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HomeMy WebLinkAbout0060 SHADY LANE - Health 60 Shady Lane Hyannis C •- o dp 5 P A I Assessor's office(1st Floor): 3D -- Assessor's map and lot number t1 SEP71 g�(� � N / PM Board of Health(3rd floor): INSTALLED IN W iLj4y�,.'Cj! Sewage Permit number Engineerin De � �TITLE 5 Q`oF tN�To 9 Department(3rd floor): Ia :aIO�II!lI6N'I'AL�s 'r'. , d� �o House number 4 . ; Definitive Plan A TOWN I�ECvl1LA`�iia W,PProved by Planning Board ' APPLICATIONS PROCESSED oBaea Lt•I% "8:30-9:30 A.M. 19 and 13639. :00-2'00 P,M,only ��a TOWN OF B ARNS TABLE BUILDING INS APPLICATION FOR'PERMIT TO O rA TYPE OF CONSTRUCTION t Q TO THE INSPECTOR OF BUILDINGS.* 19--�_ The undersigned hereby applies for a permit accordin to Location ; 9 the following information: I ILA V\Ck Proposed Use Zoning District — J� Fire District Name of Owner �r � 5 Address Name of Buildert� 2 P h 4P Y1G �2 � Address 0266 Name of Architect ,K I S SF. c�2:E,o Number of Rooms Address Exterior Foundation Floors Roofing Heating Interior Fireplace vk Plumbing ia q` Approximate Cost 14^ 04 Diagram of Lot and Building with Dimensions Area Fe r ; TOWN OF BARNSTABLE LOCATION ( S�di4� 1-.1�° SEWAGE # 5 VILLAGE 13,SSESSOR'S. MAP Si LOT INSTALLER'S NAME & PHONE NO. 6;-'4./S 6&05• C0VW- 62,32 SEPTIC TANK CAPACITY CJCi o r LEACHING. FACILITI:(type) p tt- (size) Co b O . NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER C3 Le BUILDER9-11 DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes __ No 7 -n9rf)q 9 c� -Z LO=0AT1014 S E W A C E PERMIT NO. l® -S /Y'.y </1! VIL;LACE UNSTA LLER'S NAME i ADDRESS 7wl /,/1� S U I L D-E R OR 0-WIEE-R DATE PERMIT I-SSUED DATE COMPLIAN-CE IS-SUED �3 v) U `� � (� � � ,, �, n _' i -� � o c �. R.. T ,d �`'' � � 0 - � �. Y THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ApplirFa#ion for Disposal Works Tonstrurtiun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (� an Individual Sewage Disposal System at: .. • -•-. ��. (� --•---•--------------------------------------- -in-Addre sLocat r Lot No. ... 4._....5,g ' �` o- Owne Address W CE>osy-; - - yL J � A"�C.: ........................................................•----......._._.....------------.......... .... --.......--- �� .... _:_.(.gy. :ti.�....'...9.Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......... ...........................Expansion Attic ( ) Garbage Grinder ( ) ak Other—T e of Building No. of persons............................ Showers — Cafeteria Q' 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........................................ Test 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--______-_-----.-_--_--. --------------------------------------------------------------------------------------------•-------......................................................... 0 Description of Soil................................................................................:........................................................................................ x V . ---------•----------------------------------------------------------------------------------------------------------------------------------------------•----.....------------------------.....----.---- W U Nature of Repairs or Alterations—Answer when applicable.....®.1`. ..... ....... f...... .................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Com ianceq s been issued by the board of health. S' ..o---- ;—------------------------- -------a�." Dace Application Approved By - �... _. �-t! f�` � ---- - ------------------------------ Dace Applicatidn Disapproved for the following reasons: -- -------------------------------------------------------- ----------------------------------------------------------------------------------------------- ------------------------- ---------- ----- ... s� , . Permit No. ` '��' Issued .-------- / - 1 ✓ �� Dace No. '':: Fzzs...'