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Home My WebLink About0094 QUAKER ROAD - Health (2) 94 98 QUAKER RD. HYANNIS A= 310 300 �l 1 f i i G' �I Ha ardous Materials Inventory Sheet Checklist Date Physical Street Address-Check database to ensure it exists Working Phone Number 1 Actual Amounts - ( ie. gas being used to fuel machines, thinner to --{�—clean brushes all count as hazardous materials-no blanks) L--Storage Information - location of storage,,how long is storage for? r ; If none, note that. L-�Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it _---Attach the Business Certificate with your sign off and comments 'The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. r Date: � Aaa TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS _ NAME OF BUSINESS: °.cu� C if 0 iala BUSINESS LOCATION: 4jT /?a cjQ ker TRA INVENTORY MAILING ADDRESS: q/a 8(ji2 per RA ';P A.IA I00%IS FUR , 0a(,01 TOTALAMOUNT: TELEPHONE NUMBER: 4s 5 - 3� fob CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: :ZF acy 3e R (0 MSDS ON SITE? TYPE OF BUSINESS: C � CCAO ion Se rlil ce INFORMATION/RECOMMENDATIONS: Alzog 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 WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant' Signat .e" Staff's Initials TOWN OF BARNSTABLE BOARD OF HEALTH ii ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date l Time: In Out Owner (f Tenant Address —` 2 Address Complian Remarks or Regulation# Yes LAO Recommendations 2. Kitchen Facilities z 3. Bathroom Facilities 4. Water Supply A?Pm �7'' 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities I 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17.Temporary Housing 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms ,—t> Number of Vehicles Allowed/(Tax) Number of Persons Allowed (max) l Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here I �� TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date —� — C Time: In Out Owner n ,/ Tenant Address ( ?�a� �J�I Address Compli ce Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply Aomyed. _6 6 i 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service K.. 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing 18. Driveway Width �i l 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here 4 PW "'o.. W3 _ovff, -TOWN-Dfo-BARNSTABLELE. V gl ' OrdinAn' de', 6`r".�',`Re i"At, il mo x , zA WA 214 1 NO';`'NOTICE ame,�6f Of fend PI . drYMdriage - , . - '� 4�kddr6ss of Offender 1t A t MVIMBReg # la-AgState/I e pl� :..'Business' Name, � on _gu,,i n i 'ess `Address'. Of f IFL.n ure 'Eh in 91 Vill,age/S iat hIp b" .Location of 'Offense, r Enforcing Dept-/Division -IJ . z Of ieM se -T F L)... �ct,q A t-A r This will serve only As A warning . At it ,is .timec.no 1ega action hadbe been takdrl y It -is the, goal of. .4lencies to'ac'achieve voiunt��, 466iip ilance rown-..1112 i _ i. -!Otdinancds' "Rules. .--and..,Rehulatons.' Educati6n -,efforts' and warning"l no; are i n u nt- S 's e' 6- attempts to gain Vol &;,:yf,.comp;compliance b i;�. . qu violations will result. y' ,':the To, wn'. �,p 7-PRM/,A., R EN' q�Qlp_r OLD,--.ENFORCINGQ�ENDER C� _F TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date le//1 G/� ;� Time: In f' y Out .` Owner ,AA) Tenant ��1�14 i,1 L6 -,/ LV/1 Address j20 3 42 Address ey y aU4 del` f%V Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities �.•� 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities A S 7. Lighting and Electrical Facilities U ii ._ A— ak v 8. Ventilation r I 9. Installation and Maintenance of Facilities ` 10. Curtailment of Service 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal / r y 12t,, 68i 16. Sewage Disposal �F. !�v� j�l C- C 0 r 17.Temporary Housing 18. Driveway Width ✓j 19. Number of Tenants Observedy PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition �2 0-A t't l o Number of Bedrooms J Number of Vehicles Allowed (max)_ Number of Persons Allo (max) Person(s) Interviewed : ...._ Inspector r> FI If Public Building such as Store or Hotel/Motel specify here UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I Town of Barnstable M O Health Division I 200 Main Street Hyannis,NIA 02601 I litiiiii{'}i}��i?��li}}}}11?1i?11�1i}IiF14}93if1i}i��s?ii�ilil h SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete �9n item 4 if Restricted Delivery is desired. i 7�1 - 1'&Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Datd of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is7delivery m item 1? L7.Yes 1. Article Addressed to: If(fE. below: ❑No i PO BOX 342 HPInfli a MA 3. ,Service Typ rtified Mail ❑Express Mail I ❑Registered KRetum Receipt for Merchandise - ❑Insured Mail C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yds 2. Article Number ! ii 7dO6(J23401 2022s 51771185 5 �o (Transfer from service laben PS Form 3811,February'2004 Domestic Retum Receipt .102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • I FO Town of Barnstable Health Division 200 Main Street i Hyannis,MA 02601 I I I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signa re i item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and.address on the reverse X ❑Addressee so that we can return the card to you. B!Received by Printed Name) C. Date f Delivery ■ Attach this card to the back of the mailpiece, 0 or on the front if space permits. D. Is delivery address different from item 17 ❑ ,es 1. Article Addressed to: If YES,enter delivery address below: ❑No N D an,ela Silva 94 Quaker Road 3. Service Type iyallm,,MA tl�(��l *-ertified Mail ❑Express Mail ❑Registered etum Receipt for Merchandise ❑Insured Mail 13 C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number Jr 7008, 323� 0�02 5177 8568 (transfer from serv/ce label) 1� ' j_. �' PS Form 3811,February.2004 Domestic Return Receipt 102595-02-M-154o i oFtHE t Town of Barnstable Regulatory Services * M SS. Thomas F. Geiler, Director 9$ 1639. `0 Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail:7008 3230 0002 5177 8568 • Octob r 21, 200 Daniela Silva 94 Quaker RoadYD Hyannis,'MA 02601 Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.l 11, sec. 127A and 127B, 105 CMk 400.000: State Sanitary Code, Chapter 1: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter 11: Minimum Standards of Fitness for Humans, Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable, on October 20, 2009 conducted an investigation of a dwelling unit located at 94 Quaker Road(Southern unit) Hyannis. The owner's name of this dwelling unit is Mrs. Nancy Johnson. The tenants name is Daniela Silva. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D); (E) the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this, finding. Conditions foundmithin the dwelling, which give rise to the emergency finding of unfitness and determination of immediate'danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (A,B,C) (A) Failure to provide hot water..(B)No heat provided due to gas being turn off. (C) Shut off and failure to restore gas Based upon these findings any and all occupants are hereby ordered to vacate within (24) twenty-four hours and the landlord/owner"is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Q:\Order Letters\Condemnations\94 Quaker road.doc Furthermore, anyone,who fails to complywith any order of the board of health may be subject to fines ranging from$10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied until gas, hot water and heat are restored to this unit. Note: This is an important legal document It may affect your rights PER5as DER O BO OF HEALTH C . McKean, CHOIRS Director of Public Health Town of Barnstable Q:\Order Letters\Condemnations\94 Quaker road.doc . oFtHE Ta,. Town of Barnstable Regulatory Services BARNSTABLE, 9 MASS. Thomas F. Geiler, Director Gp 1639. `0 MAMA Public Health Division Thomas,McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Certified Mail: 7008 3230 0002 5177 8551 i October 21 2009 Nancy Johnson ' PO Box 342 Hyannis, MA Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.I 11, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.006: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Humans, Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable, on October 20, 2009 conducted an investigation of a dwelling unit located at 94 Quaker Road (Southern unit)Hyannis. The owner's name of this dwelling unit is Mrs. Nancy Johnson. The tenants name is Daniela Silva. Based on the results of that investigation,,the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), (E)the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this i finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety 410.750 (A,B,C) (A)Failure to provide hot water. (B)No heat provided due to gas being turn off. (C) Shut off and failure to restore gas Based upon these findings any and all occupants are hereby ordered to vacate within(24) twenty-four hours and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order., If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be' forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Q:\Order Letters\Condemnations\94 Quaker road.doc Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied until gas, hot water and heat are restored to this unit. Note: This is an important legal document It may affect your rights PER ORDER OF THE BOARD F HEALTH JasMcean,' O\RS Director of Public Health Town of Barnstable Q:\Order Letters\Condemnations\94 Quaker road.doc FORM30 &w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H TH CITY/TOWN W a 1 EPARTMENT �O�L/y./� 9c; ADDRESS WM soy`0 TELEPHONE c Address��'� Occupant Floor Apartment No No. of Occupants No. of Habitable Rooms 1V No.Sleeping Rooms_- No. dwelling or rooming units--No.Stori s Name and address of owner __ Q % 1 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: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: "D wzo a� Central ❑ Y ❑ N Equip. Repair V TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: �A ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vents CC 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 PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF JU Y." INSPECTOR TITLE DATE ® TIME10` ` v P.M. A.M. THE NEXT SCHEDULED REINSPECTION (T3 r 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. t ea"'h........... i�."► --p,+•'h..K.orr'..,�y::Tw:,.^4+"'+1.w*d"^. •�;.,r ..,,�.,. FORM 30 C�IW HOBBSB WARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE TH CITY/TOWN W EPARTMENT ADDRESS ��M sveys0 TELEPHONE - Address V'�NG v"'4 — Occupant Floor Apartment No No.of Occupants No.of Habitable Rooms_ No.Sleeping Rooms�Z No.dwelling or rooming units_ No.Stories Name and address of owner a 3 L>T� V ' �..y 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: y BASEMENT Gen.Sanitation: t Dampness: I -� Stairs: L t i Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: '0 A- Cf4_-_D � �) El❑ Y N E ui . Repair / Sc�V TYPE: Stacks, Flues,.Vents: PLUMBING: Supply Line L075 d C ❑ MS LIST ❑ P Waste Line: H.W.Tanks Safetyand Vents 16 > CC> 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.: WashJ3asin,;S,k�ower or Tub t. 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 -EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PM JU Y." INSPECTOR TITLE AQ DATE TIME (O` v 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. � 5 } �� .�`.w' .y,,,,l�!'"yw.�N•T.+m^'�Y3!f1+...,y.A'Y'''.axpF°1^W+t�e`r"q:n,re,,.. ,.. $, ,.�`4�s'—+""i`°'F'.:, \FORM 30{ Caw HOBBSSWARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN EPARTMENT ADDRESS .,M SV0 Jo TELEPHONE Occupant—l .1�/lJ"`� Floor Apartment No No. of Occupants 19, No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units--No.Stories Name and address of owner Ll�, V ' Remarks Reg. Via YARD Out Bld s.: Fences: t 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: A Foundation: Chimney: BASEMENT Gen.Sanitation: i Dampness: Stairs: _ 4 r t Li htin : STRUCTURE INT. Hall,Stairway: V Obst'n.: } Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: n HEATING Chimneys: -� , CtC___*) I Ilk � Central ❑ Y ❑ N Equip. Repair _/ r TYPE: Stacks, Flues,Vents: _ PLUMBING: Supply Line: j (; ''�'p =64) ❑ MS ❑ ST ❑ P Waste Line: , H.W.Tanks Safety and Vents A/-0 Cc) ELECTRICAL Panels, Meters,Cir.: f ❑ 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-Sboweror_Tub ' Infestation' Rats,Mice, Roaches.or Other:,- Egress - Dual and Obst'n: General Building Posted Locks on Doors: 4 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 INSPECTIO" PORT IS SIGNED AND CERTIFIED.UNDER THE PAINS AND PENALTIES O�1ERJUAY." 1 f INSPECTORS 7 TITLE T`I o-, o c� A� DATE TIME �� 3 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 throught 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. I • SECTION • . DELIVERY ■ Complete items 1,2,and 3.Also complete A ature item 4 if Restricted Delivery'is desired. x- ❑Agent ■ Pr.tt your name and address on the reverse ❑Addressee so that we can'return the card to you. B. Received by eAid4d Name) C. Date of Delivery ,■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 11 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No I�AG`�� Jnh�sen�`IPNNiS �9 0 .� 3. Service Type 71M� zbo �� .ceraeedMail ❑�r�Mail ❑Registered 6.Retum Receipt for Merchandise lisps ❑Insured Mail ❑C.O.D. 4. Restricted.Delivery?(Extra Fee) ❑Yes 2.,Article Number ' i'''• '• :: :• : R .iromseMce?snag i;I=;t70061081"0i{0000 552W 9216 ; Ps Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 f UNITED STATES POSTAL SERVICE First-Class Mail Postage 8 Fees Paid USPS Permit No.,G-10 • Sender: Please print.your name, address, and ZIP+4:in this box• Town of Barnstable _ . Health Division >4 8 200 Main Street Hyannis,MA 02601 llt��i�ltltlliall�e�e,i!l�I,��l��illiF�,tlilila,�flteiafrl�! I ;I Certified Mail#7006 0810 0000 3524 9216 Town of Barnstable Regulatory Services i M • BAMS'rABLE; s 9�0 SS, �� Thomas F. Geiler,Director 6 prF ^"Ay''° Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 „ Office: 508-862-4644 Fax: 508-790-6304 April 3, 2007 Nancy Johnson P.O. Box 342 Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 94 Quaker Road Hyannis, was inspected on March 30, 2007 by Meredith Morgan, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.351 —Owner's Responsibility to Maintain Structural Elements. GFCI outlet in bathroom not tripping. 105 CMR 410.602—Maintenance of Areas Free from Garbage and Rubbish. Large brush pile in back yard. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing GFCI outlet or replacing it with a two- prong outlet; by removing brush pile. QAOrder letters\Housing violationARental ordinanceU4 Quaker Road.doc t 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 the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF TH BOARD OF HEALTH T omas A. McKean, R.S., CH Director of Public Health Town of Barnstable Cc: Meredith Morgan, Health Inspector QAOrder letters\Housing violations\Rental ordinance\94 Quaker Road.doc FORM30 HAW HOBBS&WARREN M THE COMMONWEALTH OF MASSACHUSETTS BO D OF HEALTH CITY/TOW N Ffl R-AA D PARTMENT A SS _� /`„/ /� �-TEE E P HrOKIE Address QU �I!CGf_— :�/U�J— Occupant__ Floor _A artment No. of Occupants p p No.of Habitable Rooms No.Sleeping Rooms_ No. dwelling or rooming unit _ n1�. tories_— Name and address of owner _(/l� --JNm_lNd / *'�/ 7 Q/L�'VlS �� 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 Ej M Doors,Windows: Roof Gutters, Drains.- Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑•Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: I Aj PLUMBING: Supply Line: LJ f JQ " ❑ 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 -r 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 INSPECTIO PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTMFF P JU 11 j- INSPECTORTITLE 'L� A.M. DATE TIME . ib P.M. THE NEXT SCHEDULED REINSPECTION P.M. r . . '"� ,•.,.: o,��, R � ,. c,t,rrt'i.. i�.n r:.. ,.t- 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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this.category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of.the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410..253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410,450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and.410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical,plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). . (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. j I FORM 30 HhW HOBBSS WARREN'" THE COMMONWEALTH OF MASSACHUSETTS �� BO D OF H LTH CITY/TOWN W DEPARTNIENT c^ ADDRESS M syey`0 ELEPHONE `f(� Address Q o �P, _ AA A5 Occupant � or, � Ci)W Floor ApartmEV)No. UUU _ No. of Occupa ts_ '�, t No. of Habitable Rooms IT No.Sleeping Rooms_ No.dwelling or rooming units No.Stofies �l� Name and address of ownerLU �,/j--,-09 r l� /Y( C �y1"!�� 0' Remarks R�Viol. ra YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Vie Drainage on Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation.- Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. 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 INSPECTIO ORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENAL E J , �,p�/ INSET O TITLE N k ' , V I A.M. DATE44( TIME�� t M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. ..a..,�...�.,-.�,y.�;;,s,..,�,�.�.�,�6_'Ln�-,,. ' y;S: y�w.,'`��1n5"�ij�)Yr'ji�.aw ktr r"'^'�-k'1�^ *^_ -L'ram`r".��'Y;ITS.f.kLCu'��*a[L �p++�;3Cyvp'aR?'�.y�;Z..'M.-"'.�•l/'�`'"^"`'""" '��+^•. 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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410:830 through 410.833 nor shall failure to include affect the legal obligation,of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. n ! 1 f I E \ 1 L�1! .� ..t.:. -.. .�- TOWN OF BARNSTABLE BAR-W 4809 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager WJ Address of Offender rj) MV/MB Reg.# Village/State/Zip ../ ItS Business Name am/.PM7 on f. 2 0(7 Busifiess Address Signature of Enforcing Officerl' villa: ge/State/Zip / MCIA,, !Location of Offense Enforcing Dept/iDiv'ision Offense 7_� A�) Of r��/TKSP alopool Facts! I A f y j This willserve only .as a warning. At this time no legal actilon 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 aVl�teffip7�;s to gain voluntary compliance. Subsequent violations will result in ajpropf',iate legal action by the Town. WHITE-OFFENDER'S. CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ' �`"_".Tx. rF.7`...'.-x"..'ql...r*-...�.-r"*'yy-^'•""'.r wr.: TOWN OF BARNSTABLE rd BAR-W -4 rul0 v Ordinance or Regulation WARNING NOTICE r Name of Offender/Manager I t ' r t, f Address of Offender r`t f .r R a�. r; t MV/MB Reg.# Village/State/Zip Business Name !' ^yam/,pm,, on 20t=F Business Address . Signature .of Enforcing Officer Village/State/Zip ''Location of Offense f F t f � Y ; , ' kt !. Enforcing Dept/Division Offense Facts 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. 7 - tJ WHITE-OFFENDER'�' CANARY-ORD./REG.-PROG. PINK ENFORCING OFFICER GOLD-ENFORCING DEPT. i ,per �;..a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION s V TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 9 4—9 8 Ouaker Rd- --Hyannis, MAC Owner's Name: Grant / ,Tnhn Gnn Owner's Address: Date of Inspection: f 3--/._d&—V ® �k Name of Inspector: lease print) Wi 1 1 i am E_ • Robi_nson Sr. o� eO P (P P ) p Company Name: William E. Robinson Septic Service Mailing Address: P O Box 1 089 Centerville. MA dt Telephone Number: (5 0 8 ) 7 7 5—8 7 7 6 ' a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my; training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP' approved system inspector pursuant to S on 15.340 of Title 5(310 CMR 15.000). The system: Passes fi Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails � � GG Inspector's Signature: i ®� Date: / —/016 �(, The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea&,or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments i ****This report only describes conditions at the time of inspection and under the conditions of use at that' time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of l l i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 9 4—9 8 Quaker Rd- Hyannis Owner: Grant f Johnson Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A.71have Passes: not found an information which indicates y that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unso d,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existinlg tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to-broken or ob cted pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with app oval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will ass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 9 4—9 8 Quaker Rd. Hyannis Owner: Grant / Johnson Date of Inspection: s r= o G—u C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a rface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or.more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) ti Property Address: 9 4—9 8 Quaker Rd Hyannis Owner: Grant / Johnson Date of Inspection: 0--if—go, D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than''/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water ) supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified,laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in,310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. L rge Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- You mu t indicate either"yes"or"no"to each of the following: (The fol owing criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary.to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped .. Zone II of a public water supply well . 7' If you h e answered"yes"to any question in Scctiun E the system is considered a significant threat,or answered "yes"in Section D above the large system bas failed.My owner or operator of any large system considered a signific nt threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. he system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 9 4—9 8 Quaker Rd. Hyannis Owner: Grant / Johnson Date of Inspection: Check if the following have been done.You must indicate"yes""or"no';'asp to each of the following: Yes No :. ✓ _ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? 'Has the system received normal.flows in the previous two week period? V Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓Was the facility or dwelling inspected for signs of sewage back up? V✓/Was the site inspected for signs of break out? V ere all system components,excluding the SAS, located on site? L/I_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan at the Board of Health. 4/ — Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] C 5 Page 6 of 11 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 9 4-9 8 Quaker Rd. Hyannis Owner: Grant Johnson , Date of Inspection: /,9,- 6. FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-1L Number of bedrooms(actual): , DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): ,t, a Is laundry on a separate sewage system(yes or no):,,?,6 [if yes separate inspection required] Laundry system inspected(yes or no):;t Seasonal use: (yes or no):A, Water meter readings,if available(last 2 years usage(gpd)): 1 9 9 9-2 0 0 0 90,000 gal. Sump pump(yes or no): sew O 1 9 9 8-1 999. 