HomeMy WebLinkAbout0056 PINE GROVE AVENUE - Health 56 Rine Grove Avenue
Hyannis
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SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Signatur
item 4 if Restricted Delivery is desired. X ❑Agent
■ Print your name and address on the reverse Addressee
so that we can return the card to you. ; ecel by( ' ted N me) C. Date of Delivery
■ Attach this card to the back of the mailpiece, �� i
or on the front if space permits.
D. Is delivery a - i m item 1? ❑Yes
1. Article Addressed to: If YES,a ery a elow: No
9 2010 y
John Monteiro
56Tine Grove Avenue
Hyannis, MA 02601 3. Service Typ U p�
Ukertified Mai rem Mail
❑Registered return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number I r 7008 3230 0002 5177 9312 —To
V
(Transfer from service Jai
Ps'r-orm'3811,Febr6ary�2004 i Domestic Return Receipt 102595-02-M-1540
UNITED STATES POSTAL SERVICE First-Class Mail
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LISPS
Permit No.G-10
I • Sender: Please print your name, address, and ZIP+4 in this box •
!I
i awn of Barnsiable
IY);I Nublir.;)-lealth Division
200 Main Strect
Hyuruiis,IMA102601
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Certified Mail#7008 3230 0002 5177 9312
Town of Barnstable
DYNE Tp�
Regulatory Services
1
BARNSra81 E. Thomas F. Geiler,.Director
MASS. Q f
%639. � Public Health Division i
Thomas McKean, Director i
`200 Main Street, Hyannis, MA 02601 � l
Office: 508-862-4644 Fax: 508-790-6304
August 4, 2010
John Monteiro
56 Pine Grove Avenue
Hyannis, MA 02601 o
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170 .
The property owned by you located at 5=5 Pine-G-r-ove Avenue-(Lower Amnesty-Unit).
Hyannis, MA was inspected on July 28, 2010 by Timothy B. O'Connell, R.S.,Health
Inspector for the Town of Barnstable because of a complaint.
The following violations of the State Sanitary Code were:
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements:
During this inspection there was evidence of water staining and what appeared to be
mold growth through out apartment due to chronic dampness.
You are ordered to correct the violations listed above within thirty (30) days of your
receipt of this notice by pulling any required building permits (if applicable); by r
fixing all areas that are leading to chronic dampness within dwelling so that they are \
weather tight and waterproof; by removing all mold using best industry practices..
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. Should you have any questions regarding above
violations, please contact the Town Health Division and ask to speak with inspector who
performed the inspection.
PER ORDER OF-THE BOARD OF HEALTH
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Q:\Order letterMousing violations\Rental ordinance\56 pine grove,hyannis
ICitizen Web Request Page 1 of 3
4�"UK'., 1�1 4P.
•— ' y
:?a 3 I t e k'J'eo est ay, I
Request Information
Request ID: 31672 Created: 7/27/2010 11:52:20 AM
Status: Assigned To Staff Assigned To: O'Connell,Timothy
Health Office
Anonymous: No Request Category: Chapter II : Housing Substandard
Routine work: No Estimate: No
Date scheduled:
Estimated 8/10/2010 Change Estimated Jul August 2010
Completion Completion Date:
Date: Sun Mon Tue Wed Thu Fri Sat
25 26 27 28 29 30 31
1 2 3 4 5 6 7
8 9 10 11 12 13 14
15 16 17 18 19 20 21
22 23 24 25 26 27 28
29 30 31 1 2 3 4
Created By: Parvin, Lindsay Priority: Medium
1 Health Office
_ ____.___W..............................--..............--.......--......_...... ........__....__......._................._..,..............
_....
Citation Numbers:
Requestor Information
..................................__..........._......._.. _..............._...............................__.._...._.._._._._._....._...............---........-._....._,..._......_................_........_..._......_............_........._.._...... ....._......_......_................
__._ _ ...
Requestor
Request Parcel Number 3
Requestor is a friend/advocate for
Map 290
Lot
.,... Block: O(
3 the resident of 56 Pine Grove Ave.
While requestor was helping the Parce(_Lookup
tenant move out of her basement
apartment the requestor noticed
http://issgl2/intemalwrs/WRequest.aspx?ID=31672 7/28/2010
Citizen Web Request Page 2 of 3
rt1�•1
large mold spores growing on the
walls and on the underside of the
mattress.
Email:
Edit_Requestor.._Information
Track Request Progress
Request Work History: Internal Note History:
I Entered on 7/27/2010 3:23:09 PM Entered on 7/27/2010 11:52:20 AM
by O'Connell, Timothy by Parvin, Lindsay
Talked with person who complained. I have The above mentioned tenant is in the proce!
scheduled an appointment for 7 28-10. moving out. They have access to the unit until
update delete Friday 7/30/2010. Requestor is concerned that 1
owner will rent the unit again without addressin
any of the mold issues
System entry on 7/27/2010 11:52:20 AM: -
Assigned to O'Connell, Timothy
Enter work progress: Enter internal note:
(Vieli4ed by everybody) (Viewed internally only)
F
g �
Spell Gheck �<� � ' Spell Check
..... .... ........ ---_ _........
Add document or image link:
I 'Browse.
( ` You _cnl ai-so t Pe in a folder narne to see everything in the folder
Current Links:
http://issgl2/intemalwrs/WRequest.aspx?ID=31672 7/28/2010
Health Master Detail Page 1 of 1
t 4!-
. P Vg d w & Detail
"C3C Cc As, rrvd?i�3iitlr Heath
._e.;ii_-.dav Jj
Aoo ica cn Center P;Ur.rel _ookup Sc€ect;or Ite ;s
Parcel Septic ^Perw Well _ s el r€
Parcel: 290-078-€03 Location: 56 PINE GROVE AVENUE, HY Ni IS Owner: MONTEIRO, JOHN 3
Business name: Business phone:
Rental property: Deed restricted. Number of bedrooms : 7
Contaminant released: rFuel storage tank permit:
I xSaue Parcel Changes ' Return to Lookup
Parcel Info Parcel ID: 290-078-003 Developer lot:I._OT 3
Location:56 PINE GROVE AVENUE Primary frontage:30
Secondary road: Secondary frontage:
Village:HYANNIS Fire district:.HYANNIS
Sewer acct:2607 Road index: 1249
Interactive map >
Town zone of contribution:=VP (Wellhead Protection Overlay District:) State zone of contribution:SPLIT
T
Owner Info Owner: MONTEIRO, JOHN J Co-Owner:
Streets:56 PINE GROVE AVE Street2:
City:HYAN` I S State:1'JA Zip: 02601 Count
Deed date: 3%27/1998 Deed reference: 11315/156
Land Info Acres: 0.34 Use: Single Tarn MDL-01 Zoning:RB Neighborhood: 1010'
Topography:l...eve! Road:Paved
Utilities: Public Water,Gas,Septic Location:Rear- Location
ConstructionInfo 1 ::1 inq (.a. 'ku 't.: � ,r . 'J, ro:Are ,d ,i—,, Bs.thrIx
1 i 11986 2928 1404 14 Bedrooms3 Full
Buildings value: 1,45,500.00 Extra features: MOO Land value: $1 05,100.00
http://lssgl/Intranet/healthMaster/HealthMasterDetail.aspx?ID=290078003 7/28/2010
t
F0RM30 C,W HOBBSB WARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HE H
CITY/TOWN
w �I -
'' DEPARTMENT I
ADDRESS
C e�Pcr
) TELEPHO
Address Occupant_ l
Floor Apartment 0. No. of Occupants
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units No. ton
Name and address of owner
6 ..�— l4qRemarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness: --
�` Stairs: 0
Lighting: ILIVII
STRUCTURE INT. Hall,Stairway: `
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 11220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box.-
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
—Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION 941PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI U '
INSPECTOR TITLE
DATE " TIME `� P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
'iF" - -,'y ,';r:. - ._•.:.. YI kv it r 'SJ'ti .77 d - •' - w.• �- .:✓ .. k. r.z i y, r,.,.� .-
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage.or trash,which prevents egress in case of an emergency 105�CMR 410.450; 410.451 and 410.452.
(H) Failure to comply with the security.requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents,cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
,m"'r+''SYn v�'^t1l "ie+"•.:M..�+'..r.�.n^r.-.�^.:F"R riTA
4" FORM 30 C&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY/TOWN
� _ D DEPARTMENT
'per ADDRESS
TELEPHONE,
Address ._ Occupant
Floor Apartment No. No. of Occupants #
No. of Habitable Rooms ��No.Sleeping Rooms
No. dwelling or rooming units No.Stories
Name and address of owner
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs: rN p I�A F-
Li htin : , --- Y 1�_ .-�` "" /`_ '`'(t V 1 y v
STRUCTURE INT. Hall,Stairway: ,,� �; 't.•�:.,Q trS� ( ��.�`nrx -
Hall, Floor,Wall,Ceilin
Hall Lighting: ?:
Hall Windows:
HEATING Chimneys:
Central -❑ Y -O N Equip.-Repair-
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
—Pantry
Den
—Living Room
Bedroom 1 .
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n:: --
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
• ^" ° " ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL- BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750"OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES_-OFTPEftJURY.r'
INSPECTOR �+� �+ TITLE
DATE —71 1_0 TIME P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
f
P. 1
COMMUNICATION RESULT REPORT ( OCT.28.2005 2:52PM )
TTI BARNSTABLE BOARD OF HEALTH
FILE MODE OPTION ADDRESS (GROUP) RESULT PAGE
----------------------------------------------------------------------------------------------------
356 MEMORY TX ECNMC DEV OK P. 1/1
----------------------------------------------------------------------------------------------------
REASON FOR ERROR
E-1) HANG UP OR LINE FAIL E-2) BUSY
E-3) NO ANSWER E-4) NO FACSIMILE CONNECTION
Town of Barnstable Health Inspector
OMce Ho=
Regulatory Services 8:30—9:30
f ThomM.F.Geiler,Director I:00—2:00
RAIMMIM
MAN
16 Public Health Division L
° Thomas Mclean,Director
200 Main Street,Hyanrzi,s,MA 02601
Office: 508-862-4644 lax: 508-790-63
A1VMSTY PROGRAM APPLICANT— SEPTIC QUESTIONNAME
I. Cxeneral Information: Size-of Property;
Address: �Pl&!F&VK AONIr Map dtd"Parc,el
Name; / BCD Phone #: . 740, IY76
2a. How ninny bedrooms exist at your property now?
2b. Are you planning to.add any bedrooms? I y d If yes,,how many?
2c. How many bedrooms total are proposed at this property(iuciuding the amnesty unit)?
2d. Please include a copy of the floor plans for the Entire property,showing the'existing
rooms in the home plus the proposed amnesty apartment and/or addition. 'lease label .
each room clearly on the plans,
Town of Barnstable Health Inspector
oFtHe tqy Office Hours
P` o Regulatory Services 8:30-9:30
Thomas F. Geiler,Director
1:00—2:00
• aaaxsrnsr.E,
'""SS.
1639• Public Health Division I
,0�
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-63
AMNESTY PROGRAM APPLICANT— SEPTIC QUESTIONNAIRE
1. General Information: Size of Property: Osel
Address: 37 / 1'/eF ICE AWN1 Jr Ma 9(� Parcel 7 .- ��?
V#A1P D (mowName: l lv/'1�17��� Phone #: ,�s
2a. How many bedrooms exist at your property now?
(3
2b. Are you planning to add any bedrooms? A 6 If yes,how many?
2c. How man bedrooms total are proposed at this roe including the amnesty unit)?
r
y P P property 3' � ty )
2d. Please include a copy of the floor plans for the entire property - showing the existing
rooms in the home plus the proposed amnesty apartment and/or addition. Please label .
each room clearly on the plans.
3. Is the dwelling connected to public sewer? YES or NO
If the dwelling rs�onr3ected to pub°lrc sewer,slap questrnns#4 through#9=below
4. Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells?
5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER?
6. Is a disposal works construction,permit on file? . YES Lor NO
6a. If yes,how many bedrooms were approved according to this permit? ;Bedrooms.
7. Were any building permits obtained for construction of additional bedrooms? i YES nor 1V0
.8. Is there an engineered septic system plan on file at the Health Division? Z"1 YES 7,or `1V0
9. Has the septic system been inspected by a DEP certified inspector within the last two years?, YES r,or c-NO
----------------------------------------------------------------------------------------------- ------r='----�=---
FOR OFFICE USE ONLY
�ZCvO�
The Public Health Division has no objection to bedrooms at this property.
Special Conditions: �®W
Signed: Date: /0
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TOWNOF BARNSTABLE BAR-W 459
Ordinance or Regulation
WARNING NOTICE
Name of Offender/Manager �`
Address of Offender Sip My/Ma Reg.#
Village/State/Zip146LMoi-r- b�
Business Name > am m, on 197 f-
Business Address '41
Signature of Enfor ing Offiaer-1
Village/State/Zip
Location of Offense (� (,l^��ifr7lul
CJ // Efi orcing Dept/Division
Offense �U1_SiOrtCzt/t(� -�l_�- -f /
Facts L6\,
_ This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary. compliance. Subsequent violations will result in
appropriate legal action by the Town.
TOWN. OF BARNSTABLE BAR-W 459
Ordinance or Regulation
4 WARNING NOTICE
Nqqne o-f Offender/Manager �`
Address of Offender + .fY'`airf rile MV/MB Reg.#
Village/State/Zip (AA0 r'r , �Vt,� `
Business Name dam/,'pm, on 19 74
Business Address !A, le4 i �-
Signature of Enforcing Offic.err
Village/State/Zip
Location of Offense _�, ti"3!'tlu+' 2�kx��
U Enforcing Dept/Division
Offense
Facts -. Uk
This will serve only as a warning At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary. compliance. Subsequent ,violations will result in
appropriate legal action by the Town.
TOWN OF BARNSTABLE BAR-W 49
' Ordinance or Regulation '
WARNING NOTICE
Name of Offender/Manager r !L4at,E• fit
Address of Offender /�'` ; !�t` `�` ' MV/MB Reg.#
Village/State/Zip 1.trs� r 'ttt, `� ='� �
Business Name ;am/pm; on h 19 ..'
t
Business Address , -
Signature of Enforcing" Officer
Village/State/Zip
Location of Offense _ #"`f
' Enforcing Dept/Division
Offense
Facts �� 4 ' i t• i �,�,� a`.�, � s t x /
This will serve only as a warning. At this time no legal action has been taken.
It is the goal of Town agencies to achieve voluntary compliance of Town
Ordinances, Rules and Regulations. Education efforts and warning notices are
attempts to gain voluntary compliance. Subsequent violations will result in
appropriate legal action by the Town.