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ta> COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,ss. BARNSTABLE DISTRICT COURT
SUMMARY PROCESS DIVISION
DOCKET NO.
)
CMJ MANAGEMENT COMPANY, agent for )
The Village at Fawcett's Pond Apartments, )
Plaintiff )
V. )
STACEY SEVANO, )
Defendant
SUBPOENA DUCES TECUM
TO: Keeper of the Records
Town of Barnstable // �G
Board of Health
367 Main Street
Hyannis, MA 02601
y
YOU ARE HEREBY COMMANDED in the name of the Commonwealth of Massachusetts in r
accordance with the provision of Rule 45 of the Massachusetts Rules'of Civil Procedure to apbear before the #
Barnstable District Court, holden at Barnstable,Barnstable District Court,3195 Main Street, Barnstable,
within and for the County of Barnstable,on Jwte 30,_2016 a19:00 in the forenoon, and from day today
thereafter until the action then and there to be heard and tried between CMJ Management Company V.
Stacey Sevano.
You are further required to bring with you the documents listed in Exhibit A,attached hereto.
Hereof fail not as you will answer your default under the pains and penalt'IeeS in the law in that behalf
made and provided.
Dated at Boston this 13'h day of June 2016,
Notary Public—
My Commission Expires:
PLEASE CALL LEIGH A.MCLAUGHLIN UPON RECEIPT OF THIS SUBPOENA (617)227-9999.
TRUE COPYATTEST
Constable
t
EXHIBIT A
Any and all documents, reports and/or citations with regard to 148,West Main Street,
Apt, D-207,'Hyannis;MA.
Leigh A. McLaughlin;, Esquire
Gilman, McLaughlin& Hanrahan LLP
101 Merrimac Street
P.O. Box 9601
Boston, MA 02114-9601
Tel. (617)227-9999
Email: linclau hlinigilmac.com
Olt
Crocker, Sharon
From: Crocker, Sharon
Sent: Monday, June 20, 2016 11:40 AM
To: 'Imclaughlin@gilmac.com'
Subject: CMI Management Co-The Village at Fawcett's Pond 148 W.Main St, Apt D-207,
Hyannis
Attachments: 2016_06_20_11_24_49.pdf
Attorney Leigh A. McLaughlin
Gilman, McLaughlin & Hanrahan LLP
Boston, MA
617-227-9999
RE: 148 West Main Street,Apt D-207, Hyannis
Thank you for returning my call.
This is to act as an acknowledgement that you have agreed I will not be required to attend the court hearing on
June 30, 2016, which I received a subpoena for, provided I forward the records to you with my statement as Keeper of
the records. Thank you and I will be sending the official records out by tomorrow,June 21, 2016.
1 have emailed you the initial complaint of our records on 4/6/2016 along with some backup and with the
business card of Criminal Investigation Officer(CIO)Anthony Manfredi who was the person called in to take
pictures. We were told he took 55 pictures; however,we did not receive copies.
I spoke with Jenny at the Barnstable Criminal Investigators Office, 508-375-6125 and she suggested you contact
her and she will be able to assist you in reaching Mr. Manfredi.
Please let me know if there is anything further you may need.
Sincerely,
Sharon Crocker
Administrative Assistant
Keeper of the Records
508-862-4739
1
,/A�4
jk4'n ,�jq
Town of Barnstable Barnstable
Epp THE Tp�y
Board of Health I
e``aMV
9`'MASS.RM 200 Main Street,Hyannis MA 02601
�prfb MA1°�� 2007
Office: 508-862-4644 Wayne Miller,M.D.
FAX: 508-790-6304 Paul Canniff,D.M.D.
Junichi Sawayanagi
June 22, 2016 -
I, Sharon Crocker, Administrative Assistant to the Town of Barnstable Public Health Division
and to the Board of Health, certify these are True Attested Copies of all the documents,
reports and/or citations in the Public Health Division's files for the rental unit D-207 at The
Village at Fawcett Pond, 148 West Main Street,Hyannis, MA.
List of Attached Records:
1) Citizen Request Management Record dated 4/06/2016 2 Pages
2) Fax and Cover Sheet to Britt O'Hara from Donna Miorandi dated 4/8/16 3 Pages
3) Email from Charlie Lewis,Animal Control Officer,to Donna
Miorandi, Health Inspector, dated 4/25/2016 1 Page
4) Article II Minimum Standard for Human Habitation—Rental Inspection
Dated 4/15/16 1 Page
5) Copies of business cards regarding inspection 1 Page
6) Pictures taken by Health Inspector Donna Miorandi on re-inspection
done 4/25/16. 7 Pictures
7). Invoice'—Oceanside Inc. dated 12/1/2015 for work done 11/23/15 1 Page
8) Invoice—Ford's Hometown Services for service done 11/22/2015 1 Page
Sharon Crocker June 22, 2016
Administrative Assistant
Keeper of the Records
Q:\Legal\RECORDS REQUESTS\Records Req for 148 WestMain AptD-207Hy Plaintiff AttyLeigh McLaughlin Jun2016.do6
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Citi`�'n Web Re-quest �� I Page 1 of 2
Citizen Request Management - Internal Use
Request ID: 55713 Created: 4/6/2016 1:38:54 PM
Miorandi Donna
Status: Closed Assigned To: Health Office
Anonymous: No Category:
Chapter II : Housing
� Substandard
`.d E.C. Date: 4/28/2016
` Created By: Sousa,Vanessa Citations:
F.
Health Office
Time Worked: , 5.00 Response Time: 0.25
Requestor Details:
Email:
Request Location:
148 WEST MAIN STREET
Building D Apt 207
Hyannis, Ma 02601
Parcel Number: Map: 290 Block: 027 Lot: 002
Request:
Police Department calling for Health inspector to do a well being check.Apartment infested
with bugs.
•Request Work History:
Entered on 4/8/2016 10:31:48 AM
by Miorandi, Donna
Last modified on 4/28/2016 8:09:11 AM
DZM responded within 15 minutes of call. Upon arrival DZM met 80 year old Stacey Sevano in
Unit D-207. She lives alone and the apartment was quite odorous.This was probably due to her
dog (a poodle)who looked neglected and the fact that she(Lily) was not being let out to urinate
or defecate outside.There was dog feces on the kitchen floor and an accumulation of dog hair
throughout.There is also suspicion that there is a dead cat in the apartment due to the fact that it
has been missing for a while.As a result of this it is presumed that one of the reasons there are
so many flies in the apartment is due to the possible decaying cat. It is perhaps under all the
debris in the bedroom.The bedroom door was hard to open due to the fact that there was so
much debris on the floor around the bed. Many green bags of unknown piled high. Does not
appear that she was sleeping in the bed due to being inaccessible-rather she was sleeping on a
very old dirty sofa. Her appearance was that of unkempt-hair not brushed and dirty looking long
hair. It is doubtful that she has taken any recent showers or baths due to the dirty laundry in the
bath tub.The apartment was loaded with flies, spiders and many large cobwebs. On Nov. 22,
2015 Ford's Hometown Services(Pest control Co.) performed an extermination for a "very high
infestation" of drain flies, pantry moths and spiders. On Nov. 23rd, 2015 Oceanside, Inc.
http://issgl2/lntemalWRS/WRequestPrint.aspx?ID=55713 6/20/2016
Citi,%n Web Request . ` Page 2 of 2
performed a clean-up utilizing respirators and personal protection. It entailed Hepa-Vacuuming,
sanitizing of window sills,tables, and all horizontals.The unit needs the same performances and
then some all over again.This is being performed by Oceanside, Inc again today(4/8/2016).The
oocupant, Stacey Sevano did not want to go willingly to the hospital so the fire Dept. requested a
Section 12 and they took her to Cape cod Hospital, Charlie Lewis took the dog to Barnstable
Animal Hospital.There were many(at least 4) Barnstable police officers on site and many Hyannis
Fire Department representatives, including Captain William Rex).At this time due to the conditions
CIO Anthony Manfredi of the Office of the Sheriff-Barnstable County was called in to take
professional pictures. DZM is awaiting copies of those 55 pictures that were taken by him.
Yesterday,(4/7/16) Britt O'Hara of the management company(Corcoran Jennison Management
LLC)for The Village at Fawcett's Pond condos informed me that Stacey Sevano was showered and
released from Cape Cod Hospital and sent to a motel. Unknown motel and this was set up by
Elder Services/Protective Services.The name given to me was Mel McFadden. Do not know if she
is alone in hotel or under supervision. Stacey Sevano does not drive a car as of late as I have
been told by Britt O'Hara that she totaled her car about a month ago.The apartments come under
HUD and have annual inspections. In talking with Britt O'Hara yesterday(4/7/16) she stated that
they are due for their inspection at the end of April and are anticipating having the clean-up done
by April 25th. She has asked me to pencil in April 25th as a date,for a re-inspection of the unit. I
am told by the Barnstable Police Department that Office Stephen Estey,(Otis)will have the
incident report from them.At this time I am awaiting a copy of that report.As a final note, I was
informed by Britt O'Hara that homemaking that was arranged through Elder Services would not
enter the unit due to many"bugs". Update will be entered as they come into me (DZM).
4/22/2016-DZM has been communicating with Britt O'Hara and is scheduled to unit on
April 25th. 4/25/2016-DZM re-inspected. Unit was re-carpeted, repainted and cleaned. Hot water
is good and refrigeration is good. DZM allowed re-occupancy.Tenant(Stacey) will reoocupy on
Wednesday after Oceanside brings her belonging back into unit and stacks them. 4/28/16-DZM re-
inspected the apartment and approved it for re-occupancy.
Internal Note History:
System entry on 4/6/2016 1:38:54 PM:
Assigned to Miorandi, Donna
Entered on 4/8/2016 10:31:48 AM
by Miorandi, Donna
Last modified on 4/25/2016 3:00:41 PM
Charlie Lewis wanted to charge Stacey Sevano with neglect but did not due to the apparent
-outcome of not being able to pay and being 80 years old. DZM was informed by manager, Britt
O'Hara, that they are evicting her on June 1st. May have a problem getting her out but will have
to go through the eviction process.
System entry on 4/22/2016 8:21:59 AM:
Estimated completion changed from 4/21/2016 to 4/28/2016
System entry on 4/28/2016 8:09:41 AM:
Request Closed by miorandd '
System entry on 4/28/2016 8:09:41 AM:
-Request Closed by miorandd-email sent to requestor
}C II
h4p://issgl2/InternalWRS/ViRequestPrint.aspx?ID=55713 6/20/20I6 o
w
Fax Send Report APR-08-2016 09:44 FRI
Fax Number • 915088624713
Name BARNST HEALTH
Name/Number 915087904113
Page 3
Start Time APR-08-2016 09:44 FRI
Elapsed Time 00'40"
Mode STD ECM
Results [0.K]
TOWN OF BARNSTABLE w
Health T�ivision-200 Main Street-Hyannis,MA 02601
FAAH
o
N,.N,,,�,�,s= Date: =covcr
Numbe
I Town of Barnstable
Health Division,
i
Phone: .; Phone: 508-862-4644
Fax phone: ��— rax phone: 508-790-6304
CC:
REMARKS: ❑ Urgent XFor your ❑ Reply ASAP ❑ Please comment
review
E i
Citizen,Web Request Page 1 of 2
k k y
.1,rAWNSTArLi'P i
Citizen Request Management
4 Jfi
Request ID: 55713 Created: 4/6/2016 1:38:54 PM
Status: , Assigned To Staff Assigned To: Miorandi, Donna
Health Office
.. Chapter II : Housing
Anonymous: No Category:
jo Substandard
E.C. Date: 4/21/2016
Created By: Sousa,Vanessa Citations:
Health Office
Time Worked: 4.00 Response Time: 0.25
x
Request Location:
148 WEST MAIN STREET
Building D Apt 207
Hyannis, Ma 02601
Parcel Number: Map: 290 Block: 027 Lot: 002
Request:
Police Department calling for Health inspector to do a well being check. Apartment
infested with bugs.
Request Work History:
Entered on 4/8/2016 10:31:48 AM
DZM responded within 15 minutes of call. Upon arrival DZM met 80 year old Stacey Sevano in
Unit D-207. She lives alone and the apartment was quite odorous.This was probably due to her
dog(a poodle)who looked neglected and the fact that she(Lily)was not being let out to urinate or
defecate outside.There was dog feces on the kitchen floor and an accumulation of dog hair
throughout.There is also suspicion that there is a dead cat in the apartment due to the fact that it
has been missing for a while. As a result of this it is presumed that one of the reasons there are
so many flies in the apartment is due to the possible decaying cat. It is perhaps under all the
debris in the bedroom.The bedroom door was hard to open due to the fact that there was so
much debris on the floor around the bed. Many green bags of unknown piled high. Does not
appear that she was sleeping in the bed due to being inaccessible-rather she was.sleeping on a
very old dirty sofa. Her appearance was that of unkempt-hair not brushed and dirty looking long
hair. It is doubtful that she has taken any recent showers or baths due to the dirty laundry in the
bath tub.The apartment was loaded with flies,spiders and many large cobwebs. On Nov. 22,
2015 Ford's Hometown Services(Pest control Co.) performed an extermination for a "very high
infestation"of drain flies,pantry moths and spiders. On Nov. 23rd, 2015 Oceanside,Inc.
performed a clean-up utilizing respirators and personal protection. It entailed Hepa-Vacuuming, y
sanitizing of window sills,tables, and all horizontals.The unit needs the same performances and
then some all over again.This is being performed by Oceanside,Inc again today(4/8/2016).The
oocupant, Stacey Sevano did not want to go willingly to the hospital so the fire Dept. requested a
Section 12 and they took her to Cape cod Hospital. Charlie Lewis took the dog to Barnstable
Animal Hospital.There were many(at least 4) Barnstable police officers on site and many Hyannis
Fire Department representatives, including Captain William Rex).At this time due to the conditions
CIO Anthony Manfredi of the Office of the Sheriff-Barnstable County was called in to take
http://issgl2/intemalwrs/WRequestPrintPub.aspx?ID=5 5713 4/8/201.6
Citizen Web Request Page 2 of 2
professional pictures. DZM is awaiting copies of those 55 pictures that were taken by him.
Yesterday,(4/7/16) Britt O'Hara of the management company (Corcoran Jennison Management
LLC)for The Village at Fawcett's Pond condos informed me that Stacey Sevano was showered and
released from Cape Cod Hospital and sent to a motel. Unknown motel and this was set up by
Elder Services/Protective Services.The name given to me was Mel McFadden. Do not know if she
is alone in hotel or under supervision. Stacey Sevano does not drive a car as of late as I have
been told by Britt O'Hara that she totaled her car about a month ago.The apartments come under
HUD and have annual inspections. In talking with Britt O'Hara yesterday(4/7/16) she stated that
they are due for their inspection at the end of April and are anticipating having the clean-up done
by April 25th. She has asked me to pencil in April 25th as a date for a re-inspection of the unit. I
am told by the Barnstable Police Department that Office Stephen Estey(Otis)will have the
incident report from them.At this time I am awaiting a copy,of that report. As a final note, I was
informed by Britt O'Hara that homemaking that was arranged through Elder Services would not
enter the unit due to many"bugs". Update will be entered as they come into me(DZM).
3
http://issgl2/intemalwrs/WRequestPrintPub.aspx?ID=55713 4/8/2016
Message Page 1 of I
Miorandi, Donna
From: Lewis, Charlie
Sent: Monday, April 25, 2016 3:33 PM
To: Miorandi, Donna
Subject: RE: Stacey Sevano dog
After we had the dog checked by Vet, shots updated, dog license obtained and groomed the dog was returned to
Ms Sevano. In fact the party I had fostering the dog donated some dog food which I will bring to Sevano when she
calls me for it. l
-----Original Message-----
From: Miorandi, Donna
Sent: Monday, April 25, 2016 3:04 PM
To: Lewis, Charlie
Subject: Stacey Sevano dog
Hi Charlie: Just curious if you are releasing the dog back to Stacey at Bldg. D-207 at 148 West Main St.,
Hyannis.
I re-inspected the unit today and she is going to reoccupy sometime after Wed. this week.
Regards,
Donna Miorandi
4/25/2016
TOWN OF BARNSTABLE KHA�
i
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
4 Date4 Time: In Out
Owner 'AM?'AM?& Tenant
sued �4WO I
Address 0 / Address Won E�40'
VANEI�. Of
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities V/
3. Bathroom Facilities V.
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7 Lighting and Electrical Facilities
8.Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17.Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART 11
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max i
Number of Persons Allowed (max) p
6
Person(s) Interviewed Inspector
If Public Building such as.Store or Hotel/Motel specify here
r
IL
C O R C O R A N
J E N N I S O N
Management LLC
Britt D. O'Hara
Property Manager
The Village at Fawcett's Pond
148 West Main Street,Hyannis,MA 02601
T.508-771-8702 1 F.508-790-4113
bohara@cjmanagement.com
OFFICE OF THE SHERIFF
BARNSTABLE COUNTY gNERIPP
`• • F.
CIO ANTHONY MANFREDI
ouiqil
Dept of Public Safety
P.O.Box 315
Barnstable,MA 02630
508.375.6129 Fax:508.375.6286 • amanfredi@bsheriffnet
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Date: April 25, 2016 —Reinspection
Oceanside, Inc.
217 Thornton Drive
NVOICE
Hyannis, MA 02601 Invoice Number: 20150149 D207 CLN
Invoice Date: Dec 1,2015
Page: 1
Voice: 508-771-3110
Fax: 774-470-2211
THE VILLAGE AT FAWCETTS POND THE VILLAGE AT FAWCETTS POND
148 WEST MAIN STREET 148 WEST MAIN STREET
HYANNIS, MA 02601 UNIT D207
HYANNIS, MA 02601
FAWCEPON 20151212-U.NIT D207 Due at end of Month
LAROCHE,PETER US Mail 12131/15
Emergency Call Out-After Hours For 1,489.09
i� 1 Cleaning-Including Work As Described
Below
1)Respirator, Personal Protection,Bags&
Supplies
2)Labor-Hepa Vacuuming,.Sanitizing of
Counters, Window Sills,Tables, Horizontals
Etc.
3)Equipment Charge for Disposable
Attachments
4)Equipment Decontamination
5)MISC DISPOSAL
Aff,7"�' Q9
Subtotal j 1,489.09
Sales Tax
Total Invoice Amount 1,489.09
Check/Credit Memo No: Payment/CreditApplied
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ORD' "" I D Home of the
SERVICE S 549 Grove Street,Worcester,MA 01605-3898
SIN FHOMETQVVN
Tel:508-852-4066•Fax:508-438-0060.1-800-649-9992 "PEST OF THE?MONTH"
Y0 ENVIRONMENTAL
PEST&LAWN PROFESSIONALS www.Fordshometown.com
ACCOUNT N0. JOB TICKET:NO.. ORIGINAL SERVICE DATE DATE OF LAST SERVICE DATEDF SERVICE &KVICETIME. T {TECHNICIAN
' .
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PET
/PiT
0-12 .,ESTI LOCE, rn JILGE�{1 -µ^C701 1 LI E.
BILLING ADDRESS Wy SERVICE ADDRESS
I L L AGE AT FATATCETT 1 S PONT! VII L Lnt_E AT FAW ETT'S Pr ITEIi
148 WEST MAITZ STA.EET 148 WEST PRAITQ STREET
HYr;.IDIIS 11h 02601 I-ri"ANNIs Iv9 02E01 e.
(508) f 11-8'702 150513
TYPE OF SERVICE;. TARGET PEST WRITE.EACH LETTER THAT APPLIES BELOW IIN METHOD COLUMN
0rle Shot ❑ ANTS ❑ ROACHES B&G HAND PUMP F. GEL BAIT K BAR CUPS
❑ MICE/RATS/RODENTS ❑ BED BUGS SPOT SPRAY G. HAND DUST L GRANULAR BAR
1701411Er-+I IA L ❑ HORNETS&WASPS ❑ TERMITES fy { CRACK&CREVICE H MICRO INJECT FOG M. BURROW BAR
SPIDERS ❑ FLIES �;; !f/ D. AEROSOL GLUE BOARDS N. B&G POWER DUST
❑ VOLES MOLES ❑ OTHER E. ENCLOSED BAR J. SNAP TRAPS 0. POWER SPRAY
.. -.: ..
pp AREASNSPECTEDAND_ORTREATED. CHEMICAL. EPA'REG.#, %AI QTY.. ` MET!�oi
KITCHEN ANTERIOR PERIMETER A<STORAGE AREAS ❑ AC-90 56-58 0.005
)(REST ROOMS ❑LOADING DOCK ❑GARAGE ❑ ADVANCE 388B 499-492 5.40
❑BARS t` ❑EXTERIOR PERIMETER ❑BASEMENT ❑ ADVION ANT BAIT 352-746 0A5
❑PRODUCTION AREA '❑OFFICE AREA ❑ATTICS ❑ADVION ROACH BAIT 352-668 0.6
'SEATING AREA ❑SHED ❑OTHER ❑AEROTHOR INSPECTHOR 6959-79-81824 0.5
j£E A 7-E4 SIC/9-/N PII&SI ❑ BORID DUST 9444-129 99
Aq r r T zC v W "PI.- [-1 BORATHOR SCATTER BAIT 81824-12 5.00
❑ DRIONE 432-992 51
�2. y /4 of { ❑ ECOEXEMPT D NA 6 25
t6_= tam S•i..v3;_�Gr _v@ter i -r 1-��dY) -
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❑ ECOEXEMPT G NA 3.50
=�G Jeff Floyd' O`A 9SC•L•.'•t ❑ ECOEXEMPT IC2 NA 12
�t� ❑ ECOPCOACU 67425-14 .10
CO N D I T I ti AI 14 P,�40 i ill ❑ ECOPCO EC 67425-20 50
19 EXCITER 655-798 6
S JBFFj TR.^.r_T ONE UUITt tv+ tv>LEPA,]TY 9.GENTROLIGR 2724-351 9
- I J'. L
�/1p�1rQµ M-ecxf k4Dg4r �� TIME IN ❑ GOURMET ANT GEL 73766-1 6
�J 4(N l►•e1 1`t ,' �%t ❑ MAXFORCE FLY SPOT BAIT 432-1455 10
f TIME OUT ❑ MAXFORCE MAGNUM BAIT 432-1460 0.05
Sp j @!'S . L PREVIOUS ❑ MAXFORCE QUANTUM ANT BAIT 432-1506 0.03
THE SIGNATURE BELOW ALSO VERIFIES THAT THIS BALANCE +'- Do ❑ MAXXTHORSG 81824-3 0.20
PROPERTY HAS BEEN PROPERLY POSTED AND
PRENOTIFICATION HAS BEEN RECEIVED BY OWNER OR TODAY'S mot- / ,0 (.= 47629-16 G?
MANAGEMENT. WE HAVE ALSO PROVIDED THE CHARGES ❑ ORTHENE 499-373 1.00
MASSACHUSETTS CONSUMER INFORMATION BULLETIN. COUPO ❑ PERMADUST 499-384 35.50
DISCOUNT
AMOUNT JLJ PRECOR IGR 2724-352 1.20
l?E?sg LO_g 3-10J4 PAID 10 RODENTHOR SOFT BAIT 82744-2-81824 0.005
TECHNICIAN LICENSE NO. ElROZOLTRACKING POWDER 7173-113 0
WERE TERMITE MONITORS INSPECTED? 12455-
YES NO ❑ SUSPEND SC 3 0.025
❑TALPRID 2455-101 0.03
ACTIVITY LOCATIONS: ❑TAURUS SC 53883-279 .6 OR.09
❑TEMPO DUST 432-1373 1
'The undersigned,authorize and agree the work listed has been performed as described and 9L.TEMPRID SC 432-1483 21 ' 4-66
that I have received all state pre and post mandated materials.Payments received after invoice ❑TERMIDOR SC 7969-210 9.1
date will be credited next invoice. Returned checks subject to a$30.00 charge. Delinquent ULD-BP 00 499-450 19 "Fl !fl
accounts are subject to a 1112.% er o th or 18%per year FINANCE CHARGE on balances IR
after 30 da s.Also d linquent�ac are subject to a$5.00 late tee on balances after 60 ❑ZENPROX 2724-804 16.20
days. ❑ZP RODENT BAIT PELLET 12455-18 2
G ��' cy 3'• ��� ElZP-RODENT BAIT OAT 12455-102 2
i CU OME DATE ng m. 7y e,.q IT ,y _
r t �• L SE RETURN TH PORTION WITH YOUR PAYMENT PLEASE INDICATE PAYMENT AMOUNT&CHECK NUMBER
ORD rna'ERvICE DATE li!' 3�'�'{!1 ITrv' C!4 i+J71J1 = R._- a z o =
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OMETO WN
SERVICES 549 Grove Street,Worcester,MA 01605-3898
Tel:508-852-4066•Fax:508-438-0060.1-800-649-9992 Charge my: ❑ ❑� ❑FJ� ❑L�I
to tJR ENVIRONMENTAL " .-wu I
�: Exp: I '
PCST&LAWN PROFTSSIONALS www.Fordshometown.com
Card!!: VER#
"r I L LA GE AT FA WCETT T S POr-?L! Signature '
1 '48 L.TEST AinlTd STF:EET
H� tiITTdIS P:7A 02601 ACCOUNT NUMBER VILWES{11
�500-00
Fords Hometown Services,est. 1941,has always been owned and will continue to be operated by the Ford Family.
Message Page 1 of 1
Miorandi, Donna
From: Lewis, Charlie
Sent: Monday, April 25, 2016 3:33 PM
To: Miorandi, Donna
Subject: RE: Stacey Sevano dog
After we had the dog checked by Vet, shots updated, dog license obtained and groomed the dog was returned to
Ms Sevano. In fact the party I had fostering the dog donated some dog food which I will bring to Sevano when she
calls me for it.
-----Original Message-----
From: Miorandi, Donna
Sent: Monday, April 25, 2016 3:04 PM
To: Lewis, Charlie
Subject: Stacey Sevano dog
Hi Charlie: Just curious if you are releasing the dog back to Stacey at Bldg. D-207 at 148 West Main St.,
Hyannis.
I re-inspected the unit today and she is going to reoccupy sometime after Wed. this week.
Regards,
Donna Miorandi
4/25/2016
D
TOWN OF BARNSTABLE ,�I
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date Time: In Out
Owner W Tenant
s-rAffiv ��Mo
Address Rj, M /Z Address V 4
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities V/
3. Bathroom Facilities V.
4. Water Supply V,
5. Hot Water Facilities
6. Heating Facilities
7.i- hting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits oe
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17.Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
NN
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max
Number of Persons Allowed (max) -J9
a �
Person(s) Interviewed, �1 , - Inspector �C
If Public Building such as Store or Hotel/Motel specify here
( - I
Oceanside, Inc. , 3,
217 Thornton Drive � '
Hyannis, MA 02601 Invoice Number: 20150149 D207 CLN
Invoice Date: Dec 1,2015
Page: 1
Voice: 508-771-3110
Fax: 774-470-2211
Q
THE VILLAGE AT FAWCETTS POND THE VILLAGE AT FAWCETTS POND
148 WEST MAIN STREET 148 WEST MAIN STREET
HYANNIS, MA 02601 UNIT D207
HYANNIS, MA 02601.
-+-
FAWCEPON 20151212-UNIT D207 Due at end of Month
A..J
LAROCHE,PETER US Mail 12131/15
Quantity ttem € � � Descn tion xUntt Price Amount
::,.. �.-
Emergency Cali Out-After Hours For 1,489.09
j Cleaning-Including Work As Described
Below
1)Respirator, Personal Protection,Bags&
Supplies
2)Labor-Hepa Vacuuming,Sanitizing of
Counters, Window Sills,Tables, Horizontals
Etc.
3)Equipment Charge for Disposable
Attachments
4)Equipment Decontamination
5)MISC DISPOSAL
J �.
� m
Subtotal I 1,489,09
Sales Tax u i
Total Invoice Amount ^1,489.09
Check/Credit Memo No: Payment/CreditApplied
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N Home of the
S 549 Grove Street,Worcester,MA 01605-3898 "PEST OF THE MONTH"TM
SIN.F 194I Tel:
YOuR ENVIRONMENTAL 508-852-4066-Fax:508-438-0060-1-800-649-9992
REST&LAWN PROFESSIONALS wiv",.FordshometoA ii.com
�6. J66 Ti6K& DATE OF kR'\rl6E VICE TIME ACCOUNT NO... ORIGINAL DATE DATE LAST SERVICE" ;TECHNICIAN:
P.'�LJTRY PLc�m
71 LETE 3 0 1 0470701 1.112;3,1 0 1( Z 0-12
BILLING ADDRESS SERVICE ADDRESS
VILLAGE AT FATAICETTIS POND VILLAGE AT- FAtiICETT'3 PONT-1
148 WE-3T MAII; STREET 148 krEST IgiIN STREET
H'.,`ANNI3 1-a 02601 HYANNI3 1,S 02601
T7
(5081) 7,71-8702 (508) -:326-1889
.,:..: PL
TYPE OF SERVICE
TARGET PEST .WRITE EACH"LETTER THATAPPLIES BELOW-IN IVIETH D.COLUMN
One Shot C) ANTS 0 ROACHES C/13&G HAND PUMP F. GEL BAIT K. BAIT CUPS
EI MICE I RATS I RODENTS 11 BED BUGS &SPOT SPRAY G. HAND DUST L. GRANULAR BAIT
C01441 E RC I A L 0 HORNETS&WASPS 11 TERMITES 6) CRACK&CREVICE MICRO INJECT FOG M. BURROW BAIT
SPIDERS 0 FLIES D, AEROSOL GLUE BOARDS N. B&G POWER DUST
❑ 9?
VOLES MOLES 0 OTHER F'1/4 E. ENCLOSED BAIT J. SNAP TRAPS O. POWER SPRAY
1,co" T Y
Xi
:AREA CHEMICAL.: IRE )0 01
DORTREATED::
.�_PA' G.
KITCHEN }INTERIOR PERIMETER KSTORAGEAREAS El AC-90 56-58 0.005
)(REST ROOMS 0 LOADING DOCK D.GARAGE El ADVANCE 388E 499-492 5.40
Z11 JR,
0 BARS 0 EXTERIOR PERIMETER 0 BASEMENT El ADVION ANT BAIT 352-746 0.05
0 PRODUCTION AREA 0.OFFICE AREA D ATTICS [I ADVION ROACH BAIT 352-668 0.6
i'SEATING AREA D SHED El OTHER El AEROTHOR INSPECTHOR 6959-79-81824 0.5
7je'l:� ,4 7 e d
oeo'Al El BORID DUST 9444-129 99
40� A17RY BORATHOR SCATTER BAIT 81824-12 5.00
El DRIONE 432-992 51
El ECOEXEMPT D NA 6.25
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CO IV L)/ 7- Al 14 P�je.T ig,A"C_,A1 E) ECOPCO EC 67425-20 50
EXCITER 655-798 6 1%aaa
FEE T^aFPi TEE—IT OVE UNIT! W_IkRFAMTY g GENTROLIGIR 2724-351 9
dn�IraK ea lkn*Air TIME IN El GOURMET ANT GEL 73766-1 6
9L
❑ MAXFORCE FLY SPOT BAIT 432-1455 10
sp j-ders TIME OUT
Ivi I 0 MAXFORCE MAGNUM BAIT 432-1460 0.05
PREVIOUS El MAXFORCE QUANTUM ANT BAIT 432-1506 0.03
THE SIGNATURE BELOW ALSO VERIFIES THAT THIS BALANCE U El MAXXTHOR SG 81824-3 0.20 '
PROPERTY HAS BEEN PROPERLY POSTED AND TODAY S owv/ g%K 47629-16
'$k 4Z
PRENOTIFICATION HAS BEEN RECEIVED BY OWNER OR CHARGES ty-)U ' 6.
-
MANAGEMENT. WE HAVE ALSO PROVIDED THE 0 ORTHENE 499-373 1.00
MASSACHUSETTS CONSUMER INFORMATION BULLETIN COUPO
DISCOUNT El PERMADUST 499-384 35.50
AMOUNT El PRECORIGR 2724-352 1.20
0%TESTT LOCE 21004 PAID El RODENTHOR SOFT BAIT 82744-2-81824 0.005
TECHNICIAN LICENSE NO. El ROZOL TRACKING POWDER 7173-113 0.2
0 SUSPEND SC 432-763 0.025.
WERE TERMITE MONITORS INSPECTED? YES NO 0 TALPRID 12455-101 0.03
ACTIVITY LOCATIONS: El TAURUS SC 53883-279 .6 OR.09
El TEMPO DUST 432-1373 1
-The undersigned,authorize and agree the work listed has been performed as described and TEMPRID SC 432-1483 21
that I have received all state pre and post mandated materials.Payments received after invoice ❑TERMIDOR SC 7969-210 -9.1
,date will be credited next invoice. Returned checks subject to a$30.00 charge. Delinquent ULD-BPJ00 499-450 19 5 R
accounts are subject to a 11/2%per o th or 180X per year FINANCE CHARGE on balances
'after30 1,S.Also d linquent a are Subject to a$5.00 late fee on balances after 60 0 ZENPROX 2724-804 16.20
days.
0 ZP RODENT BAIT PELLET 12455-18 2
0,
El ZP-RODENT BAIT OAT 12455-102 2
11W_CqK0MEtAL DATE 10 NO TAI 7-P, 9 P-6-
OLF 5SE RETURN THK PORTION WITH YOUR PAYMENT PLEASE INDICATE PAYMENT AMOUNT&CHECK NUMBER
RD' nERIV'ICE DATE. 1!/22-3.2`2.0 1 INV# 0 4 7 0 7 0 1
S;OETow
N'Z
V][CES 549 Grove Street,Worcester,MA 01605-3898
YO ciR ENVIRONMENTAL Tel:508-852-4066-Fax:508-438-0060-1-800-649-9992 Charge my: El� EIM El F9_1':,P E] Exp:
PCEST&LAWN PROFESSIONALS wwwFordshometown.corn
Card VER#
7-l'ILLAGE AT FAWCETT'S POND Signature
-48 WEST 1-1AIN srm.EET
I.-A 02601 ACCOUNT NUMBER VILIJES I--'I
5 ri C,.C,0
Fords Hometown Services,est. 1941,has always been owned and will continue to be operated by the Ford Family.
f R
Fax Send Report APR-08-2016 09:44 FRI
Fax Number 915088624713
Name BARNST HEALTH
Name/Number 915087904113
Page 3
Start Time APR-08-2016 09:44 FRI
Elapsed Time 00'40"
Mode STD ECM
Results [O.K]
TOWN OF BARNSTABLE „
Health Division—200 Main Street-Hyaunis,MA.02601
FAXN` T
. : Date.
9�� 0
Fo n,• Number of pagrs including cover sheet. -5
FROM:
Town of Bamstable
— Heahh Division'
Phone: ; phone: 508-862-4644
Fax phone: r ix phone: 508-790-6304
CC. -
REMARKS: ❑ Urgent XFor your ❑ Reply ASAP ❑ Please comment
review
Citizemwl Request Page 1 of 2
Citizen Request Management
tp�
Mkt I�1r+.�tD l:
Request ID: 55713 Created: 4/6/2016 1:38:54 PM
; .
Status: Assigned To Staff Assigned To: Miorandi, Donna
Health Office .
s
' Anonymous: No Category: Chapter II : Housing
Substandard
_• E.C. Date: 4/21/2016
Y
Created By: Sousa,Vanessa Citations:
I Health Office
Time Worked: 4.00 Response Time: 0.25
Request Location:
148 WEST MAIN STREET
Building D Apt 207
Hyannis, Ma 02601
Parcel Number: Map: 290 Block: 027 Lot: 002
Request:
Police Department calling for Health inspector to do a well being check. Apartment
infested with bugs.
Request Work History:
Entered on 4/8/2016 10:31:48 AM
DZM responded within 15 minutes of call. Upon arrival DZM met 80 year old Stacey Sevano in
Unit D-207. She lives alone and the apartment was quite odorous.This was probably due to her
dog (a poodle)who looked neglected and the fact that she(Lily)was not being let out to urinate or
defecate outside.There was dog feces on the kitchen floor and an accumulation of dog hair
throughout.There is also suspicion that there is a dead cat in the apartment due to the fact that it
has been missing for a while. As a result of this it is presumed that one of the reasons there are
so many flies in the apartment is due to the possible decaying cat. It is perhaps under all the
debris in the bedroom.The bedroom door was hard to open due to the fact that there was so
much debris on the floor around the bed. Many green bags of unknown piled high. Does not
appear that she was sleeping in the bed due to being inaccessible-rather she was sleeping on a
very old dirty sofa. Her appearance was that of unkempt-hair not brushed and dirty looking long
hair. It is doubtful that she has taken any recent showers or baths due to the dirty laundry in the
bath tub.The apartment was loaded with flies,spiders and many large cobwebs. On Nov. 22,
2015 Ford's Hometown Services(Pest control Co.) performed an extermination for a "very high
infestation"of drain flies, pantry moths and spiders. On Nov. 23rd, 2015 Oceanside,Inc.
performed a clean-up utilizing respirators and personal protection. It entailed Hepa-Vacuuming,
sanitizing of window sills,tables,and all horizontals.The unit needs the same performances and
then some all over again.This is being performed by Oceanside, Inc again today(4/8/2016).The
oocupant, Stacey Sevano did not want to go willingly to the hospital so the fire Dept. requested a
Section 12 and they took her to Cape cod Hospital. Charlie Lewis took the dog to Barnstable
Animal Hospital.There were many (at least 4) Barnstable police officers on site and many Hyannis
Fire Department representatives, including Captain William Rex).At this time due to the conditions
CIO Anthony Manfredi of the Office of the Sheriff-Barnstable County was called in to take
http://issgl2/intemalwrs/WRequestPrintPub.aspx?ID=55713 4/8/2016
Citizen;W&b Request Page 2 of 2
professional pictures. DZM is awaiting copies of those 55 pictures that were taken by him.