205, 500 gal. Last date of occupancy: _� �l S�-�<--• C MERCIAL/INDUSTRIAL Type of establishment: Desig flow(based on 310 CMR 15.203): gpd Basis f design flow(seats/persons/sqft,etc.): Greas trap present(yes or no): Indus ial waste holding tank present(yes or no): Non-s itary waste discharged to the Title 5 system(yes or no):_ Wate meter readings,if available: Last ate of occupancy/use: OT R(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): 6, z If yes,volume pumped:,/ c� gallons--How was quantity pumped determined? Reason for pumping: �i r� S j S TYP�F SYSTEM ,//Septic tank,distribution box,soil absorption system , _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installe�d(if k/nown)and source of inforym!ation: 0 6}�d CCo1aJ��Be,.. YU! [/ `C, Were sewage odors detected when arriving at the site(yes or no): 0 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9 4—9 8 Ouaker Rd. Hyannis Owner: Grant / Johnson Date of Inspection: S—o s—G B DING SEWER(locate on site plan) Dep below grade: Mater als of construction:_cast iron _40 PVC_other(explain): Dista ce from private water supply well or suction line: Co ents(on condition of joints,venting,evidence of leakage,etc.): i SEPTIC TANK:_ locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) i i e Dimensions: Z A* (e 14 46 Sludge depth: O Distance from top of sludge to bottom of outlet tee or baffle: L/9 Scum thickness: O Distance from top of scum to top of outlet tee or baffle: $� Distance from bottom of scum.to bottom of outlet tee or baffle: ' How were dimensions determined: 0 y0j;-;.. 1-1^��C Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels I as related to outlet invert,evidence of.leakage,etc.): GR SE TRAP:_(locate on site plan) Depth b low grade:_ Material of construction:_concrete_metal_fiberglass polyethylene_other (explain : Dimens' ns: t Scum t ickness: Distan a from top of scum to top of outlet tee or baffle: Dista a from bottom of scum to bottom of outlet tee or baffle: } Date f last pumping: Co ents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as elated to outlet invert,evidence of leakage,etc.): I 7 I: Page 8 of I 1 " ' Q OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART C SYSTEM INFORMATION(continued) Property Address: 94-98 Quaker Rd. Hyannis Owner: Grant / Johnson Date of Inspection: ---e T T or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth elow grade: Materi 1 of construction: concrete metal fiberglass�___polyethylene other(explain): Dimensions: Capac ty: gallons Desi Flow: izallons/day Al present(yes or no): Al level: Alarm in working order(yes or no): Da of last pumping: Co ents(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PU P CHAMBER: (locate on site plan) Pu s in working order(yes or no): Al s in working order(yes or no): Co ents(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 10 of 11 OFFICIAL'INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94-98 Quaker Rd,- Hyannis Owner: Grant / Johnson Date of Inspection: 8 6-c-- SKETCH OF SEWAGE DISPOSAL SYSTEM f Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100//feet.Locate where public water supply enters the building. r ll i� � Sid • 3 r r I 1 a 10 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 94-98 Quaker Rd. Hyannis .Owner: Grant / Johnson Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): locate on site plan,excavation not required) If SAS not located explain why: P Y Type eaching pits,number:�eachingy )chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: / innovative/alternative system Type/name of technology:�'a w Z I Comments(note condition of soil,signs of hydraulic failure,level of ponding, damp soil,condition of vegetation, etc.): do04 0ga l r • CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert:j Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PR (locate on site plan) M erials of construction: Di ensions: D pth of solids: C mments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page I 1 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C i SYSTEM INFORMATION(continued) Property Address: 9 4—9 8 Quaker Rd. Hyannis E Owner: Grant Johnson Date of Inspection: /3' d___0 SITE EXAM Slope r Surface water Check cellar Shallow wells Estimated depth to ground water ot6 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) i `;/Checked with local Board of Health-explain: T� m Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: 49,9 I. i a ` I t , a i f I1 � . 1 TOWN OF BARNSTABLE LOCATION % �,' r 1 , :, ,� d SEWAGE VILLAGE rl+' ' ASSESSOR'S'.MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) : S".� �;y' -r '?- �_ .. • :".: (size) �',Z�,�G'- NO. OF BEDROOMS BUILDER OR OWNER ( -, .�-•'' '� ,. P:ERMTTDATE: c ':� — � COMPLIANCE DATE:f , _/. �f . ,. 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 i g ..:.�_ z . Edge of Wetland and.Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet" `Furnished by TOWN OF BARNSTAS..L L .:a:ATION 0 SEWAGE X_22 7a- Vf11AGE }' ASSESSOR'S..MAP& LOT INSTALLER'S NAME&PHONE NO. r,'Ce SEPTIC TANK CAPACITY LEACHING FACILITY: (type) NO.OF BEDROOMS r . BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE:/, -Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility - Feet ` Private Water Supply Well and Leaching Facility (If any wells exist ' on site or within 200 feet of leaching facility) X Feet Edge of Wetland and.Leaching Facility(If any-wetlandsex�st within 300 feet of leaching facility) ~Feet y Furnished by f 411 �� No.UI &V 779 I r Fe 5 0 J +„ram THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01ppricatiou for ]Diopozar *pgtem Cow5truction Permit Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) 11 Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 94-98 Quaker Rd. , Hyannis Grant / Johnson Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E. Robinson SepticService P O Box 1089 Centerville Type of Building: Dwelling No.of Bedrooms5 Lot Size sq.ft. Garbage Grinder( ) 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 Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Title-5 leach system consisting of a D—box and 4 concrete leach chambers with i stone all,. around. 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 Certifi- cate of Compliance has been issued by this Bo d Health. Signed Date I;L Application Approved by Date Application Disapproved for the following reason Permit No. -7 Date Issued t' �{y3/. i�'..�. ... _r' - ,1..: .� .... .. -..iwl`..`Fr.p�y "w� r _a• y. `i�l'" w .. ,. • a["' a.e--'y-,. I , No. c�i \ # Feet 5 0 r" THE COIOIMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIV �QN ;.BLOWN OF BARNSTABLE, MASSACHUSETTS ZippYication for igpog�*pgtem Congtructfon Permit Application for a Permit to Construct( )Repair( N Upgrade( )Abandon( ) ❑Complete System ❑Individual Components i Location Address or Lot No. Owner's Name,Address and Tel.No. 94-98 Quaker Rd. , Hyannis Grant / Johnson �3: j Assessor's Map/Parcel ' Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Wm. E._ Robinson SepticService P O Box 1089 Centerville Type of Building: Dwelling No.of Bedroom5 Lot Size sq.ft. Garbage Grinder( ) Othe / Ty? f 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 Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable)_Title-5 leach system consisting of a D-box and 4 concrete leach chambers with v/ c stone all around. Date last inspected: Agreement: r,.. 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 Certifi- cate of Compliance has been issued by this Bo d SPHealth. Signed Date/Z-/;9 Y . Application Approved by r Date I& 1 Z-TiOYV Application Disapproved forte following reason Permit No. 'L-VZ'Z-) - 7 3/ Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Grant / Johnson certificate of (Compliance THIS-IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( X)Upgraded( ) Abandoned( )by Wm. E. Robinson Septic Service at 94-98 Quaker Rd. , Hyannis has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z dated /Z Installer Wm. E. Robinson Sr. Designer The issuance of s 1)ernut shall not be construed as a guarantee that the system will function as designed. Date U1 Inspector �%ki 7 --..,—^------------------------------A.----��,--- No. vv r -7 3/ 5 0 THE COMMONWEALTH OF MASSACHUSETTS 3 ld-3(d PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Grant / lwigogat &pgtem (Congtrurtton Permit Permission is sRi re eby granted to Construct( )Repair( X)Upgrade( )Abandon( ) Systemlocatedat 94-98 Quaker Rd. , Hyannis 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. �l Provided:Construction must e completed within three years of the date of this p Date: / Approved by F A NOTICE. This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CER MCATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I. William E. Robinson,5 eby cemfy that the apphcadon for disposal works construction permit signed by me dazed / --y `� o-6-.4 , concerning the property located at 94-98 Quaker Rd. , Hyannis meets all of the following criteria: • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated wi dwelling. The soil is as CLASS I and the percolation rate is less than or equal to 3 minutes per inch. There are no within 100 feet of the proposed septic system — There are no p vate wells+vithin 150 feet of the proposed septic:s}stem There is no i in flow and/or change in use proposed • There are variances requested or needed • The bona, of the proposed leaching facility will tgt be located less than five feet above the Mcim adjusted grauttdwater table elevation.[Adjust the groundwater table using the Frimptor method hen applicablel If the ..A-S.will be located with 250 feet of any vegetated walards.the bottom of the proposed t . g facility will am be tooted less than fourteen 1141 feet above the maximum adjusted groundwater table elevation, Please complete the following; A) Top of Ground Surface Elevation(using GIS information) S 6 B) G.W.Elevation _ +the MAX. High G.W.Adjustment _ ), 6 DIFFERENCE BETWEEN A and B 3 C SIGNED DATE: AL [Sketch proposed plan of system on backj. y:haith folder:--cn s i o��/ � � � iV '� • ii FORM 30 C&W HOBRSS WARRENT"" THE COMMOISr ALT'H OF MASSACHUSETTS BO&R r D OF HEALTH CITY/TOW N DEPARTMENT ADDRESS TELEPHONE Address 9z v 1/_E f- V',,f�77 a Occupant— Floor— �_Apartment No. !?Z No. of Occupants No.of Habitable Rooms__No.Sleeping Rooms No. dwelling or rooming units -/ No.Stories Name and address of owner A�G.,, y 3-oo 1-I'Som 11 j0 Xxy, 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: Ajo-v qrc,4;•s ra 44 3S/4. Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central Y ❑ N E ui . Repair . - k/pE'� CC-C-1& TYPE: KOVI 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 F PERJURY." INSPECTO � TITLE DATE f ( TIME -----!(r 3 A.M. THE NEXT'`SCHEDULED REINSPECTION P.M. } ` ►w< .}mac r- t:F+ .y}{�,''° ,+ x, y .LL , . . -4t. .i. t..": r 4 �. �� «•. .i{ °-�'°-y,�'. q .. y�+'r ei 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. FORM30 � ,w HOBBSB WARREN Tn THE COMMONWEAL OF MASSACHUSETTS k BO RD OF HEALTH $ Gy V%S`if o IJt CITY/TOWN 1 DEPARTMENT k%G yoW t ADDRESS L tJ 7 1 TELEPHONE 9 ( � Address - occupant--' Floor. Apartment N No.of Occupants . Z. No.of Habitable Rooms. ' No.Sleeping Rooms Z' No.dwelling or rooming units No.Stories_ __ Name and address of owner ✓ �y v hH Sep, !/1pkX0; Remarks Reg.' Vio. -YARD Out Bld s.: Fences: Garbage and.Rubbish Containers: 4 Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches-.. Dual Egress:and Obst'n,: ❑ B ❑ F ❑ M . Doors,Windows.- Roof Gutters, Orains Walls: . Foundation: Chimney: BASEMENT Gen.Sanitation:` Dampness: Stairs: . and X*<X:_S e. r1k) tue 44 S4 Lighting: STRUCTURE INT. Hall;Stairway: : Obst'n.: Hall;Floor,Wall;Ceiling: " . Hall Lighting: E: Hall Windows: HEATING Chimneys: Central �tY ❑ N Equip. Repair //0 k+ �Vc) QC,44i, C tV-c-I&L+44 Zoe TYPE: tTh✓ Stacks, Flues,Vents: PLUMBING: Su ly Line:': ❑ MS ❑ ST .❑ P Waste Line: H.W.Tank s Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.:..: ❑ 110 ❑ 220 Fusin ,.Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wirin :. DWELLING UNIT Ventil:, L to . Outlets Walls Ceils. Wind: I 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 105CMW-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 (f'� 3 . �) A_.M) DATE_ TIME [/ P.M. 1 A.M. THE NEXT rsCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may_endanger or impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall,within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns,shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. r r { a QyofTHE.--. down of Barnsta6Ce i BAR a9TABLE, i Department of Consumer Affairs MUa. p °pew 1 39. 230 SOUTH STREET • P.O.BOX 2430 • HYANNIS, MA 02601 ., :. `homau f Geiler,Director FAX: 508-775-3344 TEU 508-790-6250 I. t TO:._ Thomas McKean, Director., Public Health s Y .:.FROM: .Thomas F. Geiler,..: Director.,. ConsLtmer Affairs SUBJECT: Commonwealth VS. Yvette Pires LATE.,. . __ . February c, , 19n1:.. The ,_above referenced matter is scheduled for trial Apri 1. ..8,_..l991 at 9»00 a m».,:.. You,_ or a member , of your.. _st.af f, preferably ... donna Miorandi,..,are requested....to., be. present. ..Copies.,„of the citat,ions ,w.µ. ` .n involved and ax.,written_ report by Donna have been forwarded . to the District Attorney.vs.,:,.Off.i.ce.......: ,. A .....: ... . .......:. PARKING CLERK LICENSING AGENT WEIGHTS AND MEASURES BYLAW ADMINISTRATION THE COMMONWEALTH OF MASSACHUSETTS o OFFICE OF THE DISTRICT ATTORNEY CAPE&ISLANDS DISTRICT PHILIP A. ROLLINS P.O. BOX 455 DISTRICT ATTORNEY 3231 MAIN STREET BARNSTABLE,MA 02630 (508)362-8113 January 15 , 1991 "ECEIVED JAN 1 6 1991 Mr . Thomas Geiler C/O Town of Barnstable TOWN OF BARNSTABLE P .O. Box 2430 WEIGHTS AND MEASURES Hyannis, MA 02601 LICENSING/PARKING RE : COMMONWEALTH VS . YVETTE PIRES 90/6494 Dear Mr . Geiler: Please be advised that the above-referenced matter is scheduled for 'trial April 8, 1991 , at 9s00 a.m. Your appearance is necessary in order for this office to prosecute the defendant . Please submit a written narrative of the incident advising us Cf the facts, • including any witnesses you may have with their names , addresses , and telephone numbers before the above court date. Thank you for your prompt attention to this matter . If I can be of further assistance, please do not hesitate to contact this office. Ver truly yours Richard J . Piaz Assistant Distr c ney RJP/ddb NAMES 1 BYLAW VIOLATIONS OFFENDER NAME SEARCH Help Citation Date of Date Number Offender Violation Paid 19566 PIRES JOANNA 091589 010890 19t4$✓PIRES YVETTE 111489" 19520/ PIRES YVETTE 041290 19519✓ PIRES YVETTE 041090, 19518✓ PIRES YVETTE 040990. 19517✓ PIRES YVETTE 040590- 19516010'PIRES YVETTE 040490, 02991 ._. PIZZUTO ANN 030683 031383 03982 PLEASANT PARK CONDO 051685 13429 PLIMPTON, CALVIN DR 061989 071589 13428 PLIMPTON, CALVIN DR 061889 071589 09514 PLIMPTON, CALVIN DR 092306 .101086 09513 PLIMPTON, CALVIN DR 092386 101086 09759 PLIMPTON, CALVIN DR .092986 . 