` nc�o THE COMMONWEALTH OF MASSACHUSETTS 1 -- BOARD OF HEALTH TOWN OF BARNSTABLE Appliratiou for Disposal Works Tnnstrnrtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( V�an Individual Sewage Disposal System at: Location-Address or Lot No. G fie�t,f C e r.:e site ........... v, Owner '7 Address aA.0C__ C...-:>1�1 G-i7 . c7Z �tlGtitndt�R Installer Address I d feet Type of Building Size Lot...........................S q. U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P.I Other fixtures -------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length.............!_ Width................ Diameter---------------- Depth................ xDisposal 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water_.___.___'..._......._" Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------------------------------••--••-•••......••-•......................................................... 0 Description of Soil...............................................................................--------------------------------------•-----------------=------------------------------ x U •--•-••--------------------•--•••------------------------•................................................................................-.......................................................... W ----•------•-----------------•--------------------------------------•---•-----......---•-•-•----•-----•-•------•---------------------••------•-------------•-----------••--•----••--------..•-----•--•- V Nature of Repairs or Alterations—Answer when applicable...... (-a...._CSLr�_tn_ A�.:b-----__ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compl�iaan�ce>-has been issued by the board of health. Signed=�''`"\. :�.-���� ----------- -- ------------------------ --/°2 -//-�--XS . I>are / .... L-- ------------------APplication Approved BY / -- -- �- C Dare Application Disapproved for the following reasons: ------ ................................. -------------------------------------------------------------------------- -- ----------------------------------------------------------------------- ---- ------------------------------------------------------ ............................ ------....--------. --------------------------------------- Dare Permit No. !A) FY/J-��' .............. Issued ............ r 1 ---- f ------- ................ - Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / TOWN OF BARNSTABLE Q-TEr#ifirate of Tomplin tre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by......... i'r::- ....... ---------------------------------------------------------------------------------------------- ---------------------- Installer loco S!/A �� - `�, at ........ ------ ......... ; A �- y �`'w t as - has been installed in accordance with the provisions of TITLE 5 o The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....: '--` - dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE... >/ �^......f. �7----- f-- ------- .................. Inspecto( ...... /.- - .... d--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No. TOWN OF BARNSTABLE . o0 _. _f__.�...C. v✓ � FEE........................ Disposal Vorks Tuns#rnrtinn rrmit Permission is hereby granted ;arc__....... ............................................................... to Construct ( ) or Repair (i) an Individual Sewage Disposal System atNo..----- =------------------------------------------------------------- -•-••----------...........-- Street yy as shown on the application for Disposal Works Construction Permit Dated...... ................................ sA :._/e- / �V Board ot'�Health ...... ;7' DATE.......... '} ......-�. r"�.�.......-•-•--•-----._..... FORM 36508 HOBBS&WARREN,INC..PUBLISHERS oFt �,,ti Town of Barnstable Health Inspector Office Hours Regulatory Services 8:00—9:30 * �xsTns Thomas F.Geiler,Director 1:00—2:00 s Only �Eo +a Public Health Division �__ c as_McK=Thom ean,_Director 200 Main Street,Hyannis,MA 02601 Office: 508-862`4644--:3 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: Address: _ -�� _ Map Z_,6a Parcel 3n Name: , Phone: L5'6 g, Z 7i5- 6>911 2—How4 any_bedrooms exist onyouur property now? :2— / a"Z,11 lease-inl> de_a_c_opy of your floor plans.'' I` 3. Is the dwelling connected to public sewer? YE3 %or NO If the dwelling is connected to-public sewer, skip questions 4-9 below. 