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HomeMy WebLinkAbout0035 SUFFOLK AVENUE - Health . .- ... _ Suffolk Avenue Hyams 122 f o ' X i { i 8 e o Health Department Drop-Off Hours: 8:00 AM — 4:30 P.M Town of Barnstable Received by Health oFT"E' � Regulatory Services Department on Richard V.Scali,Director BARNSTABLE. ' . ;�q ,0r Public Health Division �fDN1P�� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE Property Address: Assessor's Map/Parcel Number: Applicant(s) Name: IN`�� �t '� i( !Soo Phone: E-Mail: L •� �Vn) � Size of Lot: 2a. How many bedrooms exist at your property now? 2b. How many bedroom are you planning to add as part of the Accessory Affordable Apartment Program application? 2c. How many bedrooms total are proposed at this property (including the Accessory unit)? 2e. Is the proposed Accessory Apartment contained within: _ the main house; OR a detached structure 2f. Submit floor plans for all buildings on the entire property. Show all existing rooms in the dwelling and the proposed accessory apartment. Label each room clearly. Label measured width of all open doorways. Use straight edge for hand drawn plans and be sure all labeling is legible. Signed: 1 Date: 1 z ACCESSORY AFFORDABLE APARTMENT SEPTIC QUESTIONNAIRE FOR STAFF USE ONLY 1. Is the dwelling connected to Town sewer? ❑ Yes It No 2. Dwelling located ❑ INSIDE OUTSIDE the Saltwater Estuary Protection Zone 3. Dwelling located ❑ INSIDE ❑ OUTSIDE public supply well Zone of Contribution 4. Dwelling is connected to ❑ ON-SITE WELL )n PUBLIC WATER 5. Disposal works construction permit on file? Yes ❑ No ^1 03 6. If yes, how many bedrooms were allowed by this permit: bedrooms 7. Were building permits obtained for additional bedrooms? ❑Yes ❑ No 8. Engineered septic system plan: �� k a. On file at the Health Division? . [] Yes ❑ No b. If proposed accessory unit is detached from principal dwelling, is that plan on file? ❑Yes ❑ No 9. Existing septic system capacity is bedrooms For the accessory unit to receive approval from the Health Department the following action must occur: ❑ Existing system accommodates proposed additional bedroom(s) ❑ Upgrade existing system to accommodate additional bedroom(s) ❑ Must remove a bedroom from the main house ❑Must connect detached structure to the existing septic system ❑ Must install septic system for the detached structure enoK �•r +�CS �c �/ 71.��3� ro0►tl' Sign Date Z O 2 c r A c 2 F ' i � r rTr . z E z G � U Q 8Q5- ► � 7 X IK X p Z A z -1 o 0R i U R --Cl ;U 2 E 4� �G V -P. O -- .1 /s -d zz_Z - r r Z � lE I O Z tA z � r i D � Z z � c i '� 1 COMMONWEALTH OF MASSACHUSETTS d EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' DEPARTMENT OF ENVIRONMENTAL PROTECTION + d oW �qM See TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Ss Property Address: #35 Suffolk Avenue Hyannis,MA Owner's Name: Amarildo&Raquel Marques Owner's Address: #35 Suffolk Avenue Hyannis,MA r. r� Date of Inspection: 08/19/05 ' r�s Name of Inspector: (please print) Mr. Carmen E. Shay ` Company Name: CAPEWIDE ENTERPRISES,LLCE Mailing Address: P.O.Box 763 - ; Centerville,MA 0632 C s Telephone Number: (508)-428-4028 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the.inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant_to Section'15.340 of Title 5(310 CMR 15.000). The system: XX Passes P�tN OF,ygs Conditionally Passes yid sq�, Needs Further Evaluation by the Local Approving Authorit c�' CARMEN sN Fails E. �. . SHAY c; Inspector's Signature: Date: 8/19/05 cFgT1 % �FS�15PE� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Hea DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments 2' Liquid observed in Leach Pit#2. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 - Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills.MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No XX Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool XX Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool XX Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool XX Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow XX Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped XX Any portion of the SAS,cesspool or privy is below high ground water elevation. XX Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. XX Any portion of a cesspool or privy is within a Zone 1 of a public well. XX Any portion of a cesspool or privy is within 50 feet of a private water supply well. XX Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were an of the system components pumped out in the previous two week Y Y P P P P s • XX _ Has the system received normal flows in the previous two week period'? XX Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up ? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site'? XX _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? XX _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no XX _ Existing information.For example,a plan at the Board of Health. XX _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] i Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: #35 Suffolk Avenue Marstons Mills.MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: Unk. Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None Available Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: March 1993—2"d Leach Pit installed- per Owner&BOH Records Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast iron _40 PVC XX other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 24"to Top of Tank Material of construction: XX concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 5' deep x 5'wide by 8' long (1,000 gallons) Sludge depth: 4.0' Distance from top of sludge to bottom of outlet tee or baffle: 2' Scum thickness: i/4 inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: Measured Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Structural integrity of tank was ok. No evidence of cracks, leaks, or water infiltration/exfiltration. 4" PVC Tee present at inlet end. Outlet baffle present and in good condition. Liquid level equal with outlet invert. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): .„�,. 7 I Page 8 of 1 l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: XX (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_ Comments(note if box is level and distribution to.outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): D-Box Present—one outlet,no evidence of significant carryover. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills.MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: P Y Type XX leaching pits,number: 2 leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions:_ overflow cesspool,number: innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): No evidence of hydraulic failure of septic tank or of leach either leach pit 2' Liquid observed in leach pit#2. Covers located and removed as part of inspection No Riser present on either pit Top of each leach pit is 38" below ground. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.): r 9 r Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. Swine Ties: Tanbark Road A- Tank In— 14.5' B- Tank In—23' A-Tank Out— 12' B-Tank Out—28.4' Water Line A—D-Box— 11.5' B—D-Box—34' A—Leach Pit #1— 15.5' B—Leach Pit #1—41.4' A—Leach Pit#2—29.5' B—Leach Pit#2—42'4" Exist House A D-Box each Pit#2 7 Septic Tank (1000 Gal.) B Leach Pit#1 0 Page 11 of 11 R OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: #35 Suffolk Avenue Marstons Mills,MA Owner: Amarildo&Raquel Marques Date of Inspection: 08/19/05 SITE EXAM Slope Surface water -'/2 mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water 18' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: XX Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Quadrangle of USGS Map. Per USGS MAP PLATE 2: Elev.of Ground=Elev.-35 Elev.Of Groundwater=Elev.-5 Feet Elev.Of Bottom of Leach Pit 9 Feet below grade or Elev. -26 Therefore: 26-5=21 feet separation between Bottom of Leach Pit and Groundwater. Groundwater Adjustment using Index Well SDW-253(Zone C): 2.6 feet Adjusted Groundwater Separation=26'—7.6= 18.4 feet between bottom of pit and ad*.groundwater Grade=Elev. 35 feet Pit#1 Septic Tank Bottom of Pit=Elev.=26 feet Adj. Groundwater=Elev. 7.6 COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS d DEPARTMENT OF ENVIRONMENTAL PROTECTION a ,e�M SVOv MAR' 9 PARCEL, - LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 35 SUFFOLK AVE HYANNIS MA 02601 Owner's Name:DOMINIC CAMMARANO RECEIVE® Owner's Address: P.O.BOX 910 ONSET MA 02559 Date of Inspection: MAY 12,2003 MAY 2 7 2003 Name of Inspector: (please print)_SEAN MCGONAGLE TOWN OF BARNSTABLE Company Name:M.S.S. HEALTH DEPT. Mailing Address:_603 FERRY ST MARSHFIELD MA 02050 Telephone Number: 888-810-9104 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: _XX Passes Conditionally Passes Needs Further Evaluation by.the Local Approving Authority Fails Inspector's Signature: Date: The system inspect r"shall copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:35 SUFFOLK AVE HYANNIS MA 02601 Owner: DOMINIC CAMMARANO Date of Inspection:_5-12-2003 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic.tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: . Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 • e Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM .PART A CERTIFICATION(continued) Property Address:35 SUFFOLK AVE HYANNIS MA 02601 OWner:DOMINIC CAMMARANO Date of Inspection: 5-12-2003 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 4. Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:35 SUFFOLK AVE HYANNIS MA 02601 Owner:DOMINIC CAMMARANO Date of'Inspection: 5-12-2003 A. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X_ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number '1�, of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of a cesspool or privy is within a Zone I of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.]. PASS Yh (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary'to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:35 SUFFOLK AVA HYANNIS MA 02601 Owner:DOMINIC CAMMARANO Date of Inspection:5-12-2003 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X_ Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of the system components pumped out in the previous two weeks? X Has the system received normal flows in the previous two week period? _X Have large volumes of water been introduced to the system recently or as part of this inspection? X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X_ _ Were all system components,excluding the SAS,located on site? X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of .scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X_ _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:35 SUFFOLK AVE HYANNIS MA 02601 Owner:DOMINIC CAMMARANO Date of Inspection: 5-12-2003 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design) 4: Number of bedrooms(actual):4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):440 Number of current residents:VACANT Does residence have a garbage grinder(yes or no):YES_ Is laundry on a separate sewage system(yes or no):NO_ [if yes separate inspection required] Laundry system inspected(yes or no):N.A._ Seasonal use: (yes or no):VACANT_ Water meter readings, if available(last 2 years usage(gpd)):PROVIDED Sump pump(yes or no):NO_ Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information:NO INFORMATION Was system pumped as part of the inspection(yes or no):YES_ If yes,volume pumped: 1000gallons--How was quantity pumped determined?CALCULATED CONFIRMED BY PUMPER Reason for pumping:_MAINTENANCE TYPE OF SYSTEM XX Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site(yes or no):NO Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:35 SUFFOLK AVA HYANNIS MA 02601 Owner:DOMINIC CAMMARANO Date of Inspection:5-12-2003 BUILDING SEWER(locate on site plan) Depth below grade:_26" Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line:N.A. Comments(on condition of joints,venting,evidence of leakage,etc.): ALL PIPING IN GOOD SHAPE VENTING APPEARED NORMAL SEPTIC TANK:_(locate on site plan) Depth below grade:_17" Material of construction:XX_concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 8'X 5'X 4' 1000 GALLONS Sludge depth:4" Distance from top of sludge to bottom of outlet tee or baffle:20" Scum thickness: 8" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baflle:4" How were dimensions determined: TAPE MEASURE DIPPERSTICK Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.):EXPLAINED IMPORTANCE OF PUMPING,INLET T PVC OUTLET T IS CONCRETE BOTH IN GOOD CONDITION, TANK APPEARS STRUCTURALLY SOUND LEVELS LOOK GOOD GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or battle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIONFORM PART C SYSTEM INFORMATION(continued) Property Address:35 SUFFOLK AVE HYANNIS MA 02601 Owner:_DOMINIC CAMMARANO Date of Inspection: 5-12-2003 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert:_0 Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.):BOX APPEARS LEVEL,DISTRIBUTION EQUAL,NO SOLIDS,NO LEAKAGE PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 I Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:35 SUFFOLK AVE HYANNIS MA 02601 Owner:DOMINIC CAUN ARANO Date of Inspection:5-12-2003 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number:2_ leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.):SOIL DRY,NO BREAKOUT,NO EXCESSIVE VEGETATION CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Inspection Form 6/15/2000 9 Page 10 of l I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION.(continued) Property Address:35 SUFFOLK AVEHYANNIS MA 02601 Owner:DOMINIC CAMMARANO Date of Inspection:5-12-2003 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. B � 1 2 MCI 13 S U Title 5 TmmnPi-tinn Fnrm f,ii cnnnn I n Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:35 SUFFOLK AVE HYANNIS MA 02601 Owner:DOMINIC CAMMARANO Date of Inspection:5-12-2003 SITE EXAM SlopeLEVEL Surface water NONE Check cellar DRY Shallow wells NO Estimated depth to ground water_12 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) _XX_Checked with local Board of Health-explain:_B.O.H.RECORDS INDICATE WATER>12 FEET Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation B.O.H.RECORDS,CONFIRMED INFO.WITH HAND AUGER: Title 5 Inspection Form 6/15/2000 11 �92.3 0 ,M,e,t,e,r, ,R,e,a,d,i,n,g, ,R,e,v,i,e,w, . . , Batch Number From Date . . . MICHAEL JOHN Status . . . . Serial Number . . Service Address . 104461 35 SUFFOLK AVENUE Meter Position • 1 , Account ID . . Work Order • • . 0 Read Mtr Meter UM R R E S Account P Date Pos Reading Consumption CS S R I ID — 04/07/03 1 2308 1,700 FC 1 N 1 00153240 — 01/07/03 1 2291 2,700 FC 1 N 1 00153240 ,_ 10/07/02 1 2264 2,600 FC 1 N 1 00153240 — 07/12/02 1 2238 2,500 FC 1 N 1 00153240 _, 04/02/02 1 2213 31200 FC 1 N 1 00153240 — 01/03/02 1 2181 1,700 FC 1 N 1 00153240 10/09/01 1 2164 800 FC 1 N 1 00153240 _ 08/09/01 1 2156 2,900 FC 1 1 N 1 00153240 �-�q -Z-1z77 ,O,p,t,:. , ,1,=,R,e,a,d,s. , ,6,=,T,e,x,t. , ,F,4,=,D,t,l,s. , ,F,8,=,D,a,t,e, S,e,q, F,1,2,=,D,i,s,p,l,a,y, T,o,g,g,l,e. , ,F,2,4,=,M,o,r,e, , v SUN 2 2000 COMMONWEALTH OF MASSACHUSETTS '� TOfgNOF�RNST '�' ExECUTm OFFICE OF FIvi7IR.ONMzNTAL AFFAMS V 1nD "�E DEPARThMNT OF L$NVIRONWZNTAL PBiOrI7!MON ONE WINTER tZ'i ZT, 310111'TONf>rSA 02106 (617)2924600 � �:r'r:ery AZtO$n PAUL CXLLUCCI S.9T'.3LlIN {3esaa asr 911,111S41fMiAIN SWAM IbMPICIAL O 1'@r WASPOCTIOM IOQM mind lkirm PAItT A OMIl1 -AT10M Addnm of If as ow0oaasaamay.xe Our all IM�poaatre: ¢�� � �ra!j —•• ftm rf1 flaataeaOtr:41'fwea i'.!i«4� �1� �"/�I t i h i. 1'e'f�33b I onr•D®P � israter/ure�K 10,A6Q aaf 1111e B:t'1A CMI S E.®OOf Cone"blame: Y i/ ec�pll Atim 0 Ad*om* Tala011rarllllrslfbaa: � .. � I heae pwaonaAy Inspeotad tru,sewalls d epoW eystan+at Oft addnuas and that Ma infon ulen reponed below la true.. immwela► aura ow,nets a of to tleaa of Noapestlon. The lnapeadm was parfonraad based an nay traleairaR end e:pedonoe In the props A:r►aasvi wd rraebrtwao"e?ipe."awW ftpoaal al,ttenw. The.syatona: L rraaWINWMy Pams Heeds PuRthw Avvijaen By to Loeel Appm*q Authorlty o PaYe brasawra�8 �;� Dell: -rho Pyttwn inepeatw elwfl wbovot a aspy►rf we inapeotlon rayon to to ApproVOW Autharlty(Aowd of Mould►ae 0810hvii0 n if*gv Aft OlM:n at ehpe N"" tten. if 00 Sip n i r•Nlared sysarn a has a dool"Wear of 10.000 ppd w groom.tho b»paator and tfan rrstaan s wa+sr shad wrbnrlt the oelleat to*A"prop""r'rpfenal elllee of the Dope om"of I m rkonrnenfal hote~. The ode"•lw"IMP,owl: as Oto ayseara+ swnw and eeples aant to ft buVir,If appReable,oral tlae approvbns awtlaorlty. RIOTEs-AND COMN"719 ra a =tvised 9/2/98 iYerla111 r �A SUNGURFAM SEWAW 01111111POGAL 41YGTM 11111111111My90lN FOW IAII'T A f:�T�CATtO1I Dow of bopodkm sf o�l� /aCI f t MWICTM tdnsk A. At C. or D. A. SVSM PASM _ I Mva not feared ony ktfarn IN"which Indicotse that any of the feilwo eorwItlons deseribsd In 310 CM 16.2031*AkJ Any tfsluro of%oria nee ovelMMW sra Indicated below. 6. SYSTtIr COItfIlTff®Ii10"If £1. One or more system comporionts as doeerlbod In the'Conditional pass" section Breed to replaced or repaired. Tirs +.t,aum.r,K,on sorrrplstlon of the NONCOM?" or tOP*,ae ppravad by 00 Speed of HoolMt,wl1 k4leate ves, no. or not dstM rMed(T..11,or NO). Dendbebasls of deternr4lotfon In nstalrges. if*not detwoninod%sidliaks r.tyr nal. — The aspek mnk to metal, unless the owner OF eperete het pro the system Inspoctot wft%a oopy e4 a Cjj•rlfloaMl of Cenaplforste tee 80,1d1 indo me that the tank wM Instslhl tidn twwrty f20i Veers prior to the dots Of It"i-40"kwlc or the aepele tank, w►tether or not meW.Is orsakad,stare Iy unsound,shows su"uw4 at kMterodon Of wrRM.i4on,4m- teak fogure is bmwA ud. The system wid pose Wdeaotion axWtrd DOW teak is raplocsd with a ewq*btnfg Ai,.We eersk as etppre ed by tfre St11rd of lbeleh. Sewopa bookup or broskout or wotar level obvieved In the dlstr bulon box Is due to broken imr iagrtr.,voted pp;, or die to a brokers,sw tlsd or M$WAN*m box. Un oystem wd pass Inspection if(with approval of tl! i oewnl el MasIBAi. II plpsls)are repfaood t le w—ad ;II*Vlbrr9arr box is IaMMM Of wplaeed ® The eye t1 perrrpkrp more Una four tkoss a year Am ea broksn or obetnm tad pipit). The sys+carry �,�1 eqr It(with etppr. evoll of the lewd off I%dlhl: Broken pfpafal we Mph.@ ���,,, n bsersretlen Is rorlrovod revised 9/2✓98 I'slsioffld II) Mti11FACE ONWAOt DMFOSAL SYST®d SdSFECTgM FOf1M PAW A CIT*ICATtt]M teanttborsefl 3�' s�I��o•�G C. RJT1t®t NVALUATiOM®ISDOM ED BY THE YOAt1D OF HEALTW ceratlerts exist wldd roouite halite►ovdustiort by"Board of hiselth In ordor to determine If system to f"".1 O,If i'taet,:t t'-rt P,MM ltsshA.owlish ared Elea w retrsrrrrta L 11 SYSTEM tfll U PASS ltiflaM DUM OF Hl M.TH Sd A,CCOFDANCE 10 cm 16.303 limb)TM'A1 - 91111ldN +ar NOT FUNCTi0YM0 E A Mhlltfift WHO O try F110TWT THE Max HEALTH GAPETY AND THE DMIOI11Bf 114T. _ Cesspool or privy b ttr�tftbt W fest of surfaes wow Cssapool or privy Is+v thin 60 bet 016 bsrdsdrts vesstetad woo ar s safe Marsh. 