102886 13356 PLIMPTON, DR HOLLIS W, JR 030189 051089 Cancel Press XMT for more data Next screen NAMES Next Offender PLIMPTON, DR HOLLIS W, JR Next Action Next Citation Nbr Next Alarm Nbr Next Call Number ADDR=B9 FORM RCV DOCKET NUMBER CRIMINAL COMPLAINT Trial Court of Massachusetts COURT DIVISION District Court Department Barnstable NAME.ADDRESS AND ZIP CODE OF DEFENDANT TO ANY JUSTICE OR CLERK-MAGISTRATE OF THE DISTRICT COURT DEPARTMENT: Yvette PirFs 90 Quaker iZci . The within named and undersigned complainant. on behalf of the Commonwealth, on oath complains that on: 11yaunis, IIA O26O1 the date and at the location stated-herein the defendant; did commit the offense(s)listed below. L J _ DEF. AND SEX OFFENSE CODE(S) • 999 DATE OF OFFENSE PLACE OF OFFENSE Barnstable COMPLAINANT POLICE DEPARTMENT 'rhomas c. Geiler I Barnstabla DATE OF COMPLAINT RETURN DATE AND TIME 8-n-90 SEPT. 5, 199O u:SO A.ti. COUNT-OFFENSE TOWN OF BARNSTABLE RULES & REGS. BD. _ - SOURCES OF FILM Did, as a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause, maintain, or allow a source of filth in violation of Town of Barnstable health Department Rules and. Regulations. Citation A 951b dated 4-4-90 - 98 Quaker Rd. , Hyannis COUNT-OFFENSE TOWN OF BAR14STABLE RULES & REGS. BD. --UF--y4iE LT11 i 1 —SOURCES Did , as .a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause, maintain, or allow a source of filth in violation of Town of Barnstable Health Department Rules and Regulations. Citation #19517 dated 4-5-90 - 98 Quaker Rd. , Hyannis COUNT-OFFENSE TOWN OF BARNSTABLE RULES & REGS. BD. F—F I Did , as a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause, maintain, or allow a source of filth in violation of Town of Barnstable Health Department Rules and Regulations . Citation #19518 dated 4-9-90 - 98 Quaker Rd. , Ilyannis COUNT-OFFENSE- TOWN OF BARNSTABLE PULES & REGS. BD. Did , as a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause , maintain , or allow a source of filth in violation of Town of Barnstable health Department Rules and Regulations . i Citation #19519 dated 4-10-90 - 98 Quaker Rd . , Hyannis COMPLAIN NT SWORN TO BEFORE CLERK-MAGISTRATE/ASST.CLERK ON(DATE) ADDITi0NAL 8-6-90 I❑ cTACH X X ATTACH FIRST JUSTICE COURT ADDRESS Richard P. Kelleher Route bA _ . _ 'Rnrvist.ahl P , ''1!. r)9630 J r 1 INN OF ) r ,` 'I CITATION NO.: BAR) 'NAME OF OFFENDER: �� r ,�1,. � INSTABLE �' CONTACT: DATE OF VIOLATION: ,r '' " " �' TIME OF Vl LA.tTION: _ °w ADDRESS OF PFF N,DEf�: •` % f;"�f % R ff' 1 ,SZ CITY: ,�' r,1 STATE:/ ZIP: 0 . w YOU HAVE BEEN OBSERVEDVIOLATING:` 1 z f (spspify bylaw or regulation) uj TICE OF j /' ) a BY: W )LATION y _r! (act,conitityungviolation) i. . 0 AT: /' FINE AMOUNT: t 0 uu TOWN (place of iolation) Q LAW OR I HEREBY ACKNOWLEDGE RECEIPT OF CITATION: „r (signature Jt off ends{I j W GULATION BY. BADGE NUMBER : a uj (signature of enforcing person) Q THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER. d -ay elect to pay the above fine.either by appearing in person between 8:30 A.M.and 4 30 P.M..Monday through Friday.legal holidays excepted.before THE 'I ACISTRATE.0tstnct Court Department.First Barnstable Division,Court Compound.Main Street.Barnstable,MA02630,or by ma,hng a check,monevorder or postal note to •."wstraie WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.This will operate as a final disposition of the matter.with no resulting criminal record ' uu aes,r a to contest this matter in a noncr,mmet proceeding.you may do so by making a written requeSI to the above CLERK MAGISTRATE for a hearing Adetiam—at�onbya '-1, Ma9i5lrale will operate as a final disposition,with no resulting criminal record.provided any fine imposed by that officer is paid within the time specified fail to pay the above hne or to appear as specified.a criminal complaint may be issued against you. •-qF.BY ELECT the first option above,confess to the offense charged.and enclose payment in the amount of e attire WN OF 1,NAME OF OFFENDER: Y„r .l', CITATION NO.: BAR19548, RNSTABLE _ DATE OF VIOLATION: CONTACT: `"t'Owt,. ADDRESS OF OFFENDER: / ' ' !( r4:' — TIME OF VI �ATON: 4. CITY: f'{ ;/ 1lz STATE: f P ZIP: # , — o 0 Z YOU HAVE BEEN OBSERVED VIOLATING: .1! .(specify bylaw or regulation) )TICE OF BY: ; , y le•ctconstituting violation)OLATION 0 AT: ' FINE AMOUNT:..,r � TOWN (place of violation) r' I HEREBY ACKNOWLEDGE RECEIPT OF CITATION: ~ I.AW OR y T (signature of offender) ! uj u' ULATION BY: ' ' BADGE NUMBER ,�1'� '' W (signature of enforcing person) N Q W J —F;OLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER Friday. legal g b THE d 110,elect to pay me above fine.Rdhel by appearing in person between 8 30 A.M and 4 30 P M. Monday throe n al nol�days excepted. efore .;.S TUATE D•st•c t Co.,it Department First Barnstable Division,CourtCompound.Main Street Barnstable,MA02630.0r by mailing a check,monevomde,0,pnslat note to .•;�q smaie WITHIN T;VENTY-ONE(211 DAYS OF THE DATE OF THIS NOTICE This will operate as a final disposition of the mat tier,rh no r"s JI,Ig t:1'111^.,!-,•,Ord .00s•re to Conlest in,$matter•n a noncrim-nal proceeding.you maydosobyrmaking a written request to the above CLERKMAGIST RATE in,ane.ar•ny A o wv-"'•a!ur.0,;« �••t-Mog,slrale will operate as a final disposition,with no resull-ng criminal record.provided any hne imposed by that officer is pa-o wnh.n the time spec.b-1 .°U lad to pay the aotive line or to appear as specified,a Criminal complaint may be issued against you. •° 'n ELECT Ins Inst Option above.confess t0 the offense charged,and enclose payment to the amount of$ ';mare i TOWN OF '/� j� {,• " Ap NAME OF OFFENDER: CITATION NO.: p DMR1 ' BARNSTABLE CONTACT: r, DATE OF VIOLATION: �!oi,HF_ow. ADDRESS FFEN E P } y 91 r fir" e ' CE• �' TIME OF VIOLATION: t � / p 1 � CITY: I /'V l i; '` STATE: j ZIP: a °' a YOU HAVE BEEN OBSERVED VIOLATING: W 1Y r✓ 1. �I�, ( t c ` , i z ;��r NOTICE OF BY: (specifypylaworregulet J L i •r� /! 1: .rr iopt. ;�V� (✓rt�' r'l a VIOLATION acyconytgu(tng violation) r— uj cn OF TOWN (piece of violation) r.. FINE AMOUNT: i, (' w a BYLAW OR I HEREBY ACKNOWLEDGE ,9CEIFT OF CITATI¢N: r t, l / !•,1.7•'r isignaturgoJ offtndpfl w REGULATION BY: BADGE NUMBER 1 o (signature of enforcing person) W YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER. a W (1) you may elect u,pay the above fine.either by appearing in person between 8:30 A M and 4:30 P M,Monday Ihroug1,FR,day, legal nohdays excepted.before TNi J CLERK MAGI STAATE.District Court Department,First Barnstable Division,Court Compound,Main Street,Barnstable.MA W630,or by meihnq a check,moneyorde,o,postal nut,1, a the Clerk-Mag,suate WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE.This will operate as a final disposition of the matler wnh no resulting criminal record (21 II you desire tocontest this matter ma noncriminal proceeding,you maydoso by making a written request to the above CLERK rAAGIST RATE for a hearing.A del?rminahpn ben Judge or CIe,Ik-Mag,si,ale w11 operate as a final disposition,with no resulting criminal record,provided any fine imposed by that Officer�s paid within the time specified (3) if you fad 10 pay the above fine or to appear as specified,a criminal complaint may be issued against you, I HEREBY ELECT the first option above,confess 10 the offense charged,and enclose payment in the amount of 6 Signature_ TOWN OF r BARNSTABLE NAME OF OFFENDER: Y 1 �- I 1 �•- ( t T CITATION NO.: BARS 1 CONTACT: DATE OF VIOLATION: /,' 3"t`Owti ADDRESS Q OFFENDER' `+ TIME OF VIOLATION: CITY: lr;i 1 % l w STATE: ZIP: d DATES. . !, I.' > YOU HAVE BEEN OBSERVED VIOLATING: �•••> " 'J • `- l z 7• )i� 1 ' ' . J• . (spay fy bylaw or regulation) NOTICE OF BY: L.' t r , J' 1 r / r., a l S'r Y t uw VI O ON ,� } /', ! ct gstituting violation) N AT: T }-1.�� FINE AMOUNT: �� 'W OF TOWN (place of violation) a BYLAW OR I HEREBY ACKNOWLEDGE RECEIPT OF CITATION: y %;'I r 'j l t r'�, •; (signature of offgnget) , w REGULATION BY: J, J ff I' 'ri a i ' •`, BADGE NUMBER f + w (signature of enforcing Pe(son) N Q YOU HAVE THE FOLL OWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER, 4 I11 You may elect to pay the above fine,seiner by appearing m person between 8.30 A and 4.30 P.M.Monday through Friday.I¢yal +vl'aays excepted.before THE CLERK MAGI$TRATE.D,striclC,o.tit Department,Ft r st Barnstable ,w sion.Court Compound,Ma in Street,Barnstable.MA 02630,Or by ma,lrng a Check.money order or costa l note to file Gerk Magstrafe WITHIN TWENTY ONE 1211 DAYS OF THE DATE OF THIS NOTICE This will operate as a final disposition of the mauer.will,no resulting criminal record 121 if You de si r eto come si)his n'niller In a noncrmbmalproCPOding,you may doso by making a written request t0 the above CLERK MAGISTRATEtorahearing Adeterminal'ombya Judge or Clerk.Magistrate,will overate is a final dispos-lion,with no resuh,nq criminal record.provided any fine Imposed by that officer is paid w'll,'n the time specified. 