Yesterday,(4/7/16) Britt O'Hara of the management company(Corcoran Jennison Management
LLC)for The Village at Fawcett's Pond condos informed me that Stacey Sevano was showered and
released from Cape Cod Hospital and sent to a motel. Unknown motel and this was set up by
Elder Services/Protective Services.The name given to me was Mel McFadden. Do not know if she
is alone in hotel or under supervision. Stacey Sevano does not drive a car as of late as I have
been told by Britt O'Hara that she totaled her car about a month ago.The apartments come under
HUD and have annual inspections. In talking with Britt O'Hara yesterday(4/7/16) she stated that
they are due for their inspection at the end of April and are anticipating having the clean-up done
by April 25th. She has asked me to pencil in April 25th as a date for a re-inspection of the unit. I
am told by the Barnstable Police Department that Office Stephen Estey(Otis)will have the
incident report from them. At this time I am awaiting a copy of that report. As a final note, I was
informed by Britt O'Hara that homemaking that was arranged through Elder Services would not
enter the unit due to many"bugs". Update will be entered as they come into me(DZM).
http://issgl2/intemalwrs/WRequestPrintPub.aspx?ID=55713 .4/8/2016
Citizen Web Request Page 1 of 2
41
6A?L>3TAI3C&
Citizen Request Management.
Request ID: 55713 Created: 4/6/2016 1:38:54 PM
Status: Assigned To Staff Assigned To: Miorandi, Donna
Health Office
Anonymous: No Category. Chapter II : Housing
Substandard
E.C. Date: 4/21/2016
Created By: Sousa,Vanessa Citations:
Health Office
Time Worked: 4.00 Response Time: 0.25
Request Location:
148 WEST MAIN STREET
Building D Apt 207
Hyannis, Ma 02601
Parcel Number: Map: 290 Block: 027 Lot: 002
Request:
Police Department calling for Health inspector to do a well being check. Apartment
infested with bugs.
Request Work History:
Entered on 4/8/2016 10:31:48 AM
DZM responded within 15 minutes of call. Upon arrival DZM met 80 year old Stacey Sevano in
Unit D-207. She lives alone and the apartment was quite odorous.This was probably due to her
dog (a poodle) who looked neglected and the fact that she(Lily)was not being let out to urinate or
defecate outside.There was dog feces on the kitchen floor and an accumulation of dog hair
throughout. There is also suspicion that there is a dead cat in the apartment due to the fact that it
has been missing for a while. As a result of this it is presumed that one of the reasons there are
so many flies in the apartment is due to the possible decaying cat. It is perhaps under all the
debris in the bedroom.The bedroom door was hard to open due to the fact that there was so
much debris on the floor around the bed. Many green bags of unknown piled high. Does not
appear that she was sleeping in the bed due to being inaccessible-rather she was sleeping on a
very old dirty sofa. Her appearance was that of unkempt-hair not brushed and dirty looking long
hair. It is doubtful that she has taken any recent showers or baths due to the dirty laundry in the
bath tub.The apartment was loaded with flies,spiders and many large cobwebs. On Nov. 22,
2015 Ford's Hometown Services(Pest control Co.) performed an extermination for a "very high
infestation" of drain flies, pantry moths and spiders. On Nov. 23rd, 2015 Oceanside, Inc.
performed a clean-up utilizing respirators and personal protection. It entailed Hepa-Vacuuming,
sanitizing of window sills,tables; and all horizontals.The unit needs the same performances and
then some all over again.This is being performed by Oceanside, Inc again today(4/8/2016). The
oocupant, Stacey Sevano did not want to go willingly to the hospital so the fire Dept. requested a
Section 12 and they took her to Cape cod Hospital. Charlie Lewis took the dog to Barnstable
Animal Hospital.There were many(at least 4) Barnstable police officers on site and many Hyannis
Fire Department representatives, including Captain William Rex). At this time due to the conditions
CIO Anthony Manfredi of the Office of the Sheriff-Barnstable County was called in to take
f
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Citizen Web Request Page 2-of 2
professional pictures. DZM is awaiting copies of those 55 pictures that were taken by him.
Yesterday,(4/7/16) Britt O'Hara of the management company(Corcoran Jennison Management
LLC)for The Village at Fawcett's Pond condos informed me that Stacey Sevano was showered and
released from Cape Cod Hospital and sent to a motel. Unknown motel and this was set up by
Elder Services/Protective Services. The name given to me was Mel McFadden. Do not know if she
is alone in hotel or under supervision. Stacey Sevano does not drive a car as of late as I have
been told by Britt O'Hara that she totaled her car about a month ago.The apartments come under
HUD and have annual inspections. In talking with Britt O'Hara yesterday(4/7/16)she stated that
they are due for their inspection at the end of April and are anticipating having the clean-up done
by April 25th. She has asked me to pencil in April 25th as a date for a re-inspection of the unit. I
am told by the Barnstable Police Department that Office Stephen Estey(Otis)will have the
incident report from them. At this time I am awaiting a copy of that report. As a final note, I was
informed by Britt O'Hara that homemaking that was arranged through Elder Services would not
enter the unit due to'many"bugs". Update will be entered as they come into me (DZM).
http://issgl2/intemalwrs/WRequestPrintPub.aspx?ID=55713 4/8/2016
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BOARD OF HEALTH
TOWN[ OF BARNISTABLE
0ppYication-*rMpll Con5tructionPermit
Application is hereby made fo permit to Con t uct ( ), Alter ( ), & Repair ( )an ' dividual Well at:
GLJ f2/IG�/'`1 5
--- - - - - - �Z -----------
Location — Address Asses3s rs a d Parcel
�G��G,e
Owner Address
o c�-LJ 7 -------------- ef I' 3 &J>1-A "•, Sfi'' 0 r
Installer — Driller Address
Type of Building
DwellingA �� ----
Other - Type-of Building ----------- No. of Persons---------------------------------- -------
Typeof Well--------------=----------------------------------------------- Capacity------------------------------------------------------------- •
Purpose of Well------- `'16A -
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation ungaertif' ate of Compliance has been issued by the Board of Health.
