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HomeMy WebLinkAbout0027 SAINT JOHN STREET - Health y Saint John Street_-. .-., Hyannis A = 291 026001 t ro u- 0-7 1 3 P9 I ��9���f � �`n T�c��i Qix i a/i/�i�F � �����J �o Hy �i�, SyLV65T6dL_ „sqf NW'90NIlBYN VUELL Odn 0373456 ' I i �- - _ -- W09Z0' 66Z = `d �p SWULR R (� aaa o � � �S u 4 (' �ule S,,” e Nt..,O ENDER BIER 51399 TOWN Or "" .yDDRESS�O/FOPFN -R �yy BARNSTABLE CITY,ST E,ZIP coDE "; IKE tp� -� A A '" MVIMB REGISTRATION NUMBER' ti OFFENSE H d / f j AI V ! S LU 1....�C..r a IMN\�I ANIF MASS tFO MPS► ¢ , W 7 TIME AND DAT OF•VI ION LOCATION OF VIOLATION / t '' Z ; N;OTICE OF c�M. M.) VhAIs LU SI ATUREti NFORGIN PEflSOt�_- E } EN ORCI G.D T.- BADE.NO.,,.t i N VIOLATION / V `i l t..�,� �t�l >�.& o F OF TOWN I HEREBY ACKNOWLEdGE RECEIPT OF CITATION XLU ORDINANCE ❑ Unable to obtai g ture of Df ender. r THE NONCRIMINAL FINE FOR THIS OFFENSE IS S i/} i�'It Date mailed LL+ OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P:M.,Monday through Friday,legal holidays excepted, ly before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Att:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature II NAME OF OFFENDER Q!1 ,^, • /t / DAD 6 6 310 1 TOWN OFn ADDRESS OFOFFENDER� /117 f(' Dnn p BARNSTABLE OI Y,STATE,ZIP GEODE r �� ' _� !( ` IMF MVIMB RE ISIR TION YUMSEW " OFFENS, �{�r �tSTA Ld g. MASA K�' j a - OJ w TIME AND DATE OF IOLATION LOCATIONyF�V_IOLAT 0 '� Z NOTICE OF `N�i (A,� i p•M. 0 20 v/'" �' p�Q t` SIGtJ TUR OF-E, �RCINGPERSON Ii ��? a(1,� E F RCI DST. r�' B O E�10. o VIOLATION J//yy (/ f1 //,6 C 0� �.,. // CD OF TOWN I H REBY ACKNOWL O E RECEIPT OF CITATION X a ORDINANCE Unab,16 to obtain signa 6r o offender. �- r THE NONCRIMINAL FINE FOR THIS OFFENSE IS $ J Date mailed LU w OR� YOU HAVE THE FOLLOWING 1.44ATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w REGULATION (1)You may elect to pay the above line,either by appearing in person between 8:30 A:M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, J before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. CL 121 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST RNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNS yABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due criminal complaint may be issued a ainst you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OF OF ENDER 4rJ JBAR g&in TOWN.GF ADDRESS OF�f ER t• " r. r- • r' 9s BARNSTABLE 'IT' ST TE,ZIP ODE��°� ' °„ �� 'J L_ `pfr IKE' ti ` MV/MB REGISTR TIOWNYMBER / •�-✓ P OFFENS 14A i\"l'ARI.i:.q• /// A J /h/y''1 ]yry^ p� /`j j/ � I W P �I ASS' O P I �.AG.� —:/ // / .l ! CL �p 46}9 �0 a,,,.e. f 4 - 1 - O �fO ,I pr ,r y r W" . TIME AND DA 0 ATION LOCH IO OF VIOLATION NOTICE OF (AAWa/-R.M.)O,N A44,20 , `�"In_rt e d,��1.., r HA Q SI TUR6'OF ENFORCING PERSONS b EN BRCING DEPT. BADGE r • rw VIOLATION91/Cf.� fi' .�Qk t F OF TOWN I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X / LU Ii _-ORDINANCE Unable to,obtain Sig offendef. Ia Date mailed L 'f _y THE NONCRIMINAL FINE FOR THIS OFFENSE IS S W LU OR YOU HAVE THE FOLLOWING ALRERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION a (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, J 4f before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, a t Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST r BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME 05t©FFEND R;*Jr JI j� BAR 5139 - TOWN 00 ADORES NDERjn BARNSTABLE 111Y,STATE,ZIP CO E �dF tME f MV/MB.REGISTRATION NUMBER fLU P_ MASS. C _ CL �fD MPS I, J W TIME AND DATE OF 1 LATION LOC`TION�O�VIOLVIOLnn.TION L�,/p Z i+ NOTICE OF' ,I ,. �;/r��i�' lr �'al�, 1 �+Ilir '; W SIGNATIJ E OF ENF CING PERSON ,;}/ / �� p E FORCIN T. p BAD�rN�O. W VIOLATION r' 1 lY 1 -xl�� i� 111 OF TOWN W REBY ACKNOWLEDGEyRECEIPT OF CITATION X a ORDINANCE X Unable to obtai siknat re f offender. Date mailed f1'7 .--� THE NONCRIMINAL FINE FOR THIS OFFENSE IS S of _ W OR YOU HAVE THE FOLLOWSNG ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION 111 You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,orb mailing a check,money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 12)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA02630,Aft:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. 13)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature NAME OFOFFE /R;` /,} ,j �j M j�("ti BAR 6630$� TOWN Of, ADDRESS OFOtF,fF•eE`INDfR , �,lwllAf/ �rS,�/ JA1F/ I��J BARNSTABLE CITY,STATE.ZIP O°DE( t ,/� ,/,j/ - p/t _J /•�� of THE► MV/MB RE ISTTRATIGNNiNUU/MBER mAss, OFFENSE / I /�f V I S !ACE E PCC V if T a ��./,1 Y QCL IIARNSTARI.1.. - W tE0 MPS w W z TIME AND DATE OF,VIOLATION 1� LOG TI,N OF,VOLA�TLON• / ; yJJT '� Z NOTICE OF (A-M./ P.M.)9QN nl� ,20,04 � `�;/ � l I - 0/ SIGN URE0 ENFO�ING P.ER.ON Y i f EN�dRC�G. FF° 8�a•GAF NO. / N VIOLATION �/ /�f`r'. "1 ,aTIi6o'�^� ALC/GG.�.'"�� �i � tY /, O OF TOWN I— I HEREBY ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE ®�Unable to obtain sig atture of fender. < o�'`r�1 _ THE NONCRIMINAL FINE FOR THIS OFFENSE IS Date mailed LU rcr'-•' W OR YOU HAVE THE FOLLOWING ALTIERNNTIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL DISPOSITION WITH NO RESULTING CRIMINAL RECORD. W REGULATION (1)You may elect to pay the above fine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, J before:The Barnstable Clerk,230 South Street,Hyannis,MA 02601,or by mailing a check,money order or postal note to Barnstable Clerk,P.O.Box 2430, a Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. (2)If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT,FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:210 Noncriminal Hearings and enclose a copy of this citation for a hearing. (3)If you fail to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due criminal complaint may be issued against you. I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature BARNBTABLF- Town of Barnstable �Ar 059. Regulatory Services Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 6,2017 Suzanne Landers 27 Saint John Street Hyannis, MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property occupied by you located at 27 Saint John Street, Hyannis, MA was visited on July 5, 2017 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter. 54 Building and Premises Maintenance were observed: 04-3 (A) Outdoor Storage Large amounts of items were observed which were not screened from public view in accordance.with the Chapter 54 of the Town of Barnstable. The items included, but were not limited to: broken chain link fencing, old pieces of wood, old cushions, tarps, plastic containers and other assorted debris. You are directed to correct the violations within fifteen (15) days of receipt of.this order letter by disposing said items or storing all mentioned items from public view or in an enclosed structure. 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. P + RDER OOF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public:Health Town of Barnstable 71 Town of Barnstable Public Health Division : U.S.POSTAGE„PITNEY 60WES 200 Main Street ` Hyannis,MA 0260 0.7:AA. '17 i ➢' ®® _ •��: ZIP 02601 006.56° �- 02•.4r.. 0000336455 JUL. 07. 2017. 7015 1.730 0001 4990 2654 ..._ /J�1/�,}�✓v��,---cam - b 0 � m ! ,t 1'11I'►�,t�,;j,�1,i� �,lf1}J�„f }i 7I LISPS TRACKING# R.1 is aid. I 9590 9402 2480 6306 :7772 20 United States •Sender:Please print your name;address,and ZIP+4®in this box* —— Postal Service— Town of Bamstable' �Oa Health Division 200 Main Street - Hyannis, MA 02601 I �silI11,1�11+eel;1�'i'1'!1.11tii!!llltlill',.11II,il1-1�11d.111'Ii 1i SENDER COMPLETE THIS SECTION. J, COMPLETE,THIS SECTION ON DELIVERY s Complete items 1,2;and 3. A: ' nature s Print your name and address on the reverse gent so that we can return the card to you. dressee 1 Attach this card to the back of the mailpiece, B• Receiv y(Printed Narrie) C:_Date el' e or on,the front if space permits. 1, Article Addressed to: D. Is delivery address different from item 1? El Yes If YES.enter delivery address below: O No 1-� 0-601 11 II I illlll I'll 111 I III I Il ll I I I l llll( II I Illll III 3. Service Type ty Mail Express® 0 Registered O Adult Signature Registered MaIIT^^ ❑Adult Signature Restricted Delivery p Registered Mail Restricted ❑Certified Mail® Delivery 9590 9402 2480 6306 7772 20 ❑Certified Mail Restricted Delivery Q Return Recelpt for ❑Collect on Delivery Merchandise —• — ��^ ;r use. moo_„; _i�hen � 0 Collect on Delivery Restricted Delivery ❑Signature Confirmation rm II t ❑Insured Mail ❑Signature Confirmation i,015 1730' 0 0 0'1 ` 4 99 0 2'8 5'4 o Insured Mail Restricted Delivery Restricted Delivery (over$500) PS Form_3811.,.July 2015 PSN 7530-02-000-9053 Domestic Return Receipt Y Town of Barnstable BARNSTABLE, � � J Re ulatory Services afFp MPl Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 6,2017 Suzanne Landers 27 Saint John Street Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS,NUISANCE CONTROL REGULATION NO. 1 The property occupied by you located at 27 Saint John Street, Hyannis, MA was visited on July 5, 2017 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted in response to a complaint filed with,the Public Health Division. The following violations of the Town of Barnstable Board of Health Regulations, Chapter 54 Building and Premises Maintenance were observed: 454-3 (A) Outdoor Storage Large amounts of items were observed which were not screened from public view in accordance with the Chapter 54 of the Town of Barnstable. The items included, but were not limited to: broken chain link fencing, old pieces of wood, old cushions, tarps, plastic containers and other assorted debris. You are directed to correct the violations within fifteen (15) days of receipt of this order letter by disposing said items or storing all mentioned items from public view or in an enclosed structure. 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. P RDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. Director of Public Health Town of Barnstable No r THE COMMONWEALTH OF MASSACHUSETTS --�� BOAR® OF HEALTH _ / ld 0....OF..... _----------------------- ,� iratinn for DispogFal Workii C umunruou amit * Application is hereby made for a Permit to Construct ( ) or Repair (1 T an Individual Sewage Disposal ystem t: ...... .. .... ...� _...-��'-_�........................... .....................•--•--•----•....___.-•-•----- --.-•--•....__•------..._..-----............__ .57 L on-Add es r Lot No. .... -� :........................- ~� � /'�/`/•� n• �p�/ q•� �/^ .....................•---•-----.Address 1.d_ - __________- ---••------•--____- Installer Address dType of Building Size Lot............................Sq. feet aDwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p-i Other—Type of Building ____________________________ No. of persons.........___________-_______ Showers ( ) — Cafeteria ( ) Other fixtures ________________ _________________ W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal,Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit..................__ Depth to ground water...................... Test Pit No. 2________________minutes per inch Depth of Test Pit.................... DepI...................................th to ground water........................ tx -•• - - , O Description of Soil_-----_- - �/.... ._.d 4 /----------------------------- ......................................................... .... - -- -- -----------------------------------------------------------•---------------------------------------------------- ----------- U Nature of Repairs or Alterations—Answer when applicable.__.__ ' .,/f/��� 1_ ,r` --- I-•-----------•--------•---. .............-..................................................-•------------------••••----.......•---•--••••-•--•••---•------••-•----••-•-------•••----••-••-•---•--•-•-•---•-•---••......__.._.._._. Agreement: ! The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iIT 1: 5 of,the State Sanitary de— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ee issued by the ar o lth. Sig ed- 1"` (/ G0 + , ! �9 -a. ---•--- �� Date Application Approved By .... . G ----_• l`Da:te = � -- Date Application Disapproved for the following reasons---------------------------------------------------------------•---•--•---••-------•------•---•-•---•......._.._ •------•-------------------------••-•-•••-------•••--•••-------•-•-•-•--- ---------..._ Date PermitNo......................................................... Issued........................... Date No.----•---2-•�!...... Fps�::.:�.... :�.GGG'6.ti�.... THE COMMONWEALTH OF MASSACHUSETTS m BOAR® OF HEALTH , .U,?�:. ).....OF.....o�,..-:.:..,...fi.. ._ k�-.f� .......................... Alip iratiou for Bhipoii ai Works Tomitrurfi v it rami# Application is hereby made for a Permit to Construct ( ) or Repair (1--) an Individual Sewage Disposal System at: ..... ..� ?r�... .' ..3 ` .:........................... ................. -•--•------.......... ..._......------•-•-----•-----------..... Location Address a or Lot No. - a fop -------- ............. -----------------•-------------•---------•-- s"1 Owner `-• Address a ................ ���'����� ��✓� �_�' :. ..................•---•...---••--•---•-•-- •••--•._....__......•-----------......._........_..... Installer Address PQ U Type of Building Size Lot............................Sq. feet . F: Dwelling—No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ............................... . . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter......--........ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----_--------------- Diameter.---.--.----.------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-� Percolation Test Results Performed by..........................••--•---•------•--------•---------•-----•-•----. Date........................................ aTest Pit No. I................minutes per inch Depth of Test Pit-.-------_---_---.__ Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ?» D Description of Soil----------` V ...............................................•-•-••--•--•---.....••-------•----•--•----._._.....--•-._...-••------•----•-----•---•-------•••-•••--•---•-............................................. ....................................................................................................................................................I.........................__ .;- ................. U Nature of Repairs or Alterations—Answer when applicable----_�:" �F--'6 ........................ .: ........................ ..-------•-•-------•--••••--------------------•------------•-•---••-•----•-----•-----------------------•----•-------------------•-•-•---•-•-•--------------•---••-•-••--•------------•-................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1 p 5 of the State SanitaryQode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has 'ee issued by the,boar of ealth LSig ed.r tir. �( Date Application Approved B - -- --- -- -- ----------------•--••------ •--- Y------•---- Date Application Disapproved for the following reasons:......... j 7 Date PermitNo...................••--••--...._........... ------•--- Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH °�? ° �°.. . .,.�s b� .. .: +�c, '.........?�...;........................ ....... ..�.....:::.. ®F... �ler�ifirtt#r oaf f�rrm�li�aatrr THIS IS TO CERTIFY, That the Individual�Sew age Disposal System constructed ( ) or Repaired /by �. =,t i t =.. I. t, 1 ' ja_.. '. .Z .. .`.>a... --..a ��--- ---------•------ -:e- --------------------------- Installer r at...:If 2_.kk_ �._+.y. A gy-----•.. ...... A '� . ............................................................ at r ' has been installed in accordance with the provision of T L j,of,T� State Sanitary C d�e as es ed in the application for Disposal Works Construction Permit No ....................7!_.-..____. da.ted.--. ....-(...�.----.-T!............. THE ISSUANCE OF THIS CERTIFICATE PL;SHALL OT BE CONSTRUEy�® Ay�S,+A GUARANTEE THAT THE ` '^`���% t 'SYSTEM WILL FUNCTION SATISFACTORY Y�atF pDATE ` �J ... .... ........... .......... Inspector.... .......• Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH" 7� / 01 d� ................OF.... r _ ............................ f No. ..... ..... FEE. ...... t Per"mission is hereby granted__:_: ". ' s .................................. r to Construct, ( ) or Repa>r (, an Indiviva Sewage Disposal System ` at No..... ' ....................•---•--•-•-----• � 6 W. ,�, as shown on the application for Disposal Works Construction StZZ t Dated...........................................� � -17 __. - --Board of Heal -- .-•----------------------- --_ DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ,, C)4 H FORM 30 ,w HOBBSB WARRENTM THE COMMONWEALTH OF MASSACHUSETTS / rA6 L BOARD OF HEALTH I Li CITY/TOWN (C, o DEP RTMENT 'o ADDRESS G,,M SV By`ew TELEPHONE Address ��C�in -_ Occupant a lS Floor Apartment No. No. of Occupants ��_ No. of Habitable Rooms No.Sleeping Rooms___ No. dwelling or rooming units _ No.Stories-- Name and address of owner_� �"��_�_���-� o4 7 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: oo ,a 6AS r¢41- n J5VII Drains: ( ei Walls: -- 1 S e• C c ki C -6rjo sw 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: Sup ly 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 14W Bedroom 2 No` v-r' NO can yerviricu a)..w,,, Bedroom 3 IVV W un Bedroom 4 I �► � 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: a aK_ zge P om,l• General Building Posted ems ,a .un.•, w csial c Locks on Doors: 4-- Ice rc,,ove- +b- pvy,ke e,L,5t, Rog, ace o ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE 00 S5 OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) 'Mr "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND r PENALTIES OF PERJURY." 1, 0 p4V_r vI '(a fi on_s 1;3tZA r"Qru J k,44 Of �e ' INSPECTO TITLE DI�PL� O Alk, jj A. DATE tq TIME Em M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. .. z. . s r _. w'r•ww.i .K.�i:w:y�3r'J:r!+AA,S�i�'±Ph:�lwt'rn+'�I����r('�t�.r{ �ati1pF'1.tx::?vi.'E.gfr '�R,��iNrSfi�ibnf�na••;:i,.u..y.-,tyb,;,:,,,w,x nn.. n_. .. .-,.. ..rr.,�.� 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 s pec if ic'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 i N* 4`07� C6,1 -- FORM 30 ,� !� HOBBSB WARREN n THE COMMONWEALTH OF MASSACHUSETTS r-,i I,L& BOARD OF HEALTH " /' CITY/TOWN W CJ ubl rc. 4� o DEPARTMENT 'o ADDRESS —6+41 \ G - TELEPHONE Address_:,I Occupant Ilx✓.� --- Floor Apartment No No.of Occupants 3_ No. of Habitable Rooms—_ — -_ No.Sleeping Rooms . , s No.dwelling or rooming units _- - . No.Stories 14 _r ' Name and address of owner 5 d4 vi .�. G l.4 27 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: boo t�.r,V a k0a r ,." r044 mil'-re G O Fb r f I 4ij 6'utters, Drains: 1 r yeA `J _ Walls: -- ' n �— •1 S r w 6 AAA i tk -6 D 4,1/0 5-0% Foundation: J r Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: .. Hall, Floor,Wall,Ceiling: } y Hall Lighting: Hall Windows: HEATING 'Chimneys: t 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 Pantrysue,,a a rY�Dr► Den Living Room Bedroom 1 , NW Bedroom 2 X X NO ,Iafi c(;Ar" � t�►D acl��vn 10a9)VA'N a) w4"4 Bedroom 3 p vv 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: �,a�tia l- :SVj( .n•4- � ,,►L,�•.�c r��ks rMCSdrt•.,a.s General Building Posted ;Alw ! t•,rVcra,M r z alc)u hrv� Locks on Doors: }fl V rcw'OdeAl f•p P,Oylc en,Atl ),ox 5o. k�a ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE 1S A CONDITION WHICH 'Z Ort"�td MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE (000 Srj r OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE �, ✓^� AUTHORIZED INSPECTOR.