------------- ---------------------------------------------- ------ ---------------------------------------- Permit No. ....... .--I-. ..�>�..� .. .................... Issued -------------------------------------- Dare P --- -- -------- ------.----- _ ------- --. ------------- --------------_----- THE COMMONWEALTH OF MASSACHUSETTS ) P � BOARD OF HEALTH d, TOWN OF BARNSTABLE Certificate of TIImplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( by ...................................................... �_ -.. c---�--- =-9.r1.' c� .......... at -- . .................. ------------. - '1_t. f_(.. r....... .= `o f--------------------....--..-------------_ ---------------------- has been installed in accordance with the provisions of TITLE 55 of The State�Environmental Code as described in the application for Disposal Works Construction Permit No. ._-11_(_-_5---- _ dated THE ISSUANCE)OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �__���� DATE - ,...".. l '�� � /'......... - - Inspector•.,°... �-�••�:t���*�.::�-� ; y/� �*2.�-�---,. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G TOWN OF BARNSTABLE � ; No....n.—, 1 �j FEE....... ....... UWpofiat Works Puri # r#utri Prutt# Permission is hereby granted -..._.G:_�`- „) ->-./(........ to Construct ( ) or Repair ( U an-Individual Sewage yDisposal,System N atNo..................................................... -�j-�------- -=-=f'' I.K. - Street cp as shown on the application for Disposal Works Construction Permit No._I-. :5_.=-_-_-_ Dated-------��____v------.f.C� J } Board of Health DATE = 1.--------•----------••-••--•-------••------. �' FORM 36508 H08138 6 WARREN.INC..PUBLISHERS NOV-20-1998 16:39 ADRIAN PIPER P.01 q -®r. W V C b �o TOTAL P.01 T Town of Barnstable Health Department 367 Main Street, Hyannis, MA 02601 Office 508-7904265 Thomas A. McKean FAX 508-775-3344 Director of Public Health March 20, 1996 Jay& Annette Curley 24 Yale Avenue Wakefield, MA 01880 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE_51 The property owned by you located at 420 Mitchells Way, Hyannis was inspected on March 19, 1996 by Christina Kuchinski, Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code H were observed: 410.400: Bedroom#1 did not contain a total 100 square feet of floor space for its two occupants. Bedroom#1 contains=only 88.5 square feet of floor space. You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health cc: Deidrea DeGrace 5 i vD Mr./Mrs. A kI►�P-,I4e &A,(-a c/ CP-L/ Va(le ,kwe x), NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II. MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned j you located at �o� lh y?hlls was inspect 1 ed on 3 z9l-& . +994 by Health Agent for the Town of Barnstable because of a complaint. The ollowing violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: ok-�, spa 5 You are directed to correct the violation of within 24 hours of receipt of this notice by You Are also directed to correct the remaining Above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with. an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable 6 r FORM80 HOBBsa WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITYITOWN 4 W a DEPARTMENT ADDRESS ���� TELEPHONE Address (vo© I � ���' `( / ccupan l P1� Floor Apartment No: No.of Occupants 6Yaca_�, No.of Habitable Rooms - No.Sleeping Rooms - No.dwelling or rooming units No.Stories Name and address of owner fi /v l e� 6 1 Remarks Reg. Vb. YARD Out Bld s.: Fences: / Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: , Dual Egress:and Obst'n.: YW _S ❑ B ❑ F ❑ M Doors,Windows: I,,,, P, 57r, Roof Gutters, Drains: t ✓vl S - Walls: Foundation: v-00 Vvy Chimney: _ ,► 400 BASEMENT Gen.Sanitation: -� p Dampness: Stairs: Lighting 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.: 11110 ❑ 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 Facll. 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 PENALTIES OF PERJURY." INSPECTOR �� ,4"0 TITLE A.M. DATE / TIME 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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) Shut-off and/or failure to restore electricity or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common 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 system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (GI Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 4110.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 which results in any accumulation of garbage, 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 lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (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 dafety. (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 facilities 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 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and 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,. gas-fitting, 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition 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. Jay J. Curley Mark M. Curley Attorneys At Law 24 Yale Avenue -Wakefield, MA 01880 (617) 245-1000 y FAX (617) 245-1010 s� _ ®V� cod ch 26, 1996 Debra Pitts 420 Mitchell Way Hyannis, MA 02601 Re: Termination of Lease Dear Ms. Pitts: Enclosed is a copy of a letter and the results of a Board of Health inspection dated March 20, 1996 and received by me on March 26, 1996. You„are the tenant at 420 Mitchell Way, Hyannis, Massachusetts. Your rent is tb6ing paid by„Housing Assistance Corp. My records and the records of HAC indicate that'Ryou have two children. You and your two children are the only three people who,can occupy that house. A total of only three people can live in that house. The Board of Health indicates that many more than three are living there. Please accept this letter as a termination of your lease. You must have all the other people immediately vacate the house. Please vacate the premises yourself on or before May 1, 1996. cerely your Ja rl y cc: Housing Assistance Corp. 40 We st est Main Street Hyannis, MA 02601 -(Thomas A: McKean" n . Board of Health 367 Main Street _ Hyannis,, MA 02601 i = II i i �lhl - 3 G� S S � J � i i i ?� t°�-------�—fir,-�cr'� .���Q _ \ � I i 271 a IAIG tt Z� z I NF `I ''_► �'V 9 J0 NMOi -a i � ' J Arl OiSIAIG - .-._..�.�_r_---. .._._.-..ten..�.-.nor -.............._._.-.._�.--_.__.........•- Z Z :6 vWV ( I OW iAoi f , 'I # i. i i __.__.._. _._... .... ...... i -L_ { , NG'STAlQ I � L Z -6 0V I 1 0,14. 611u I ]l9vi e-dvq Jo fulo1 PO s .` (15UILIJEK UK riV1VI1'V VVPi K) L.['�. J n � '• - - - - 6-, TOWN OF/BARNSTABLE LOCATION ��� "/IG/'7 �1 �l�S� SEWAGE # VLLAGE /I` �/J� /ASSSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. Xel'- ZZ 491b2-i- 7 7/`9.3,�,PZ SEPTIC TANK CAPACITY /D0� LEACHING FACILITY: (type) vr7�B�de 14' L"K 1 es (size) NO. OF BEDROOMS BUILDER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet � Furnished by VW s 1 �a i i 1500 GALLON TANK DISTRIBUTION BOX HIGH CAPACITY INFILTRATORS H-20 CROSS SECTION LOCUS PLAN NOT TO SCALE NOT TO SCALE NOT TO SCALE {` NOT TO SCALE NOT To SCALE 100.17 COVERS TO BE WITHIN6"OF GRADE MIN 0 100 ROUTE 28 a^scxaor.v.c. 3"MINiMkrM 964 INSPECTION PORT TO €E WITHIN 8" OF GRADE 3 13 3" " _ a"scB aorvc 3" 1/8"-t/2" WASI ED STO,E r-ti Locus 98.09 " L t- �4++ La 97.65 i y 97.9 96.8 5' O a 4.0' 96.6 96.0 0' .92''� MSTCHEl-L.'S •'. •'.'.•'.. / WAY MII�i 94.0 3/4"=.1 1/2"flOLJBLE WASIIED.$TO1�TE 1.08' \ 43.8' I'2.1'$ 4$.0' 4' 2.8 4' -� WEST MAIN BOTTOM OBS 88.9' 10.8" ZONE II SITE SPECIFIC NOTES DESIGN CALCULATIONS GENERAL NOTES SLEEVE SEWER LINE AS SHOWN FLOOR PLAN NOT TO SCALE ALL PIPING TO BE SCHEDULE 40 P.V.C. EXISTING BEDROOMS 3 0 110 G.P.D.= ALL LOCATIONS OF UTILITIES SHOWN ARE AS G.INSTALL 40 MIL VINYL BARRIER AS SHOWN 330 G P.D. MARKED BY DIG-SAFE AND ARE TO BEVERIFIED BY INSTALLER PRIOR TO NO. OF UNITS 7 CONSTRUCTION INSTALLER TO NOTIFY DESIGNER 24 DEPTH BELOW INV. 2' THERE ARE NO KNOWN WETLANDS WITHIN FIRST FLOOR WIDTH 10.83' 150' OF THE PROPOSED LEACHING FACILITY HOURS PRIOR TO BEGINNING OF JOB TO LENGTH 48' UNLESS SHOWN. COORDINATE INSPECTIONSBOTTOM AREA 519.8 SF THERE ARE NO KNOWN POTABLE WELLS WY. SIDEWALL AREA 235.3 SF 150' OF THE PROPOSED LEACHING FACILITY. WN TV ROOM WITH \\ LAUN TOTAL SQUARE FEET 755.1 SF WITHIN SOREOFOTHE PROPOSED IRRIGATION 5'CASED OPENING DRY BATH CAPACITY SIDEWALL ®0.74 174.1 G.P.O. (� Benchmark set FACILITY Bench Left cor bulkhead _ CAPACITY BOTTOM ® 0.74 . G.P.D. PROPERTY FIRM AP A 558 C J CAPACITY TOTAL 558.8 G.P.D. FLOOD ZONE AS SHOWN ON EL=I(70.0 (Assumed) KITCHEN THIS DESIGN DOES REQUIRE VARIANCES TO 1 TITLE 5 (310 C.M.R. 15.00) OR BARNSTABLE sEDR THIS SYSTEM NOT DESIGNED TO SUPPLEMENTAL REGULATIONS. y ,,y� LIVING ROOM ACCOMODATE A GARBAGE ALL CONSTRUCTION SHALL BE IN ACCORDANC Ar.m d' h DISPOSAL WITH TITLE 5 AND BARNSTABLE SUPPLEMENTAL SLEEVE 4" LINE WITH 8" PVC FOR 10' REGULATIONS. J ON EITHER SIDE OF THE WATER LINE PORCH IN-LINE ELEVATIONS PROPOSED AS-BUILT SURVEY INFORMATION ENDS TO BE SEALED INSTALL 40 ML VINYL BARRIER INV. 0 HOUSE 98.09 PROPERTY LINE DATA FROM BETWEEN TANK AND FOUNDATION INv INTO TANK 97.9 ALL CAPE ENGINEERING 4/20/98 INV OUT OF TANK 97.65 INV INTO D-BOX 96.8 PLAN TO BE USED FOR INSTALLATION INV OUT OF D-BOX 96.6 OF SEPTIC SYSTEM ONLY SECOND FLOOR INV INTO INFILTRATOR 96.4 0' BOTTOM OF INFILTRATOR 95.08 NOT FOR DETERMINING PROPERTY LINES LEACH PIT AND TANK TO BE BOTTOM OF STONE 94.0 BENCH MARK - ----- - _- - _- _.t. _, _-- z _., ._ - BOTTOM OF OBS HOLE 88.9 _ _ PUMPED AND FILLtt7 b.sri _ .. _----- 11 O O O �l WATER TABLE NONE ENCOUNTERED �UHNEk OF t3UCRHaU 1U0.0 (ASSiJMtGj` ' - LIVING ROOM 8, (r�LP c DATE: OBSERVED BY: WITNESSED BY: BEDROOM "S�II'L'�G'S MARCH 10/06 LISA C. LYONSUNWITNESSED /// BEDROOM SOIL EVALUATOR FORM ATTACHED �-- OBS. HOLE #1 OBS. HOLE #2 ELEV. DEPTH ELEV. DEPTH T H 1 BEDROOM BEDROOM 99.9 0" 100. FILL Olt t 99,9 FILL 98.9 3" 98.5 7„ A/E LOAMY SAND LOAMY SAND 98.6 1 OYR 4/2 26" B 1 OYR 4/6 LOAMY SAND PROPOSED SAS PLEASE NOTE THAT CURRENT BEDROOM-COUNT IS 5 96.7 38" 97.3 C IOYR516 2+, 7 HIGH CAPACITY INFILTRATORS a N ENCLOSED UNDER ORDER .BY BOH TO MAKE IT 3 BEDROOM MEDIUM SAND 53" MED/COARSE SAND 54" IN A 2' X 10.83' X 48' TRENCH PORCH 2.5Y 6/6 65" 2.5Y 6/6 66" 2' PIN TO BE VERIFIED BY DAVID STANTON, HEALTH DPT a PORCH GARAGE 88.9 0 GROUNDWATER ENCOUNTERE 132" 90.8 O GROUNDWATER EN 0 NTERE 120" TH 2 100.8 PERC RATE<2 MINS./INCH PERC RATE<2 MINS./INCH VENT NECESSARY SINCE >3' DEEP 1- ✓0' 'lie ��0,� 1 VARIANCE REQUEST A variance is requested from 310 CMR 15.211. A variance of 2'is requested from the setback to cellar with the use of a 40ml vinyl barrier. 8' M I T C H E L L / S WAY setback is available. :,". `�O?�.� •�i. G PLAN SHOWING: M 2 Q 1 P24 02 4 c LISA C. PROPOSED SEPTIC SYSTEM REPAIR IN BARNSTABLE J c� LYONS : -,C FOR: DRAWN BY: LISA C. LYONS L i C• I�114 3 y LUIS CALLE DESIGNED do CHECK LISA C. LYONS o•35± acres ,,��,•.,9 ... _ LOCATION: REVISIONS:DESCRIPTION: DATE: s�+ . � .. ��`� 418 MITCHELL S WAY HYAN>`TIS SCALE 20 �i/i1 SA C 1 .1 � �* L DATE: M2gi P24-o2 MAR 10,2006 N .S. I CERTIFY THAT THIS PLAN CONFORMS TO LISA C. LYONS, R . S. (5o8) 790-9270 TITLE 5 AND BARNSTABLE B.O.H. REGULATIONS HYANNIS, MASSACHUSETTS (774) 487_i638