HomeMy WebLinkAbout0006 UNCLE WILLIES WAY - Health 6 Uncle Willy's Way
Hyannis
A= 292-307
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Board of Health o
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200 Main Street,Hyannis MA 02601
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Office: '508-862-4644 Wayne A.Miller,M.D.
FAX: 508-790-6304: Junichi Sawayanagi
Paul J.Canniff,'D.M.D.
NCE REQUEST FORM
LOCATION r _,
Property Address:'....
Assessor's Map and Parcel Number: L6 Size of Lot: C
Wetlands Within 300 Ft. Yes Business Name:
No : Subdivision Name:
APP.LICANT'S NAME: Phone
Did the owner of the property authorize you to represent him or her? Yes No
PROPERTY
OWNER'S NAME �^ CONTACT PERSON
Name: r I I{ �1 1� Name:
Address: ddress: "'
Phone: b 0 b Phone:
VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(may"attach if more space needed)-
NATURE OF WORK: House Addition 1300000 House Renovation ❑ Repair of Failed Septic System 13
Checklist (to be completed by office staff-person receiving variance request application)
Please submit copies in 4 separate completed sets.
Four(4)copies of the completed variance request form is
Four(4)copies of engineered plan submitted(e.g.septic system plans)
_ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)
_ Signed letter stating that the property owner authorized you to represent him/her for this request
_ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for
Title V and/or local sewage regulation variances only) '
Full menu submitted(for grease trap variance requests only)
_ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only],
outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the
building proposed])
Variance request submitted at least 15 days prior to meeting date
VARIANCE APPROVED Wayne Miller,Chairman
NOT APPROVED Junichi Sawayanagi
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary, Internet ..
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P Sheinis Sheinis 9 Island Farm Road
1� Carver,Ma.02330
January 5,2010
RE:Ceiling variance.for 6 Uncle Willies Way in Hyannis
Dear Board Members:
I am unable to attend this hearing since I could not change my work schedule in time, (I manage the
Olive Garden and have another manager out on maternity), and would like to request either a
continuance to the next meeting or your consideration at this meeting based on my request as stated
below;
I am applying for a variance on the ceiling height in the lower level of my home on 6 Uncle Willies Way
in the village of Hyannis. The reason for the variance is that the house was built over 50 years ago and
a good deal of the plumbing and wiring is below the original ceiling joists.The hung ceiling which is 6'9"
high at its lowest point and has been in place for over ten years is installed at the highest possible level
without me having to incur the very high cost of moving the plumbing and raising the joists in some
places.
I recently became aware of a number of issues related to my house and am working with Mr. Roma
from the Building Division and Mr. Cabot from the Public Health Division to resolve every issue in a
systematic and effective fashion so as to allow for safe, community-minded residency at this address.
Please feel free to contact me at any time, as I will be available by phone, if not in person, at the time
of this hearing.
Cell:508-292-8643
Work: 508-746-5043
Home: 508-866-8642
Thank you for your consideration in this matter.
Respectfully
I
Philip Sheinis
Philip Sheinis
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oFZHE ro,,, 'Town of Barnstable
Regulatory RegulAtory Services
BARNSTABLE, '
9 MASS. $ Thomas F..Geiler, Director
163q. 1�
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: October 25, 2010
Bar(s): 80333
Name of Offender: Philip Sheinis D.O.B.'6-29-1961 n
Location of Violation: 6 Uncle Willies, Hyannis
Da to s of Violation: July 23 2010
Violation(s): Town of Barnstable Board Code-§'170-4 Rental Ordinance
Facts:
As of October 1, 2006 a new rental registration ordinance was put into affect requiring all
property owners of rental units to register their rental units with the Town of Barnstable Health
Division.
The owner of said property.did register for 2009.but has yet to register for 2010. This
property has been inspected on numerous occasions by numerous town officials. All inspections,
have divulged that property is being rented.
On July 23,-2010 Robin Anderson, Zoning enforcement Officer for the Town of Barnstable
informed me that is dwelling is being occupied and rented. On this day due to lack of w
registration I'issued a citation to said offender. °
Respectfully Submitted,
Timothy B. 'Connell, RS
Health Inspector
Town of Barnstable
200 Main Street
Hyannis,, MA 02601
(508) 862-4644
NAME OF OFFENDER
,�ryI - ' . e e i JBAR80333
TOIL®F V ADDRESS OF OFFENDER T
IP
BARNSTABLE CITY,STATE,ZIP CODE C1 JA6 V le
pfr THE►oil,,. - MV/MB REGISTRATION NUMBER
� OFF NSE � ....
BARNSTABLE. rry,,�
MASS. �h.1 Y'C 0 Tit At � .,,- LLJ
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TIM AND DATE OF VIOLATION i LOCATION OF VIOLATION Q� r v Z
NOTICE OF 1 b (A.M./ P.M. ONE' / ,20 V �c"�"J Q
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SIGNATURE OF ERSOyy ENFORCING DEPT. BADGE NO. y 1
VIOLATION 1�NJ' tI�
OF TOWN-" I HEREBY ACKhOWLEDGE RECEIPT OF CITATION X Q
ORDINANCE Unable to obtain Signature of offender.
THE NONCRIMINAL FINE FOR THIS OFFENSE IS Ll 1070
Date mailed 4 ` J(2 w
OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER,EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL a
REGULATION DISPOSITION WITH NO.RESULTING'CRIMINAL RECORD. gg y ey p N
beforeu The BarnstableyClerrk,above Main Street,Hyannis MA IO2�reorr by mailing g as check,mo ey order or postal note to Barinstable Cletrk,P.08 Box P43300,
(Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS
S OF THE
gDATE OFyTHIS NOTICE.g q a
B�RNSTABou LE DIV SION,contest COURT COM matter In POnoncriminal
NrD MAIN STREET,BARNSTABE,BobA 02830,A n121 D NOnC�IminelRHearinps end enclose a copy ofRthis
citation for a hearing.
(3)If you fail to pay the above offense or to request a hearing within 21 days,or N 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
°Ifealth Master Detail Page 1 of 1
I 'C €t n.I .M SLI aii ._
Apolicat'on 1f r ?'arce.l !'•3t`?kuD ' Ie'::ticw 7te-nc'
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Parcel: 2-: 07 Location: f UNCLE WILLIES t4 AY,'91 YANN s Owner: SHEINIS,PHILIP A
Business name: Business hone:
Rental property: - Deed restricted: ID Number of bedrooms : 0'
._.. _
Contaminant released: Fuel storage tank permit: s
.Saue Parce Changes � ,Return to Lookup
Parer: y fo Parcel ID: 292.-307 Developer lot: LOT 4
Location:6'IJNCLE WILLIES'WAY Primary frontage: 100
Secondary road: Secondary frontage:
Village: HYANNIS Fire district: HYANNIS s.
Sewer acct: Road index: 1752
_ V,
Asbuilt Septic Scan =2'2 ,07 +I Interactive map pz `
Town zone of contribution:AP (Aquifer.Protection Overlay Dis i k'.-Q. -State zone of contribution:01)T
Ov-ner I nfo Owner. SHEINIS, €3NILIP =.' Co-Owner:
"Streetl a ISLAND FARM RL Street2:
City.CARVER ".' r State: Iv1A Zip. €0233t Cr
Deed date:9/10J1999 ' Deed reference: L2.5301223 r.
Land Info, Acres 0.38 Use:,.SSingle Farn MDL-01 Zoning:R0 Neighborhood: '0,
Topography: LevelRoad: Paved
utilities: Public Water,Gas,Septi� Location:
ConstructionI
1 11957 2968 1312 16 Bedrooms2 Full
Buildings value:$118,400.00, Extra features 52 ,800,00 Land value: $106 400 70
http://Issq l/Intranet/healthMaster/HealthMasterDetail.aspx?ID=292307 7/21/2010
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Town of Barnstable I
t Health Division
�) 20)Main Street
Hyannis,MA 02601
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Tovwf Barnstable Barnstable
regulatory Services Department edcaC
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RARNSTAULE, ' D®
"Ass. Public Health Division
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AIFD""A�a 200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas F.Geiler,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
CERTTIFIED MAIL 7008 3230 5178 0844
November 25, 2009
Philip A. Sheinis
9 Island Farm Rd. / d /Y
Carver, MA 02330
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 6 Uncle Willie's Way, Hyannis, was inspected
On November 17, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of
Barnstable. This inspection was conducted on,the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500— Owners Resp onsibilit Elements:
aintain Structural El m nt s. _
_Railing is loose and front threshold is rotting. Birds have nested in damaged roofing over
G b"ac entry.
105 CMR 410.351- Owner's Installation and Maintenance Responsibi i"ties:
Outlet cover is missing in bath room, and light fixture missing cover.
105 CMR 410.482 — mo e e ectors and Carbon Monoxide Alarms:
Smoke detectors not maintained for bedrooms. Basement bedroom has no smoke
detector or carbon monoxide detector provided.
105 CMR 410.450- Means of Egress: No second emergency egress is provided for two
bedrooms in the basement.
105 CMR 410.5037 Protective Railings and Walls:
No railing provided for all retaining walls.
105 CMR 410.190- Hot Water: Water temperature was observed at 140 deg F.
105 CMR 410.401- Ceiling Height: Basement ceiling height was observed to be 6' 9"
the minimum required height is 7'0".
105 CMR 410.300 & 310 CMR 15.00—Title V. Septic system (permit#99-217)
capacity is only for 5 bedrooms; 7 bedrooms observed.
y/1-0V L /
You are directed to correct the violations listed above within twenty four hours (24 fG
of your receipt of this notice by removing all beds from the two bedrooms lacking
proper egress and ceasing and desisting from using theses bedrooms as sleeping
quarters..
You are directed to correct the violations listed above within thirty (30) days of
your receipt of this notice by removing the 6th & 7th bedrooms by pulling permits to
install five (5') foot cased openings in the doorways.
You may resume use of the sixth and seventh bedroom by upgrading the septic / O t-,14 4 ao2C,
system to the required capacity and installing Mass. State Building Code approve
egress windows prior to resuming use of the 6th and 7th bedrooms for sleeping
purposes. L
f-C_IT&/L.
You are ordered to correct the above violations within thirty (30) days of your
receipt of this notice b installin protective guardrails and handrails as required b
A Y p g g q Y
780 CMR: Massachusetts State Building Code, repairing the loose railing, repairing
the rotting threshold, repairing the damaged roof over entry and replacing the
missing outlet cover.,
You are directed to correct the violations listed above within thirty days of
your receipt of this notice by seeking a variance from the Board of Health; seeking
relief from the minimum ceiling height requirement or raising the ceilings to the
required height. .
if.'t 1,1 i J,., cc
You are ordered to correct the hot water violation within seven (7) days of your /~
receipt of this order by adjusting the hot water to within 110 deg. F and 130 deg. F.
You are directed to correct the violations listed above within twenty-four (24) hours
of your receipt of this notice by installing smoke detectors in accordance with Mass
Fire Codes.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Non-compliance will result in a fine of$100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Should you have any questions regarding the above violations, please contact the Town
*,nnnd sk to speak with the inspector who performed the inspection.
F E BOARD OF HEALTH
ean, S., CHO
c Health
Town of Barnstable
Cc: Carlos Scarpa
FORM 30 C&w HOBBS&WARREN'm THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
CITY/TOWN
o DEPARTMENT
2vv M� ► N sz s vI
ADDRESS '
Sye
OvC L r, L4, C bo• TELEPHONE
Address ^-Z4 d ZC-O/ 2c-vS SCs►
y - Occupant ._
Floor Apartment No. No.of Occupants-
No.of Habitable Rooms s No.Sleeping Rooms--
No.dwelling or rooming units No.Stories 21
Name and address of owner L i/9 S H£.3 41
ELA v� �r®►SLv,�1 .1 IfA AV 62330 Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage 1 l.i ti SLc O.C.L
Infestation Rats or other: t2K Kac_Y7 fZ-eTT 1 N to
STRUCTURE EXT. Steps,Stairs, Porches: t,� /
Dual Egress:and Obst'n.: S-,<-«(Llo tL
❑ B ❑ F ❑ M Doors,Windows: Qb1i - y y N /
Roof t 0_0 IJ 4-S1 G v&,2 c„aC-kA AIo snYj rv-j
Gutters,94%: ►1fl eL is9,j110
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation: 10
Dampness:
Stairs: L-+
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.: Z '�IL lL-
Hall, Floor,Wall,Ceiling: (Ld (L-c?6 r-A lQ t
Hall Lighting: a T [a-SvAS taC6'c
Hall Windows: l�lta��, 1 Nf fJ G✓L- �,6'1-15 to 2
HEATING Chimneys: i<_+cvv,C0
Central ❑ Y ❑ N 12.e -- A 5
TYPE: Stacks, Flues,Vents: 7 y?�va e_ 4fA" AJO � G r10
PLUMBING: Supply Line: Vk6q I—AZ 2 O 140
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.: v 7 L Qt CC)V11,L 3-51 r!::!V
❑ 110 11220 Fusing,Grnd.: 4--r-) /ti 6,07
AMP: Gen.Cond. Distrib. Box: L/4 N7 !,I 1 S SI-4f Cv Vx4L_, wq ar Jca�
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom or S
—Pantry
Den `'1
Living Room
Bedroom 1
Bedroom 2 �6
Bedroom 3 122,
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 j2orb
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 RJURY0/z_
"
INSPECTOR � TITLE �n. S �GZU�
A
DATE TIME /b ' P.M.
A.M.
THE NEXT SCHEDULED REINSPECTION �� P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health,or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.10C 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 a-id 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 cr 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 o`a-)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 maintair.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 bathtuo 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.
TOWN OF BARNSTABLE
LOCATION l/i SEWAGE # �1
VILLAGE j4✓ nnn iS ASSESSOR'S MAP & LOT r•� --30
ZP—
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INSTALLER'S NAME&PHONE NO. hl:C.f f�-h�,,,yr�-rl. Sc.�� G �' 7 S'S'77b
SEPTIC TANK CAPACITY I�
LEACHING FACII.ITY: (type) y 01 Avn t er J (size) mptp cz r+r
NO.OF BEDROOMS f-
BUILDER OR OWNER
PERMUDATE: "a -ICi 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
O.
V
71
61
fO/r /f/I
No. 7 Fee $50
THE COMMONWEALTH OF'MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01ppYication for �Digogal *p5tem Construction Permit
Application for a Permit to Construct( )Repair(x )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
L ati n Ad ess or Owner's Name,Address and Tel.No.
0 NC e 01lys Way, Hyannis, MA Tom Wolfinger
Assessor'sMap/Parcel -ZI Z-30 ^7 10 .West Meadow Estates Dr .
I ., MA 0114?)4
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E . Robinson Septic Service
PO Box 1089, Centerville , MA
Type of Building:
Dwelling No.of Bedrooms 5/4 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil Sand.
Nature of Repairs or Alterations(Answer when applicable) New Title—5 Septic consisting
of tank, D—box and. 4 leach chambers .
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by s d of H h.
Signed Date
Application Approved by - Date 4Y —Z 3
Application Disapproved for the following reasons
Permit No. Date Issued
No. / ` / ! 4` Fee $5
a
v Entered in computer:
-- � THE COMMONWEAlT� F.�F MASSACHUSETTS11
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS
T Application for ;Di!5pC ar*pgtem Construction Per it
Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System ❑Individual Components
L m n Ad ress o. Owner's Name Address and Tel.No.
g uncle ViAy- & Way, Hyannis, MA Tom Wolfinger y "
Assessor'sMap/Parcel Z� _�� --1 10 West Meadow Estate Dr.
W.
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Wm. E. Robinson Septic Service "
PO Box 1089, Centerville, MA
Type of Building:
Dwelling No.of Bedrooms.. 5/4 Lot Size - sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow tram€ gallons.
Plan Date Number of sheets 'Revision Date'
Title t
Size of Septic Tank Type of S.A.S.f
Description of Soil Sand.
Nature of Repairs or Alterations(Answer when applicable) New Title-5 Septic consisting
of tank, D-box and. 4 .Leach chambers .
>f y
Date last inspected:
Agctement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to.place the system in operation until a Certifi-
cate of Compliance has been issued b�y.*S,54ard of H h.
Signed Date
Application Approved by i - hlr � Date y -Z 3-9 O
Application Disapproved for the following reasons
Permit No. Z 1-7 "i' ( Date Issued
----------------------------------'-----
THE COMMONWEALTH OF MASSACHUSETTS
Wolfinger BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TOERTY, that She On-site Sgwa pispal S gtem Constructed( )Repaired )Upgraded( )
Abandoned( )by m. o lnson eyuic ervice
at 6 Uncle Will s Way, Hyannis, MA has been constructed in accofdance
with the provisions of Title 5 and the for Disposal System Construction Permit No. "2 dated Z
Installer Wm. E. Robinson S r. Designer ,
r� C'
The issuance of this permit/sh knot bip construed as a guarantee that the s ym ..ill function as designed.)�/�
Date ( �'' '! Inspector -1' -
--R—�j1------------------------------------
No. 20 Fee$5 0
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS
Wolfinger
lwi!5pogar *p!tem (Construction Permit
Permission is hereby granted to Construct( )Repair(X )Upgrade( )Abandon( )
System located at 6 Uncle Willys Way, Hyannis, MA
and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this rmit.
�
Date: �` 2�~ / Approved by '' �
�-Crt TOWN OF BARNSTABLE
LOCATION , (JAC,IV, A!Z SEWAGE #
VILLAGE l e--13 1 rS UJ, L L t es ASSESSOR'S MAP &LOT v3�%
INSTALLER'S NAME&PHONE NO. Yo/ /ain�en.9�✓� 5 + �ce a S"�?7�i
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) nti+ �hRv�b�rt� (size) � A,-/ �I
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: 3'51e1 COMPLIANCE DATE: A
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
f y
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.� �,,
- ID
NOTICE: This For in Is T® BeKsrd For The Repair Of Failed
Septic Systems Only.
CERTIFICATION OF SKETCH AND APPLICATION FOR A
DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT
ENGINEERED PLANS)
I, William E. Robinson, Sr. ,hereby certify that the application for disposal works
construction permit signed by me dated L��.3— �1 concerning the
property located at 6,Uncle Willys Way, Hyannis, NM meets all of the
following criteria:
* There are no wetlands within 100 feet of the proposed leaching facility.
* There are no private wells within 150 feet of the proposed septic system.
* .There is no increase in flow and/or change in use proposed.
* There are no variances requested or needed.
* If the proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the
proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted
groundwater table elevation.
Please complete the following:
A),Top of Ground Elevation(according to the Engineering Division G.I.S. map)
B)Observed Groundwater Table Evaluation(according to Health Division well map) 6
SIGNED: DATE �—
LICENSED SEPTIC SYSTEM WSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60
i
(Attach a sketch plan of the ptWposed system. Also if the licensed installer posesses a certified plot plan,
this plant skould be svbv-01t0
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Date: A In Q
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
NAMEOFBUSINESS:
BUSINESS LOCATION:
MAILINGADDRESS: Mail To:
TELEPHONE NUMBER: tyoB) Z.glc_!�6 0.3 f 4n>,0:3 Board of HealthTown of Barnstable
CONTACT PERSON: P.O. Box 534
EMERGENCY CONTACT TELEPHONE NUMBER: SO -2 O-e. Hyannis, MA 02601
TYPE OF BUSI N ESS: Ot,vri,�%Y1,r1
Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own
use? YES �, NO
This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed
envelope for your convenience.
If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing
address: "
ADDRESS:
TELEPHONE: 6Sve2 2!%2 R2�
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health has determined that the following products exhibit toxic or hazardous character-
istics and must be registered regardless of volume. Please estimate the quantity beside the product that
you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS.
Quantity Quantity
Antifreeze(for gasoline or coolant systems) Drain cleaners
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salt (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet Fuel Photochemicals (Fixers)
Diesel fuel, kerosene, #2 heating oil NEW USED
Other petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Battery acid (electrolyte) Swimming pool chlorine
Rustproofers Lye or caustic soda
Car wash detergents Jewelry cleaners
Car waxes and polishes Leather dyes
Asphalt & roofing tar Fertilizers
2n Paints, varnishes, stains, dyes PCB's
Lacquer thinners Other chlorinated hydrocarbons,
NEW USED (inc. carbon tetrachloride)
Zak eake Paint & varnish removers, deglossers Any other products with "poison" labels
Paint brush cleaners (including chloroform, formaldehyde,
Floor & furniture strippers
hydrochloric acid, other acids)
-Metal polishes
Laundry soil & stain removers Other products not listed which you feel
(including bleach) may be toxic or hazardous (please list):
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS