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HomeMy WebLinkAbout0267 FALMOUTH ROAD/RTE 28 - Health 67 Falmouth Road (Rte 28) Hyannis A - 292 013 �I a r M1 tl 0 Y_ MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: "")6 Unit# #Of units in bldg.( 2 City/Town: MA Zi Code: C60/ EQUIPMENT INSTALLATION-INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 vz gallons per minute(2.5 gpni) Faucets with maximum flow rate not to exceed 2.zno gallons per minute(2.2 gpm) Ultra low flush water closets(toilets) not to exceed. 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A lic lumber must install the water closets and submetering equipment. s ,,4xbmetering equipment information: 1x1o/U/OlCw .mE7;5,2 �y,/lS LJ-141-ze Manufacturer Model# Licensed Plumber Certification k Print Name of Plumber License# Date 7 I certify that(check all that apply): ❑I have installed the gubmetering equipment listed above in accordance with accepted plumbing standards. ❑ ave.installed one.or more,water closets not exceeding-1.6:gallons__per-flush. [ Determined that existing water closets do not exceed 1.6 gallons per flush. ElThe plumbing permit issued by the city/town, if required, is attached. ❑ Dwelling unit is connected directly to,a meter installed by a water company and, in accordance with M.G.L : c. 186, § 22(p),does not require the installation of a submeter. T Signed under the pains and penalties ofperjury, _—�! =G,�` `� "'"5 'X 0 _ Signature of Licensed Plumber Property Owner Certification Lcertify that:-(1)This:dwelling.unit is_eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets;and water closets"in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring ' the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form; (6)That all information included on this certification is true and accurate to the best of my knowledge... Signed under the pains and penalties of perjury, 3 ag 9 r' o n r LSirhature of Owner Date. Board`ofHealth/Health-De artment-- Received B - ate '.MDPH/CSP Submetering Certification Form;Revised 10/06 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM In accordance with M.G.L. c. 186, § 22 and 105`CMR 410.000: Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the following dwelling unit is eligible for the imposition on.the tenants of a charge for water and/or sewer service. c�am. PROPERTY INFORMATION Address:�D Aa Unit# #Of units in bldg. 2 Cit /Town: *A111l/ MA Zip Code: 0'2-(!�O/ EQUIPMENT INSTALLATION,INFORMATION 105 CMR 410.000 requires the installation of.water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed r, 2 /'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed - 2 zno gallonsperminute(2.2,gpm) Ultra low flush water closets(toilets)not to exceed " 1°6"0 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet.the standards of accuracy and testing of the American Water.Works Association or similar accredited association. A lice : plumber must install the water.closets and submetering equipmen -1 C� me Bring equipment information:lit/,01i01i9" 146.741. Manufacturer Model# Licensed Plumber Certification Ilkcam= C c_ 1t60 / Print Name of Plumber License# Date I certify that(check all that apply): . ❑1 have installed the submetering equipment listed above in accordance with accepted plumbing standards. ❑ I ve installed.one or more water closets_not_exceeding;l6 gallons„per flush. ` Determined that existing water closets do not exceed 1.6 gallons per flush. f' ❑ The plumbing permit issued by the'city/fown,-if'r quired is attached.- ❑ Dwelling unit is connected directly to a meter installed by.a water company and, in accordance with M.G.L . c. 186, § 22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, Signature of Licensed Plumber, -' Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);'(2)'All"showerheads, faucets;and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The.water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring.the usewof water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service, and a copy of this certification form; (6)That all information included on this certification is true and accurate to the best of my knowledge: _ Signed under the pains and penalties of perjury, e�W 5 v/ 7 Print Name of Owner i nature of Owner Date �—Board`of Health/Health°De artment-- `—`' Received By Date MDPH/CSP Submetering Certification Form,Revised l0/M or?G 7101-F6 LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S 4AME A ADDRESS KAM 