4. Location of dwelling i INSIDE or OUTSIDE a Zone of Contribution to public supply wells? 5. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATERS 6. Is a disposal works construction permit on file? YES or NO 6a.If yes, how many bedrooms were approved according to this permit? Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8. Is there an engineered septic system plan on file at the Health Division? 0 or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? 2 9fz YES or NO FOR OFFICE USE ONLY %= TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY The Public Health Division has no objection to bedrooms at this property. v� cr Signed: Date: ftd eo v Inspector(Print): -- �' r- rn mot ,, Town of Barnstable Health Inspector Office Hours Regulatory Services 8:00—9:30 • rtsrnaLe 1:00—2:00 ■nn 9 KAS&NM �,, Thomas F.Geiler,Director Only Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT QUESTIONNAIRE 1. General Information: �,o S y Address: _ o -� Map;q Parcel5Q_ Name: ' t '� e Phone: _S (Q W -7 7i 5- R&g' Q �q b�draoms exist on r1_youu roertY now? _ floor plans. 3. Is the dwelling connected to public sewer? YE1,010br NO If the dwelling is connected to blic sewer, skip questions 4-9 below. 4. Location of dwelling i INSIDE or OUTSIDE a Zone of Contribution to public supply wells? S. Is the dwelling connected to an ONSITE WELL or to PUBLIC WATER 6. Is a disposal works construction permit on file? YES or NO 6a.If yes,how many bedrooms were approved according to this permit? J , Bedrooms. 7. Were any building permits obtained for construction of additional bedrooms? YES or NO 8.. Is there an engineered septic system plan on file at the Health Division? 0 or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO si ��ti� acre' Q --------------------------------------------------------------------------------------=---------------------i------- . FOR OFFICE USE ONLY t TO BE SIGNED BY A HEALTH INSPECTOR/AGENT ONLY �*t The Public Health Division has no objection to bedrooms at this property. U) C''`D� Signed: Date: o J co Inspector(Print): XsAd, r' m 1 14 o " 1 � � g � I a o f ' O r 1 �\yam d dig o �n s u+ 0 O 9 V W W Z J W O t �. t � � VW dop J 7p ti a n� Al, ZL y cli 1 O 1 � 1 'J i 01 LOCATION TOWN OP BARNS T ® ABLE VILLAGE SEWAGE INS A TAL . LERS NA SEP MF, PHONE NO. MA.P 4 LOT TIC TANK CAPACITY ` 5` cffvww LEACHING. g �. ACILI ry:(tyEe) NO, OF BEDRpOMS l� F'RIV (size���g BUILDER O �---- ATF WELL OR DATE PER OWr`ER L PUBLIC WATER MIT ISSUED: DA T,E �� COLIYLIA NC,E ISSUED; VARIANCE GRANTED; Yes v r ,, t �il,q_;�lu E r ;F7 �a s ' VA, ` a w t' STLA 4,4 �y; w � 1 d•� z� :, daurxk�e `r V I -,r6 C P:�zm : f �r's map and lot numbe :....... e. .. ............... ... ......... j w ro 'Sewage Permit num ld ber ..... . r 'NE p Z BAH39TANLE, i H . se number ................................... ..... ..................... rhea 4FrC 9�p 1639. 9� 0 MON a� TOWN OF t!BARNSTABLE BUILDING-,-- INSPECTOR APPLICATION FOR PERMIT 'TO ..... qa-P........... l . ... .. ...... .... TYPE OF CONSTRUCTION ........ �� - - ®�.��--------19J�a TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: . Location ....(QQ.:., c.,......441...........1.. wul.XZ: ..S........: . I°ki ProposedUse ....n 5.('ViC/. C. ......................................................... ZoningDistrict ......k.,:J................................................. ...Fire District ..:........................................................................... Name of Owner c1 ��.....1 ........ /� �? IR... dress ...... /v.......... Name of Builder' ..... ...Address ....... A,17V Al.... Nameof Architect ....:.......:............................................:.......Address .................................................................................... Number of Rooms .......3......................................................Foundation A ............... ................................ Exierior Y� �jqD..............................................................Roofing Floors .....!V'Y.I .!P.jP.............................................................Interior 1 �� Heating .:Vne......eyz5.r v.I ................................Plumbing . Fireplace ". .......................................Approximate. Cost .� (�,a Definitive Plan Approved by Planning Board -----------_______-----------19 Area ........ ¢..4....... ........... Diagram of Lot and Building with Dimensions Fee ..........115 ...... ..c��� ................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ,3 Xu� r0 - ���� Lo 7- 413 0 © q I • Rq 514&P L� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . ... .. .... ..... I UNITED STATES POSTAL SERVICE First-Class Mail Post4ge&Fees Paid USPS c Permit No.G-10 • Sender: Please print your name, address, and ZIP+4`;in this-box • 4 s- Town of Barnstable Health Division � 200 Main Street CD rn Hyannis,MA 02601 3 C, SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Compzte items 1,2,and 3.Also complete A. Signat re cad _ item 4 if Restricted Delivery Is desired. - Age • Print your name and address on the reverse X A62 ❑Addres ee so that we can return the card to you. B. Received by(Printed Name) C e df�'DL'l rQy ■ Attach this card to the back of the mailpiece, $ UG or on the front if space permits. T /.'� fD. Is delive iffere from"—" ❑Yes ` 1. Article Addressed to: If YES ent delivery a dre belo_� 0 � 's� ~ « SKaOy LA. -elQ \Ay l.�t; 3. Service Type') VIA.1 1 .Certified Mail❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7007 2680 0002 6701 7304 (Transfer from service is , PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 4 4! ppTHE. Town of Barnstable Barnstable Tpk s Regulatory Services Department All- "' cac' tyI 4ta RAF2NSTA ULE. �"A55. Public Health Division O0- i639, Fb MAC 200 Main Street, Hyannis MA 02601 2007 . Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO �! CERTIFIED MAIL 7007 2680 0002 6701,7304 J October 20, 2008 Al Celeste, Trustee J 60 Shady Lane 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 60 Shady Lane, Hyannis was inspected on October 14, 2008 by Jaime Cabot, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed 105 CMR 410.482: Smoke Detectors: No CO (Carbon Monoxide) detectors were observed in the dwelling. 105 CMR 410.450: Means of Egress: Basement Bedroom Lacks proper Egress. You are directed to correct the violation listed above within Twenty-Four (24) hours of your receipt of this notice by installing a CO detector on the first floor. You are directed to correct the violation listed above by pulling a building permit to install a minimum 5' cased openings without doors to eliminate the privacy of a bedroom in the basement. 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 THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable i N UNITED STATES POSTAL SERVICE First-Class Mail I Postage&.Fees Paid I LISPS _ POrmit No.G-10 • • ( Sender. Please print your name, address, and ZIP+4 In this box Town of Barnstable Health Division I � ` 200 Main Street I Hyannis,MA 02601 I L SENDER: COMPLETE THIS SECTION comPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and&AIso complete A. Signature. item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X J ❑Addressee so that we can return the card to you. B.Received by(Printed 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 1? ❑Yes 1. Article Addressed to: If YES,enter deli �a-_ below: ❑No AL VAaooa c � a3s Cl 3. Service T � 40®Re ertified ailp L1 Registered ceipt for Merchandise ,. �OzGoi ❑Insured Mail ❑C.O.D. ,> 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number -` 700? 2680 0002 6701 8455 (Transfer from service label" PS Form 3811,EebruarJ2-004 Domestic Return Receipt 102595-02-M•1540 �. . ' c. p M o OFFI CIAL p C� Postage $ Certified Fee ��OSru rviq •(P C3 Return Receipt Fee ostmark �.�,✓ Here t7� p (Endorsement Required) �„J oo � p Restricted Delivery Fee 7 �Vl 2 3 L00O p (Endorsement Required) CO —0 Total Postage&Fees ru A A�rnf Sent To '` r � r p . 2vZ ------------ p Street Apt-Ao.: c or PO Box No.