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HomeMy WebLinkAbout0080 WOODBURY AVENUE - Health 80 Woodbury Avenue Hyannis P A = 307 216 tr li E No2'0 1_� FA? co THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpliLation for -Misposaf *pstpm Co BtrUttion Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abando ) ❑Complete System ❑Individual Components Location Address or Lot No. �(J ((/� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel .�o� o�/� f Cj/S AA Installer's Name,�ddress,and Tel.No. Designer's Name,Address,and Tel.No. V14 ay, Type of Building: Dwelling No.of Bedrooms A14 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Envirom ode and of to place the system in operation until a Certificate of Compliance has been issued by this Board of � I! Signed Date i // Application Approved by Date Application Disapproved 1}� Date for the following reasons Permit No. r� r ��,'� Date Issued �' jj i�.�{i.*i''F4i*.rr.�-i.v r ry ...,.rylx`..ti,, r...,..^'.r1 ti .•-f+•:. .�SiF..�, i - y .r •'qrr" r.� z. . -.. ,� :h.., ;7 ...�,. .y ,J .w�V`:.;t�.�,iJN�it�iu co _ No. ,i. Fe9Z J THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitation for Disposal *pstem Construttion 3permit e Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon ) ❑Complete System ❑Individual Components 1 �{ Location Address or Lot No. �(1 , cmC t Au o Owner's Name,Address,and Tel.No. Assessor's Map/Parcel✓� ��n l4 • <r7C r!✓►!{ II/n�jjs�__ta"lller's�Npa-me,Address,and Tel.No. "y��S- fro Designer's Name,Address,and Tel.No. Type of Building: I Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd 'Design flow provided �j gpd Plan Date Number of sheets' Revision Date c Title Size of Septic Tank Type of S.A.S. Description of Soil A a E s Nature of Repairs or Alterations(Answer when applicable) p �{� 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 Certificate of Compliance has been issued by this Board of alth. ✓S'ig�te'd. ".1 G ow�., .gin.^-^."'" Date Q Application Approved by Date Z0( 0'0 Application Disapproved-by Date ' for the following reasons Permit No. Z?3 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance TMS,�i,S TO,9./ TIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandonedo(f)by l > at 50 Wbad&j A.A-,, Au-Q.:- - has been constructed in accordance— _ * with the provisions of Title 5 and the for Disposal System Construction Permit No7jD1'i—??3 dated B�f�ZOi Installet !I>or fsleft" Q,k-e f gaf-r(•)o --Tn Designer #bedrooms Approved design flow ,(1 gpd ,--. The issuance of this permit shalt not bjel/cornststrued as a guarantee that the system w"'11 ct" idn as es�ed. Date )C71. /! / Inspector � �r�...-^r".."..�-- -----No.�-------�-���---------- ------------------- --.:.-_----------------------------------------Fee -j�--=-Q-=--=----- 0. '2 . THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS -isposal 6pstem ConstCULtlon Permit 4 Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandonole System located at 130 �4)ooe F��iA,q u A/tt c and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co stru tion must be completed within three years of the date of this permit. Date —�2-0) Approved by a O OPEN A BUSINESS? YOU WISH T P For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR IOTA Lin town (which you must do by M.G.L.-it does not give you permission to_operate..Y Business Certificates are available at the Town Clerk's Office, 1"FL., 367 p Main Street, Hyannis, MA 02601 (Town Hall] i 'Y DATE: 0 b `"� " Fill in please: r r,a APPLICANT'S YOUR NAME/ &1A PILL) CA SALA tZt 5 «�'' Y`r J�(' BUSINESS YOUR HOME ADDRESS: �c> f5 W 0,9 n fi a'yL y Rv C N 64 tZ ✓j 5 F ,L, t TELEPHONE # Home Telephone Number 15 S LL 3 NAME OF CORPORATION: NAME OF NEW BUSINESS N E W IT A L t A Itl G D N 5 i rLo c-I IO N I V<:- TYPE OF BUSINESS IS THIS A HOME OCCUPATION? . YES NO ADDRESS OF BUSINESS 90 n ���n t5� RY_�q v II�A.NN� 5 MAP/PARCEL NUMBER �o - 2 I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1-. BUILDING COMMISSIONER'S OFFICE fr r' This individual has been informed of any permit requirements that pertain to this type of business. I r Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has be informed of the r req e ents that pertain to this type of business. thorized Signature** - MUST COMPLY WITH ALL g HAWDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** ,COMMENTS: Hazardous Materials Inventory Sheet Checklist Date P 'sical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials), /Storage Information - location of storage, how long is storage for? �f none, note that. Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask j Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it -note that it was given Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. TOWN OF BARNSTABLE Date: TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: New tagztAiv CZDIvs-T 2uCTlow. BUSINESS LOCATION: Ra e W nn b p), v(Y A u j= N.Aev+vi S. dA_ INVENTORY MAILING ADDRESS: 80 b WOOD b v &!. Av,= W xANN15 rtn TOTAL AMOUNT: TELEPHONE NUMBER: _so g 6 GACLO wS' CONTACT PERSON: C-LAN<<, c-„ s A Lg p_(4. EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: 1 t Liz HA (LbLC IA✓STA L c c a . INFORMATION/ ECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ® USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) �I Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield washt: �s WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials _,A TOWN OF BARNSTABLE LOCATION J �1JL7h(I��SUi2 _ SEWAGE # :W5"-�4� �f 4LLAGE l!l _kP, ASSESSOR'S & LOT 3() INSTALLER'S NAME&PHONE NO. IV­ SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 3 `.)-00 C_ LC QVIJ S(size) NO.OF BEDROOMS BUILDER OR OWNER Wi PERMITDATE: OMPLIANCE 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 � � w N S J ..�' � � � . . 1 � �. �l O GS �`\ �J _ l �' � �` � .� ,-, ,-� � � � � lJ`t � � � - wli► `�., , - -- t d° - r 4 No. C;00 5_)0_5 Fee 00 THE COMMONWEALTH OF MASSACHU SETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 2pplication for Migpooal bp6tem Cow0ruction Permit Application for a Permit to Construct( . )Repair X Upgrade( )Abandon( ) Complete System individual Components Location Address or Lot No. $8 Owner's Name,Address and Tel.No. rr l� 1.1tcam Assessor's Map/Parcel 'fin S t �RM Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -Ro( s",t3 � 5"4*2 &JU, SVCS Type of Building: Dwelling No.of Bedrooms:— Lot Size sq.ft. Garbage Grinder Other Type of Building M nnQ No. of Persons A - -_Showers(P-') Cafe�ea Other Fixtures L qy �T11V rrc,,%E+�Y S."Jk- I Cw m c)� Design.Flow 44-0 gallons per day. Calculated daily flow �'�,(p4 gallons. Plan Date Number of sheets Revision Date Title scA < lC Size of Septic Tank kkn I.S6oCA] rt,N C Type of S.A.S. Description of Soil _ An Nature of Repairs or Alterations(Answer when applicable) �� (>�0c, 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 Environmeptoluode and not to place the system in operation until a Certifi- cate of Compliance has been' d by t ' o d of Hea Signe Date S , Application Approved by Date 6" 55 Application Disapproved for the following reasons Pe r100 5 0 Date Issued / No.I .S /CL ° Fee V +, Entered in computer, THE COMMONWEALTH OF MASSACHUSETTS Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppliiation for Mopool *pg;tem Cottgtruction Permit Application for a Permit to Construct( . )Repair)Upgrade( )Abandon( )XComplete Systemdividual Components Location Address or Lot No. f3o (Q c]oC,\01a t m= Owner's Name,Address and Teel.\No. N- Assessor's Map/ParcelC'�1C> S jaV� ►,'1 ��`J` � �r, SRM E Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. tie tla �:s 5tAAY SIJu. 5\1tS. - Type of Building: " Dwelling' No.of Bedrooms Lot Size sq.ft. Garbage Grinder('M, n Other Type of Building M nQ No. of Persons Showers(y) Caf eria(�/) Other Fixtures L Au A-"V?j 13{ 1"rc:.Acra S i'hTl_cv,� Design Flow A-4rQ gallons per day. Calculated daily flow 441.1)4 gallons. Plan Date 3 ► 2 a I(_S- Number of sheets � Revision Date Titlei - Size of Septic Tank[\lek rSaocrttType of S.A.S. - CG Description of Soil 3 A r3A1 a' 74ANC N Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Tr' Agreement: M 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 Environments Code and not to place the system in operation until a Certifi- cate of Compliance has beenissued by th''Bo' d of He •th� , Signed Date S Application Approved by _ i Date G' Application Disapproved for the following reasons # i = r Permit No. a(')0 5 /D 5 Date Issued 5�� s_ ———— -- — — — .. THE COMMONWEALTH OF MASSACHUSETTS -` BARNSTABLE, MASSACHUSETTS Certificate of Compliance ~~ THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired )Upgraded( ) Abandoned( )by ll �� s•'' �_• at has been constructed'inj,accordance with the provisions of Title 5 and the or Disposal System C nstruction Permit No. Cr5 dated 3i- Installer F'�S 1,Q r' Designer r"r, /lg P The issuance of thispe t shall tot be construed as a guarantee that thes� ste�n�ct on as designed. >` Date .� 1�, Inspector/ _ r i No. 1� "" IU� ---------- ————— —————— Fee ,..0 G.,.. ... ...._. . THE COMMONWEALTH OF MASSACHUSETTS :. PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS `. 1'';Mi5flo!M,1 6p.5tem Construction Vermit Permission is hereby granted to Construct( )Repair(J'j Upgrade )Abandon`( ) System located at Ro t�C n-� ZVa etiv.�r.1 S 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:Constructioln must be completed within three years of the date thisNpe mit. Date: / �N Approved b _ Town of Barnstable Regulatory Services Thomas F. Geiler,Director • aaatvsenaIA 9� MASS, �0� Public Health Division 1639. Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 3/30/05 Designer: Shay Environmental Services, Inc. Installer: Rodney Fisher Address: P.O. Box 627 East Falmouth Address: Main Street MA 02536 Harwich, MA On 3/24/05 Rodney Fisher was issued a permit to install a (date) (installer) septic system at 80 Woodbury Lane, Hyannis, MA based on a design drawn by (address) Shay Environmental Services, Inc. dated 03/23/05 (designer) 11 I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic sy tern) but in accordance with State & Local Regulations. Plan revision or c rtified as-b t by designer to follow. OF,y�gSsgc ' (Install Signature) ��° CARMEN yc N a SHAY No. 1181 (Designer's Signature) (Affix nW Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF BARR�N,rS�TABLE I LOCATION SEWAGE # M ASSESSOR VII.LAGE 'S &LOT �� INSTALLER'$NAME&PHONE,NO. SEPTIC TANK CAPACITY., L (size)5 LEACHING FACILITY: (type.) �1 � � � � � NO.OF BEDROOMS ++ 9 BUILDER OR OWNER l�` ', ' , , r ✓✓ PERMTTDATE: OMPLIANCE DATE: Separation Distance Between the: Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by %O $0 CAI M a&rc S S OVI L-a w5 �- Uod)� f7^^'z�s.,':5s""'.�^r'2�.^' �... ..�.;..",1ir a.rr-*"G"`+cK^p-',^-.- s ^^.?+Kr*�.;..— a T-•w,,:,.y TOWN OF BARNSTABLE BAR-W M® 3717 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �fJ, �,,,,,, Orlr)yr Sri r > - Address of Offender 10 A Iq aAg4 4`,, MV/MB Reg.# Village/State/Zip Business Name . 1. am/if on s-h"I 20dj Business Address Si)gnature, of-'Enforcing Officer Village/State/Zip Location of Offense �( W44J,&ro LOA..* MA0)1,0/ Orl, 114r41A EE-nfor�cing Db,ptp/Divisiorn Offense. la.na.n 1r�t/4t �YStA� �Cr�r <C! e� r 1f1IP�AII+Ira�.n �Ylrf 1/f� �� ,ers %�3) it�s.�k+ Pf. "tl ,��#r' 1 Facts ,, , c « � ..�,r fl +� �r�, � �- � P'0� r.� r i , 0 � vb c f� t,4Pr1�� Will" n ()^ or .,\Ire (-?d0,,,( � �, frr�y'17� frr (�w4f,61, 0f,4 di If ldf will hp�1. SMiral, This will serve only As' a war"ning. 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. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. 7. .:�z„T y»r b+a"� r+r `�"e .Pr :rO�P' ;,.� �.. ::n ... t TOWN- OF B• STABLE' BAR-W � 0 3717 ` Ordinance orXegulation 1 WARNING NOTICE Name of Offender/Manager !, tc� w { C. er Sr�rr� Address of Offender ( A IQ I)Ar14;- r MV/MB Reg.# Village/State/Zip t ,, n , MA Business Name j. / am/rpm; on rw 20 d 3 Business Address � -- S 'gnature of'Enforcing Officer Village/State/Zip p Location of Offenset Enforce#ing Dept/Division Offense ,, Facts F ,.tl ? �.h t� f lrnsi 't !4 '}1 r1+3Asx A ,. (/^ rr6�n�A C9 �ul het ll dr.tf�a i }I ��` #n�• fE , Omo 4 , 1A t nat P if t �,..Tt ?�- Ilse-/#' ,, t ( �.,.#6tl y+<r Cff test t no � . Cur 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. X` WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. a, , 3 Health Complaints 21-May-03 Time: 10:25:00 AM Date: 5/16/103 Complaint Number: 4036 Referred To: DONALD Taken By:. RITA Complaint Type: RUBBISH Article X Detail: Business Name: Number: 80 Street: WOODBURY AVENUE Village: HYANNIS Assessors Map-Parcel: Complaint Description: NEIGHBOR HAS CANCELLED HER RUBBISH PICK-UP CONTRACTOR AND NOW,FOR THE LAST COUPLE OF WEEKS, THE RUBBISH IS BLOWING ALL AROUND THE NEIGHBOR HOOD AND THE ANIMALS ARE DRAGGING THE GARBAGE AND WRAPPERS INTO HER YARD. b cd4"`^"�` Actions Taken/Results: RUBBISH PRESENT AT BOTH 80 WOODBURY AND 22 JANICE LANE. WARNING NOTICES HAVE BEEN MAILED Investigation Date: 5/19/2003 Investigation Time: 3:00:00 PM 1 Barnstable Assessing Search Results Page 1 of 2 R_ y I P11, .. .. tiY'5S '*.. ME ome: Departments:Assessors'Division: Property Assessment Search Results ....... 80 WOODS UR Y A VENUE Owner: HENDERSON,WILLIAM A&MARY Property Sketch Legend Map/Parcel/Parcel Extension 307 /216/ Al Mailing Address s HENDERSON,WILLIAM A&MARY 10 ALGONQUIN ROAD ' / a QUINCY, MA. 02169 Assessed Values: Appraised Value Assessed Value Building Value: $84,600 $84,600 Extra Features: $0 $0 Outbuildings: $0 $0 Land Value: $28,300 $28,300 Interactive Property Map: Map requires Plug in: Totals:$ 112,900 $ 112,900 1 have visited the maps before �1[ lC� ' Show Me The Map April 2001 photos available ' Sales History: Owner: Sale Date Book/Page: Sale Price: HENDERSON,WILLIAM A&MARY 3295/151 $0 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $ 1,061.26 Town Fire District Rates Other Rates 9.40 Barnstable 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $326.28 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $31.84 Hyannis 2.89 West Barnstable 1.96 Total: $ 1,419.38 Due to rounding differences these values may vary http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 5/21/03 Barnstable Assessing Search Results Page 2 of 2 Land and Building Information Land Building Lot Size(Acres) 0.18 Year Built 1970 Appraised Value $28,300 Living Area 2020 Assessed Value $28,300 Replacement Cost$ 132,120 Depreciation 16 Building Value 84,600 Construction Details Style Family Duplex Interior Floors CarpetHardwood Model Residential Interior Walls Drywall Grade Average Grade Heat Fuel Gas Stories 1 3/4 Stories Heat Type Hot Water Exterior Walls Wood Shingle AC Type None Roof Structure Gable/Hip Bedrooms 4 Bedrooms Roof Cover Asph/F GIs/Cmp Bathrooms 3 Bathrooms Total Rooms 8 Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area(Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO, Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) hnp://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/Asse 5/21/03 ifl/Hti.lE 1f�U Ui/�1�E"�lfl/alt ' A.M. FOR DATE TIME P.M. M ' Al-kONED OF RETURNED PHONE YOUP CALL' AREA CODE NUM ER E TENSION EASE CALL MESS AJgE CGFiVI TO ;. •SEE.YOU �( WANITS TO` SEE YOU SIGNED TOPS I FORM4002 Z O M cn J .j i 3x rra r. s 1 i1r95 11'a 42 - " a 5$8¢ �r5 6939 "'�a�kCAPE (�ERLTY� PO 8r Town of Barnstable. -CEP t Um 1 Health Depa"Ment 367 Main Street, Hyannis, M A 02601 Office MS-79"265 Thomas A. McKean FAX SO-775-33" Director of Public Health September 20, 1995 William and Mary Henderson Cape Realty, Inc., 299 Main t. , w.Yarmouth 10 Algonquin Road Attn:. Shawn Horan t)z673 Quincy, MA 02169 OT,10E TO ABATE. VIQLATIONS-4>�=105 C11�W 410 Op -S,;�,ATE:_SAN,I IrARY =- 001P, II MINIMUM STANDARDS OF FITNESS FOR IIUMAN IIABITA1I N AND THE TOWN QF BARNSTABLE RENTAL ORDINANCE.ARTICLE 51. The property owned by you located at 80 Right, Woodbuny Ave., Hyannis was inspected on September 19, 1995 by Christina Kuchinski, RS, Ilealth Inspector for the 'Town of Barnstable because of a complaint. The following violations of the Lown gt urns able Renia„OrdinancgArticle 51 were observed: fn.550: The entire apartment, particularly the kitchon, was infested with meal moths. Larvae and eggs were found in food and crawl ng on ceiling. 410,550: Tenant stated that her apartment is infested with red ants. Ants appeared to be coming from the brick walk around the fireplace. You are directed to correct the violations of 410.550 within twe ty-four (24) Fours of receipt of this notice. You may request a hearing if written petition requesting saute is received by the Board of Health within seven (7) days after the date order is received, Ho ever, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500, Each separate day's failure to comply with an order shall onstitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. 'Pickets will be issued daily until the violations are corrected. PER ORDER OF THE; BOARD OF HEA1:111 Thomas A. McKean ' Director of Public Health �J a.. ...c'f' j i`a.1.�c's: C•. ._l.>:3i:.ko.= i•.eie 3„_7., °i.sL.i'•+5.5:.. �`.e}++d"�V�.`.L�Ic$ ♦. .�'.. ._ •, .y+�..f .may.' �'"ts,x �w� st�'��*h•^,`�i•3�f;`y�a�.'�"£'•"°� �»a`= w,F �'M�-�"Y �". d..� �ti`: " �•,,^... - _ -� - t - c.� ,y .�^E��r3�.K���K't�.d�'.�y�:.. +3'�.'.I>SS .s 1rE c.p ��-.t�"fy� +-` ". • 10/.11/95 LYa 41 $ 508 775. 6'939 C.RPE .RERLTY Y .s- �+e',tn- c )c�lnlyc:t 1 J, l�)�1i NIX T1';111k111ill"tl Town o1.11arnsL•,l,lc IC-AIII I)VIA .'16'/ Mai11 St 11yamiN, MA t A01 1.',c:9011 \Voc,dbury :\\C, I Iyaltnis. 1 scar I IVa11II IX.-pI. \Pith Ic and to the ,,hc,vc k:P,•,lior,:d }n f you1 lcllc, dAv-d 9„' /95, ;if flu• c,a ll,c (mirk ill larlunl Anuic lcim!, ( IOU) t allni div 14li.•v 901 W In 010 al c4MMMI), I c01141c•tcd " !'Mite• Co c►1 l'ulx: (`od (PA 1111M) OnSInrl,IIAM' 21, 1995 to hm' the unit ite:atc'd Jc,t IIIV;11 nlolIIs. 1Jv N�cnl to III C. 111cr17isus ,rI ;•,hl,Io,LitI,"lcly 0 1)111 t)'>1!9"' 1 •cl Annic iwulcl 1101 IVI 301111 into 111c• unit. I Jc toW ,Alnrc' (c1 t':111 11i�. c.�llit:r on !).;?:t.5 I,., •c' w-duk a lima 10 lrVal IIIC• unit. Annit' nr= Mod 19% olt,ue. A IN In (0k 1c,1,r, i unt lc) the I,Ivnilas, al,d Annie slitif 111r• door ill his J�c•c•. I )lmv 6111ca1gilc'd I1.1 Ilm-k 111c pol,low c-oiac.c'It•• 1, ,A111tic lim tc-1iv:.-w-d ' c«, !r lht unit :,ht \ti11 t,u, 15", out lint 1,l,on..• ,1n,lti,c, In a1,'V0nW•. 1111 hay; bca:l► c•0111111c:1c•1) unV'ot,lx-taliVV 110 CXlrk11W1\ Iucic: . F111111c•,11,utt• lll, wu+,:c• 01 Iltr 1,l01 1VIII iS 111c (1ttt"idk• vc-ildol whuic. SI1t cilhc-r hot 1t,od c,1 ti,► , lt,t,ci, „ol I11; I'lopu,l . '1 I o Jut,l,hm is c•;15il Q011Vd;lhlc•. Jn iilt••1. llu•• is only c vit- ilmint;", luol►k•,,,. if yoll I curl to c.ollttic.( J1111 ple-asc call him at 790-I IIKK. �iut:crcl�' vaurrc; Shawn 1 foran I.alit. RvAly 111G (A-MiM3111 I Il'lldc I-S011 Z` 148 659 889 pl., Receipt for ,) 6 Certified Mail o No Insurance Coverage Provided NDTED ST.TES �Do not use for rnationa Mail "VOSfLLSERVCE ISee•Reverselt S n to l0 � P2 State and IP O 7/7 C0 ostage M E Certified Fee " l LL Special Delivery Fee n. ,r {I?SSiqe� te4vE�ry teg iletlm—TAec�'p't.,goy;!. to Whom&Date Delivered Return Receipt Showing to Whom, Date,and Addressee's Address TOTAL Postage &Fees Postmark or Date STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see front). a 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address � leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return C.) address of the article,date,detach and retain the receipt,and mail the article. L 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed co ends if space permits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. C 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee, M endorse RESTRICTED DELIVERY on the front of the article. E 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt.If LL return receipt is requested,check the applicable blocks in item 1 of Form 3811. t'n a 6. Save this receipt and present it if you make inquiry. 109riO3-93-B-0z18 Town of Barnstable Health Department } } 367 Main Street, Hyannis, MA 02601 ,63P Office 508-790-6265 Thomas A. McKean FAX 508-775-3344 Director of Public Health July 26, 1996 Willliam& Mary Henderson Cape Realty 10 Algonquin Road Attn: Shawn Horan Quincy, MA 02169 299 Main St., Hyannis NOTICE TO ABATE VIOLATIONS OF 105 CMR 410_.00, STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 80 Woodbury Ave., Hyannis was inspected on July 17, 1996 by Christina Kuchinski, R.S. Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code H were observed: 410.500: There was a puddle of water observed on the basement floor. The water apparently originated outdoors and seeped through the foundation, basement windows, and door. A fresh water mark on the wall and statement from the tenant is evidence that the water had been several inches deep. 410.500: There was a large hole approximately(24"x 12"x 12") in the basement floor near the basement door. 410.500: There were exposed carpet nails adjacent to the right front edge of the fireplace hearth where the carpet meets the brick. 410.500: The hinges of the cabinet door near the fireplace were not secured to the frame. You are also directed to correct the remaining above listed violations within seven (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF THE BOARD OF HEALTH Thomas . McKean Director of Public Health cc: Annie Jones, tenant �i j6h S,6 (ObU� �Y /9 e 44,1A G66/ MkAft& Cvi Ili2" dL ��'y 14e.,ft de.,--roH �,{�..�t,a.<..1�� Yew► `/�, NOTICE TO ABATE VIOLATIONS OF 105 CMR 410,00, STATE SANITARY CODE 11, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE •1.OWN OF BARNSTABLE RENTAL ORDINANCE,ARTICLE 51 The property owned by you located at 9-6 �1 t r was inspected on 7/1 QG by elf 0 1leaith Agent for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code lI w/ere observed: + TAX-t-e 'rw �vP, v d oh ,f rn 4 cam!- Om F�Gv` b)a w' Ofp t1 /4 der t v ov► 4f, l �l�0• SoU 7'� �r r� .s o� 'ff�e C�� o)ov ,. Ace _1 You are directed to correct the violation of within 24 hours of receipt of this notice by _You sire Also directed to correct the remaining above listed violations within seven -- — — = (7) days of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of I lealth within seven (7) (lays after the date order is received. however, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate (lay's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. Enclosed are citation numbers due to violations observed on PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health Town of Barnstable r FORM30 HOBBs&WARREN,INC.NOV.1979.1983 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/T WN ,,,4 A DEPARTMENT 6 ADDRESS �1 l 1TTEL�EPPHOW Address Xav I r�� Occupant Floor Apartment No: N .of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories S Name and address of ownefr 7 d erlopr /Gd 46lY' n't r7 ba& F Remarks Reg. Vlo. YARD Out Bld s.: Fences: ` Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: 1 c Dcgr V-,ccLjv e-- Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: vw� yc 1 Roof Gutters;Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: h_9- Dampness: t -4� �t Stairs cJ r-LVA �' - _ITVOV (A Lighting: J ll U o� ( tom "f " STRUCTURE INT. Hall,Stairway: Obst'n.: v p� Hall,Floor,Wall,Ceiling: Hall Lighting: Hall Windows: e D HEATING Chimneys: Lam" 'o Central ❑Y ❑ N Equip. Repair E,G_4 i&_4-6u TYPE: Stacks, Flues,Vents: G'PC,(_'rr 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 Lhdna 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 BuIldina 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 PERJURY." Ilar INSPECTOR � TITLE klt�4 s� Q � A.M. DATE r / TIME �P.MV 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 these 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 410.000 through 410.499 state minimum requirements of fitness for human habitation, any violation has the potential to fall within this category in any given situation but may not do so in every case and therefore cannot be included in this listing. Failure to include shall in no way be construed as.a determination that other . violations 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 the violation(s) pursuant to 410 CMR 410.830 through 410.833 nor shall it 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) Shut-off and/or failure to restore electricity or gas. (D) Failure to supply the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253(A), 410.253(B) and the lighting in common 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 system in operable condition as required by 105 CMR 410.150(A)(1) and 410.300. (GI Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by an object, including garbage or trash, Which prevents egress in case of an emergency 105 CMR 410.450 and 410.451. (H) Failure to comply with the security requirements of 105 CMR 4110.480(D). (I) Failure to comply with any provisions of 105 CMR 410.600 through 410.602 'Which results in any accumulation of garbage, 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 lead-based paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regualtions for Lead Poisoning Prevention and Control 105 CMR 460.000. (x) 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 dafety. (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 facilities 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 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 operable. (2) failure to provide a washbasin and a shower or bathtub as required in 105 CMR 410.150(A)(2) and 410.150(A)(3) and 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,• gas-fitting, 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. (N) Amy other violation of Chapter II not enumerated in 105 CMR 410.750(A) through (M) shall be deemed to be a condition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the board of health. t ai SENDER: I also wish to receive the :o ■Complete items 1 and/or 2 for additional services. rn ■Complete items`3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai ■Attach this form to the front of the mail piece,or on the back if ace does not > a p 1. ❑ Addressee's Address 0 permit. E d y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N ■The Return Receipt will show to whom the article was delivered and the date a delivered. Consult postmaster for fee. E 0 a 3.Article Add ssed to: 4a.Article Number IM 4b.ServiM Type .' �o o W ❑ Registered ® Certified rn tNit (� ❑ Express Mail ❑ Insured c U! c a ❑ ReturnReceipt for Merchandise [ICOD a 7.Date of Delivery Z J 2��" ' , 5.Received By:(Print Alame) ) 8.Addressee's Address(Only if requested c LU and fee is paid) g 6.Signet Lye: (Add r ssee JrAgen N PS Form 3811, December 1994 Domestic Return Receipt First-Class Mail ' UNITED STATES POSTAL SERVICE Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• Health Department TOWR of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)79M65 - 1 TOWN OF BARNSTABLE 3 .5 LOCATION f o 6-c�-OeA y /� SEWAGE # elf 2 3 T VILLAGE 11YQ1l, &V/ S ASSESSOR'S MAP 6z LOT INSTALLER'S NAME PHONE NO. 14a&A/ ? 7 s^ / 3 SEPTIC TANK CAPACITY y LEACHING FACILITY:(type) CA Ile-Y.S (size�S') NO. OF BEDROOMS 5� PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER I DATE PERMIT ISSUED: 5- // 3 DATE COMPLIANCE ISSUED: 4" - R VARIANCE GRANTED: Yes No �� y F�sI4o:4.J..V...__ .... ... - THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEALTH Appliratiou for DiopooFal Workii Tonotrnr#ion punti# Application is hereby made for a Permit to Construct ( ) or Repair Individual Sewage Disposal System at - yfl�v� 1 ......�-0 .......... ............ . ........?Y... ._G�--------------------------------- ................................................... ......................... Lo ati n-Address Owner Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons......--.................... Showers ( ) — Cafeteria ( ) G" 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri -••---•......••------•••--•--•••--........--••-•-•---•......-•............... ..•-•---•-----..........._._....._..................---••••......•---.••.•. 0 Description of Soil.........................................................=.............................................................................................................. x W -•---•----•----------------••--••-----••----•-•----•----------•••---•---•---••••••••----------•-••-- •-••-•••-•-••-•-•---------•••••----•-••---------------•-•----••-•--- U Nat e of Repairs or Alterations—Answer when applicable-- .s-f Z ...--......l .:.®o................................... S ! y --------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE 5 of the State Sanitary Code—.Th undersigned further agrees not to place the system in operation until a Certificate of Compliance has b s by the rd of alth. Sne �- •. •------------- ... a Application Approved By... .. • -•-••-••••.