21 SYSTSM WILL/AL UNLM TMM DOARD OF TH INS PUKX'NATO GUPMM E AIM 01I1B1M11l I TWO 11 F:SYSitisd s gArC410tt 011 D Sd A 1/A11 M I TWAT THE PUKJC MUTH AM SAFETY AM THE E W MO=Mr- Ths of one Im s oetrdo sml wbsorprion Z lid)and Ma SAS Is within 100 teat of a stehee wo.top wrppty,x� oupplyThe svoteen hasa solsr and soli ab wOon end oto SAS Is wltMn a Zone I of a puMo wosw,sttpt,;,,won. Tice svotarn No a earth end Solt abssrpoert end 00 SAS b wNNn 60 fast of a private wabr M,rHJv we)L Tito sgstema hm a ido torts srtd ooN aboorption"Wri end ow SAS Is Im Ow 100 feet but I10 feat er morn front a Provo"wow v weli,taxies a well water analysis lar eolihmi bastorls and voleMa orprk oom~e!a Incl Gatos ittet the well is treo ft po(orden kom Ebel foo tr and dw prMerte.o of asm mle Ntreoort end nitrate nlaopen Is sepu' to etr Mato tfoaet®Ppm weed to detarntbta d)statee__ _loppr@mM srsst net%vM. 11 OTHER revised 9/2/98 F I 0MLWACE SEWAOR DISPOSAL VfSTOli1 111111SPOCTM PORN MOLT A GNIT~7M NawOersM Pneparty S 5 V f' odc- X v i Oowoae: amp of Mop�is�n: >ra � �a D. OIY m FAU.- Yoe mat Indiaats e)titmr"Yea" of *No' to oaan of to WOW": I have datorRilrad that one or more of the fd*w)ng faiheeo ea+Mlllorts et doecrlbed in$10 CMR 16.303. The hs,b l to-tt a datortninatkorr is tdontifled below. The Oloo►d of HeaOth should be cos lad deta w*w what will be nscesssry,to too-►tit ttA ttikure. 'yell Rio / Backup of eowap:nto%am"a svato n a duo trs an evarleedad or clogood SAS or teaspeal. Discharge or potedl,la of of luone to the au of tiw orantd at surface waters slue to an owtrrloodied or cUsKrl;o l 1kA.� ur cesspool. Static Vgwid level in the distribution obove ooeMt kwo►l due to an overloaded or allotted$AS or cesup(mll. w, Llow depth in eeniped is leas S"below Imam or aysilmbia vellums to less dwn 1/2 day flow. w, Reedred puw4ft crone !times in the last Yes►1W dus to o)ogpd or obstructed pdpolls)• Number of elutes pun ... Any pew of the 11 A Abawption System, eoespool or p*ov is below on No o windwissw eWvftm. Any per0on o cotuiaool or privy Is wtOn 100 fset of o surface water supply ov trlbutery tc a surface isatar supply. Any of m 9019000 Of privy IS wONn a 26ehe 1 or a posit wef. Any ►lion of a mistpoel or privy Is wtthln 90 test of a p►ivoto wow supply well. potrtlen Of a serarp0ot Ot privy is lo$*4hb t 100 feel but,tremor than 60 foat room a private worst*L�Wh' j op with no eseeptaWe wets►gi:nllty GM4118. If*e well Me been ansirted to be acceptable, attach copy of well walar nraltrsit.,°ur copform bacteria,viiaNe organic ownpowds,a orm nhrfhgsn and nitrate nitropn. IL LANE SYSTr FAILS: / yew"at bodiea"shim 'Yes"or 'No" to each of the febowbW. Tha Iallsook ott!W apply to Isrp systen►a lo eddislon Whookh above: The system servos a faGay WIN a dsstpn flow of .000 mod or gmgdw[locos Syatem)and the system Is a slpnlflesm tMsat-to cvW haeiltt and«Piety and the SM14 OMMnt er mere of sus htMwNto condlttans clot: Yoe ale dw sretafn Is W11Nril of a surfs"drinbbq wow supply .� tM sys�t Is i S00 feel of a b to a animus d*mkq water sssppfy V.system ovarl A a nhropn sWONve areo itnistim Wellhead Protection Atom:W PA)or a msippesl Liwr H all a put11s wemsr clues) The owns►of opt MM et try such aysenm shoo upgrade the system In aeeordanos with 310 CMR /5.30e(2). Plsese e�er101 11ht Ocal a!tothttd otft-is of the !e+forrllar lull+ntiaoon. 7C'a,vivied 9/2/98 rate aofit ivissumACE it Ally CROP CAL STSTURN oesl'+eCTtON fOOM PART T own Onln me :-007 c lag Check if dw fallowing hew been done. IOU mast lre tM Wm'Yes'a 'Fee'as to seoh of the feMowhag: terrapins Infarrraolien use sled by!te aetreaor,seatpertl,, of Be"of Itee11A. Net*of the system owmansi to have been pumped lime eat Teat two weeks wW the system has boon eotrinhr;l,terrral0 flo,ar metes durMM that Mato®. Large vWunm of wares Rave no been Wmadmosd Woo the system reev"y or,te P4 t of tNts inspallam - 11 As butt plaits hma llmm ab4akfad&W oxmined. Note if they are not sveambb with NIA. The tsoNft or dwetBliall woe Mepaeted for"m of sawMp•bock-up. s The system doss neat rsoohra non•saNtery or Industrial waste flow. The sits woo btl m,md fee ftm of breslteut. AN system comporwints,excluding the•NI Abewpdan system,hsve been leostnd on rite o ts. _ The ssptlo tads mwshales ware omeovered,opened,wad than Merim of ft sepAa teak wits Wapeeted fee acing,t m of►aal'Noe Of tees. me""of a:earstruatdon,dOnwrte".depth of tldlrlid,depth of sludge,d wth of asum. The site sad leasbom of the sdl Absorpdon system an des see hag been deem jnsd baesd on; ttekt**mftmwftn, leer oxvros,mm atjt _„ Osn ffdmW i t the 6162 fit say of the feNure St"O s relefaod to pert C Is at Isetrra.appeettb mgm of astepw1p N, In 41 p�CtUe:e) Its.l020"M ,- The F=Mty owner fend oecupenta, If dlffwart fron owns)were provided Oft N*jr nedoa en ttM pegm,mein t:eaaneun al suitlurmee WOO",ttyatrrte. revised 9/2/98 ltigesdbb st8tlslJl ACE SEWAGE DWORAL*VSTM VMWWTNM Bt7 M PART C MTiiOM stlPCMWATMU 33 s�/T'u0!'�/f6/ RAW R101lCfwnau ?IOMs �41sw�a ! � a.►...AmOroon+. 11)uerer of vi—eo ns li�ol�n1-.. li wAw o4 i** IwtuM):r to"mom saw„ _ at Owwoor of wrartt wsidlertrs: awbuse w1Mar(v"or rtol: low0v tseparaes epeesatI (yes of nn):e. M yes.sepsreda b4posson req*ad a.owov ev~l so-lid d 1 o►roll $*@se d we has or aol: wMer mww nod ww.M avaAa6ls flos2 i:wo♦ssr's wasteSYNO e �arcs Of na' tart deM of soaq+anep: T11100f�: ®at®nss�ar: ew f am lie an 1!<.ts8l Seaft of de 's flow wbaMw amless trap preaant:I"M or nol` tndwwMd wasso ffle O Tsalt proem ar nali Mom-esrdt wr r1aw dledwwd to i epstem:Ipsa a no)— wooer mater readtrigs.It Lent date of osou pwwy: OTIM:IMOearMol _ '.eel deco of y �IAI l�YAT10N ans>�o IIflOpll�i enB eon of InUtro+all": spasm►P> ao Port of In Kroellon:(pet or nol g& ti pee. •edNns PUMP": Asseeat 14r®letup: TTP�OIF i e todmewwwan bos/elo MbsorPllan spetonv SbvM map" gvwftw ossopset ,._.•� shared epeh" fpss Or no) Of is*.etuell;w*vl"s AnePootbori ratordr:.It an 1 u�Te air ale. Atemah MI,vp 40 wP to date oPore00 OWnwlr�wsneo oMiretvsot Capp of VSP AW*v w O ter APPAXATV AM of aN aompononts, ekata gteUW [if knownj end oowm of MAarwtaYerr------7,Ye 4 t g 90wIpo odlers dsteated whom orrly ins et the alms:fpos or no) A/o revised. 9/2/98 �wsefaa i{�ia11�ACfr<fiftMPAfsE ®�b11®1� PART O " pg/a)Tte1 Ttf�11 Iod lowak Onls.l� SJat loci fwfa iloaa on du Owl DepaA below s a:,, j aEbterasl of aeneawuen:®aeet kon,jr.40 PVC .�.►IeE OWMI llletsn*e front Navel weta omWy w44 or swoon Nn*,�,w,_ Da*vevaor�_ Car�rnenle: feendden of Jalnte. valdn1. ovidena of 104IMo•oft.) SWE TAaaa�a am**an sate pion$ N Rtenverfea N o®r�atlon:�®a+atiso_,,;noel ape®. ,�'elyethYBene o,,.,abAo�fea�6eFnl 1f*:W*to mom.In qp® Is qo ON nowad br Cwebcete of ranee (Ya1Ns) ---.. MaterEshne: / _ $aware depth.-��f Dpd+sreeo fieoote no of eaVp to bwmffl of maw tee or bafflerz Dasaare fvvrn top of Orin to top of eRlet tee ar fesffl*:-2.1 /i Owe"**on botlnon of sewn a �r of avoid too baffle: �y Cwrww o: lrseornnvondstasry for p+rnpinr. **n inlet d saatl�et tee*a baffles,defy ah Mdoeee of ,} d I* in rNstlen t*eeeea*t Inv e a xu tnti •:d Ir!Rel,lr}E Y e 'Ohm w a�i� v.•w,.—a..�, memo an solo Oat} Oedth idol+prude k%t*W of ae Iketlon: _morel inotol® s„p*lrseh M ._.alm4es dna OAvn.rnle •stet 11+1ot:rn*e:`� 000, .— Oasaenoo from tale e1 savEne to for of rrt toe er bufalo: Ol UMS f►ofn balsam of scum t n of eutiet tau w bolft: OM of anal pm oft Cenvratrvte: f�Aar ,easdela+of Onlet end eloet toes or beffil".*Ph of ft"6sW in reBettcr►to oMliet anvt4vt, e9rarti>vn antear}�,, OWderop e}Naav esc.l rev.kmed wYasMRRY6 81 WAat MOM 1B■STM PMPWTM Pam Phi■C' s!►sT®Ie NleOftwATlfdN he�lrawO :3aS' t9�aeeee►s TiWT CM HOLONG TAUK;_ _IT enk must be pueeepa e. or at*"I of. lnspaoowl llgraaaa on doe Oml 1 "PION bolero we&:— N)aterleF oP oonstrrst/an:�.oenoHrte_..Nostal�.. �!•elgstlpAe�ee,_odeerleaptsin) ®le:eeteeiene: Oo ion fleuv: dionslday Alarm%Md. Amm o"J"s order;Yes_ No— Deft 40 prevl us pwmpbeo: �poreeeeeta: lonredltla�e oA k+11et tse. of slrerrn ane111eeR swlrolses,ors.) desauo sro ata Aare) ,� .Dopo o01{pm level ebeve et4w Inve t._�Y,�!11 WV44 Corte wft: bouts M level seed eIsom "m 1�,,�e�� r Maim of soYdei=rwrL4j*fWW@ AJMMYW Ino Of PA ojUlt, ote.l�_� _.,a AL s, Oraeaa an ante plan) OW+aa In eaeOft order:nee or Aim"m in erft ldee or me)_,_— Camsmom: horse.eon~of p o ohwftar. of pumps�lea.e1a.) revised 9/2 f 96 1►�r',�1� r - � CI�=1111111111A.GE COMM*"SYSTM VUPECTMM FOM p"T C •�tet�aer $S �QT c;l aL .4 Om am at S arN= (baeb on eft plan,if pessOtMc easswrum not reo*oi,leestiar rmy be fappiathr~by non-41mrusiw rnotho6i !9 PAIR loaseetf.OMPIMS e Mom•atfm®er:� an o'Ale efwobers.tllultlw:•,-- �Oidoertes.Wwftw:_ .INN-1 rI www1hss,Abend-,WW Nt: bod*q Odds,ftwMor.dn"inrtlorn: 4000ow seeopod,famnbe AlwarOrs myetom : lowm o/Test+eeletJr. (note earth im of SOL dm o?hydrotllie .level prWlh d P eod rCO4mon of station, Ifsools on ales 0"1 xwow 040040 sP tl�dli is 1ftlMet tttl�sft: - e011111+of mom Iotrw: e>•ipth of setttet lerw ' MA ef OAnri M of mop".. Illshf do of owoerleo>tsn: br MOM slystell/lvelort hMow (ssse,RM5A pun:peai as part of Inspection)- . Convnef , (norm Rsrdean of dpw of hylre .-foWre,fevol of paro",condition of vNetotlon, ste.l i0arans on efts Omm Mloltwilm of Oww"Wed": Depth of oskb: OlnaanaiMN:- Comsrenta Inert:0eF4hlm of No.sir"of .IovM of powkw. eoraill of'va""Non.slo.) revized 912198 �oe►seru r 1, SIMUWACR KWAM 1ITSTO0 MPWMM Pam 'AYIT C ��/8T®tl iWY10lr Yam =21 Or swWA4R OPAL ff"TIM. t tpw is at am two®wege WM fellsome OWWWWke or bwhd%rmko bom OR waft watt1 160'I{.com who*PAk Wells BNPOY GMIS MKO house] s e� q ` O e � revised 9/2/98 f • i :mil "Ca S MAU MIM"SYSTiiMl slMTlc A Polar PANT c $VIM O FGFRNATlOM Isaw ll" •�.� J s s g war: Om ee Imes "Ops"fame-- ?vow dwh I@ p"Idwear._ usas Dori Web"r(alae® Oseovealen areas sheoked Oroe�Idwom deoul: shoPew._ ,_hlodwves ..._._®ooP Srm B"M sktpe *Wk"WAMW Check Collar sheaow wells LstMta ed Oath to Growndwow],l"sott Pkaim bxl*M ew the matieds used to setermine High GrowWw"W gknpgd n: _ Okt@Wmd from Oeslsn Plans en rnlnxd OOeerved sits(Abutllns prop".easervetlors ho*aeownem aw"ste,l Oeamdned from isool een0dom . _ Chookod wflh Is"Beard of heshil _..chooked Pau A Maps Choolmd pwnpbV regionis . Chaekod leesl exaavalors.Instalort Wed uses Om, Ooseelko how roar W66Nshsd the H%%,6 ra"wot* slavatlOn, lM he eomplaled) NO � f revised 9/2/96 Mw:l of ll FoRM30 �i,w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN �L ,n (G b EPARTMENT ( wo <1 -.-- L D®1�\ ( 'o ADDRESS 2 G,M s°J0� 3 5- ���4 1� �e` PI 6 TELEPHONE Address f rY Z6a 1 Occupant_oe-M I la i_ Floor Apartment No. No. of Occupants q f No. of Habitable Rooms No.Sleeping Rooms _ No.dwelling or rooming units MNo.Ston s_ Name and address of ownerylry r l is_e_1 5&A-%x a sg 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: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink e e_LJ t 2 athing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: S` — i n I a i 2 Infe Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General BuildingPosted 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 Ply." INSPECTOR TITLEt C DATE 2 `"1 -3 TIME / ' P.M. A.M. THE NEXT SCHEDULED REINSPECTION 2 D t Y 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found-to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to r r-i issued include affect the legal obligation of the person to whom the.o de s ssue to comply p y 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, in r or trash which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. including garbage p g g Y (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. ( ) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or Y 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. 1 •FORM 30 I 1 W HOBBs&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN a EPARTMENT o _ n_ - a-NR S �i - o Zbo c ADDRESS �M sv0 o 08- 4 Lib TELEPHONE Address 57 __ ___ �+ _ ._Q _Occupant__. (_I t� . Floor _Apartment No.__ _No.of Occupants! f a' No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units No.,Stories �. Name and address of owner_ Q _�'(<i� eISaMe a rP-SS Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: r Drainage Infestation Rats or other: STRUCTURE EX 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 : '1~ ' STRUCTURE INT. Hall,Stairway: Obst'n.: r Hall, Floor,Wall,Ceiling: Hall,Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line.- H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den . Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Qo wsi r s v ►r i e `Bathing,Toilet Facil., Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: ,o S}n A4;AI 4-,1',jaAk Infe alien----r' _ Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE. VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE :HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF I Y." INSPECTOR TITLEr DATE 2 -3 TIME 7 '7 ��P.M., "ti. M. THE NEXT SCHEDULED REINSPECTION 2.. '_�� � � ''` 7 ' u�" � '�"'`�•"' P:M 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali 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 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. conditions which remain uncorrected for period of five or more days following the notice to or (0) Any of the following p Y 9 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. a ' 4 FORM30 CF1&W HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS I BOARD OF HEALTH CITY/TOWN EPARTMENT wo ADDRESS tl ��`'2 qL--d— G�M ( +)� t TELEPHONE Address _0_. __ Occupant_ Floor _Apartment No. _ __r _ No. of Occupants__. -- lk No.of Habitable Rooms__.___—No. Sleeping Rooms No. dwelling or rooming units No.Stories Name and address of 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: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom(1) Bedroom 2 Bedroom 3 .Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink A0 wR r h se9 ry (1 Bathing,Toilet Facile Vent., Plumb.,Sanit'n.: /I Wash Basin,Shower or Tub: �e�!6 v Ortir+� .5rr� -" lbt rt t)iCi' Infes a Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJDAY." /(Lf INSPECTOR wf '. TITLE / DATE 1Zf -3 TIME / - P.M. 3 A.M. THE NEXT SCHEDULED REINSPECTION 2► ` C� P-M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of 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. tr FORM 30 c&—W HOBBS 8 WARREN'" THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITI SOT /TOWN = W -- DEPARTMENT 'o ADDRESS GSM 5 9 �W (�(► fl TEL PHOI E Address �--_J�c T"�`Z'><l�Ave'. � kAAIS Occupant__ ad " Floor Apartment No. t�o.of Occupants No.of Habitable Rooms No.Sleeping Rooms _ No. dwelling or rooming units No.Stories Name and address of owner IC Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. e s air , orc s: S S ' ua E ress:a st'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof -TG IC Gutters, Drains: b7, JAC� Walls: (( ` .k` Foundation: Chimney: G is Ices BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: " Obst'n.: Hall, Floor,Wall,C n 0 It G ovR,- Hall Lighting: W Hall WindowV HEATING Chimne s/ Central ❑ Y ❑ N E ui air o�Inoy ° TYPE: Stac , Flu ,Vents: s PLUMBING: S44p I y Ve: ❑ MS ❑ ST ❑ P as ine: • GL Co►rl i H .Tanks Safet and V s �oA r6ow. S bt 05 no " ELECTRICAL anels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: v Q✓ 10 hVIA4 gro0nt t1JQ AMP: Gen. Cond strib. Box: Gen. ementWirin dOYU W(A DWELLING U ScX�►1, entil. L t Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen a roo De ivin Room Bedroom(1) Bedroom 2 r�� 5 e iCll k S Bedroom 3 55� c ae ivl, SSA S 6 S �551 G Hot Water Facil. Sup.Ten.,G s, Oil, Elect..- Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink V goo,v a_S Stove o Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: S a o delp,4&rs na �.L Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: °e_ 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 REPOIRT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF JU f� _i INSPECTOR TITLE �l yl �/.�L�-72- DATE ( (� Jam_®Z TIME �,; A.P.M. THE NEXT SCHEDULED REINSPECTION - -VAIslj P.M. i 4J,0 7,5.0.: _Cond+ ons Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person'or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included-in this listing. Failure to include shall in no way be construed as'a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as. prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR.410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust.or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. t (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. { ti- w HOBBSSWARRENTM THE COMMONWEALTH OF MASSACHUSETTS FORM 30 �I BOARD OF HEALTH C Y/TOWN F. o DEPARTMENT nL ADDRESS TELEPHONE Address n S� �"'u li Wg- 4LIXO&IIS Occu ant_.W d,( , Floor Apartment No. No. of Occupants No.of Habitable Rooms No.Sleeping Rooms No. dwelling or rooming units�--�- Stc ries 9_ Name and address of owner tV�1-0_ v. i GV C�� __CSC O-.O� S 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 : 6 STRUCTURE INT. Hal t rwa Obst .: Hall, Floor,Wall, eilin : Hall Li htin : Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safet and Vent ELECTRICAL Panels, Meters,Cir.: /p ❑ 110 ❑ 220 Fusing,Grnd.: �s AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPOR IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF ' INSPECTOR TITLE t DATE ? TIME P.M. THE NEXT SCHEDULED REINSPECTION l Cam./ 3 P.M. I 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR.410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water.' (F) Failure to,provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source/or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. n' in violation f h M h Massachusetts Department of Public (J) The presence of leadbased paint on a dwelling or dwelling unito the assac use p 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, Aso 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. it 1(N) Failure to provide a smoke detector required by 05 C MR 41 0.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. r,., �.ry,...�..,�:,-".srMv..-^...TX-,rt..,..,,F.rr.::-h-�"'✓L.--..,�^e.+--...>'�y-..>..«�tir:-..—..+»..w—,.... TOWN OF BARNSTABLE A Ordinance or Regulation , WARNING NOTICE Name of Offender/Manager rj1p&) Pill,- S f- y lk Address of Offender �,� :�t� MV/MB Reg.# Village/State/Zip da 0 t7 I S PM 02, 60 Business Name Z .fib am/p on 1/ 1.5 2062 r — . Business Address Si=gn`ature .of Enforcing Officer Village/State/Zip / Location of Offense �5k'-jiu 5 `{64Ve w l +Fd I� li paf, Enforcing Dept/Division Offense toy K Llft) b.20 inr+6; Drolkd 4eJ Facts der tier►r i �a ((� f� v t,�t; y [1,01 a�ti /w{fG.a�tr �r/ t�"� ttd'T G.- �L t y TU Y P 'S- Y c P49 41''{a";4,,., `i e ka A This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result . in appropriate legal action by the Town. TOWN OF BARNSTABLE E W Ordinance or Regulation WARNING NOTICE Name o:e"Offender/Manager - >P Address of Offender Ave MV/MB Reg.# Village/State/Zip ll.aor of I AAA 0.7 6 C. l Business Name am/pm, on / 2002 Business Address SIg-nature .of Enforcing Officer Village/State/Zip. Location of Offense +ram rs ` Enforcing Dept/Division Offense " " < r G `" " 4A ,£ � ,,, A; cl,: �:x `< Facts ` ..