�G �7 l.(d►1 v City,State,ZIP+4 Certified Mail Provides: l a A mailing receipt a A unique Identifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Retum Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 38111 to the article and add applicable postage to cover the fee.Endorse mailpiece Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. e For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking.,If a,postmark on the Certified Mail receipt is hot needed,detach and affix label with postage and mail. IMPORTANT:Save this rec®ipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 r ; FORM30 C&w HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH A 2 SXA 15(-d- CITY/TOWN = F �A VAL.-I ij 01 DEPARTMENT 0 20o r�lA, � S� . �-,► c�2�al ADDRESS °,M s0 •� Svc, 6r�y� ELEPH E Address an U•�NN1S Occupant AL e;zLe& - Floor �- Apartmen Nf o. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units_ No.Stories — Name and address of owner &L 2L -C�.c�S?ftE' t-E —COO S 0A0 lA N PL 1� Q 1J Q(S 0S W 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: Li htin : STRUCTURE INT. Hall,Stairway: ►PTO 0 Irr—i-a 5 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 V t s V P6,." ELECTRICAL Panels, Meters,Cir.: NJ O (. l.� ❑ 110 ❑ 220 Fusing,Grnd.: F 19 go AMP: Gen.Cond. Distrib. Box: Cj%Aj, Gen. Basement Wiring: 'LfEN —Cc5 CpfLA, ILL DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den i Living Room Bedroom(1), I R Bedroom 2 ,!✓- Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.: Stacks, Flues,Vents,Safeties: �1 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 O PE RJURY." INSPECTOR TITLE DATE 2� TIME 2 A.M. THE NEXT SCHEDULED REINSPECTION � ` A P.M. f 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 ordi.nary 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 pa'i'nt 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 su&f�icilties 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 insulatioh 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. Po (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 1 MR 410.503 A and 410.503(B). required by 05 C ( ) (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 occupantupon:the failure of the-owner- to remedy said condition within the time so ordered by the Board of Health. FoRM30 &W H08BS&WARREN TM THE COMMONWEALTH.OFMASSACHUSETTS BOARD OF HEALTH . A, 2 Qv rA 5L It- CITY/TOWN a DEPARTMENT ADDRESS (sob) b 6 -z - 61 TELEPHONE ' Address Iq I� I �N�L ` ANtd�S Occupant /�-n L CO LIS-TC Floor Apartmen No. -'` No. of Occupants No. of Habitable Rooms No.Sleeping Rooms _ No.dwelling or rooming units No.Stories Name and address of owner kc: Sl �-E �L a r- Cp') 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: i Foundation: Chimney: BASEMENT Gen.Sanitation`. Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: C_-v Obst'n.: �, u1K> Q a-arZFr2vUw'� qIU U32. Hall, Floor',.Wall;.Ceiliri : Hall Li"`htin� *•. Hall Windows: /t r!4 HEATING �:.. t Chimne s:�= _ mow. Central ❑ Y ❑ N Equip. Repair Ae!Gjn/�iL +�c� TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: 94T 10 jzua .M r ❑ MS ❑ ST ❑ P Waste Line: 4 c.S'tk- H.W.Tanks Safet and Ve t s �U ?A S A.r-C v 6 C(" ELECTRICAL Panels, Meters,Cir.: Imo,►C} QrF 1_-; T P,C. ❑ 110 ❑ 220 Fusing,Grnd.: F (a(2 . �f-4-or— AMP: Gen. Cond. Distrib. Box:,� 11�Y L.T lam. Gen. Basement Wiring.-.I DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom . Pe6try _Living Room r �. Bedroom(1).. �= I,. Bedroom 2 '"'W" — czz c;C• Bedroom 3 ® , G 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.: t Wash Basin,Shower or Tub: ; =^ Infestation - Rats, Mice,•Roaches or Other: Egress Dual and Obst'n: z General Building Posted NJ /A Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJUAY." INSPECTOR TITLE �* —A:M DATE z 0 TIME �+ �-�� P.M. !7 Q A.M. b-- 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 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 b 105 CMR 410.201 or improper ventin or use of a space heater or water heater as O P q Y9 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