Si ned - � --
date
A lication A roved B �/1 A.-
Application ------------------ --f- �
PP PP Y- date
Disapproved for the following reasons:----------------------------------------------------------------------------------------------------------
--------------- — —— r ____—-- — — -- — --- --- —----—— — — — -- — —---date -------------—n -
Permit No.- --(�--- -�------- -- Issued - - if +` ��-J- -- --
- -- — — d to
BOARD OF HEALTH
TOWN OF BARNISTABLE
Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed Altered ( ), or Repaired ( )
�,{ �— Installer tt }
a t— "�` -----( -------`--�---YA41f- -------
—- - -- --- — - -
has been installed in accordance with the provisions of tfle Town of Barnstable Board of Healt4 Private Wel rotect on
Regulation as described in the application for Well Construction Permit No. -b�-T�� —Dated-�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------------------------- - ----------------------------------------------- Inspector---------------------------------------------------------—----------------
yvI
No------—------------- - Fee--------
BOARD OF HEALTH
TOWN OF BARNSTABLE
j� Zippfication-*rVerr Con0ructionpermit
Application is hereby made for a permit to Con,st}}uct ( ), Alter ( ), or Repair( )an individual Well at:
— -- — —
Location — Address AsseSSOIs&faP and Pa—
cel j
1'yl /1,7`,
----------------------------------- -
Owner V Address
Installer — Driller J Address
Type ofTBuilding
Dwelling---------- -----------------�------------------�------------
Other - Type of Building---------------------------------- No. of Persons- -— ----- -—--------------
�cG.✓C �n G �
Typeof Well----------------------------------------------,--------------------- Capacity-------------------------------------------------=------------------------
Purpose of Well - v -�-r -
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed-
date
Application Approved By
date/
Application Disapproved for the following reasons:----------------------
---------=-----------------—---------- --- - -- --- —------- — --
V lJ I l ✓ date
Permit ——Permit No. -- — - - - __--—--_- —- Issued -- - — - — --
"` date --
`
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( , Altered ( ), or Repaired ( )
. � ------------------------------------- ---- -- - ---
Installer _
at_______ __---- ____� __T n�____ _ _-_________1____Y �h1_1_J--____________-__-______________-________
has been installed in accordance with the provisions of the Town of Barnstable BoardMated
vate Wel Prot don
x;
Regulation as described in the application for Well Construction Permit No. %U -,-7---� 25
f j
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------------------------------------------------------------------------------------ Inspector--------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Vrll Con5tructionVermit I
No. z T , Fee-v---=-----------
Permission i hereby granted _��____[_� -1 1� 7�I -b � - - - - -
--
to Constru ), Alte ( ), ,,o��rfRep.' ( ),an,�I�dividual Wel t�/ ]�
No. -- —�— --./ m -— -t J 1 ,-� -- --�JV_-- --------- ---------------------------------------------------
S'tree
as shoZM
he~�applicati ri for a Well Construction Permit
tom-- --- Dated _ _
DATE CJ�J`—I Board of Health
J_- —� _ __ - - ------
/ �
Fee yS------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
lication-*r Melt Construction Permit
Application is hereby made for a permit to Construct (✓7, Alter ) or Repair ( )an individual Well at:
----�y�-- Ynvi� T - ----------
Location -—---------—--—*-— Address 7�sses rs Ma and Parcel
Address
- _ -- - - 3
Installer Driller Address
Type of Building
Dwelling-------------------------------------------------------------------
Other - Type of Building----------------------------------- No. of Persons---------------------------------------------------
Typ,f of Well---- � Capacity
--------------------------------------
Zi�� T/O __
Purpose of'Well--------------------------------------------------------
�' ✓tom pl✓ �GG�G� ,df/o��/1 g�f��fi �fJ /�'YY,�I if/�;�
Agreement: �" ✓
The undersigned agrees to install the aforedes�individual well in accordance with the provisions of Th g gr p e
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate of mpliance has been issued by the Board of Health.
Signed -- -- ---------------- �`
---- -- ----------
-------- --------- ----------
dat
Application Approved B � -Zl'1 l__
- --- - -- --
date --
Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------
c� `� date
Permit No. -- C- /--- -- - Issued-------- - -?�--- ?�------------------ --------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
��S b..c rrt,�� 4i/Qi�� �}'� -------------------------------------------—-------------—---—------------------—
by- ------ -- -- - ------ -�'f 1
Installer
at--
------ Al, E Y�.—�-f�-,01`1— ----------------------------------------------- -- -------------------------
has been installed in accordance with the provisions of the Town of Barnstable Board of Healtth Private Well Protection
Regulation as described in the application for Well Construction Permit No. -�5 7 Dated
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- ---—---— - ---- -- Inspector--------------------------------------------- - ------------
i
Y Fee!7--�----------.-...-
BOARD OF HEALTH
t TOWN OF BARNSTABLE
Application-*rVell Con5truct ion Permit
Application is hereby made for a permit to Construct (.-), Alter ��or Repair ( )an individual Well at:
Y"v/ 57_._
Location — Address Assess rs Map and Parcel
Own Address ��LJ
(�/ 5 rri o iv _____li_G�_� _ i ��c n Tyi -�d --��____--`-���3------1L � S
Installer — Driller Address
Type of Building
l�welling------------------------------------------------------------------
Other - Type of Building ----------- No. of Persons--------------------------------------------------
Typeof Well Capacity-------------------------------------------------------- ------
-a 'Purpose of Well-----I '�'_%__/9_7-10IJ -- -
y -
Agreement:' � 1,�_& �/1 Cr"� 5/0 /1"-17
The undersigned agrees to install the afc r descnbed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of epmpliance has been issued by the Board of Health.
`-- ------- - l/ y'
Signed- ----. -- --� --------- ----------- ------ ----------. dat q q.
Application Approved B =� ---- - -� -— --7
date
Application Disapproved for the following reasons:----------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------=----------------------------------------------------
c� 'f date
Permit No. -- 1_��-•3-1---------------------- Issued -----7-2/ ---- ------------------ --------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif irate Of,Compliance
THIS IS TO CERTIFY, That the Individual Well Constr cted ( ), Altered ( ), or Repaired ( )
by- 17,c 3 1,�.�-vt.��.' �t/� �_ �� !��'--------------------------------------------- - -6 ----- —-
-------------------------------------------------- --
J/ Installer
at— -- _d✓, G> -. s -t- Q, r— -----------------------------------------—_---------------------------------- -
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
' q
Regulation as described in the application for Well Construction Permit No. 6V 99 -S-T Dated--7-=--z�" --!
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE—---- ------ —-- ---- -- Inspector------------------------------------------—— - ------------
dAN
a3�cas:ijg61Q&NM s dW l rW �.
BOARD OF HEALTH
TOWN OF BARNSTABLE
Well Conoruct ion Permit
No. ---------------- Fee------------------
41"
Permission is hereby granted— w�-vk �{. Pir'f_ �'/ --------------------------------------------------------
to Construct (11 Alter ( ), or Repair ( ) an Individual Well at:
No. ----4t -a t, i- --------------------------------------------------
st eet
as shown on the application for a Well Construction Permit
--------------------------- Dated------------------------ --------
-----------------------------------------------------
DATE Board of Health
---------------�-----------------------