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HomeMy WebLinkAbout4632 FALMOUTH ROAD/RTE 28 - Health 4b32 Falmouth Road lOtuit , A= 024 - 076 17 i i I i M i i TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 1 l I Time: in Out Owner Tenant Q P "I Z Address U G` Address -l 6 G"wl Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities LAM 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 J'3 17.Temporary Housing tL 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms _ Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here / - ♦ ti TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION AgInvet Date �® �� Time: in Out M cettr - -�..6 Owner®1S 1l9`lG�(L Tenant Jffr'Ylr✓S ',�15�i�;�1� Address JT Address �'3 rA-filnuly Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply A1DPd o, 5. Hot Water Facilities f4c O ed; 0rf 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 �'�,S r-./ �6j—(� 14T �Z 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Al d a Number of Persons Allowed max){ Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here r W HoBBsBWARREN M THE COMMONWEALTH OF MASSACHUSETTS FORM 30 � BOARD OF HEALTH CITY/TOWN W o DEPARTMENT ADDRESS Address- 32 � � @`""'��` �/ ccupant J l � _ Floor Apartment No. _No.of Occupants No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units___No.Stories_ Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage d l [1 Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: ' Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairwa Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: / PLUMBING: Supply Line: ❑ MS LIST ❑ P Waste Line: I H.W.Tanks Safety and Vents ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing, Grnd.: ,,^ AMP: Gen.Cond. Distrib. Box: 4- Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Roo Bedroo 1 _ Bedroom Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub.- Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSP CTOR.(See Over) "THIS INS P TIO EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIE OF J RY." INSPECTOR ' TITLE A.M. DATE TIME J w� A.M. THE NEXT SCHEDULED REINSPECTION Jr. P.M. i `4 � 1 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those . items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potentialito fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to'include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or,the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D).` (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that mayexpose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2) and 4.10.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. FORM30 C&W HOBBSBWARRENTM THE COMMONWEALTH OF MASSACHUSETTS B RD OF HEALTH CITY/TOWN DEPARTMENT 06A rd U i S Wr na 61 'q^ DDRESS �/��.\()sue �j� e �6 D � / �Jl`, 3(�/Jud/E�UV' V i 0LEPHONE Address4/63Q- r0 rYA&X V CA14 Occupa Floor ApartmP t No. No. of Occupants No.of Habitable Rooms� No.Sleeping Rooms No. dwelling orrooming units T No.Storiesy,_,,_�, � zm 0 /, Name and address ress of owner " ��� � 6 ffV d Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish 4 Containers: Drainage � ' 9 Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup. en.,Gas,Oil, Elect.: -Stacks,,Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR. (See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALT F INSPECTOR TITLE W\ dM—LJA) DATE �' � � A TIME y A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of Ieadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. r Parcel Detail Page 1 of 2 r� rf G° TtI" eye-, 11".,.1:!+.•?'�rl.t_.). f_a i � Logged In As: Parcel Detail Monday, Ap Parcel Lookup Parcellnfo Parcel ID 024-076 I DeveloperLot,LOT 35 __ _------- - - - __- - -- Location 4632 FALMOUTH ROAD/RTE 28 Pri Frontage 1247 Sec Road SANDALWOOD DRIVE _ I Sec f Frontage 243 — -- - - --- ----------- — !- Village COTUIT _I Fire District 1COTUIT Sewer Acct - - Y� 'l Road Index 0522 _ ------------ 1; Interactive M a t �t,l_ i7. Owner Info Owner,TAYLOR LOIS L TR Co-owner Streets 808 SO MAIN ST �I Street2�! - City CENTERVILLE I State MA zip j02632 Country'US _ - - - - - - - - Land Info Acres 1.20 Use 1ST0RE/SH6P MDL-9j zoning ;RF Nghbd'C102 Topography I Road . Utilities - - -' - it Location - Construction Info Building 1 of 1 Year 1880 1 Roof "` - —` Ext` 'I Built Struct -__._ __.___-- Wall !WOOD FRAMEW Effect 5571 - . I Roof T _— '-a ACNONE Area - ----- - -- Cover Type - Style Stores/Apt - ':1 Int: - Bed i !I - -- Wall ' - - - --- - Rooms -. Int Bath Model Commercial - I Floor Pine/Soft Wood Rooms 2 Full + 1 H l Heat Total Grade(Average Type _ _._ Rooms http://issql/intranet/propdata/ParcelDetail.aspx?ID=1363 4/30/2007 Parcel Detail Page 2 of 2 20s A FU 5' 7.' BlAT 6 36 .. _ Heat Stories I Fuel -Gas T lI F ation ;Poured Conc. �I a 30 THS 1 B,AS AL M1 Permit History Issue Date Purpose Permit# Amount Insp Date Comm 7/1/1993 B36060 $80,000 1/1/1997 12:00:00 AM CO AD Visit History Date Who Purpose 2/15/1994 12:00:00 AM ME Sales History Line Sale Date Owner Book/Page Sale P 1 10/24/1996 TAYLOR, LOIS L TR 10450/188 2 7/15/1995 TAYLOR, LOIS L 9756/264 3 5/15/1993 TAYLOR, BLAINE E & LOIS L 8556/287 4 9/15/1991 TAYLOR, BLAINE E & LOIS L 7702/200 ; - Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcc 1 2007 $260,600 $0 $18,700 $144,000 2 2006 $299,500 $0 $19,300 $144,000 3 2005 $224,200 $0 $19,900 $144,000 4 2004 $205,000 $0 $20,200 .$144,000 5 2003 $167,200 $0 $20,700 $108,000 6 2002 $167,200 $0 $20,700 $108,000 7 2001 $167,200 $0 $20,700 $108,000 8 2000 $161,100 $0 $21,600 $67,300 9 1999 $161,100 $0 $18,200 $67,300 10 1998 $161,100 $0 $18,200 $67,300 ; 11 1997 $135,600 $0 $0 $67,300 12 1996 $134,500 $0 $0 $71,000 Photos http://issql/intranet/propdata/ParcelDetail.aspx?ID=1363 4/30/2007 TOWN OF BARNSTABLE (� LOCATION 3pZ ' SEWAGE # VILLAGE .Q-0-�%x,:-A ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.artkb, SEPTIC TANK CAPACITY LEACHING FACILITY:(type� (size) (54Au�S NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER S"-z a-' e—a� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: o / 3 y VARIANCE GRANTED: Yes No f ° �'` �5 � d® Via. � � �� �. 4 � C�� FF N70------./--. 3..�f� - "00 L/ Fizz......../A!:!9)....» •a THE COMMONWEALTH OF MASSACH_USETTS � b - BOARD OF HEALTH 0 �"� �a `' Appliratiun for Disposal Works Tonstrnr# n rruttt Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at � ........ /-n3 ��.......................... ......................_.....................................................».................. -Location-Address •---or Lot No. ................ ». �.1 ............_... ........_.._........................... -•--•••-------.......................».». ner - Address a -- ........................... .... Installer Address Type of Building ize Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic' (•� Garbage Grinder P4 Other—Type of Building ....................._.__.__ No. of persons............................ Showers ( ) 7- Cafeteria ( ) a' Other fixtures _ _. _9oS/r�RY_Gg5? S / - 5r.�............. Design Flow...........�l ______________________gallons per person per day. Total daily flow....X3.T`p�.__......................,�lons. W Se tic Tank—Liquid Li uid ca aci Ar- -.gallons Length Width.15.�...... Diameter.x�......._... De th..::_ .:... P q P �'------•----g � -- -...-- r -- -- P x Disposal Trench—No..................... Width.................... Total Length........... Total leaching area...___....__.. sq. ft. Seepage Pit No------ iameter.-..-/.o........ Depth below inlet___,I�........... Total leaching area. .......q. ft. Z Other Distribution box ( ✓e Dosing tank ( ) Percolation Test Results Performed by---•------------•---••••••••-•••••-•...................•.------•-----_.. Date------------------...------............. aTest Pit No. I...........:....minutes per inch Depth of Test Pit.................... Depth to ground water......................... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -_----• ----------------------------------------------•---•----....----------------•-----------......................................................... 0 Description of Soil.........................................................................................................................................-............................ x U ---------------------------------------------------------••----••------•--------------..._.......----...------•---------...-------•------------................._...........-••-•----...••-•----- w x -------------- •-------- U Nature of Repairs or terations—Answer when applicable_---_•-_ Z/1—' :•.- �3S as�3__.-.L./sT/f___-________•...___•._•__.. ---�TL�"----------------------�_�'ST....�`'1.r......._...----------.......------------...._....----------- --....._. ....----- --------. .__...... _..------ -----.... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLB 5 of the State Sanitar Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has e� issue- by the boar of heal-h. Signed__._ ._._ . e � ( _- Date— Application Approved By..... ....... '� ......... Date Application Disapproved for the following reasons:........._.................................................................................................... » -•---•--------•.....................................•---•----------•------•------•------•-----------.......--------------------------------------------------........_._......•••---------------•_---•-» Date Permit No........ .�r.�--.............»..» issued-.................... ................................... Date f No................-.....-- FEs......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .� Applirutiou for Disposal Works Tonstrur#' u rruti# Application is hereby made for a Permit to Construct ( ) or Repair (' an Individual Sewage Disposal System at ....... ° --. :.% ............. _<„......-----•-............ ........................................... •----------•..........................•_. Location-Address or Lot No. •--•--•------------•............................_..........................................•• ..............................................---••...••-•-----••.._.................._._......... Owner /j'_k�. ddress W � J Installer Address Type of Building ize Lot............................Sq. feet Dwelling—No. of Bedrooms..... ....................................Expansion Attic ( Garbage Grinder O PL4 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures at ............................. i ;�.. .. G< �s -/_8 % t as /�'W ---;'w ............................ - -- -- ---- W Design Flow.._...._._ot�._..•_....... ..gallons per person per day. Total daily flow-__. .. dal `�~ •- --=--------------- Ions. i WSeptic Tank—Liquid capacityP'(6 ..gallons Length�q �?._.. Width._r 0...... Diameter. `.__..__..... Depth_d°� x Disposal Trench—No..................... Width.................... Total Length..._......__. Total leaching area............. ..sq. ft. Seepage Pit No.___ ...____ iameter•__-/ ........ Depth below inlet._ A'. ... Total leaching area. '... i....sq. ft. z Other Distribution box ( ... Dosing tank ( ) aPercolation Test Results Performed by....-..................................................................... Date....................................... Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0-4 44 Test Pit No. 2.................minutes per inch Depth of Test Pit..............:----- Depth to ground water........................ a ------------------------------------------------ ••--•------------ --..------------ •------- ---..----•---------•------------------------ •............ 0 Description of Soil....................................................................................................................................................................... x V .....•-••-•••--•---•-••-------------•-•......-----•----------••....---••------------•••---••-•------•--......---••-------------------------.-•••--------------------------------------......-------------- W UNature of Repairs or.Alterations—Answer when applicable. �-'eve-fc �_. Tsl;&?'43._.__4"'11�� ........................... _ . - .... ................. ..............•---- 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 ben issued by the board of health. (j Signed_ . +_±� C?nA ...... � `1 _i Date Application Approved By.......S`...•..... ,` � l/ r• ✓ 3 Date Application Disapproved for the following reasons---------------------------------------------------------------------------------------------------------------- ..................•------•---------------------------•-•-••--------------............---•-----.......---•.•----•----------------------•----------•--•--•---•-•------••-----•------•-•--•---••---------••- Date PermitNo........; ... .!_ .... ..._.... Issued•..............................•-----•-•-•..._.......... f Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dle wrtif irate larf Tautpfiaurr THIS IS TO CERTIFY„That the Individual Sewage Disposal System constructed ( ) or Repaired by.. .......................... / ` .C3. .. .Installer------------------•-•----....------.._...._._._._....------•-----•----....----•-----•^---•--- has been installed in accordance with the provisions of TITI 5.of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._......,>' a j 1_ _...... dated---------....................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................U......... a ------ Inspector--------. ...................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................:f: :.� . ........0F..........,�:�..:�:......,1 : .;== �.. ..... Disposal Works T atli#rt ' ttUprrutit Permission is hereby granted. C= t�..------ ­ to Construct ( ) or Repair ( � ),an Individual Sewage Disposal System at No............. ... .... �, r ...... + _ t.�;.� Street as shown on the application for Disposal Works Construction Permit No. : ............. Dated.................. ...............':.,_.!......+. ......f .. 1. j f�.............................................. bYFY�`�, �. �' —• Board of Health DATE.--..% =...........' �J FORM 1255 A. M. 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I tfI 1 • 1 TS n 6 71 ' +' \ � ��,� �' , • �oz,c8 f' gr�.cH a3 3Z i' aJr; ��/'H- _low r i L, ' ioo cl ToP I opt Q � �.34hY.1 OF HEALTH v U U IoL,c3�E �xCAV4MR ._�y L AraENv i 1 NOTES—TO Lc. ? 35 lr%.ST �.r C�/ll' /Q aZyv q 0 ` #� v OJ 3N i' - �---- i — �J / EL'=VAT/ON ANE BASED OY1/__!-t s aim a A-7 v n' `r q1 � '^I r•� '°I � �, ,� 2 THE.S'EPT/C SYSTEM SHALL BE INSTALLED ACCORDING Tc� 7,,ES r ,y p`� -�- _ TJ'Tl_E V 8 ANY LOCAL RULES THAT APPLY 3 PRIOR TO BACKFILLING THEd BOARD OF G�5 VIAt-vL ® G V Div pOyr7 ICI f q m HEALTH SMALL BE N07117ED. _ _. r _ 4 WATER St,�LY ISf�ROVIDEt? BY T�.� ASSESSORS M�+F?__� LOT' \ h ' F 5 f EMOVE AI_L UNSUITABLE MATFRIAL F4R 1'EN FEE T IN A', ? � ,� ,� DlAfrTIONS AND TO AN EL t V OF BACKFIL L W/TM r'S ! � j' CLEAN .SAND N C'GMFLfANCE YYI TH 310 CMrr'.i5.0,?(I7) 6. N � C,�r°A.9��' �f �./i/7f'sy:H1/!J-•iG'G fj ''L' ..:s :�8 t(V// n/*: !!.t/ !'+'A.* r��.f'.�' /7�.L1� ,s►a �� k"'�eP�^;.:•p#e�t^,,+r . i - „�, ,� � ky,%�j' /��'�l�I►'"�` i7� ..o:"s>�ilf/',tl[s et'if,f►✓ai/Y?'!ds/}, G�►i/r✓at/P � y G g 99.7/ /•f/ 7� N/ 1 oo r. ,ouak � o, coGf of /wv�w. t.,T^/ 0 SITE PLAN 8 SEPTIC D w LOT E ��!' -./�, 7-i"•,/�L.� lam) /� � r Q t ' E GAPE N �INNEE IN 4 . r._. _ .. V __._ -......-. . _... _._ ....a . _.. . . .........,,. . �/// ()f"FICf U ovi r