�i 3 � ., ' x 3z .r +. #"l �.rt�f , This will serve only as a warning. At thisItime no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in '"appropriate legal action by the Town. NAME OF OFFENDER � T n *f I e}�a Q W Q 9 7 TOWN OF AODRF,S� OFFEND�Li 1�Y) } (le_ un'1 BARNSTABLE CITY,S�LAjE,ZI�COD . �t 3 f 1!K.J'Lf1 / / IHE/p� BARNSTABLE A S � OFFENSE V �..r-� ( ♦ . � I -E•Y'. Y4i+- ✓"_w a. .ayy. .e f j 0 renwu+� i S>t lL �' T Ec / / OYt 7?Or'1� �p� > TIMJND D�7E OF IOLATIO M. P. ,ON ,I J 9 LQ�I� OF VIOL I 0// Ave• y.g r�l, W NOTICE OF 1.A. r+�J �i �{ SIGNATUREOF flrlN_ IS� N�FvR ING EPT. BADGE VIOLATION � t"u � :< V. 0 OF TOWN I VEREBY ACKNOWLEDGE RECEIPT OF CITATION X 11J ORDINANCE Unable to obtain I n ��ure of offender. t � THE NONCRIMINAL FINE FOR THIS OFFENSE IS IS 7U. I' Date mailed "' w OR YOU HAVE THE FOLLOWING 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. Cn REGULATION 11)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,Hyanms,MA 02601,or b mailing a check, money order or postal note to Barnstable Clerk, a I P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATfyOF THIS NOTICE. 12)If you desire to contest this matter in a noncriminal proceeding,you may do so byy making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA02630,Att:21 D Noncriminal Hearings and enclose a copy of this citation �! for a hearing. III 131 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 S�J re <l Er tr- FFICIA „ � p Postage $ C� �V�I/ f1' Ln Certified Fee n/ 3o C7 ?�n Postmark? Return Receipt Fee �1� Here M (Endorsement Required) ,[k 0 Restricted Delivery Fee ♦ ® 0 C3 (Endorsement Required) p Total Postage&Fees Is l� —n Sent To, � o(�G Street,Apt.No.,or PO Box No. O o 3 S' ------------------------------ C3 City,State,ZIP+4 Q 2 b U Certified Mail Provides: n A mailing receipt YW o A unique identifier for your mailpiece o A signature upon delivery �``iv* o A record of delivery kept by the Postal Service for two years Important Reminders: 0 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. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)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. o 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 not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,May 2000(Reverse) 102595-99-M-2087 1 M Town of Barnstable Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 November 19, 2002 Mr. John Michael 35 Suffolk Ave. , M 02601 _ NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODER - MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 35 Suffolk Avenue, Hyannis, was inspected on November 15, 2002 and November 18, 2002 by Sam White, Health Inspector for the Town of Barnstable,because of complaints. The following violations of the State Sanitary Code were observed: 105 CMR 410.351: Bathroom sink clogged with black-colored debris rising up from the drain. 105 CMR 410.351: Exposed wiring observed outside, adjacent to slider door on back deck. 105 CMR 410.351: Electrical faceplates missing in front and back right bedrooms. 105 CMR 410.480: No locking device for security against unlawful entry. Door to cellar apartment (occupied by owner) does not have a locking device. 105 CMR 410.482: Smoke detectors not in proper working condition. Batteries missing from detectors. Hyannis Fire Department notified. 105 CMR 410.500: Water is penetrating through the roof onto and through the kitchen ceiling. Kitchen ceiling very wet to the touch with bucket filled with water below. Ceiling soft and stained. Floor below soft, and depresses when stepped upon. 105 CMR 410.500: Kitchen floor tiles broken and loose. 105 CMR 410.500: Front steps/porch in disrepair. Cracked and loose slabs on steps. 105 CMR 410.500: Back deck is in disrepair. Broken railing-and hole in the deck observed. 105 CMR 410.503: Missing handrail on front porch. Q:Health/WP/Tulli 11 e� 105 CMR 410.551: One (1) screen missing in back right bedroom. Additionally, Health Inspector Sam White was present when there was no electricity provided on Friday, November 15, 2002. However, the electricity was restored later that day according to the tenant. The tenant stated the electricity was not provided for a period of time before that date. This is a critical violation of State regulations. The tenant also stated that hot water has been intermittently available. The absence of hot water is also a critical violation of State Regulations. 6'''1 You are directed to correct the i'moke detector violations within twenty-four (24) hours. You are also directed to provide a handrail within five (5) days. The remaining violations shall be corrected within thirty (30) days of your receipt of this notice, by providing properly operating smoke detectors, a safe handrail, by `— nc�eggtng-the-bathroeni-sinl by installing electrical acep a es w ere missing, y properly covering the exposed wiring, by installing a proper locking device for the door to the cellar apartment, by repairing or replacing the roof causing the leaking into the kitchen, by repairing the kitchen ceiling and floor, by repairing the front porch and back deck, and by installing a screen in the back right bedroom. 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 could result in a fine of up to $500.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF T BOARD OF HEALTH omas A. McKean, R.S. Director of Public Health Town of Barnstable cc: Heidi Tulli, Tenant Q:Health/WP/Tulli TOWN OF BARNSTABLE B�IR-W ;+ Ordinance or,..Regulation . WARNING ;NOTICE: .. f Name of Offender/Manager Address of. Offender �'C, i('Ao eve My/MB .Reg.# Village/State/Zip a,44t6nir, 0 A 040 Business Name /f ai./pm; on ".`� 19 ' Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense VLA22,h U t ril or Facts ? ► r lurrw)►a )A 7'..1" /[ 12610 ` This will serve only as a warning. At this time no legal action has been taken. It . is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. ' TOWN OF BARNSTABLE 124 r BAR-W -> Ordinance or Regulation ,.� w WARNING. NOTICE Name' of Offender/Manager i n) ffio, e Address of Offender J S 070 1K Aae MV/MB Reg.# Village/State/Zip ='�''3t1t 1 / Business Name �(F �/pm, on / 19 � Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense .:ZS . .�1 '/0/ Enforcing Dept/Division Offense Facts � a�-_ t�♦tr �1� x: • ttr '' 1 - p1fi� !aai , �' , %t ' C � i� sty O This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to ` achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. ]�W .-=� 7 PAR ] Real Estate System - General Property Inquiry] Help [ ] ;:ar6�1 Id: 291 122- - Account No: 199895 Parent : Location: 35 SUFFOLK AVE HYANNIS Neighborhood: 62BC Fire Dist : HY Devel Lot : 1 LC14034-D Lot Size : .26 Acres Current Own: NG, KIM HOK-KIN & ANNA Y State Class : 101 3 ANNABEL AVE No. Bldgs : 1 Area: 1740 Year Added: FRANKLIN MA 2038 Deed Date : 110193 Reference : C131964 January 1st : NG, KIM HOK-KIN & ANNA Y Deed MMDD: 1193 Deed Ref : C131964 .. , Comments : Values : Land: 15700 Buildings : 96400 Extra Features : Road System: 35 Index: 1553 (SUFFOLK AVENUE ) Frntg: 108 Index: 186 (BRISTOL AVENUE ) Frntg: 99 Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 112994 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : Taken: Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [291] [123] [ ] [ ] [ ] Health Complaints 20-Sep-96 Time: 11:55:00 AM Date: 9/20/96 Complaint Number: 451 Referred To: CHRISTINA KUCHINSKI Taken By: BARBARA SULLIVAN Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: Number: orff- 3� Street: Suffolk Ave Village: HYANNIS Assessors Map_Parcel: r� Complaint Description: house at corner. Trash in yard. Actions Taken/Results: r _V j Investigation Date: Investigation Time: d , _ L �� y ►. ` TOWN'OF BARNSTABLE BAR-W 430 Ordinance, or Regulation WARNING NOTICEhA >r Name of Offender/Mans er Q�F g Address of Offender -(446 MV/MB Reg.# Village/State/Zip Business Name am pm, on ' 19 Business Address F,1 /J,�IT.r. Signature of Enforcing Offibe`r Village/State/Zip Location of Offense r Enforcing Dept/Division Offense LU I CnAA c" Facts i 4'' f a- c7'L l� ('✓7 `" �` ..t� LA This will serve only as a wakening. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate` legal action by the Town. TOWNyP OF BARNSTABLE BAR-W 430 Ordinance or Regulation WARNING NOTICE Name of Offender/Managers r{�,� . 00 . Address of Offender C_, c� ��t � t -''' MV/MB Reg.# J Village/State/Zip ( "�"LiOf-P1 t4 r �nli -1 r �U.�_ Business Name pm- on 19 Business Address ,/`� �r� W_ �, X Signature of Enforcing-Oflic-err 'Village/State/Zip Location of Offense ' Enforcing Dept/Division Offense O f 'r a ► . ' fr. s �r ? It�}ri Facts � r � ( � t - tt✓�°, -f. ,f) L.�� This wild gerve only as a warning. At this time no legal action has been taken. It is the. goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. . Subsequent violations will result in appropriate legal action by the Town. TOWN OF BARNSTABLE BAR-W 430 Ordinance or Regulation ' WARNING NOTICE Name of Offender/Manager - z A }c �" ' Address of Offender ' MV/MB Reg.# i Village/State/Zip 1 r Business Name 1 � 'am/'pm; on J 19 T Business Address �. r,x , Al ' �,. , Signature of Enforcing Officer Village/State/Zip Location of Offense fir, r' Enforcing Dept/Division Offense Art _ a. Facts f:} r rI ! /� -j 0, ✓1 �+ This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. oFtw�, t. Regulatory Services Thomas F.GeRer,Director gAItN5TA8LE, = public Health DIVIS iou 5tA3& Thomas McKean,-Director 2Q0 Main Street, Hyannis,MA 02601 DATt: NUMBER O PAGFS TO"FOLLOW: `Z `[ 2 �'TO f FROM. PHONE: PHONE: (508)862-4644 FAX PHONE: �, 2 Y FAX PHONE: (508)790-6304 cc: . NOTESICOMMENTS: r� Q-.\FiEALTHTax Foi=40Cc �APPLICATION NUMBER{COURT USE ONLY) APPLICATION ADULT Trial Court of Massachusetts °A FOR COMPLAINT El JUVEN LE _ District Court Department The within named complainant requests that a complaint issue .❑ ARREST COURT DIVISION A ❑ EQUEST HEARING against the within named defendant,charging said defendant with the offenses)listed below. ❑REQUEST El REQUEST SUMMONS WARRANT (one or more felonies) NO.COUNTS POLICE DEPT.CODE POLICE INCIDENT NO. OFFENSE DATE OFF.LOCATION CODE ARREST DATE CITATION NO.(if applicable) NMI 0, MA- TSAT LAST NAME FIRST NAME MIDDLE NAME ALIAS NAME(LAST,FIRST,MI) STREET ADDRESS CITY STATE ZIP HOME PHONE n n O 2000/ Sdg CITY OF BIRTH STATE OF BIRTH SID NO. PCF NO. LICENSE STATE MARITAL STATUS SEX ETHNICITY HEIGHT WEIGHT COMPLEXION HAIR EYES MIry FT IN LBS f�FFt'�EI( FOF0 �TI®i u _ r CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 1. Q !Di ,1 S� t w LjIRc VARIABLES(e.g.VICTIM NAME/WEAPON/CONY SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 2. /05 f! mR /c�.3�ikd �1ec IricR �iri� o,;� r J e �e�r s l� I�r v r— 5 u2 /vJ✓i€� ' VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. IDESCRIPTIION, OFFENSE DATE Q"fa /r 3. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 4. )0 Crwle (�,5t70 Wei r 'S "f7rry �J� �,�0 1, K ciZi�� 11/0✓ I�� �� Wes✓ VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCEITYPE&VALUE OF PROPERTY/OTHER VARIABLE) IS DEFENDANT IF NOT IN CUSTODY,BAILED TO COMPLAINANT(OFFICER CODE OR NAME AND ADDRESS) CO-DEFENDANT NAME(S)IF ANY IN CUSTODY? (GWA 0j� (3-Rrn S1'UQ- YES 0 P"bii.- 4"} t*\ 017.45yan NO ENI M. -ZOJ Mau+ �)-4 3 fAl d-zG ui DATE TIME g WITNESS(ES)(OFFICER CODE(S)OR NAME(S)AND ADDRESS(ES). NAME AND ADDRESS OF EMPLOYER(S)OF DEFENDANT MOTHER'S MAIDEN NAME(LAST,FIRST,MI) FATHER'S NAME(LAST,FIRST,-MI) EMPLOYER PHONE DEFENDANT WORK PHONE OCCUPATION DESCRIPTION OF INCIDENT(or attach on separate page) of 5�� tf G2.✓Hdt �i cJ a n L�°c �I12 loubl;L l�e� i1- �/cde�•�et— L, •. UPaA �' °^/`"'ti.l plg vit7/cb�1S �o ', ,p (� K"(� �{.-„ rb,_ � l.Jh I` -�. o, —, �)" M wt;�(, ,.,�c S V""�., O jy '{• ,�Q i Avs- (J ✓r r7/P./�Ihs hewGyn � Ct�Go�1 ,y �'rS Gem ✓'al���� X SIGNATURE OF COMPLAINANT DATE DC-CR2A(8/93) I` '„�.„ff�...�.+�'-�*.? �€'?- '� G';ats„. .�'" .r v,.. .� ,,. �r..: t �.. _i• .n, +,.,saa �:.:,y 4 rd-'�� -- 5v '.;r i� ��„. ���, �,..r�< . � �-. �n�,��.. ���.� �� �,� s�?f`�E;SE?;IA`➢FO�iM�T�O��" `' �.�� _���� ��� ��:�.� z.,.Y.e�.-, CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 5. 10S cma ity,so3 pD � to 2 aXZ VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLE UBSTANCE/TYPE&VALUE OF PROPERTY/OT ER VARIABLE) CHAP./SEC./SUB. DESCRIPTION `- ,/_ y� t OFFENSE DATE 6. 10'5 Ckga 1410+ Soo j5gcry JP— ,/K 'is ,� �15 �rf �F� i/21!, eq'A �0 WCV 1 S )7r &V . VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) IJ I CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 7. )65 CA12 L110° 5�1 5 �.►9 5 � ',n Q's _ • Gn 1 S 2e la /Vd✓ VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCElrYPE&VALUE OF(PROPE TY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE g, 15 c rn(L to a Wr�ei'�a -�, l G y AL.) 10 zr� VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE s. C s Sue¢,,, wy. S A4V 10 Zvx-. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCEfrYl5E&VALUE OF PROPER OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 1 o. 2 srl a. P C�(� , t I&I Neif S -z�,z VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANC YPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 1. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 2. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCElrYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 13. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 14. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) CHAP./SEC./SUB. DESCRIPTION OFFENSE DATE 15. VARIABLES(e.g.VICTIM NAME/WEAPON/CONTROLLED SUBSTANCE/TYPE&VALUE OF PROPERTY/OTHER VARIABLE) ONt N ,:, `. DATE ACTION TAKEN JUDGE/CLERK ❑ COMPLAINT TO ISSUE DATE TIME ❑ Arraignment set for: M. ❑ Summons for defendant ❑ Warrant for defendant ❑ SCHEDULE FOR CLERK'S HEARING M. ❑ SCHEDULE FOR JUDGE'S HEARING M ❑ HEARING CONTINUED-NEXT DATE M. ❑ COMPLAINT DENIED AS TO ALL COUNTS REMARKS ❑ SEE CHANGES ON FRONT �</ � � � `-J � � 1 111:127F. 3% ' PUBLIC HEALTH- [Chap. [Chap. Chap. 111.) �, ``111.127B V2. PUBLIC HEALTH. Entry fee; notice upon offending owner. 1 71 111:127D. etition under section one hundred t<; fee for a p eti- 2 notice of such agreement shall be recorded as a betterment in the rter dee Section 127D. The entry on the filing of such a P 3 { masand twenty-seven C shall be two dollars. Upon owner of record to ap 4 try of deeds or registry district of the land court rovis ons of chaptere80 73 s after the issuance of said Bement 74 tion, an ox•der of notice shall issue requiring , is recorded and shall be otherwise subject to the p pear at a time not later than fourteen day as provided for in this section. The assessment under such agreement mortgagees or petition of 6 ses. Instead,the allocable 76 order of notice,to file an answer to the matters alleged in the petition in 7 may be charged or assessed to the organization of units owners but shall 75 therein the names and addresses of any not constitute an assessment of common expen percentage inter- 77 eluding share of the assessment, prorated on the basis n the p shall be served at least seven clays before the re- share area and facilities,shall attach 78 record known to the owner of record,and to submit to a hearing by thereon. deliver- y `� ests of the benefited units in the common a Such order of notice ualified to serve civil process 10 combi- 80 turn day thereof,by any officer q thereof, or,by leaving such copy as a lien.only to the units identified de of the septic systemor any notice and benefited 9 respondent an attested copy 11 by the repair,replacement or upgrade ing to the resP lace of abode, ox•,at the address to which the rent 12 improvements and the at his last and usual or, if the respondent is a corporation, service may 13 nation f such septic systemJe for their allocable share ofxthef assessment 82 leaving an attested shall al p is sent or delivered, r ovided by law or by 14 84 lace of abode of the president,trea as provided for in this section. Words defined in section 1 of said 83 also be made in the manner p' chapter 183A and used in this paragraph have the same meanings as ap Copy 16 85 thereof at the last and usual p surer or clerk of the corporation, or in such other manner as the court 15 pear•ing in said chapter 183A. w, may direct. code; requisites. art thereof 1 `ti: 111:127E. COPY of report of investigation; admissibility In evidence. the depart 1 111:127C. Petition in district court for violation of sanitary building or any p Section 127E. A copy of the report of the investigation by 2 Section 127C. If the condition of any 3 x ovided 3ith ins ection,certi , tation established under the state sanitary code, as p' < J ment of public health or the of housing cities of Boston, 4 used for residential purposes is in violation of the standards of fitness for 2 in shall human ha one or in violation of any board 4 ;= Worcester and Cambridge, 5 by section one hundred and twenty-seven A, an affected tenant or by 5 ,zee; b the custodian of the records of such agency petition may be filed by Y 6 fied as a true copy Y ht under section one hundred and 6 of health standards, a p ate,: proceeding brought prima facie 7 be admissible in any p inspection, in a district court, housing twenty seven.C without further authentication, and shall be p the board of health,or,in the cities of Boston,Worcester and Cambridge, �( by the commissioner of housing remises have 8 f . petition shall state that the p, 4 evidence of the facts stated therein. ro riate inspection 9 �•R court, or superior court. Thepa payments; disbursement of funds; aP }een inspected by the board of health or other app' P f ageuc� and that tre condition of said premises has been found to be in 1r or1 1 'l11:'•27F Court order regarding rental paY 1 `ointment of receiver. that the facts are as al- 2 } i violation of the state sanitary code; that such of any tenantythere oge and 12 pf etitioner or r` materially impair the health or well the tenant or any 13 �•. Section 127F. If the court b ndsat en o cie nauthorize the p 3 t, ;; 14 { leged in said petition,it may Y 4 " �' any other affected tenant to pay to the clerk of the court the fair value o that said condition was not substantially caused by remises,or such installments thereof from 5 ;F other person acting under his control. the use and occupation of the p provided the court finds that any petition in such court with stating 15 F r. direct; p 7 An affected tenant may also file a p 16 air the health, safety or 3 inspection agency 17 ✓� a�;°_tim2 to time as the endangeayor matex Tally imp to rem- that remises have been found by an appropriateeuch violation rnaY 8 that such p' provided that he states (a)facts 18 payments are necessary to be in violation of any such standards,p' code well-being of such tenant and that such p Yin 9 violation of the state sanitary *. edy abatement of rent due to the 10 sufficient to demonstrate a likely the health or well of any 19 the condition constituting the violation; and that said tenant is not m into account any to a any A?;344' which may endanger or materially impair led by such tenant, (b) that the 20 eV aa;rears in his rent,taking 11 remises occup n the premises tenant in the building or p' erson occupying 12 .. such tenant or r existence of such violations, or if he is in arrears is willing P question were not substantially caused by 13 conditions in q equal to or less than on acting inspecting agency at least shall not be considered to be good to be due i t eq al the amount of 14 rs under his control and(c) that a s quest for inspection � arrearage into the court as ordered. P good faith ?d Tent the landlord alleges ing person may bring ing 15 5. any Pe ro riate lisp g counterclaim that said p k -,: of such premises was made to the app P petition and that there has prior to the filing of the p 26` e amount of any an damages owed because of a breach of . twenty-four hour's p' �egainat the landlord,including Y i been no inspection. 195 ? 194wil 7 , i `" 't , t i 111:127E PUBLIC HEALTH. [Chap. 111] [Chap. 111.1 PUBLIC HEALTH. 111:127I. y temporary restraining orders,preliminary or permanent injunctions; or- 6 warranty or a violation of an other law. In determining said fair value, 16.' e. the court may be guided by any findings issued by the department or 17' der payment by any affected occupants to the clerk of court, in accor- 7 �a any other agency concerned with the condition of residential premises 18 J dance with the provisions of section one hundred and twenty-seven F; or 8 i;. and any other evidence relative to the effect of violations of such stan- 19 appoint.a receiver whose rights, duties and powers shall be specified by 9 lards upon the use and occupation of residential premises. Any order of 20 - � �: the court in accordance with the provisions of this section. 10 the court shall be forthwith sent by the clerk of court to any and all 21 Upon receipt of service of any petition in which the appointment of a 11 ., mortgagees and lienors of record as the court deems proper under the 22 PP t s� receiver is sought,the owner shall provide to the petitioner,within three 12 c I; circumstances. 23 1 ;_ days, a -written list of all mortgagees,and lienors of record. At least 13 i E The court may direct the clerk by written order to disburse all or any 24 is fourteen days prior to any hearing in any such proceeding,the petitioner 14 `. P 25 is shall send by certified or registered mail a copy of the petition to all 15 portion of the rental payments received by him to the respondent for the 4., r purpose of effectuating the removal of the violation. The court may also 26 mortgagees and lienors included in the owner's list as well as to all other 16 direct the clerk to make such other disbursements of the rental pay- mortgagees and lienors of which the petitioner may be aware, and shall 17 ments to the respondent or to any other person as in the judgment of the 28 _ notify them of the time and place of the hearing. Upon motion of the pe- 18 court will permit the owner to maintain the property. 29 r titioner, the court may order such shorter periods of prior notice as may 19 ' be justified by the facts of the case. 20 When the violation is removed, the court shall direct that the balance 30 a of funds,if any,remaining with the clerk be paid to the respondent. The $1 Whenever a petitioner shows that violations of the sanitary code will 21 y judgment ,not be promptly remedied unless a receiver is appointed and the court 22 court may render ud ent for costs in its discretion. 32 1 `determines that such appointment is in the best interest of occupants re- 23 In lieu of or in addition to any relief that may be provided under this 1gsidin in theproperty,the court shall a ' section,the court may appoint a receiver under section one hundred and g appoint a receiver of the property. 24 {: ffk Any receiver appointed under this paragraph may be removed by the 25 j y twenty-seven I. court upon a showing that the receiver is not diligently carrying out the 26 work necessary to bring the property into compliance with the code, or 27 111:127G. Removal from district.Kr superior or housing court; transmittal o� that it is in the best interest of any tenants residing in the property that 28 rents and removal fees. br , �,- ;.�-' removal occur: 29 Section 127G. At any time after thirty days from the date of a district - 3 .., No receiver shall be appointed until the receiver furnishes a bond or 30 3 • 4.. F court's order authorizing the making of rental payments into com•t under;, r'guch other surety and provides proof of such liability insurance as the 31 section one hundred and twenty-seven F, upon application of any party S Court deems sufficient in the circumstances of the case. Upon appoint- 32 and upon payment of a removal fee if five dollars, the clerk of the dis-, � u g. ment,the receiver shall promptly repair the property and maintain it in 33 trict court shall remove the case to the superior or housing court for fur- j r e-safe and healthful condition. The.receiver shall have full power to bor- 34 .G ther proceedings therein in the same manner and to the same extent as ; row funds and to grant security interests or liens on the affected prop-o 35 th if the petition had originally been brought in said covet. The clerk of y to make such contracts as the receiver may deem necessary, and, 36 court shall forthwith transmit any rents held by him, as the result of a notwithstanding any special or general law to the contrary, shall not be 37 subject.to ari order issued under section one hundred and twenty-seven F to- writteny public bidding law nor considered a state, county or mu- 38 '•] Pcourt., nlgi al employee for an gether with the removal fee,to the clerk of the su erior or housing ¢ t Py purpose. In order to secure payment of any 39 ets incurred and repayment of any loans for repair, operation, mainte- 40 ° ce or management of the property, the receiver shall have a lien with 41 111:127H. Repealed,1992,407,Sec.9. g P p y, � � c Monty over all other liens or mortgages except municipal liens, and 42 # 111:127I. Court orders or injunctions; appointment of receiver, petition lien priority may be assigned to lenders for the purpose of securing 43 . s for repair,operation,maintenance or management of the property. 44 4 F- appointment; bond; powers and duties; liability. � euch lien shall be effective unless recorded in the registry for the 45 . , Section 127I. Upon the filing of a petition to enforce the provisions of ty in which the property is located. 46 ' the sanitary code,or any civil action concerning violations of the sanitary ;, oca code by any affected occupants or a public agency,whether begun in the Deceiver shall be authorized to collect rents and shall apply the 47 n - district, housing or superior court, and whether brought under sectionto payment of any repah•s necessary to bring the property into 48 one hundred and twenty-seven C or otherwise, the court may. issue pHance with the sanitary code and to necessary expenses of opera- 49 196 197 I s I:j 1I 111:127L. PUBLIC HEALTH. a PUBLIC HEALTH. [Cha Chap. 4 111:127I. P 111. !is: repairs or rehabilitation. Seven days' notice of 5 effectuate the necessary P ven to the respondent as well as any tion, maintenance, and management of the property, including insurance r a hearing on said petition shall be gi after h may,by 6 � l expenses and reasonable fees of the receiver,and then to payment of anyThe 7 mortgagees or he holders of record.i for such financial assistance, if it 11; unpaid taxes, assessments, penalties or interest. Any excess of income r r:. that it is in a reasonable amount and 9 in the hands of the receiver shall then be applied to payments due any ` decree, authorize the receiver ar app y 8 mortgagee m•lienor of record. . finds such assistance is necessary, itate the remises is not so 10 that the sum required to repair udent an nd l unreasonable expenditure to 11 { prop t65 ^� excessive as to constitute an imp' 3 {. Nothing in this section shall be deemed to relieve the owner a ro <' 1 erty of any civil or criminal liability or any duty imposed by reason of to accomplish the purpose. 12 13 acts or omissions of the owner, nor shall appointment of a receiver susxb be rescribed by 14 n the owner or any other person may have for pay ' -"y Application for manner andotan n such formsce shall be aas mayde to department esrib of Pend any obligation public health •; :anent of taxes,of any operating or in expense,or of mortgages „said department. 15 or liens,or for repair of the premises. 1 " r artment may expend for such assistance such sums as may be 16 f k Said dep tf The receiver shall be liable for injuries to persons and property to the ial appropriated therefor. a ? ! same extent as the owner would have been liable; however, such liability t«g app P unused portion of any sums received by 17 p, including i� gg The receiver shall return any the receiver to the 18 shall be limited to the assets and income e of the receivership, �� 'him to the commonwealth. The balance owed by J any proceeds of insurance purchased b the receiver in its capacity as re on the r er 20 ceiver: The receiver shall in no instance be personally liable for actions _commonwealth shall,together with interest thereon at the rate of six per 19 ri>! 's capacity as receiver. No per annum, constitute a debt due the commonwealth,up 21 �;. or inactions within the scope of the receiver p y cent P account therefor to the owner of record and shall be recov 22 r against the receiver except as approved by the 87 ;; ��°dung of an such debt, suit shall be brought g t owner in an action of contract. Any 23 d ointed the receiver. Nothing herein shall be construed to le from such property in- 24 xwl court which app limit the right of tenants to raise any counterclaims or defenses m any including interest thereon, shall constitute a lien on the P P Y 25 .�. process or other action regarding possession brought by a re- or evolved,if a notice of such fien is eeds within ninety dayslafter the debt becomes 26 summary p registry of d ceiver. eSr. ,in the proper 27 trial. -:+:-+• 1 -; due. r s eedy 1' The remedies set forth herein shall be available to condominium unit k be advanced fo p l., owners and tenants in condominium units. Whenever used in this see-'-, T�,y proceeding under this section may tion, the term "petitioner" shall include a condominium unit owner or _ �� code; validity. y,. ,a�1127H Agreement to waive enforcement of sanitary teement re 1 tenant, the term "owner" shall include a condominium association, the ? terms"mortgagees"and"lienors"shall include mortgagees and lienors of ?� ` �N Pro of a lease or other rental ag.. 2 whereby a lessee,tenant or occupant eniers into a 3 I; individual condominium units, and the term "rents" shall include condo- TJlaSng to real property K. Any P words whatsoever, minium fees. The receiver shall have the right to impose assessments Bement or contract, by the use of any 4 5 rs(> upon individual condominium units for payment of expenses incurred m0r�9 ovenant, agr rovision of section one ,t; 6 `•'� the exercise of his powers, which liens shall have priority over all othert�� <the effect of which is to waive the benefits of any p hundred and twenty seven C to one hundred a Vona seven I, inclu- liens and mortgages,except municipal liens. eive,shall be deemed to be against Public The receiver shall file with the court and with all parties of record,on ais - rein ;t27L. Repairs by tenants of residential premises to cure violations; f bimonthly basis, an accounting of all funds received by and owed to the 8a receiver, and all funds disbursed, and shall comply with such other re ement for cost. 1 j. porting requirements mandated by court, unless, for cause shown, the ,_. 2 applicable Section 127L. When violations of the standards of fitness for human r of other ., court determines that less frequent or less detailed reports are appropn� ., s� habttation as established in the state sanitary code,°endanger or in ate; provided that said notice shall not be less than five clays. a tlations, may we,ordinances,by-laws,rules or regc of a tenant of residential pre 5 t= �y impair the health,safety or well-being 111:127J. Petition by receiver to apply for financial assistance; nottce3 ple s'' and are so certified by the board of health or local code 6 a i hearing; financial assistance; lien. o'rcement agency,or in the cities of Boston,Worcester y courtnof law, and if7 r Section 127J. A receiver may petition the court for leave to apply for "�'�the-commissioner of housing inspection, or by g v"vI er or his agent has been notified in writing of the existence of the 1 financial assistance from the commonwealth to supplement funds other nts are insufficient wise available from rents, if he deems that the re to, � 199 198 TOWN OF BARNSTA.BLE �,.—as � � l�ft�' SEWAGE # 01 2 � I.AGIP S �ASSESSOR'S MAP & LOT 1 -1Aa 'IT STALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILrrY: (type) — CU (size) NO,OF BEDROOMS BUILDER OR OWNER Snk, Q PERMITDATE: "-A ;92 COMPLIANCE DATE: 3l7p_ /-S Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells=exist on site or within 200 feet leng facility) Ar Feet Edge of Wetland and Lea n Faciliachity(If any w �1 st Feet within 300 feet of lea hing acility) At Pr Furnished by i V� G �c1 �_ �? _A _ J TOWN OF B/�AReeNS,TABLE -4)$��(( ®��� A-(.� SEWAGE # Ctln-- 1. S M-�O ASSESSOR'S MAP & LOT r tINSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 060 C1- ad l EACHING FACILITY: (type) 5Z A (size) NO.OF BEDROOMS 3 ` BUILDER OR OWNER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If.any wetlands exist within 300 feet of leaching facility) Feet Furnished by r 1 o�Y N Q t � . YY f N� TOWN OF BARNSTABLE ` ?CAno,-d SEWAGE # - 6 i VILLAGE ����,j ASSESSOR'S MAP & LOT . c INSTALLER'S NAME 6z PHONE NO.J s:EPTIC TANK CAPACITY f,000 6rd LEACHING FACILITY:(type) �� (size) 1,= a I NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: , DATE COMPLIANCE ISSUED: _ S VARIANCE GRANTED: Yes No i I � / • � iN !a/ 754 r THE COMMONWEALTH OF MASSACHUSETTS /FiRz BOAR® OF HEALTH .� -�-51 TOWN OF BARNSTABLE a ( a � irtt t �� ux �i��u�tt1 �xk� C�nn,��rnr�i�an �ernti# Application is hereby made for a Permit to Construct ( ) or Repair (XY9 an Individual Sewage Disposal System at: Chase_MorgaFe Corporation Tampa_Florida -....... .-• ... -•---......... ......... --........ 35 Suffolk Av 0cftAft§ or Lot No. ....................... ............................. ------..._-••-..._....._..---------.........._.....----•.............-------------................ J.P.Macomber Jr. Owner Address W Installer Address Type of Building Size Lot............................Sq. feet Dwelling X No. of Bedrooms.............3"---"----"-.___-.-----------Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building .....___.... No. of Other—Type g ________________ persons............................ Showers ( ) — Cafeteria04 ( ) d 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....................................... 1.4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water---------............... f14 Test Pit No. 2..............:.minutes per inch Depth of.Test Pit---:................ Depth to ground water........................ O Description of Soil.........Sand & GraT,r x " "- ""-"""""•"""el.. " - - .. V ........................................................................................................................................................................................................ W """""""----•-----•----------""------------------•••----...•-••-•... •------•----••........-•-•-•.._...... - ------------------- ---------- - -- -........- Dinit" "cesspools. Z-I��II"""A-all U Nature of Repairs or Alterations—Answer when applicable.___-_""__-_--______""".-_--"______--"-""_-__"""-"""-__.._-__-_•""............................. tank ,l-cTistribution box, 1-1000 gallon leach pit. ""-"-"---"-""-"- ................................. 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 Compli nce has be*nis5u bo d of health. Signed --- 3/4/93 ...---...-. . ------------------- ---------------------------- ..... Dace Application Approved By ...........ZJI J.. ... .. 1.. 3...^...�..". .�. Dare Application Disapproved for the following reasons: ....................................................................................................................................... . . - -------------------------------I....... ........................................ Dace Permit No. ....-9--. ..:-.. �.. .................................................................Issued ..............................................---- Date a �r� (r a'R'�, • No.._..9.��.:.10 FEs..... . .3r�� . THE COMMONWEALTH OF MASSACHUSETTS _5,7 BOARD OF HEALTH ; iOWN OF BARNSTABLE a ( a a ie Appliration for Disposal Works Tonstrurtion rrruti# Application is hereby made for a Permit to Construct ( ) or Repair (1,} an Individual Sewage Disposal System at: 1 ---Chase_Mcx ,Fe Corx�gxatio - Tampa Florida -- --• . ............ .......... ........••-- Loca' n-Address or Lot No. •35 Suffolk Ave t yannis --- = --•------ --------- ------------- -------•-•-------------------------------------------------------------------------- •--- -------- � ...J.P.Macomber Jr.Owner Address..................•---••---------•-----------••- •-----•-•-------------------------------------•-------••----------•--•------------•--.......-•---- Instal ler Address Type of Building Size Lot----------------------_---Sq. feet .-� Dwelling X No. of Bedrooms---•........... ...........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons...............__........... Showers ( ) — Cafeteria ( ) d 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........................ 44 Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ a' ------------------------------------------------------------- ----------- --------. ----------------- ----------- -----------------------------------•---------- 0 Description of Soil_._. and & Gra. el x .......................... .. -- - •--------------------------------------- w omit---------ces s s-----...poo l---------s........... - .._.. I-107JJ --a1---- U Nature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ aa:r�?�__j:naistr bution boat 1-1000_-r,allon leach pit 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 gtlissued------ ----�------ d of health. Signed . 3/ /93 Y P PY system in operation until a Certificate o�Compliance has be b the boa Date Application Approved B ` PP Pp Y s c " ��---. -'3- ��..................................... Date Application Disapproved for the following reasons- --------------------------------------------------------------------------..........................................------------------ Date Permit No. ------. --3.. © ------------------------ Issued .....---------- - Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ("UTer#tfirate of C1111raptinure THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (XXX� by-----------J-;P Ma c o rnb_e r Jr Installer at -------------3 ---Suf f o 11t----Ave....Hyannis...-------------...--------------------------------------.....-----------------...---...-------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTIIOWSI ATISFACTORY. DATE............................................................... .................................... Inspector .................. ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE o.FEE.__..�.._3.......... Disposal Works Tuunutrudion Pruti# Permission is hereby granted.........J.P.Macomber Jr. --•••.... ................• ----- to Construct ( ) or Repair ( X) an Individual Sewage Disposal System at No.....3y_�uffolf Ave tivannis ----•------••--•-------------------------------------•-------.--•-• ------------•---------•---•--•------....•-••--------------------•••----•--------........ Street �� �D as shown on the application for Disposal Works Construction Permit No... _-_____ ____ Dated.......................................... b ---------------------------"_ S " _._....._.__..............................--.........Board of Health DATE....----•-. -.-:_. ..-•-- ----------•--••-•-----•---•---• ���/// FORM 36508 HOBBS&WARREN,INC.,PUBLISHERS III