0 O UILDEll OR 000ER DATE PERGIIT ISSUED DATE C 0 M P L I A N C E ISSUED / - i-� _W u/ --i- 1 Z � C C Cy r- 613 No.C/Y Fee THE COMMONWEALTH OF MASSACHUSETTS Entered-in computer: t Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 0ppfication for Mi5p0ar *p-55t= Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( MComplete System ❑Individual Components Location Address or Lot No. ,�_® Owner's Name,Address and Tel.No. _ Assessor's Map/Parcel �71�t � Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: �j Dwelling No.of Bedrooms / Lot Size 116 *5� Garbage Grinder(X® Other Type of Building / e,,ICe No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee ' ed by t ' B d o eal Sign e Date Application Approved by ' Date Application Disapproved for the following reas n / Permit No. Date Issued • � .+.....•-...i. � j..,,� �y . r '.sc l - . ram..^' '•°"''ti�..- t _+ Y. -613 95 No. ' .;:.>.�.,. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: it • Yes PULIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 121pplication for Mi po�af 6 It �Cougtruction Permit , Applicatio,for-a Permit to Construct( )Repair(. )Upgrade( y Abandon( L complete System ❑Individual Components Location Address or Lot No. Zb? Owner's Name,Address and Tel.No. _ Assessor's Ma /Parcel Installer's N e,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: ,J Dwelling 'No.of Bedrooms % Lot Size �� �fCd�. Garbage Grinder( �© Other Type of Building _ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 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 Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee iss ed by t i B d o Meal Signe Date Application Approved by �� ® _ Date O Application Disapproved for the following reasUns� Permit No. Date Issued THE COMMONWEALTH OF, MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS I�T'O CERT Y, that the On ite,Se ge Disposa System Constructed( ) Repaired ( )Upgraded( ) Abandoned y�/)by 0 l S (J Nl at has constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � � ated Installer Designer The issuance of this permit sha not pbe lconstrued as a guarantee that the says erYr w.1 fu ction as designed. Date � � ! 't Inspectorr--��"" _r . ---=---- ---- ---- ---- No. 7 Fee r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS �N!5ponl *pgtem Con6truction emit - Permission is hereby granted to Construct(/ )Repair( /)Upgrade )Abandon( ) System located at Z f� 7 �ll�✓!© �'�1 /' ,0� �-� �l�'����5 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: Construct' n ust e co pleted within three years of the date of thi ermi. Date:_ �� 4 Approved by o L 0 CATION J S E W A G E PERMIT NO. mac: t �� _ i VILL'AGE 'S- NAME ADDRESS 10� SIT A L L E R 0 UIL'DER OR OWN_EI? \ ® ATE PE;RIRIT ISSUE ® a� i DATE C0MPLIAWCE ISSUED I C)L I i I v h y 3 / 1 N c �' �v r F r.F f Town of Barnstable FIKE r�tic Regulatory Services • Thomas F. Geiler,Director sAM ISLE, 9�ArE a•0� Public Health Division Thomas McKean,Director 200 Main St, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 May 27, 2003 George Marquit Sr. . Marquit Family Nominee Trust 267 Falmouth Road Hyannis, MA 02601 .IMPORTANT NOTICE RE: Map & Parcel 292-013 Dear Addressee: You are directed to connect your building located at t267-Falmouth Road,Hyannis, Massachusetts, to public sewer on or before August 29, 2003. The Department of Public Works, Engineering Division, has notified us that your property abutts recently installed vacuum sewer lines. The lines were extended because of the density, and the size of the lots in the area, and the potential for serious health problems. Failure to comply with this order will result in a complaint against you, in a court of law, due to your failure to comply with a Board of Health Order. If you should have any questions, please telephone me at 862-4644. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S. CHO Health Agent for: TOWN OF BARNSTABLE BOARD OF HEALTH Wayne Miller, M.D., Chairperson Susan G. Rask, RS. Sumner Kaufman, M.S.P.H. Return receipt requested Cc: Barbara Childs, Water Pollution Control Mark Giordano, Engineering Q:Sewerorder.doc r Town of Barnstable Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,RS. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. September 3, 2003 Mr. Mark Marquit 267 Falmouth Road Hyannis, MA 02601 Dear Mr. Marquit: You are granted an extension of time, on behalf of your father George Marquit Sr..; to connect the duplex at 267 Falmouth Road Hyannis to public sewer. You have until November 30, 2003 to connect the building to town sewer. This extension is granted because additional time is necessary to secure and compare quotes from private contractors. Many contractors who are listed in the Yellow pages of the telephone book (listed under "Septic") are licensed within the Town of Barnstable to perform sewer connection work. It is suggested that you always obtain price quotes from at least three contractors before choosing a contractor to do the work. If you should have any problems in the future in this regard, please feel free to call our Health Agent Thomas McKean at 508 862-4644. Since ly yours, ayn iller, M.D. Cha' Board of Health - Town of Barnstable sewer l r dNA.)i Si /'•'I6.. Illp 4r ACA l,ti� uarw 0d va (— O-q4- ro r ap -de- �1�v_� ®o�J B��C.��, e v'e-J O'N I r el w a � I i j t � , � i k � . i I I � � i i � � ; - � S - - ., � � " r _ I ' f I ' ' - � � � � � � � _ � � � � � I � I � � i ; ' , ' - �- .. � � � � - + � � . - I � �� � � i � ; . � - !- i� i � � I i � - i l � : - � � �� I. � f � • � i � I � i Town of Barnstable �aarrt�Aar.�, Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask,R.S. FAX: 508-790-6304 Sumner Kaufman,MSPH Wayne Miller,M.D. November 20, 2003 Mr. George"Mark"Marquit 267 Falmouth Road Hyannis, MA 02601 RE: Extension of Time to Connect Building to Public Sewer Duplex at 267 Falmouth Road Hyannis Dear Mr. Marquit: You are granted an extension of time, on behalf of your father George Marquit Sr. to connect the duplex at 267 Falmouth Road Hyannis to public sewer. You have until May 1,2004 to connect the building to town sewer. This extension is granted because additional time is necessary to secure and compare quotes from private contractors. Many contractors who are listed in the Yellow pages of the telephone book (listed under "Septic") are licensed within the Town of Barnstable to perform sewer connection work. It is suggested that you always obtain price quotes from at least three contractors before choosing a contractor to do the work. If you should have any problems in the fixture in this regard, please feel free to call our Health Agent Thomas McKean at 508 862-4644. Sinc ly your , a ayn Mille ,M.D. Chai an Board of Health Town of Barnstable sewer 1 Oi 4 ct/ /vt . 917 3 3el)C V'-e, ka-d 6- CoSqOpelqeAtA�lo IfAe- N f,'A� c-L4 i 4,e— i C�) kavc P� c li e. � 'iN W,- d, '(' /u' l �'- c� P c�- Re (31 PQ rho Fw Ma I L r/e—ev `1 Q—c V ; � t . " r t r Date: c /?_3/ 0(,, TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: ' -t-S BUSINESS LOCATION: 5 INVENTORY MAILING ADDRESS: _� a-ty-) f- TOTAL AMOUNT: TELEPHONE NUMBER: Su K - 9 91 - 0C CONTACT PERSON: �-_� Cl_1 r c,a-n 15 EMERGENCY CONTACT TELEPHONE NUMBER: `JD � - 4 a 4 - 4 11 a. MSDS ON SITE? TYPE OF BUSINESS: 41 I INFORMATION/RECOMM DATIONS: 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 materials 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) __ Misc. 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 Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. 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 (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers �S(including bleach) �^ G�e' { Spot removers &cleaning fluids 41 (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS YOU WISH TO OPEN A BUSINESS? io For Your Information: Business certificates (cost$30:00 for.4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must d❑ by M.G.L.-it does not give you permission to operate.) Business Centificates.are available at the Town Clerk's Office, 13C FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE:- - L? M z M gA, Fill in please: 'APPLICANTS YOUR NAME: 1 BUSINESS YOUR HOME ADDRESSJ Q 5bQLj L an SDa �J- 6� rnnr4 n.�_ U Ut q. TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS 1 S C. L �> TYPE OF BUSINESS � IS THIS A HOME OCCUPATION9, : YES NO �/ � e Z~I�`�S Have ou been iven.a roval from the buildin dtvisio YES: Y. g pp. 9 .NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER 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 This individual has been informed of any permit requirements that pertain to this type of business. Authprized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been inf rme the UgLit requirements that pertain to this type of business. Aut sized Sign ture COMMENTS: .C_ C 3. CONSUMER AFFAAbe ' AUTHO ITY This individual d of the --nsing uirements that pertain to this type of business. at e* .COMMENTS: