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0339 PITCHER'S WAY - Health
339 Pitchers Way 1 TOWN OF BARNSTABLE LOCATION �p� /r9 �� j���,/' C� EWAGE # VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. /�'/aCoh„� pr 273= vptar SEPTIC TANK CAPACITY O Q U LEACHING FACILITY:(type) 6� rl/dw/2114,l err (size) NO. OF BEDROOMS .2 PRIVATE WELL O PUBLIC WATER BUILDER OR OWNER /9G f/! Al e-6 io 1 v DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: .VARIANCE GRANTED: Yes No -�,fr4o.. /4,*0° s� Feb 261,910:56a DECLEANING 7744702907 p.2 XMK181016 SWORN STATEMENT IN PROOF OF LOSS AND SUBROGATION AGREEMENT Retaining Wall Repairs $290,000.00 12DP17030 AMOUNT OF POLICY AT TIME OF LOSS POLICY NUMBER 06/22/18-19 XMKI81015 DATE ISSUED COMPANY FILE NUMBER ` 06/22/18-19 Arthur D.Calfee Insurance DATE EXPIRES AGENT To the CERTAIN UNDERWRITERS AT LLOYDS LONDON, England. ' By the above policy you insured BARACKO,Geraldo D&Aldeide against loss by _ Open Perils to the property described in Schedule"A" 1 TIME AND ORIGIN: A Vehicle Damage loss occurred about the hour of o'clock on 1013WDI8 The cause and origin of the said loss were: v Vehicle lost control and hit the retaining wall 2 OCCUPANCY:The building described,or containing the property described,was occupied at the time of loss as follows, and for no other purpose whatever: _ Dwelling 3 TITLE AND INTEREST.At the time of the loss the interest of your insured in the property described therein was owner No other person or persons had any interest therein orencumbrance thereon,except: ` 4 CHANGES:Since the said policy was issued there has been no assignment thereof,or change of interest,use,occupancy, possession,location or exposure of the property described,except: 5 TOTAL INSURANCE The total amount of Insurance upon the property described by this policy was,at the time of the loss,$ $290,000.00 as more particularly specified in the apportionment attached under Schedule"C" besides which there was no policy or other contract of insurance,written or oral,valid or invalid. FULL REPLACEMENT COST ACTUAL CASH VALUE 6 The value of the property at the time of loss was XX XX 7 The whole loss and damage was $9,265.00 $7,875.25 8 The amount less deductible of $2,500.00 claimed under this.policy is $6,376.25 . 9 The said loss did not originate in any act,design or procurement on the part of your insured,or this affiant;nothing has been done by or with the privy or consent of your insured or this affiant,to violate the conditions of this policy,or render it void;no article are mentioned herein or in annexed schedules but such as were destroyed or damaged at the time of said loss;no property saved has in any manner been concealed,and no attempt to deceive the said company,as to the extent of said loss;has in any manner been made.Any other information that may be required will be furnished and considered a part of this proof. 10 The insured hereby assigns,transfers and sets over to the Insurer any and all claims or causes of action'of whatsoever kind and nature which the Insured now has,or may hereafter have,to recover against any person or persons as a result of said occurrence and loss above described,to the extent of payment above made;the insured agrees that the Insurer may enforce the same In such manner as shall be necessary or appropriate for the use and benefit of the Insurer,either in its own name or in the name of the Insured;that the Insured will furnish such papers,information,or evidence as shall be within the Insured's possession or control for the purposes of er*rdng such claim,demand or cause of action. The Insured covenants that no release or settlement of any such claim,demand,or cause of action has been made. 11 The furnishing of this blank or the preparation of proofs by a representative of the above insurance company is not a waiver of any of its rights. 12 THIS STATEMENT IS MADE UNDER THE PENALTY OF PERJURY. Al named insured's sign&date betm; Gerardo D Saracho Date Aldeide Baracho Date � AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION 3 S I ?Arka-t S La1f;L0 SEWAGE#, VILLAGE 11 V �11 1 aASSESSOR'S MAP&LOT ,9Sy -S INSTALLER'S NAME&PHONE NO. nz�nt IwA M sz s Ya m SEPTIC TANK CAPACITY ) __r 1664 I LEACIHNG FACILITY: (type) r?Pe s (size) /9 X r NO.OF BEDROOMS BUILDER OR OWNER a C3 �JaQQAQ PERMITDATE: 11M, COMPLIANCE DATE: AlaI Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7� - 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 L) - C a �S y C C� aa.h 7Y 'S^'S C 6 ,3.7 Ess Y/ http://issgl2/intranet/propdata/prebuilt.aspx?mappar=290008&seq=1 3/5/2012 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 by M.G.L.-it does not give you permission to operate.) You-must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law._ DATE: AV 191 JM Fill in please: APPLICANT'S YOUR NAME/S: .S i V i o -2 ' O "'0 1 BUSINESS YOUR HOME ADDRESS: 33G PiTChCG S \�vf-y I-!-y-1NNiS QQ-601 ry TELEPHONE # Home Telephone Number O 5 9 NAME OF CORPORATION: Si,L i- S, C . CL. Lvr1( u .NAME"OF NEW BUSINESS S i L K C Q ey,rj�-r INC TYPE OF BU IS THIS A HOME OCCUPATION? 4 YES NO. _ ADDRESS OF BUSINESS . G I`Chcs vvrl MAP/PARCEL NUMBER � y (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations.of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSI ER'S OF7eh E This individ a n infor. f per it requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION ,� VJZJ RULES AND REGULATIONS. FAILURE TO Au horiz Si n`,�u e. * COMPI.Y MAY RESULT IN FINES. COMM NT 6 end i . L� 2. BOARD OF HEALTH This individual has een tor,�dn.of he permit requirements that pertain to this type of business. -�A �/I MUST COMPLY WITH ALL Authorized Signature** HAZARDOUS MATERIALS REGULATIONS. COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS:" Date: i l 10� l I t'1 TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: jjL AS C(Wkuu^�(Z BUSINESS LOCATION: PI TC ZgS W/4� Y/P/u/u S 060� INVENTORY MAILING ADDRESS: 33� 21 TGr1ws L"jp e 4 V4iVry;s- x6of TOTAL AMOUNT: TELEPHONE NUMBER: SOB 615- y311 CONTACT PERSON: s,Lyi/y o q)ZLL'O /zi O EMERGENCY CONTACT TELEPHONE NUMBER: S06 81S 73// MSDS ON SITE? TYPE OF BUSINESS: C- A 2 �1� 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 removers Windshield wash r � I WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Ap i s Signature Staff's Initials l�. I TOWN OF BARNSTABLE LOCATION�33 n7 r�,�ct-. a 1,k CkkA SEWAGE # �� - VILLAGE el i7 rl a� ASSESSOR'S MAP & LOT '9 " INSTALLER'S NAME&PHONE NO, SEPTIC TANK CAPACITY 4 U LEACHING FACILITY: (type) 7"�.oP.p (size) 9 X NO.OF BEDROOMS_ BUILDER OR OWNER C v ' J c PERMiTDATE: COMPLIANCE DATE: j Separation Distance Between the: Maximum Adjusted Groundwater.Table to the Bottom of Leaching Facility 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 I within 300 feet of leaching facility) Feet Furnished by � 1 � 1 S�•� 3 C C o c Lf a►.3 CS �a• l� a Z5 13•1 a a . FROM :CAPEWIDE FAX NO. :5084283928 Mar. 09 2006 01:13PM P2 C) Town of Barnstable Regulatory Services Thomas F.Geiler,Director Public Health Division '::I$ fi; Tholll.as.M.cTiean,Director 200 Main Street,Hyannis,MA 02601 i Offices 508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: Z.- -�,.". �� SevW:ige Permit# '�" _Assessor's MaplParcet 2`0 ' /r � Designer: yMv �.� ! Installer: �"`� ''`� r; c C. Address: bax Address: R szky (O On �- o� ZaoL� _ ,,; c e�: cn r , ; ..,.._,.,was issued a pc1111it.to install a (date},, • (installer) septic system at tt-l�ts G)AZ-1' ^�i~��rased on a design drawn by (address)( -F�Coce_ -NtuarA,, dated - -- — (desig q) I certify that tho septic system referenced above was installed. substantially accorduig to the design, which n?ay include minor approved changes such as lateral relocation of the diatrihutio.n'box and/or septic tank. I ce'd-ify that the septic System referenced above was installed with major changes (i.e, greator than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)1Q1it in accordµiw,e with State & Local R,T tlations. Plan revision or certified as-built by designer to follow. �t� OF BRUCE I G. 1 MURPHY (Installer's S a.ture) No. 749 _ •. •�i/y�T pR�P (DesignQi s,S+ re) (Affix Designer's.Starnp (Iere) PI.FA,SF .RFTIJRN TO RARNSTABT.,F. PUBLIC HFAL'I'ii -1I1V1SIoN. ' C:ERTIFICATE OF COMPLIANCE )VjL a.NOT BE ISSI;ED UNTIL BOTH THIS FORM AND AS431JILT CARD ARE RECEIVED BY THE BAI2kNS'J'A13LE.1'UBL.IC HEALTH DIVISI()N. TIIANKY()If. Q,lleal.11t/SelSlic/I)0Mi}rtrr Cereificawn PA+m 3-26-04.doc .. Q s r: r iA _.� TOWN OF BARNSTABLE • I: ATION �� 9 ��-�'r"�.l S l-�1C�.t,1 SEWAGE # °&-6 ,V)��,LAGE ASSESSOR'S MAP & LOT d INSTALLER'S NAME&PHONE N0. C�,Ae t,,A �►�� 5�7 SY21 uo SEPTIC TANK CAPACITY (�r_ lJ LEACHING FACILITY: (type) (size) 19 US S NO.OF BEDROOMS BUILDER OR OWNER 0.0 PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 7� 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 a -c w v SL• Q� 0., ,� Gq rr �„ �r No., �6-0" / �� Fee d� THE COMMONWEALTH OF MA,SSAC-HUSETTS Entered in computer: " Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIppric tton for �Ngonl �bpwm Cow9truction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade(1/) Abandon( ) ❑ Complete System Individual Components Location Address or Lot No. 339 ?Iz'cker s tZ F►y Owner's Name,Address,and Tel.No. nn 14'(i4 An i S. ( es.4l/tO ,�IQ✓4G4 p Assessor's Map/Parcel ZC1 0 Installer's Name,Address,and Tel.No. 4k0ewf ao& En t"eren>r1 Designer's Name,Address and Tel.No. o-flow 743 yfpallee Gsana( Sv✓wejoes eemfftvi(fit of If P-0. ,3eiZ6�/5 4 .a2L � Type of Building: tw Dwelling No.of Bedrooms Lot Size I I/boot sq. ft. Garbage Grinder ( ) Other Type of Building S,'nII,c�_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) 33'0 gpd Design flow provided L401'}- gpd. Plan Date 12—'Li—o S Number of sheets Revision Date Title 3 31 pijjLQrs Size of Septic Tank 1500 a A I Type of S.A.S. D ii -- ea^j ` S C'o me Description of Soil Nature of Repairs or Alterations(Answer when applicable) A),Ql„) L,e.v}a, r~ e.� 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 Boar of Health. igned Date ( —uo(o Application Approved Date Application Disapproved by: Date for the following reasons Permit No. c��� �'7 '��5 Date Issued _ No., / d �t < PC*' 51, Fee Entered incomputer:TFVtEC ,MM'ONVI�EALT{H OF MASS USETTS PUBLIC HEALTH DIVISION - TOWN-Of.BARNSTALE, MASSACHUSETTS. Yes ZIpprico.tion for � gpo5al �V!5tefii Corigtrurtfon Permit Application for a Permit to Construct( .) Repair O Upgrade(1/ Abandon O ❑Complete System 1\211`n"" vidual Components Location Address or Lot No. 33 q i T c 11 e c s w Ay Owner's Name,Address,and Tel.No. Assessor's Map/parcel ZCi 0_ Installer's Name,Address,.and Tel.No. C4/;7 w,,& r h rei��. c� Designer's Name,Address and Tel.No. �c. 1303e 7&3 %E Rv l I< H1 Y4 4 1, F, J C �Xt,,S// ✓� d Type of Building: Dwelling No.of Bedrooms :3 Lot Size I��bQ0{ sq.ft. Garbage Grinder ( ) Other Type of Building S,^,Itic j,,._ Iti No.of Persons Showers( ) Cafeteria( ) Other Fixtures, -� Design Flow(min.required) 330 gpd Design flow provided L4 Cf gpd Plan Date I a-Z l-o�� Number of sheets Revision Date Title 3 35 0. f t h o v S Size of Septic Tank t S o o G,a 1 Type of S.A.S.Q, (Z..e ✓a,,,r) S r o Description of Soil Nature of Repairs or Alterations(Answer when applicable) Le t,J L e g ct, C-, e (N 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 Boar of Health. I igned, Date Application Approved Date / b, Application Disapproved by: Date - - -_ for the following reasons 1 Permit No. 0O (D O 5 7 Date Issued -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded (✓) Abandoned( )by (_AID.P, S,rl, at Q,T-(t^ r c ),A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Q;I�10' 05q dated . Installer �f0%00IJ""L k�iC�01 .,)e LC-L Designer �4-4 4e,g LA,.�r.� S�( #bedrooms Approved design flow 3 30 gpd The issuance of this permit shall not be construed as a guarantee that the syste wtI'_fi afded. " .DatInso \ e r - - - - //- - - No. 9-M t9 '0,5 Fee �DC� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS 1=fgpont i§pgtem Cou5tructtou. ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( Abandon ( ) System located at 3 3`1 p T t l„t es 14 q o I 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. Provided: Construction mu t be completed within three years of the date of this pe t. Date :q2/�L4 � � Approved b y OlYrAcl mt�;I-ev f - Town of Barnstable Regulatory Services Thomas F. Geiler,Director 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: Sewage Permit# 2 -vSH Assessor's Map\Parcel"q0"9- Designer: � q"o-e- Installer: ,r6 Address: Yo AcI Ad Address: V Q- 130, - (0 3 U z3 L On ��t�'Z�� a�tB was issued a permit to install a (date) �(installer) septic system at 3-35 9. fiC, "s WtA.77 14 4* 6j based on a design drawn by (address) �*nkgy. dated / (designer) 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. nstaller's i ature) (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLI•ANCE WELL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNST.ABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/SeptioDesigner Certification Form 3-26-04.doe LOCATION.- 339 PITCHERS WAY SEWAGE#.• 2006054 ASSESSORS MAP & LOT 290-8 INSTALLER- CAPEWIDE ENT. PERMIT DA TF- 02-14-06 COMPLIANCE DA TE 02-22-06 SEPTIC / 53. 5' � r TANK 2.8 . ALL �\ 2 6� D$p of wA T� 29' < /PUMP CHAMBER FLOOD ZONE "C"_ SEPTIC CERTIFICA TION REs zoNE. "RB- TO WN.•HYANNIS SCALE-1"=20' PL.REF-22825P ELEV SEE ABOVE I CERTIFY THAT THE ABOVE - YANKEE SURVEY CONSULTANTS SEPTIC SYSTEM IS L0CA TED `� ^ , �r � P. 0. BOX 265 ON THE GRO UND AS SHO WN, BRUCE �.> UNIT 1, 40 INDUSTRY ROAD U• AND IS INSTALLED IN = yam` er� 1t-e �' SUBST IAL COMPLI NCE . MARSTONS MILLS, MA. 02648 p�°•749 TEL• 428-0055 WI DESIGN P AN FAX 420-5553 �•^"• *Ts "`'�-`-�;�r .v- � JOB BR' E G. M HY, R.S. DATE. oz=zz=zoos NUMBER_SEP_ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, V FL., 367. Main Street,Hyannis, MA 02601 (Town Hall) DATEc:3 0 Fill in please: APPLICANT'S YOUR NAME: SC `\0 BUSINESS YOUR HOME ADDRESS: 3°\ TELEPHONE # Home elephone Number O a NAME OF NEW BUSINESS ..5 V p►�.6�,r G p TYPE OF BUSINESS c aY1 r IS THIS A HOME OCCUPATIO N? _YES ; _NO Have you been given approval fro h building.:division? :YES No ADDRESS OF BUSINESS'� A1�WiSS aFsp MAP/PARCEL NUMBER_® When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -_[corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO NER'S OFFI E 1 This indivi ual.h s en i e any permit requirements that pertain to this type of business. A hor' ed Si ' ature** r COMMENT d� f L � 2. BOARD OF HEALTH This individual ha info f t ermi irements that pertain to this type of business. Aut orized 'gnature** , COMMENTS: /YL-0 , 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature**. COMMENTS: 0� c YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street,Hyannis, MA 02601 (Town Hall) DATE& o C OR Fill in please: APPLICANT'S YOUR NAME: 5C`s(- �\ 0 So��-,�Q S BUSINESS YOUR HOME ADDRESS: 30\ G IC S k9 1 TELEPHONE # Home elephone Number 'sL1 wU 3 a NAME OF NEW BUSINESS 6V5 CO vl.s -c ZE7� pv-, TYPE OF BUSINESS. c s©y)'O IS THIS A HOME OCCUPATION?_YES ;XNO a,C�, vJ Have you been given approval fro _ h building.division? YES, NO ADORESS OF BUSINESS'� 1 6o M P/PARCEL NUMBER 1� When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -_(corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO M NER'S OFFI E This indivi ual h s en�iVe any permit requirements that pertain to this type of business. A or' ed Si ature** COMMENT ' I spa7/ } i 2. BOARD OF HEALTH This individual ha info�iVf t ermi irements that pertain to this type of business. Authorized gnature* COMMENTS: /YL4 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature**. COMMENTS: � � ( a y ��..,..w.r�."" ��� h� ��'�� ��� 4 Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: —5 V COS Ay- h BUSINESS LOCATION: 330� R0Ae C5 �A�( 4\j 0o1 n\S Ong V-'U01INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: -�O3a-LAa 0-f 508 9 22 E l "Ck CONTACT PERSON: EMERGENCY CONTACT TELE HONE NUX�ER: 5®� E) MSDS ON SITE? 1 TYPE OF BUSINESS: ��S't `� C gsSo tie r INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS Md c' The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) ___ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils fo Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda kustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar 10 PCB's Paints, varnishes, stains, dyes 0 Other chlorinated hydrocarbons, Lacquer thinners n (inc. carbon tetrachloride) NEW USED (� Any other products with "poison" labels Paint &varnish removers, deg:lossers (including chloroform, formaldehyde, Misc. Flammables _'1 hydrochloric acid, other acids) PD Floor&furniture strippers Other products not listed which you feel v Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers U (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS -. ` *.� T,r.,. 4a: - .. "L ~Sm's+:•t•;-w,4.-v6..+�_+.i!'^ i ....-+L,. M �'' ^a2 Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY '. NAME OF BUSINESS: 5 V 5' �'� +Y'`'�C� O h BUSINESS LOCATION: cue r S � �U���S INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: Y � ' ' S EMERGENCY CONTACTgTELEP{HONE NU VDER �D2a cY) MSDS ON SITIE? TYPE OF BUSINESS: Co n S � `�� C '� M�sO n e r 5-l-eXA INFORMATION/RECOMMENDATIONS: Fire District: • `�;;; ?...'�� ' ter- r r Waste Transportation:' a, Last shipment of hazardous waste: A rLL Name of Hauler: w. _� `4- Destination: Waste Product: v (`y Licensed? Yes No NOTE: Under the provisions of Ch. 111 Section 31, of the General Laws of MA, hazardous materials use, I'f storage and disposal of 111 gallons or more a month requires a li ense 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 fbe-registered regardless of volume. Observed/Maximum Observed/Maximum (� Antifreeze (for,gasoline or cool`arit systems) Misc. Corrosive NEW USED F`` Cesspool cleaners YI V Automatic transmission fluid M Disinfectants Engine and radiator flushes Road Salts (Halite) p Hydraulic fluid (including brake fluid) Refrigerants Motor Oils c '.` 77— Pesticides NEW USED P (insecticides, herbicides, rodenticides) V Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) O 4.. 3 Diesel Fuel, kerosene, #2 heating oil 0 NEW USED Misc. petroleum products: grease, Photochemicals (Developer) 5 (� lubricants, gear oil b NEW USED Degreasers for engines and metal` Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout 'Swimming pool chlorine - 0 Battery acid (electrolyte)/B tteries Lye or caustic soda Rustproofers i Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes 0 Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW. USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, U Misc. Flammables hydrochloric acid, other acids) U Floor & furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): U Laundry soil & stain removers -"-)p (including bleach) _ Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS F a �)�. T ��� � ��. � , �� �� �� _ _ � � � �- 02 � � LoC � � �� ���� =_�t' 4 TO ALL NEW BUSINESS OWNERS DATE: i Fill in please: � � J S��5 YOUR NAME: ��'� APPLICANT'S �; ,,;y v � . �r�� „ BUSINESS c YOuR HOME ADDRESS: z5 V�As-h i ` M TELEPHONE ` ' Telephone Number Home NAME OF NEW BUSINESS y N51-2vc-nv►q TYPE OF BUSINESS wSr2vcra +J IS THIS A HOME OCCUPATION? YES LjjNO Have you been given approval from the building division? YE NO ADDRESS.OF BUSINESS.25 Wg51,h Q<-4*P 5T # C- MA- QZ.601 MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below,you may apply for a business certificate at the Town Clerk's Office (1st floor-Town Hall). You MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEN H This individual ha e n inf rm d of the p r it requirements that pertain to this type of business. A 4-z--d Signature**COMMENTS: CL--��.- . s�.c�— G-t�_ .�►Oac.�►.��oci-o �rs�1Rud�-� 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUS/NESS CERT/F/CATEONL Y. i i 317/a 14- i alDate: l/ 4' TOXIC AND HAZARDOUS MATERIALS EGISTRATION FORM NAMEOFBUSINESS: SV S cov S5 VN c-yloyt BUSINESS LOCATION: 33c�)( ACV),fv5 UJA9 AVghh.c5 M9 Ca6o� 'SIP MAILINGADDRESS: Mail To: TELEPHONE NUMBER: Board of Health at � Town of Barnstable CONTACT PERSON: ed5o - 5 5on:FO5 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: V4 JA 353 Ti fJ'J Hyannis, MA 02601 TYPEOFBUSINESS: kr\Vnd 5 C,Q i0-e- Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES _ NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(forgasoline orcoolant systems) (0 Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants 0 Motor oils Pesticides 0 NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) 0 Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine _ 0 Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes 0 Asphalt & roofing tar Fertilizers — 0 Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, O NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners Floor & furniture strippers (including chloroform, formaldehyde, Metal polishes hydrochloric acid, other acids) Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): V Spot removers & cleaning fluids a G — (dry cleaners) Other cleaning solvents (� Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE L,LATt''iN . �i SEWAGE # 91- Y .. rit,LAGE &// i'l 15 ASSESSOR'S MAP&LOT ih1S' ALLER'S NAME&PHONE NO. kQCOP46 of Solt 1 -n C SEPTIC TANK CAPACITY LEACHINO FACEL=: (ty ), F'fo•c�rr 1Cv5S err (size) NO.OF BEDROOMS BUILDER"OR OWNER PERMITDATE: i COMPLIANCE DATE: qr — 1,3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by . s \� r i A y 1 y No. � = f' Fee$ 40.00 THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYfcation for 30fgpooal *potem Con6tructfon 3permit Application is hereby made for a Permit to Construct( )or Repair�X�an On-site Sewage Disposal System at: Location Address or Lot No. 339 Pitchers. Way Owner's Name,Address and Tel.No. 477-9644 I bran s 'ads s. Marjorie Jordan sessor s ap arce 31 Simons Road Mashpee,Mass. Installer's Name,Address,and Tel.No. 5 — — Designer's Name,Address and Tel.No. 5 0 8—77 5 3338 J.P.Macomber & Son Inc. J.P.Macomber & Son Inc. Box 66 Centerville,Mass. 02632 Box 66 Centerville,Mass . 02632 Type of Buildmi Dwelling)CXXNo.of Bedrooms 3 Garbage Grinder(NO) Other Type of Building RES No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Loamy sand to medium sand Nature of Repairs or Alterations(Answer when applicable) Add an additional 3-33 0 r e c h age r S t o an existing tank pump chamber box and three flow Piff ,ss0rs. 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 E vironmental Code nd not to place the system in operation until a Certifi- cate of Compliance has been iss d by thi ar H th. Signed e ` Date /9/9 0 Application Approved by L Date Y /U —9 4- Application Disapproved for the following reasons Permit No. 9+6 -'�/7 f Date Issued 'l6 40.00 s THE COMMONWEALTH OFrMASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01ppYication for Migpogal *p5tem Congtruction Permit Application is hereby made for a Permit to Construct . or Re air an On-site Sewage Disposal S sem at: !k Location Address or Lot No. 339 Pitehera Way Owner's Name,Address and Tel.No. 477-9 44 U�`annis jags. Marjorie .Jordan Assessor's MapfParcel 31 Simons Road Mashpee,Mass. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0 8—77 5 3338 J.P.Macomber & Son Inc. J.P.Macomber & -Son Inc. Box 66 Centerville,Mass. 02632 ; i Box 66 Centervil:l:e,Mass . 02632 , ' I Type of Buildin DwellingXXXNo.of Bedrooms 3 Garbage Grinder PO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title f Description of Soil Loamy sand to medium sand Nature of Repairs or Alterations(Answer when applicable) Add an additioria.l 3— 3 rPehno nrn ttp an existing t9nk -pump cha.mb6f'YWo� and three flow Difflltssors. v 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 Environmental Code nd not to place the system in operation until a Certifi- cate of Compliance has been issu d by thi bard th. Signed /'� ` Date 9/9/9 6 T Application Approved by <<GG Date 9 4 Application Disapproved for the following reasons t* Permit No. 9 _`�'�i ` Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced'(�Mh on- by J.P.Maeomber & Son Inc. Installer at 339 Pitchers Way H,yannis,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.l6 dated P— 1 y - 9G Date Inspector THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. —————————————————————— ———— — 9&_ —------—— Fee $ 40.00 No. yy THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS i 30igogaf OpMem Construction Permit Permission is hereby granted to J.P.Macomber & Son Inc. to construct( )repair 3(1 X-an On-site Sewage System located at No.# 339 Pit ehAr s Way Hyannis,Mass. Street and as described in the above Application for Disposal System Construction Permit. No. Date Ali The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within three years of the date below. Date: 9 _ q Approved by Board of Health �d OO � t CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, Joseph P.Macomber Jr. , hereby certify that the application for disposal works construction permit signed by me dated 9/9/46 , concerning the property located at ers Way,u apais ,Xa ss meets all of the following criteria: • There are no Nvetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is A feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNE ' DATE: 9/9/A.9h LICE SE EPTIC SYSTEM INSTALLER IN THE TO`VN OF BARNSTABLE NUMBER (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. Proposed 3-330 Existing Rechargers Packed in 3 a minium of 2. 51, Flowdiff- of 12" stone with a ussors 211 cap of 3/811 stone. Existing Box Existing 1000 gallo Existing pump Septic tank. Chamber TOWN OF BARNSTABLE LOCATION "SEWAGE # d i 1V-A LAC ASSESSOR'S MAP & LOT " INS T ALLER'S NAME&PHONE NO. KIA4C Oft'b el- ®M I;"e SEPTIC TANK CAPACITY LEACHING FACILITY: (ty ),� F'1r��c�l�o--tci�,srPr"S (size) NO.OF BEDROOMS ., BUILDER OR OWNER PERMITDATE:_L' COMPLIANCE DATE: Separation Distance Between the: � Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by T -? �`l rf - W Z -_�48 659 941 Receipt for Certified Mail © No Insurance Coverage Provided UMnD STATES Do not use for International Mail v STRL SERVICE (See Reverse) � s , (b t Street and o. 2 al P at and ZIP Cdod C � Postage Z M Certified Fee , C Special Delivery Fee fZ. IRes"tiictl`e'd�D�liC�r��e� �� 1 Wet Tu rrn'OVVii�I'SF'awing`t 1 to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage $ �U&Fees Postmark or Date I I' STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, 'CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return Cl) address of the article,date,detach and retain the receipt,and mail the article. rn 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, endorse RESTRICTED DELIVERY on the front of the article. 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Saxe this receipt and pi�sgn,it-if you make inquiry. 105603-93-B-0218 a,_ r r ?» 3416 659939 Receipt for Certified Mail o No Insurance Coverage Provided E Do not use for International Mail (See Reverse ch o� rn ,= t and l0 � P.7 State and ode O O rost5ge co C7 E Certified Fee LL Special Delivery Fee V) ra r F9estriicted(DeliveryFFee 'A a to rn Mecerpt<Showing to Whom&Date Delivered 44 Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees �� Postmark or Date ` _ / STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). a 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return t'') rn address of the`article,date,detach and retain the receipt,and mail the article. rr 3. If you want a return receipt,write the certified mail number and your name and address on a 2 return receipt card,Form 3811,and attach it to the front of the article by means of the gummed 07 ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT 2 REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, V)` endorse RESTRICTED DELIVERY on the front of the article. e9 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. a 6. Save this tceipt and present it if you make inquiry. 105603-93-13-0218 1 Y !� •� ` 1 The Town of Barnstable 0 � { s,m,T,n i Department of Health, Safety and Environmental Services i639 ,639 Public Health Division sooe� `� 'EO MAY k• 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health November 20, 1996 Marjorie Jordan P.O. Box 343 West Barnstable, MA 02668 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 339 Pitchers Way, Hyannis was inspected on November 19, 1996 by Jerome Dunning, 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 U were observed: 410.500: Broken window observed in the front room. 410.500: The wall in the kitchen contained a hole over the stove. 410.500: The tile over the countertop next to the stove was missing and the counter was not anchored. 410.500: The wall in the kitchen contained holes and sheetrock is t exposed. 410.500: No covers provided on the baseboard heater in the kitchen. 410.500: The master bedroom and bathroom floors were not smooth, impervious surfaces. 410.500: There were also loose tiles on the floor next to the bathtub. I ,ti You are directed to correct the 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 2- Thomas A. McKean Director of Public Health cc: Cheri Carpenter FoRMso Hoses&WARREN,INC.NOV.1979-IM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN W R ; DE ART NT WaA A P* ADDRESS w TELEPHONE—Tr Address Occupant _ Floor T Apartment No: No.of Occupants �Y1 �✓ "�-4� No.of Habitable Rooms No.Sleeping Roomsl - No.dwelling or rooming units - No.Stories f4 " k► ,6 26 Name.and address of owner AA&fre ) t Remarks Reg. Vlo. 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: 444 Chimney: ' BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting. L STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels,Meters,Cir.: ❑ 110 ❑220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls eils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den LMna 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 TITLE A.M. DATE 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 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`perso'h 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 01R 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and{t410.202. (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. (G) 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 41I1.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.6.02 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. ( ) 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. •' -c V O.. a y •�.y 4..✓-' �.:�" '.a+�.W,r-...t �...�.y .=y, a.,x. ..y V..i 4}a.: -: .FORM90 Wseis&WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACNU$ETTS BOARD OF HEALTH CITY/TOWN u W a DEPARTMENT—� ADDRESS TELEPHONE Address Occupant _ Floor Apartment No: No.of Occupants I No.of Habitable Rooms No.Sleeping Rooms 21 PIP— No. -- (�I ,,1�p" �V,VI,I ( No.dwelling or rooming units No.Stories m Ma. b IJ Qc Name and address of owner_0-vu^ Remarks Reg. Vim 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: L14;,,,41114 141.44 " Roof Gutters, Drains: Walls: 1AJ 40 JAA, 114,04bu A Foundation: A Chimne : ' BASEMENT Gen.Sanitation: Dampness: 0, 1 Stairs: C.401j -4% .4,Y-L IZ_4�� YAZ-11� Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Li htin : Hall Windows: HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks,Flues,Vents: PLUMBING: Supply Line: ❑MS ❑ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s)„ ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑220 Fusing,Grnd.: ,,�►, AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen L° Bathroom Pantry Den Livina 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: ress 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 TITLE A.M. DATE TIME P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. r f 1 410.750: 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 01R 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 41o.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. W 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. - ..a..� - •,i,, -�L ��„_ �. . ..tom.-ti 1.. �""w..C�..'�» �:�.-.'^.=C. .,�`f"v_._ �•-.i,.�a �} ..,......., .�',��2'.,_:.i�a:a:,,-s.a, rrY:a£�:� _ uw,_._ ,.:y'y.-.. .FORM 30 HOBBSB WARREN,INC.NOV.1979-1M THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I v W CITY/TOWN M W4 A DEPARTMENT" 3y 3 o }- ( ADDRESS / _ 71 L7(`l t!s ![/' rt' -t&,Q.—JA ,FIB TELEPHONE Address Occupant _ Floor Apartment No: - No.of Occupants M 0,r� No.of Habitable Rooms No.Sleeping Rooms �j l ! , No.dwelling or rooming units No.Stories b CA e,,` J�ty� /•� Name and address of owner ©...10.•� �"'""�' f Remarks Reg. Via. 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: W API r.;A- 1"At,4 Wlo(o 1&_&,r Foundation: A Chimne : _ v BASEMENT Gen.Sanitation: Dampness: .���,�..� -. ...� Al A-A. V......-+,0) Stairs: „n. �`.tYtse,lo ram,, �r�,,a,,,(,c,cUr^ Y't<.fr -t,• Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: r ,, Hall,Floor,Wall,Ceiling: Hall Lighting: 4—0, r,r,r,e Hall Windows: v �✓ HEATING Chimneys: Central ❑Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s)_ ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑220 Fusing,Grnd.: 4n. AMP: Gen.Cond. Distrib. Box: ,.;.►.r� / 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 L Y Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH r MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL—BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE s AUTHORIZED INSPECTOR.(See Over) ' "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR TITLE A.M. DATE 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 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 C_MR 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. (G). Failure to provide adequate exits, or the obstruction of any exit, passageway orcommon 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. 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. F� Mr./Mrs. M P: . pox 0LZ) NOTICE TO ABATE VIOLATIONS OF 105 CMR 410,00, STATE SANIT-ARX CODE lI )`MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND TILE TOWN OF BARNS'TABLE RENTAL ORDINANCE ARTICLE 51 The property owned by you located at 6323,q f,i~2Kr W`�- was inspected on 1994 by?g""- b,,vM•`v % Health Agent for the Town of Barnstable because of a compl,jint. i he following violations of the Town of Darnstable Rental Ordinance Article 51 and the Sanitary Code II were observed: L110, D W i You are directed to correct tlle violation of within 24 hours of receipt of this notice by Yon 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 I lealtli within seven (7) days atler the dale order is received. Itowever, these violations must be corrected regardless of any request for a hearing. i,lease 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 a e violations !inclosed are citation numbers due observed on PER ORDER of THE BOARD UE HEALTH Thomas A. McKean Director of Public Health Town of Barnstable TOWN OF BARNSTABLE BAR-W 1751 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager j t° �.� -- Address of Offender , tju-f" viePA4 MV/MB Reg.# Village/State/Zip Business Name am/pm; on 19= Business .Address Snature of . Enforcing Officer Village/State/Zip Location of Offense. Enforcing Dept/Division � 10 , 60 Offense Facts 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. ...a.. . 'ez....._... .... t..:,:. ,.,_:;..-:.. t_t.•.� f .._;«..•: ,..:e.:.-� s r,v,..,..-., ._.es.r ,a.._,.._. ..x,. .x rt.,.. . . ..... t« ,_•. .. ... .. i. . „�. _ z.._..;+., R TOWN OF BARNSTABLE BAR-W 1751 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager ( ' �D AArt-f-' Address of Offender �� %' � � 1hj , MV/MB Reg.# Village/State/Zip I&A ,r, ( Business Name am/pm, on 19_ Business Address —S mature �of Enforcing90fficer Village/State/Zip Location of Offense Enforcing Dept/Division 'Offense Al auO� Facts `..This will serve 'only ..as a.malrning. '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 '.comp,l:iance Subsequ.ent; violat'ions :.will result in appropriate' legal .action by the. Town` k,.t_-F ..,._ ...,-..- -..._. ,..o. _...t.. -6._a, .o.e. �... :x.✓r.2.s+., ,..:.�.... :+ih�t�,to TOWN OF BARNSTABLE BAR-W �l Ordinance or Regulation ,.- WARNING NOTICE Name of Offender/Manager Address of Offender `A: w 1'z.e... 1AI,, MV/MB Reg.# Village/State/Zip ,r�,anir.� , A >, ,f Business Name lfi am/pm; on 19_ Business Address ` Signature of Enforcing'10fficer ,-:Village/State/Zip Location of Offense ,# `Y41 r Enforcing Dept/Division Offenses ,T, F.acts hra 3' F. ►�/ �a. �� ,� T t ,. .$ ,, . `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. _ .: •__ ...: _ .. ..J ... _, w ..."..,.. ....., fij..,ti.,... :r..w...,_ 4.3t«!. .......exen� m:'« _ ,u ..,. .. ....., ...E.. .... t _. :h. . ._ SENDER: I also wish to receive the t7 ■Complete items 1 and/or 2 for additional services. rn ■Complete items 3,4a,and 4b. following services(for an d ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. Qi ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. d ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2, ❑ Restricted Delivery rn r ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. 0 3.Articl@ Addressed to: 4a.Article Number E 4b.Service Type d n 3� p �✓�0 ❑ Registered Certified °C Im W ❑ Express Mail ❑ Insured F cN1 of Return Receipt for Merchandise ❑ COD H a NQY 7r,� ate of D ivy T Z Ga Y s D 5.Received By:(Print Name) L,I 8! d ressee's Address(Only if requested W 196E and fee is paid) t 6.Si ure Addressee orA c gn ( 9 ' ) ( S P X l N � PS Form 11811, December 1094 Domestic Return Receipt 1 A UNITED STATES POSTAL SERVICE First-Class MailPostage&Fees Paid USPS I I Permit No.G-10 I � • Print your name, address, and ZIP Code in this box• I I I I I i Realm Dep$ftma � I Imr Of Bamstable I D BOX 534 Massachuftfft 02 I I Il I i Z 5.1-18 659 940 ` Receipt for Certified Mail No Insurance Coverage Provided Me Do not use for International Mail PMAL SERVILE ( ee Reverse) G0 Sant t _... . tnd to 000, tate and ZIP Code 40 CIOPosta M ,C Certified Fee 0 o , 1 Special Delivery Fee fis`t7icte5 D'e`IiCefy f°e� - I jR'etu�ri'A'e'c�i�ltSlio'?iSiiS� l to Whom&Date Delivered ) Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage t� &Fees J Postmark or Date I STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address Lo leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). CC 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return rn address of the article,date,detach and retain the receipt,and mail the article. rn L 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item i of Form 3811. d 6. Save this receipt and `present it if'you make irNuiry. 7 105603-93-B-0216 �PofT"`T��o The Town of Barnstable t.DABd7TAffi� • P s Department of Health, Safety and Environmental Services ML i 039 Public Health Division i639 �� 367 Main Street,Hyannis,MA 02601 Office 508-790-6265 Thomas A.McKean FAX 508-775-3344 Director of Public Health November 22, 1996 r, Ms. Marjorie Jordan P.O. Box 343 W. Barnstable, MA Dear Ms. Jordan: Health Inspector Jerome Dunning observed several bags of refuse on the ground behind the dwelling adjacent to garbage containers on Tuesday November 19, 1996 at approximately 3:00 p.m. Mr. Dunning then called the tenant, Cheri Carpenter, later that afternoon at home, however, the tenant was not home. The tenant's boyfriend answered the phone and stated he would clean it up immediately. You called Jerome Dunning on November 20, and said it was cleaned up. Then you, called November 22, 1996, and stated the garbage is under a tarp in a pick-up truck. On November 22, 1996, one bag of garbage was observed by Mr. Dunning on the ground and appeared to be torn by an animal. There was no one home at the tenant's home this afternoon. A written warning notice will be mailed to the tenant today. A reinspection is scheduled to be held on Monday November 25, 1996 and.a non-criminal ticket citation will be issued at that time if neccessary. Sincerely yours, t omas A. McKean Director of Public Health cc: Tenant, Cheri Carpenter ; SENDER: O oComplete items 1 and/or 2 for additional services. I also Wish to receive the y °Complete items 3,4a,,and 4b. following services(for an H u Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai > °Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. d u Write°Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery fA r °The Return Receipt will show to whom the article was delivered and the date ., c delivered. ^, Consult postmaster for fee. 0. d 3.Article Addressed to: �, 'i, 4a.Article Number a0i Z m c E J 4b.Service Type 0 0 > ❑ Registered Certified Cn ❑ Express Mail ❑ InsuredLU y I o ❑.Return Receipt for Merchandise ❑ COD c / 7.Date of Delivery 0 ' ila(� p 5.Received By: (Print Name) 8.Addressee's Address(Only if requested LU ��J and fee is paid) t ¢ F 6.Signature: (Addressee or Agent) PS Form 3811, December 1994 Domestic Return Receipt O -r9t-Class Mail---"" UNITED STATES POSTAL SERVICE C) P�/) c�., ________ stage-&-Fees-PaTrd ,, '` -Mrmit-No.G-10--'-` • Print your name IgAess, and ZIP Code in this box • 8e81th Departmed lbWR of Bamstabte Pr, Box 534 HYaMms Massachusetts 026M 9 TOWN OF BARNSTABLE, ` - xi LOCATION i;�� WAY SEWAGE # 7, 3 7 TVILLAGE / �! a�e�ll�/! S ASSESSOR'S MAP & LOT 94- t9O INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY l''��0 LEACHING FACILITY:(type) - �'dGy S (size) i NO. OF BEDROOMS ._7 PRIVATE WELL OR PUBLIC WATER !!G�- BUILDER OR OWNER DATE PERMIT ISSUED: DATE .COLIPLIANCE ISSUED: VARIANCE GRANTED: Yes Now/' lH�r 4 y { t � I ` ` � v. ` s � �e, � \ � Os -- �,�®� � _ � \ � _ � i . . � " � � � i � � w., ! / ��/ i . i -�. ., ._ � - �'. . �. j. � f J:P:MACO , R & SON INC. 66 C-ENTERYjh E;MA:0=2632 `776 93�5 � � * - r �� � ... � O .� . •:' g G ,• � V i?� : .` ;; �` s � t� . . � � � .�.�, . . • �I� ,o \ � I� ` \ \ ,�f�� � � � �\ ----, l � A i l � // �,�� �i/ ��� i i � , y i20 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..----/oral....---.....OF... d .:HArnstable AvAration for Dhiposal Workii Tonstrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair O an Individual Sewage Disposal System at: • .Mrs._.J � ...LR.:.Xa q r------------------------------------------ ................................................................................................. Location-Address or Lot No. .....3.39...P.1 char.6...Wad'.. ------------------------ ...................................................... Owner Address . .......................................................... •---•••--------••---.......-•--•--------•••-•--------•-----•-•---------------•----------------•-- Installer Address UType of Building Size Lot............................Sq. feet Dwelling l,.No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures --------------------------•----- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ I pth........_....... Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area...... ..............sq. ft. Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area_..e.............sq. ft. Z Other Distribution box ( ) Dosing tank ( ) . Percolation Test Results Performed by--------7.................................................................. 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:........._............. W .............................................-.............................................................................................................. 0 Description of Soil......S."ci...&:_GI`w al----•-•-••-----•------------------••••••-•--•••••----•---•••-••-------•-----•----•••------------. V •••••••-•------•--....••-•••••••-••••••-•-••-----••-•--••-•-•••••••••....••-•-•••-•---------•-••--••.............................••. W . V Nature of Repairs or Alterations—Answer when ................................................ -......----•------•------•••----•••••-•••••••••-••••--------------•--------•----•--••-•••--•••-•-•--•---••-•----------------------------•-----••-••-•---•••---•-...........:---------------------..---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'T'i p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in h operation until a Certificate of Compliance has bee issued y e d of healt Signe ••-• • • • ..... ...................... ..... /111�7...... Date Application Approved By.............. ------•-------------------- Date Application Disapproved for the following reasons:--••----•---••••••••-•-•••-•••••-•-----••------•-•-•-----•----••---•--------•--••••--••••....................._ ---------------------------------------------------•-----•----------------------......--------......-----•------••----•••••••••-••••----•-••----•••••-•••-•...••--••••-•••••--•••....•-------••••-•••--. Date PermitNo----9.7.--2--76......-----•-••••-....... Issued_....................................................... Date � a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................. .........................OF...... .. ........................... .1'.� Appliratiun for Uhipmal Works Tunitrnrtiun Vautit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: av ......... - ....... -: x ---------No. .......---------------•-•--•-------. --- 4.?* Loaifio)VAddress orLot....... .. .... ..`. ....................... ..........--........................................................................ Address W ;. Installer Address Type &'Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) . Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons........_................... Showers ( ) — Cafeteria ( ) Otherfixtures ------------------•--•-----••--•---------------•----•-•---•-------•--••-----------------..._...---•------------------------...................---••••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length...............• Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area_______----_------sq. ft. 3 Seepage Pit No..................... Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-------------------____. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•-•---•--••--------------•---•---••-•--•-••----••---------•-•--..--------------....------•-------...--•------•---••-•-----•-----•-......-•--------......-•-- 0 Description of Soil....................... W UNature of Repairs or Alterations—Answer when applicable-.__..-____..................................................................................... ......................................................... .f f... A .....e.... :+.... .... Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of'TILEw 5 or the State Sanitary Code—The undersigned further agrees not to place the system in operation until a.Certificate of Compliance has been issued�by jhe board of heal. .... Application Approved By----------- --------------` _. .....----_---.-- - .- •. .............................. Date Application Disapproved for the following reasons:.............................................................................................................. -•--------------•---.........--•-•--•----...-•----•----------•----•---•----•--------------•-------------.-•-----------•-----•-•-------•-•----••-•-•---•----••••-••--•---•------•----....._•---•••------- Date PermitNo.. :. ...�G-----------------------•-.. Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................... �prtif irtttri�la�I f�uiYt�li�nr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( " ) or Repaired (• } by-------•-s----•---•---•--------------•---•----•--•--•-----------------•-------------------------- `,se.I::;1-1. .1.i}L L� Installer at s a S.�,,ii---------- --m�T-. has beeir r$stailed irk X�cordanC wit' thL.e provisions of T Rio The State Sanitary Code as described in the application for Disposal Works Construction Permit No............................ dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE......................... '� 3` �.. 5 7.-----• Inspector.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7-37G ...........................................OF...........----........_. l...... .l.......••••-••••••--•••...••--•............... ..................... JV..t I i , ; FEE...... �t �U• l�v DwVnsal Iforkii Tunutrttrtiun rrutit Permission is hereby granted............ ------------ --•----..---.------.-..----------•--.-------•-•------.._.-----------------.................- ---•-••---- to Construct ( ) or Repair (t ) an•Intliv�d`ual""e,age Disposal System atNo................................................. ----- -- ------- -•- r i t C h f_ r C. •'7 j ..,� -: L c Street 8,376 as shown on the application for Disposal Works Construction P rmit No_______ ___________ Dated_._.__....._.__.__.__....._.._....__._.... ......... = -_-.�....0 . . . .................................... of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS fIYDRANT LOC[IS o ,. NOTE BENCH MARK SOUTH ,EAST CORNER � DA � OF THE FRO UNT STOOP EL=28. 7' tiY° FE y� } TOP OF WA TER EL- 21. 5' TOp OF HANK 21.5 BAN 24.3 OF HANK 0lA OF TOP 21.3 80 231� ROAD AD _ -- EDGE OFF �0 z4.e � 22.5 E UPo HYANNIS LOW POINTX� DA �� v 22.7 ,a �E OF _ R= ?. `�—� \ LOCUS MAP FE1 " E EDG _ vp X Q � 00- t d PLAN REF` 22825 P 232 6017 o f \ ASSESSOR'S MAP- 290-8 X WA 71.4 w ��� ZONING.• "RB" TER Q CATS • C� \O DEED REP161311 FLOOD ZONE "C" Av,� �4l ,96 PANEL NUMBER- 250001 0008 D `� N 24 9 \ p DATED- 07-02-92 DIRT yy ,n 26 a v Q d SITE PLAN OF LAND DRIVE Dot; EL 27 LI \ \ LOCATED AT.• NEw 339 PITCHERS WA Y o T ,.••.,, HYANNIS, MA. . , S-E ", Cy 29 1 BENCH MARK 5 5 yI E o ' `S PHI, `�� ; PREPARED FOR. ,24 ; p YLE . ► GERALDO BARA CHO 2 4 26 20• t �cn, _ o s 3 w; DECEMBER 27 2005 w ASSESSORS ti� \ �` SCALE- 1"=20' MAP 290-8 V.• \ RE ASSESSORS p LOT 100 f7/ w k �'° 10 8 \ REV MAP 290-7 w o� 27 2 C, �.. 1 LOT 101 o HED ��� E X REV of � \� YANKE'E LAND SURVEYORS EXISTING SRUCE �l� & CONSULTANTS SEPTIC TANK ;` EXJSTINGgER pG�p cN 127 79 �(1> 26 ( RG. MURPtiY i�. P.O. BOX 265 90 THE XIST i �� - No. 749 j UNIT 1, 40 INDUSTRY ROAD E INC SEPTIC SYSTEM A 02648 ' Q E ASSESSORS �f- �o � MARSTONS MILLS, M �,�, �D p g S A N76.52 3 MAP 290-113 t�IM9 TM 508-428-0055 FAX 508-420-5553 b SEPTIC INSTALLERS CARD LOT 42 _ a SHEET Al OF 2 JOB A 5397.1 JF a EL. 7OP OF IVUNDA77ON 1 20' MIN. F-- 10' MIN. ALL COMUTE COVERY PLAYER OF S CONCRETE PROFILE OF t z-P'�°'�L � ��R A,PnVg/V PER f. N'ASH6 S9171VE i " S1CH 80 PW EL=29.25' SEWAGE DISPOSAL SYSTEM " ' ' " " " " ' ' ' ' ' s' cAsr t�nN PIPE EL.=9_3.75 "� /[OR wU mRvlmUM t7p CLEAN SAND 9" le NOT TO SCALE PI7L^N l PER FT. A7T ILIAC PN+B PJ7CH 1/tC'PER Pl.- QOW WIN. C FLOW L/NE UNION V LVE L=28.5' 110- LEEDER HO O /NVERT M/N. 14• CK VAL —9Z �EO•� �q o 0 o e eo 0 00 0 ° " ee oe °e ° os o O EL.-___ EL. tNVSRT 6." LBYE� e e i ee oee°�°Be ee a oe 1 eee 101 e BLEV P75' INVERT Aunir EL = 94 a. EL'=97 96.75 EL.=A!t,?5 /NVERr " EL.-_ ° fl7 HE WATER TESTED EL. ,ZB 1,500__CALLONS IF AFORE TITAN ONE 0V7WT 1000__GALLONS PLACE ON B" 57ONE 90'x 18'x 8" EXISTING SEPTIC TANK, --i--- GENERAL NOTES PUMP STATION NEW "DB=9" 9i4. >a 1-1�z- SOIL ABSORPTION ' �o EXISTING DISTRIBUTION, muaU WASt�v sm E BOX 'WITH T SYSTEM (SAS) 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM 7V D.E P. TITLE 5 AND THE MWN OF _RA99STA -__ RULES AND LOW POINT FERNDALE ROAD ELEV.=1� REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE WETLAND ELEVATION 12101105 ELEV= 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT 7V OBSERVED WATER TABLE OIAOS) ELEV= 20 7' NTHIN 6" OF FINISHED GRADE-- TWO COVERS WITHIN 12" OF GRADE 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN OBSERVATION HOLE 1 ELEV=_27 2 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE PERCOLATION RATF S,9_ MIN./INCH AT.�iZ_ INCHES USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4" SEALED CAP DEPTH HORIZ TEXTURE COLOR M077 OTHER 4) ANY MASONARY UNITS USED M BRING COVERS TO GRADE SHALL EL=29' BE NORTERED IN PLACE. LEACH FIELD 5) NO DETERMINATION HAS BEEN MADE AS 70 COMPLIANCE R77H 0-8" A SANDY LOAM OYR4-2 DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS M AL OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. -38" B LOAMY SAND OYR6-8 6) UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRAC7YIR 40 MIL LINER 36-12 " Cl MED. SAND IOYR8.4 PERC IS To CALL "DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS PRIOR 7V COMMENCING WORK ON SITE EXISTING GRADE EL=26127' WATER 78" - 0.7' 7) CONTRACMR IS 7V VERIFY GRADES AND ELEVATIONS AS WELL AS SITE CONDITIONS PRIOR 70 CO„f�A(ENCING WORK ON SITE SOIL TEST 8) PARCEL IS IN FLOOD ZONE___C NOV. 01, 2005 SOIL TEST DONE BY BRUCE C. MORPHY, RS 9 °o) LOT IS SHOWN ON ASSESSORS NAP 290 AS PARCEL _08___, EL=24. 7' DATE OF SOIL TEST oe 12" 10) PUMP TO BE ON SEPARATE CIRCUIT IN ELECTRICAL PANEL °era WITNESSED BY' DONALD DESMARAIS 11) THE FORCE MAIN SHALL BE CONSTRUCTED TO DRAIN BACK 70 PUMP CHAMBER 16" SY19NE BASE PERC ,¢' 11130 12) THE ALARM SHALL CONSIST OF A RED LIGHT WITH AUDIBLE BELL INTERLOCKING PIN & BLOCK DESIGN CAL CULA TION 13) PUMP SHOULD BE ABLE To BE DISCONNECTED AND LIFTED OUT OF THE PUMP CHAMBER GRADING WALL NUMBER OF BEDROOMS GARBAGE DEPOSAL . . . . . . . . . NOT ALLOWED 14) AT ALL BENDS ON FORCE MAIN, I CF MIN.OF CONCRETE THRUST BLOCKING IS REQUIRED. 15) CHECK PUMP STATION ON/OFF FLOATS 7b REQUIRED 5" SEPARATION. CONSTRUCTION NOTES. ESTIMATED FLOW ' ( jj -I--O__GAL/BR/DAY x _ __ BR) ��?30 GAL/DAY INSTALL LEACH:FIELD 19' X 35' X 6" EXISTING SEPTIC TANK CAPACITY 1500 GAL (EXIST.) A7TH 5 OVER DIG 770 APROX DEPTH OF 36" PUMP CHAMBER SIZE . 1000 GAL (EXIST.) SOIL CLASSIFICATION . . REPLACE MTH CLEAN MEDIUM SAND DESIGN PERCOLATION RATE < 5 MlN./IN. CHECK PUMP I CHAMBER FLOATS EFFLUENT LOADING RATE . . ... . . •74 GALIDAY/S.F. GAS LINE TO BE RELOCATED LEACHING CAPACITY (AREA X RATE) 492 GAL/DAY NOT YANKEE SURVEY 24 HOURS RESERVE LEACHING CAPACITY . . . 492 GAL/DAY OLD LEACHING FIELD 710 BE REMOVED (35 X 19 X .74) PRIOR TO SEPTIC INSPECTION SEPTIC OVER DIC LOCATION TO BE STAKED BY YANKEE SURVEY PRIOR 710 CONSTRUCTION INTERLOCKING PIN & BLOCK WALL TO BE STAKED BY SHEET 2 OF E YANKEE SURVWY PRIOR TO CONSTRUCTION JOB NUMBER____ 53971 I