(See Over) �� '.•�.. "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." r (� INSPECTOR- TITLE DI�Tdy- of 4/k fUtk­ / A.M. DATE TIME A.M. THE NEXT SCHEDULED REINSPECTION P.M. ,.. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions,when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of 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 ( ) P PP Y q Y P P Y 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 4.10.452. (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 Caw HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS UNIA/WifA- BOARD OF HEALTH / Tn S�b1� CITYITOWN C - a DEPARTMENT Q Q IVIa,. , ADDRESS �M s/ TELEPHONE Address Floor Apartment No. qb.of Occupants J No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner MeA . - ,� ?. a 1 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 6 .5h r•; Containers: �� Drainage e Q-A ,^ fn 11 t, Infestation Rats or othe . car, 6 STRUCTURE EXT. Steps,Stairs, Porches: , Dual Egress:and Obst'n.: LgA11"A rd ❑ B ❑ F ❑ M D Windows: JP_6rts ,6, stv R o_ s _c 1 60 Walls: r ' zz FoundAon: Ar4&fAlr n L041'' k 4. _ n1114 'r', c / QQ Chimne . r. �ro F Soo BASEMENT Gen.Sanitation — Dampness: Stairs: rz� n Q �F+-c sum cap. Li htin 10 ,, OVHCOKE e'C JQ STRUCTURE INT. Hall,Stairway: 4e bst'n.: f O14. u d c ^;#'_FTattx?ss a , loor,Wall,Ceilin : 10 Gh,►& Hall Lighting: Hall Windows: HEATING Chimne s: c 6eYe g Central ❑ Y ❑ N E ui . Repair i4 Se c� TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: ; S n a H.W.Tanks Safety and Vents r, u V w-el S 15� „ ELECTRICAL Panels, Meters,Cir.: 5 e „�l� \ ❑ 110 ❑ 220 Fusing,Grnd.: roe Z„ _ S a AMP: Gen.Cond. Distrib. ox: z1g n reSM,evT, t;' -.\A Gen. Basement Wiring: DWELLING UNIT p s 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' kin , Stacks, Flues,Vents,Safeties: eeG 0 Kitchen Facilities f ,.y , Stove 0 Qe Drb y, Bathing,Toilet Facil. 'V Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation R Mice, Roaches or Other: Egress Du a ` bst'n: VIVAIK�, S seye-el Pe - e a�►► 40 �, a F General utldi or- , -2; p,'V\ lLe s 4-0&S Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH Sc � s MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE_ .hmr� OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE 10- G AUTHORIZED INSPECTOR.(See Over) 7�s�c.he'J "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND J PENALTIES OF PERJURY." ---" INSPECTOR TITLE 6 rt?C-/W �� T��� / '� c'6 DATES/ / Z• 3C1P r�I TIME A.M. THE NEXT SCJiEDULED REINSPECTION P.M. z..w�+,iyc•uat. .ns'hts''�{'9i, ,c$«. A5!'7rt} �:..�Ar, ..,. ,R,, � r> T - 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 4.10.300. (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. l " r pbs �'� FORM3O H�� HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS 4/YjA/l„r07'kD BOARD OF HEALTH re)5, bt2 CITY/TOWN OCatlth DEPARTMENNT00 ,,�,, 'c,M ADDRESS (,J SV< . TELEPHONE — - Address �_ Tt n.n�s_ Occupant_ _��! S { Floor r , Apartment No. PO4 of Occupants_ 15 No. of Habitable Rooms_ _ No.Sleeping Rooms- 'S No.dwelling or rooming units_ -_ No.Stories j Name and address of owner____ c1k+n-- .__ `7-7 Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 6,L iSh 4 46r;--c- rwN e-roa A, 11 Containers: . lo uAr ¢ Drainage ©r�} M i k�lc 4 s M.(- Infestation Rats or other:" 4, ub STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ' ti' _ c- ,A c ❑ B ❑ F ❑ M Doors,Windows: P.10 t3j- a 643 -f1 wisw}. rRoof \ J(,:. r4f,_%4e, G tt s ra°ins. cdS t r►1�e mil}` n +s :I��+ 40 Coo , c�,.•IaNsrr a FOUnda#�On: c�I e� Rs7 J� rr� 4. ��' ar�A��.-a, _Q `/ria ��16 Chimne T:tv Alora on tan n Ir ry F_ 1 SAA BASEMENT Gen. Sanitation� �x ' 7J Dam Hess „ r 2,L�2"'Xn 1tUri h+e1'�7!`rA�S Y.S�•o�cQ eMt� . _ -Zr Stairs: et, ,, � �Iac44,1 kJAAl SAJ amid mod' Li htin : .-tools d:-),10 ar STRUCTURE INT. Hall,Stairway: 4e (g,-/cA , r Obst'n.:!) —C ,nnr Is, e f ",rWNd 4ccessl6L # Fial'1 Floor,Wall, Ceilin ek,Id. J Hall Lighting: Hall Windows: HEATING Chimneys: , No )WV Pr4V, AtCQ rcryeral "hu,r Central ❑ Y ,' ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: ,,.4fin, r r PLUMBING: ' Sup ly Line: , ❑ MS ❑ ST j ❑ P Waste Line: H.W.Tanks Safet and.Vent s r� .�� u/ Iuwt�ws �sMcn ELECTRICAL Panels, Meters,Cir.: _ ; s p0110 ❑ 220 Fusing,Grnd.: ---"S POA n s e'd Ar*1a AtW e)1C 1�.v►'a cr41 AMP: r Gen.Cond. Distrib.`3ox: _ Q�� (e5}.r, '14 Gen. Basement Wiring: r „ o F ",_4 . DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 f , Bedroom 3 ' Bedroom 4 Hot Water Facil. Sup.Ten., Gas, Oil, Elect. riv 1n> i- c�rhx,ked , Lj IStacks,.Flues,Vents,Safeties: 44W(,W +A e C"11 c,4 a r Kitchen Facilities d,k-S-rnk-;,,` (0 Stove) No 'SWvP_ or-bv Bathing,Toilet Facil. 'Vent�'Plumb.,Sanit'n:: ,• I► Wash Basin, Shower or Tub: Infestation Rs.Mice, Roaches or Other: Egress e"Na''aZObst'n''� Wa)K,, ,s seY&r1j re shv^tb*t !l ►atr cwll.�5 cle 40 General "-BuildinyPosted" MVd lhatn 0 4*k*. 411- Iilto ?,'4 PAN 444 s4 Locks on Doors: .15*-At7Imo' A,_ 'Anw' )L-wo 14ti ?5114- ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH NYC` MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE � �,y"l OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) �,%s�,�,�,,,1 "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR ak ' TITLE DATE i-1131YO l Z4 TIME A.M. THE NEXT SC EDULED REINSPECTION i 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. No.a.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OFv1 HEAILT�rtJ-1/f ------.._f.l� / ......OF.............'�l�L.�i�.���_�1/-.L.`�.�..................... Appliratiun for DiupuuFal Works Toustrurtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (I-'�an Individual Sewage Disposal System at: ....a.....�'.._'2 - 1� . "....... ------------------------------------------------------------------------------------------------•- .--___-__...Lo..... -Address .............................................Lot ... - - ------ --------- ------ r� / O ner Address Installer Address Type of Buildingll Size Lot............................Sq. feet U Dwelling�No. of Bedrooms................................. _Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ..................... W Design Flow.............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-----------------•------------._......---------------...-•••-•......-•-•- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_.______-____-__---___. �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ r+ '•---------- --------------- ------------•--- ----------._...------------------------................................................................. O Description of Soil........ ._..___.� � ------------•------------------------------------------------------------------------------------------ x W ..........................................----••------------------•------••---••••-••-•-••-•......__...--•-•-... U Nature of Repairs or Alterations—Answer when applicable-------/�__Z_.._ ;" -_Q_ ld ................... --------------------------------------•---------------------------------------------.....----•----------------------------------------------------------------------------............_......--••••••-•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary,Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n issued b the oard f health. Signe yr�� -----••••. .........................� ApplicationApproved By........... ---------------•-----------------.............•••............._..•••.-- .... �/ y Date Application Disapproved for the f of ing reasons---------------------------------------------------------------------------------------........................ _..--------------------•-----•-Date PermitNo................................................... Issued....................................................... Date I�r.�Yraa�a� �..�..........._._._. - ------------------------ THE COMMONWEALTH OF MASSACHUSETTS �. BOARD OF HEALTH ApplirFation for Disposal Works C>zonstrurtion Urrmit Application is hereby made for a Permit to Construct ( ) or Repair (P l an Individual Sewage Disposal System at r, } ..... .........t: ::. . -= ..............................-..................................•....._.......................... Location-Address or Lot No. 1 .---...---- .............. -•--------- ...... ._... Og ner r s .Address....--•---...... ................. !IG__. ....r f.4e..........���� ... .........................-- Installer Address Type of Building Size Lot............................Sq. feet �., Dwelling�;<o. of Bedrooms..................._........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No, of persons_____`..................... Showers ( ) - Cafeteria ( ) � Other fixtures W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length________________ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total.leaching area....................sq. ft. Seepage Pit No-----------_---_--- Diameter..................._ Depth below inlet....._.............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ' aPercolation Test Results Performed by...................................................................••-•-•• Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Description of Soil_.______ &- rG /� , •-__--• V ............................................................................................................................................ ............... W 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 T I.LE 5 of the State Sanitary,Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beT issued b r he oar f health. f Signed r ' . + j ZA99 �--• -_ Date Application Approved.By.......................------- ------ --------------•--------------------....-•-••-•-- ate Application.Disapproved for the f of ing reasons:----••-•--•-•---••-•--•• --•--••--••---------•---•-•••-----••-••••-----•--••---•••--•----••-------•---•......._ Date PermitNo.............................•---••--------•------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' 51 # 4 err iff rtt �e of TompliFana . TS'IS T CERTI That the Idwldual Sewage Disposal System constructed ( ) or Repaired at•-••`;----- ��---- '} v........+ � i Installer has been installed in accordance with the provisions of TITLEI 5 of The State Sanitary Code s SVscribed in the application for Disposal Works Construction Permit No '' ___________ dated__ .._.�. ------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED ASiJArr�RANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................... ................ Inspector_..---- ............................................................... THE COMMONWEALTH OF MASSACHUSETTS -.- BOARD OF HEALTH `. .. o No............. FEE.. ................... -Dispos 1 o0 T_ r Uaat� rani# ar Permission is hereby granted_._ : C ° ,�` I to Construct ( ) ora, 'Rep an Indivi u�aewa e_pisposal S,y$em � r n atNo... �' !.......................... ......•'.--._._.__--- �nr ¢ ,rdd ................................ •r . ... Street,: as shown on the application for Disposal Works Construction Permit No..................... Dated....... :_._.__...._____........ -r � a ........................•-.._...------------oars -- l- 'ea••------ ------------•- --------- ------------------------------••....__....._.._. Board of Health DATE-----------------••-•------•--- Y FORM 1255 A. M. SULKIN, INC-, BOSTON �. LO ~ AT10 SEWAGE PERMIT NO. VILLAG Lxazv-ol I N S T A LLE 'S NAME i ADDRESS F�W/a/LI// C 0 U I L D E R OR ER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED __ _ �I .. ., a o �@�� '� � �, :,� ' 1 � ... .� J