�.._ ............ .. ......... Application Disapproved for the following real s:--••---•---•...........•.....................•-----•--•-•••------•-----•-•---------•--•-•-•-••---•-------_...-- -••---------------------••-•--•--•-•-----...........-q--...........-------------------------•-------•...........-------------•---•---•-•..............................--------...Date•......._..._. PermitNo.......a..."...._•...�-•--- ----------------- Issued........................................................ Date J No.._ ��.'.��7..` Fax . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApON I pl tatilan for Disposal Works Tonstrnrtion rrrutit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at ....... 7 _CZ/ ...........:....-(/•----------•............ ....' '`.':.:.............. ....._..... ...._..._._....... //� •• �'� •Location-Address, / or Lot•No. I ' ....:....._/.:...:J` ......../..,'`........ ...................�� ......•...... . .. �.......f..Li�..•�.............�G..�. _...�::.:.:....... ....�„............. 1 Owner ...............•_-•--.Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms.........:.............:....................Expansion Attic ( ) Garbage Grinder ( ) r- Other—T e of Building No. of persons............................ Showers — Cafeteria G4 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 ( ) 1•4 Percolation Test Results Performed by-•---•-------•..................................••••-......--••-•••.••••• Date........................................ a a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ---•----•-----------------------•-••-•-••---•-•--•••............--•••••-•••_. ......•--..............•-••-•...--•--•--•....-•-••-••-•-................... 0 Description of Soil........................................................................................................................................................................ V •• ............ W ---•-------------- --••-•••---------------•-------•--•-•••------------------•--•---••••••••-----•••-------------------------------•-----------......................•......_----•------------ ..... UNature of Repairs or Alterations—Answer when applicable.._`._u._`'..'-y........_....._._. f.. - .....:.:r' .. G Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITLE. 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b- s ued y the board of ealthh.. i . • . Application Approved By..)EV/ t.l..'! ......... Date Application Disapproved for the following reas :........................................................................................................---- --.......-•--------------••--•-•-••-••••-•••-••••.....�._.......--••--.....--•••--•-•--•-••••-•••..._...............................•••••••--••-•........._......•...............Date------........ Permit No.-•-•-•L,1..._.... �:-::.�. ..........._— Issued.............•--------------........---•--------....... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.... ........................................................................ At wrtif irate of (Z�ont rlittnrr _ THIS IS TgRT CEIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired �r by-----------•------- 'f� '=---C--•.r/ ------•...................................ingcs.i�------•---•-•--...........................•............. ................... ......._ r. 1 ly `./at . .v'.. �.. ..S has been installed in accordance with the provisions of T 5 of e Stato Sanitary Cqd. s desrfib the application for Disposal Works Construction Permit No.-- ��......��. ..._....... dated.....�._.��. ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CON TRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................................&-..'..�J.n._ ............... - Inspector................. - }.... - ..... ........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD- OF HEALTH ai No.. ...G.... ...... Fas........................ Disposal Works Tonsh-Wiott f rrmit Permission is hereby grante .................... ,,r to Construct ( ) or Repai ( an Individual Sewage Deposal System atNo........ .._U...._%.. �Gr�� /, . ..'.. ....r.'�� ..................... ---L..... ............. --•-• - Street 7 (`> as shown on the application for Disposal Works Constructio P t No 6.sl-...�.... ate&:y_)_._.. z .fir. ?-.._.... C. ` B�'oai d- fHealh DATE.... ............................................. t FORM 1255 A. M. SULKIN, INC., BOSTON '___-_-- ------------ --- -------'---'- -'-� ------- ------' - - ---'--------------- - ' (- - -----�� -------- - - ------------'-----'-----'---'-__----'_-'- VENT PIPE (0 Least 24 inches tall)--- '�chedule 40 PVC w/Charcoal Odor Filter '11 OUTLET PPES FROM THL 'NOTE: ALL PIPES ARE TO BE 4* SCHEDULE 40 PVC CHAMBER cover must be SECTION A- -A 14 TTRLSF47070ROAXT 1EAST 2 FT 12 CONCIR 10' min. from ---- within 6 in of finished grade \ ETI COVER _ho­u s e to septic tank PROFILE VIEW OF LEACHING SYSTEM Existing Foundation —D BOX co�er must be Septic tank covers must be I " — la —01c) Top of SAS t 11p SFPTIC TANK -_�Cr�-� ED CD L-3 C3 CD ED = PLAN SECTION CROSS-SECTION W- 1=3 C:3 C�3 = Q FULL FOUNIAMIJ It 10 On On � �~~- /-- � l ^ /r ' CY) NOT TO SCALE | �~ cl compacted stone 0 3 11 Effective Length Not to Scale C Effective Width > -S W SOIL ABSORPTION SYSTEM (SAS> GENERAL NOTES NOTE: PLUMBING TO BE RAISED BY LICENSED PLUMBER & PERMIT REQUIRED 500' C H-10 LEACHING UNITS WIGGINS PRECAST compacted stone 1. Contractor is responsible for Digsafe notification NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Bottom at Test Hole I Elov.-83.70 Not to Scale and protection of all underground utilities and pipes. ZJ. oundwater 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance | PERCO and Local Regulations. Date of Percolation Test: FEB. 2, 2005 NIF SABINO 6. If, during installotior) the contractor encounters any Test Performed By-. RONALD CADILLAC, R.S. NIF DELIO soil conditions or site conditions that are different Results Witnessed By. DON DESMARIS (BARNSTABLE B.O.H.) from those shown on the soil log or in our design i Excavated By-. UNKNOWN installation must halt & immediate notification be Percolation Rate: Less Than <2 MPI 0 50" CO made to Carmen E. Shay - Environmental Services, Inc. 0� Cl� 7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. B. Install Tuf-Tite gas baffles or equals on all outlet tee ends. 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. Test Hole 10. All solid piping, tees & fittings shall be 4" diameter No. 1 Schedule 40 NSF PVC pipes with water tight joints. 11 Municipal Water is Connected to ALL OF The Residence and Abutting DEPTH SOILS ELEV. Sandy Loom UQIL TEST HO�E_#f 10 YR 3/2 ELEV.�_'93.70 THE PROPERTY L-INES ARE APPROXIMATE AND COMPILED FROM THE PLAN BY ROINALD CADILLAC, PLS, IRS. Loom K DECK I AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN 10 YR 5/6 1 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN THE SEPTIC SYSTEM INSTALLATION. Sand 40 POLYETHYLENE LINER FROM ELEV. EXISTING CESSPOOLS TO BE PUMPED OUT AND 10 )R 7/4 EXISTING < - REMOVED TO FACILITATE INSTALLATION OF NEW SAb. DUPLEX NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE I Lo I FROM THE EXISTING CESSPOOLS TO BE DISPOSED > I I OF AS PEP BOARD OF HEALTH SPECIFICATIONS CL 'cr in LATION TEST with Title V of the Massachusetts state code, the approved plan - ASSESSORS MAP 307, PARCEL 216 ! it h � / � � KJ | \| �� � � � � � ! 9m' I perc #1 Depth b, Pn�� �" tob8^ ucmu/cS rnuruocu � P�cRote= 2MF1 r TOP OF FOUNDATION �=-�-� SPOT GRADE { / w|w29/ZOw[ B - INDEX ~ 8.8 for 12/04 ADJUSTMENT = 2�S FEET VENT r/rc� c ' uovu/ca EXIST-INC 08S[pV[D H2O Elev. ~ 98^ or02' »c|o° [rode 00 Q0' � � 104.46 SPOT GRADE ' ADJUSTED H2O Elev. ~ 5.3' below Grade or E|ov 88.4 PL -- -- --- - | PROPOSED CONTOUR | ` � -� | -�----��---� ------- EXISTING Cum/uun ­24" EXAM. AC I CESS MANHOLES (40 FOOT RIGHT OF WAY) DEEP TEST HOLE & 10. -6 PERCOLATION TEST LOCATION ILL:: 6 FOOT STOCKADE FENCE Note: PARTIAL 5' RLMOVAL -Remove soil down to el. 87.00 � & Replace With cleanrote less than or or equal to 2 min./in. before & after p/oc*nnon, INLET4. . (5 FOOT STRIPOUT PARTIAL AS SHOWN) THE «cccys ouvsns FOR THE xcpmc TANK. | PLOT P 1__ A N DISTRIBUTION BOX AND LEACHING COMPONENT --/ SHALL BE RAISED mWITHIN 6" OF FINISH onAoc. STEEL REINFORCED PRECASTCONCRETE INSTALLnop-n/c c^s BAFFLES on �mux/x ''~ ` `~`''~~'~` '` NOTIFY ~'~~~^ ~`~ � ON ALL ounsr rcc swos cowrnAcron To vrmry LocAr/ow OF ALL ur/uncs PLAN VIEW pnmo TO cxCwVArmm . PREPARED FOR �w^ xmo�� oomm i | /- -\ / � _ AT- ' rr^ i VARIANCE REQUESTED: ovn�` | `p ��| ' FROM 5' _7- THE HOUSE �� MA (^ Liquid depth | DesiQn Calculations | � Number o/ Bnumona: 4 8ru,onm EXISTING P PARED BY: �- -�' Gn,uone Grinder: No ---------- '~-` ---'------ ' ' Leaching Capacity Required: 4+0 Gn| /Doy (w|w PER TITLE v} CROSS SECTION END-SECTION Septic /vnx - a x 440 sn/ /ony ~ OUo USE NEW 1,500 o�� *-zo s�p��c Tank. �(/ bO HAY cr) SOIL ABSORPTION AREA: Using percolation rate of <2 min/inch O 4D ! 0. VIRONMENTAL SERVICES, INC. oonvnn Area: o./^ gal/sq. /t. x *16 sq. u. 307V* q000nu P.O. BOX 627 ' TYPICAL 1500 GALLON SEPTIC TANK 5iue*oo Area: O./* nm./nn. n. x 180 sq. *. ~ 133.2 om|onu Providing: 4*1.04 gallons EAST FALMOUTH, MA 02536 NOT TO SCALE Uoo� (J) PRECAST 5oV C � 2o Vw|�� ��wwC v 2' [rF[��vE DEPTH, SCALE: 1 ^ 20' /A-9� LOADING) � - - ' � = \' ' '-~ �°' `~ ' `"/ TV BE USED NTH 4' OF WASHED STONE ON THE 30[S AND | | 3.25' Or WASHED STONE ON THE ENDS. | | | | 'KUJLC|#bU/lU | FILENAME: SU/lUPP�UG | SHEET 1 OF 1 | VY | |