131 II you fad to pay the above fine Or to appear as specified,a cnnunal complaint may be Issued against you. 1 HEREBY LLECT the first option above,confess to the offense charged,and enclose payment in the amount of S Signature TOWN OF BARN NAME OF OFFENDER:STABLE CONTACT: CITATION NO.: BAR- 1,8 , DATE OF VIOLATION: ';gip}HF,°ti ADDRESS F FFENpER.• -' /•• ° ; �` /'. ,o TIME OF VI CATION: 'J T— ire 9 CITY: ` % ;< rt' STATE:1 ZIP: . . r )r a ' ' w ',�.i� ? ' r"' ''' (6Peci1 �yla pr a ul�tipnl .. to r.' NOTICE OFBY: 11 J ,. l( ;. ti �i ! g r r VIOLATION J t . ! t 1 fact con;utuu�tg viola IQnI. , F , � uj to OF TOWN I (place of violation) r r ` FINE AMOUNT: w a BYLAW OR I HEREBY ACKNOWLEDGE RE �IPT OF CITATION: � (si naWre f If I w REGULATION BY: / '') 'r.' / e P e.nGerk•., 1 BADGE NUMBER I-� f. �'''1 '.• 1/'/, a. (signature of enforcing person) I w V) YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD T Q 0 DISPOSITION OF THIS MATTER. w (t) you may elect to pay the above fine,either by appearing in person between 8 30 A.M.and 4.30 P.M.,Mondav through Fr,oay.le Tl „o' 0. CLERK MAGISTRATE.District Court Department.First Barnstable Division,Court Compound.Main Street,Barnstable,'Monday 1hroorbymad nl q,_.:,I days excepted.before Twg' a Vie Clerk Magistrate WITHIN TWENTY-ONE(211 DAYS OF THE DATE OF THIS NOTICE.This will operate as a(Intl M disposition of the by"ar.w4j•n eca_mOnev order or postal mole''. 21 ll you des'e to cemesuhsmanennanoncriminalproceeding,ypu NOTICE se by making a written request to the above CLERK MAGISTRATEfo esvl!^,g cr•m,nal record Judge or Clerk May•st,ate will operate as a final disposition,with no resulting criminal record, ine or a hIi A delermin000n by a 13l 11 You fail to pay the above!ine of to appear as specified,a criminal complaint may bf issued against you mDosed by trial officer is paid w In.n In¢Lmp sD¢C,hed l HEREBY ELECT Ine first option above.confess to In offense charged,and enclose payment in the amount of 6 Signature TOWN OF / h' - NAME OF OFFENDER: l r "- I'�' '`� �� CITATION NO.: C BARNSTABLE CONTACT: BAR ., DATE OF VIOLATION °ttHF,°wti ADDR!iu FFE�DEfi: ") ';' R: r� ' • � TIME OF VIOLATION: _ CITY: i, ii v,.•i tin.,. • STATE: �' ZIP: -.x, ' w t # 0. o YOU HAVE BEEN OBSERVED VIOLATING:` , NOTICE OF (specify bylaw or repulation) w BY: l i.' VIOLATION ,.. , / (acttontTwunpvioleponl y OF TOWN AT: 1i FINE AMOUNT: :' 1...0; o (Place'of violation) w a BYLAW OR I HERBY ACKNOWLEDGE RE(41PT OF CITATION: a (signature of olfantler) W REGULATION BY: BADGE NUMBER I Y (signature of enforcing person) w h YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER Q w (1) You may elect to pay the. above fine, e.,ther by appearingn •. CLERK MAGISTRATE,D'svoct Court Department.Fri Person between 8 30 A M and 4.30 P M. Monday Iryvuyn Frivay. .,:ye,•nauays,rice.vied.Oelpre r,.F Q. Firs By Division,Court Compound.Main Street.Barnstable.MA 02630.or by mad.i+q a coeck,mom'•yorder or postal note ir, the Clerk May-scale WITHIN TWENTY ONE 121)DAYS OF THE,DATE OF THIS NOTICE Th,s will operate as a final disposition of Thy manor.wr••n,,.,:�h.•,q Crm,nal,nco,d 21 tivo•,,ueLre lO cunlesl v+,s mailer na nOncnminal prOceed-ng,You may doso by making a written request to the above CLERK MAGISTRArEfur ..nly•o: ie.k Magi>valr'w•❑operate as a final dispos,t,nn,with no resultingcriminal record,Provided A"tar"'g AOeI¢rm�nabpnnva "..vu la,l lu a•I,,e mmu,,!fin p r dad any fine unposed by Intl Officer is Paid w,i,, Ine I me sOeeULed pay e Or 10 Apptlflr as specified,a criminal COm lain)may be ISSUed against you I HFRF BY ELECT the Irrsl opl'on above,confess In Inp..Offense Charged,and enr.lo Se,payment in In amotI ni Of s Sro^dl:,,e ._........... CRIMINAL COMPLAINT DOCKET NUMBER Trial Court of Massachusetts couRTOIVIsION District Court Department Bar-astable NAME,ADDRESS AND ZIP CODE OF DEFENDANT. TO ANY JUSTICE OR CLERK MAGISTRATE OF THE DISTRICT COURT DEPARTMENT: Yvette Pires 90 Quaker Rd The within named-and• undersigned complainant, on. behalf of the commonwealth, on oath complains that on tlyaunis , 11A 02601 the date and at the location stated herein the defendant did commit the offense(s) listed below. DEF. AND SEX OFFENSE COOEiSI 999 DATE OF OFFENSE PLACE OF OFFENSE !Barnstable COMPLAINANT POLICE DEPARTMENT 'lrnomas F. Gciler I Barnstable DATE OF COMPLAINT RETURN DATE AND TIME C-6-90 i SEPT. 6 , 1990 8:30 A.Ii. COUNT-OFFENSE T014N OF BAIUISTA13LE RULES & REGS. BD. - CFI L Did, as a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause , maintain, or allow a source of filth in violation of Town of Barnstable health Department Rules and Regulations. Citation #19516 dated 4-4-90 - 98 Quaker Rd. , Hyannis COUNT-OFFENSE TOWN OF BARNSTABLE RULES & REGS. BD. rO�,.A-LTIL *I - b U 1J OF FILE11 Did , as .a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause , maintain , or allow a source of filth in violation of Town of Barnstable Health Department Rules and Regulations. Citation #19517 dated 4-5-90 - 98 Quaker Rd. , Hyannis COUNT-OFFENSE TOWN O�-F-�BAARµNSTABLLEFpRULES & REGS. BD. L'AL i it 71 S CUR�ES O Did , as a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause , maintain , or allow a source of filth in violation of Town of Barnstable Health ! Department Rules and Regulations . Citation #19518 dated 4-9-90 - 98 Quaker Rd. , Hyannis i COUNT.OFFENSE TOWN OF BAR6TABLE PULES & REGS. BD. Did, as a person owning, occupying or having charge of a building or premises with the Town of Barnstable, cause , maintain , or allow a source of filth in violation of Town of Barnstable health 1 Department Rules and Regulations . i Citation #19519 dated 4-10-90 - 98 Quaker Rd . , Hyannis :COMPLAIN NT, SWORN TO BEFORE CLERK•MAGISTRATEiASST.CLERK ON iOATE? A0C17, N'.� 8-6-90 I� COUNTS + ATTACHED IX X FIRST JUSTICE COURT.a00PESS Richard P . Kelleher Route oA � gnrr)-,rnhl � e , THE CgMMONW ALTH OF MA ACH ISETTS / BOARD OF HEALTH NOTICE TO ABATE A NUISANCE I& or owner Ms As occupant of you are hereby notified to rei&dy the conditions nam d below within 24 hours of the service of this notice, according to Massachusetts General Laws,Chapter I11,Section 123: b I I If at the expiration of time allowed these conditions have not been remedied, such further action will be taken as the law requires and a fine of$20.00 per day may be charged. �S-&.�Q B Order of the Board of Health , 0 a nspector FORM S600 A.M.SULKIN,INC. REVISED 1979 ; P I III at ax � PLEASE PRINT LEGIBLY WITH BALL POINT PEN OR TYPE APPLICATION FOR COMPLAINT TRIAL COURT OF MASSACHUSETTS . TOTHE DIVISION: DISTRICT COURT DEPARTMENT . The within named complainant requests that a complaint issue against the within named defendant, charging said defendant with the offense(s)listed below. ' DA OFF SE PLI,CE OF OFFEp)¢S NAM ,ADD ESS AND ZIP CODE OF COMPLAINANTW/-" I �•.n I � _ DESCRIPTION OF OFFENSE(S) NO. OFFENSE G.L.Ch.-Sec. I- ygvlosgA �a � 2 � INAME,ADDRD ZIP COD1�F DEFENDANT U S —� 3 %& 4DOO � N � ° N s % Ioo500 L- - COURT USE A HEARING UPON THIS COMPLAINT APPLICATION DATEOFHEARING TIME OF HEARING COURTUSE' - ONLY-0- WILL BE HELD AT THE ABOVE COURT ADDRESS ON: } AT 1-4-ONLY CASE PARTICULARS — BE SPECIFIC NAME OF VICTIM DESCRIPTION OF PROPERTY VALUE OF PROPERTY TYPE OF CONTROLLED NO. i.e.OWNER OF PROPERTY, i.e.GOODS STOLEN, i.e.OVER OR UNDER SUBSTANCE OR WEAPON PERSON ASSAULTED,etc. WHAT DESTROYED,etc. $100. i.e.MARIJUANA,GUN,etc. 2 . 3 4 5 _ OTHER REMARKS: DEFENDANT IDENTIFICATION INFORMATION COMPLETE DATA BELOW IF KNOWN SEX RACE PARENTS(JUVENILE CASES ONLY) ❑ M ❑ F IS DEFENDANT UNDER ARREST? OYES - ❑ NO DATE of PPLIC TION COM�NTS R p PLEASE ATTACH CITATION FOR MOTOR VEHICLE COMPLAINT. �p (� X ® COURT USE ONLY DATE DISPOSITON AUTHORIZED BY ❑ CASE REFERRED TO POLICE ❑ NO PROCESS TO ISSUE _AT REQUEST OF COMPLAINANT AFTER HEARING,INSUFFICIENT EVIDENCE _COMPLAINANT FAILED TO PROSECUTE ❑ SUFFICIENT EVIDENCE HAVING BEEN PRESENTED,PROCESS TO ISSUE a ❑ WARRANT ❑ SUMMONSRETURNABLE ❑ FORWARD TO COURTROOM FORA RRAIGNMENT 0 ❑ DEFENDANT FAILED TO APPEAR ❑ SUMMONS RETURNABLE ❑ AFTER HEARING,CONTINUED TO Z -- - -- o! LOC&TIOPI , t SEW&(, E PERMIT UO. VILLAGE W.57 ALLE/R•S 1/J�&P/I E: ADDRESS p bUILDER 5 1TJ--//L MF- � ADDRESS VWIr/S0k DQTE PERNAIT ISSUED �`��_7-7 D ATE COMPLI W-ICE ISSUED : �� /',�7 �'�hh '� � � � .� ' �pr`� ` f i �s �h i ,� w � � � - � � � ,� � \ �/ / �/ v ,' •� �� o �• ` .t t `� o � � ` 3s� ' �• 1 No........ ....... Fizu ...'�........ THE COMMONWEALTH OF MASSACHUSETTS BOARD ®� HEAL H .... /'�t/1'1.. OF....-.......�........... . .... ................. ...............-_................. Appliratinn for Biiipoml Marks Tomitrnrtion Vrrmft Application is hereby"made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: -------- ... -----•---- t ddr >� No. -- =�-• - -- ---------------•-----------•---------------- t -- ...... .. --- -- . 9 ...... Owner f Ad ress W a Installer Address Q pe of Building Size Lot___________________________Sq. feet U Dwelling—No. of Bedrooms...__ ._._. .Expansion Attic Garbage Grinder (Nll' a4 Other—Type of Building --------------------------- No. of persons---------------------------- Showers (V) — Cafeteria ( ) Q' Other fixtures ---------------------------- W Design Flow._ r70___gallons per person per day. Total daily flow_____.____.f —0'�_..___-.-.--_---gallons. WSeptic Tank-Liquid capacitvj_-_-___---gallons Length---------------- Width------.......... Diameter__---_-------_ Depth._...__-_----- x Disposal Trench—No...................... Width... ... 4below tal Length-------------------- Total leaching area--------------------sq. ft. _Seepage Pit No.•_____ _________ Diameter. inlet.--- ___-_ _--... Total leaching area----.___-_.-._-.--sq. ft. Z Other Distribution box ( Dosing tank ( ) -'IJ,� �� ' 77 aPercolation Test Results Performed by................................................ ...................... Date____•____---_-_:-- Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water...---.---_--.-----.-- L%, Test Pit No. 2................minutes per inch Depth of Test Pit_.................. Depth to ground water------------------------ } � ...... ----------- -----------------------------------------`/_ 'Z �t/`�' �` ` Ux — ........ ---------------- W -------------- - 4-- ------•-•---•----------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable----------- ------------------------------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual.Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beee*issued by the boa of health.Signed- .. - -• ----•---•-------------------------•-------� • Date Application Approved' By..... tt------------------- -••---......•------•------------------- ------------•---• ---•--•---------------••-----..._................•........Date Application Disapproved for the following reasons: ______________ •-------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ------------------------- Date PermitNo......................................................... Issued---- ........................... Date ------------- \t - 5 - No.......{ ------• // Fes$.... {..�....... THE'COMMONWEALTH OF MASSACHUSETTS BOARD O HEA H E'Lf!f`2 ...,....OF...... _ ............................. Appliration -fur 4iipuial Workii Totes rnrtiun Prrutit Application is hereby'made for a Permit to Construct ( or Repair ( } an Individual Sewage Disposal Sys em at: dd L No. ........................... - - . Owner �� A ress W + Installer Address Q pe of Building f Size Lot.............................Sq. feet Dwelling—No. of Bedrooms----- ............... Y______________"-__.Expansion Attic k100' Garbage Grinder aOther—Type of Building --.,_._____"-_-_____-< No. of persons..__"______________________ Showers (�) '; afeteria ( ) Q Other fixtures ----------=------------- ............................................... ----------- 0vo W Design Flow._ -•-•lr� - gallons per person per day. Total daily flow.__...., ;' __._gallons. WSeptic Tank-�Liquid capacity__-_f__-_gallons Length_-_____________ Width................ Diameter_........_'____Depth_._..____-._.... xDisposal Trench—No_____________________ Width---________�4___ tal Length.-_____ ___._ Total leaching area........_...........Sq. ft. Seepage Pit No..____ _ Diameter_/_ �f below inlet____ -----/ ,� /4 G •,;`Total leaching a�t...- sq. tt. Z Other Distribution box (`/j Dosing tank Percolation Test Results Performed by-----_- ------- ----------- ............................................. Date--------------------------------------- a Test Pit No. 1-----_..........minutes per inch Depth of Pest Pit.................... Depth to ground water........ ..:_:._"-..---. f� Test Pit No. 2----------_-----minutes per inch _,Depth of Test Pit._._________-------- Depth to ground water---------------------- - . __ • Descriptio"}yf��j of.Soil(/may Y ��'//''��".�'/{� .. - ----,---,.-u.-- ---------- --- ------------------------- U or W --------------- �''------ .�A x - ----- - V Nature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------..._-. .. _ ..___.. --- .. Agreement .The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article ZI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued.by tthhe bo of health. Sign d- 14-4 4'�/ --- T� •--------•---"---------- • � . _ O •�, ' Applieation...Dsarorovedfor the ollowin reasons:._ ' ---• ----------------•--....,---------------- Date ---•---•••-•••---•----••-•-••------•------••-•---•--•---------•-••--------•---•-••-••----•---••••---••••-•--•-•----------••------•••------------------------------------------------------------------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ..........OF.......... '�2' ...........-- -- ......... 0trtifirFate of WOmPhaurr T IS TO CEaY, t the Individual Sewage Disposal System constructed ( ) or Repaired ( ) w► by - T+` ........................................................Ins ller r/ ------•-- --. �----- --------_*Tie .......................................................... at :�__.. -- _ has been installed in accordance with the provisions of A XI of / tate Sanitary Code as descr*b d`in the application for Disposal Works Construction Permit No.... ......:......1 .l ___._.. dated...._.'/ e"n�-�_________._._. THE 'ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM. YdILL FUNCTION SATISFACTORY. DATE.............. - •........................................ Inspector_._.:--............................................................................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF7 HEALTH No...... FEE__. !!a i� u 1 atrk urtiun rr' it Permission .is hereby.granted.. • • -------------------------•. ................................................ ................. to Constr c ( � or Repair ( an Ind' Idual Se g Dispos stem at No._".• ---- - .------ - k'=� s ...- - Stre as shown on the application for Disposal Works Construction it N _ _..... Dated_,-. / .......... :�_ /—�` �j Board of Health DATE :.............../---......----------"------------- ----------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - v OIL- 1` ' 1 t cX�? . ,�,►,�, ��R pro XX A4 f t _ 1 lk � F t c,i r _M :• iJ �t •1 suVO � t C-SZTIFIEI7 PLC>-r L OCAT I O" I CGtZTiP-{ TE-IAr T14C-- FcVtJ-DA-rjC)H -5"OwkJ Pt_A�l RC�cIZc�.1C C W V--Z E Girl CC.>AAPLYS WIT" TNT 51 US U► e: �•-C�r C, A►.�� SETBAC-4 WGQUIIZEME:"TS OF TNT LA�J'� COvzT `ZI (,• F BAXTEP, REC.15tc-.iliaD i.AtitC� SUZ�'�.YosZS T1415 QL-Aw IS +JOT ESA->S'O u�.1 AN US'TElZV%LLG U lWs'MdAAENT 6A) Zvm' 4 THE UFC'SETS �,IaoWlx� APPL.1 C4," r KOT es USCo To' DL:TEzMtv4& L -r Like V tC(.1A11, �GM1 Q r_.