HomeMy WebLinkAbout63-65 QUAKER ROAD - Health 63 — 65 Quaker° Road
Hyannis,
A = 310-384 -055
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TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date _ 6 Time: In Out
Owner ( Tenant
Address u Address
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
110
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal o j q6
17.Temporary Housing r
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
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• TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date 211 17-01, Time: In Out
Owner_Y �tAn WLIAS t Tenant
Address bq)( ZLt o° Address b_�- Qum K ��
t �/at�� �s: ►nn ►� Hy,AN��s
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities ' UAY- M C6)L./to 6
3. Bathroom Facilities - -
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
rQ�r
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 v
14. Insects and Rodents ✓
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
18. Driveway Width LX
19. Number of Tenants Observed l
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms 2- Number of Vehicles Allowed (max)-
Number of Persons Allowed (max) ,
Person(s) Interviewed � Y F Inspectorfi
If Public Building such as Store or Hotel/Motel specify here
f �
C Management, Inca .
P 0. -Bo .2249 -Hya ni3s, MA 508-775-3336
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December 20. 2068 s
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There s a Wright
Town of Bar-_stabl. :i
Board of I.eo'th.
00 Main ;treer �j �r it:;:
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Hyannis, XIA 02601 ;
Dear Theresa:
,ti
Enclosed is list of tenalLIts,property location and phone numbers for the nnual n3 ,ct.o� of
these rentals.
a}It
; ---- 50 —367 261'"� ;k
fl
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3 � ��rnane So Tes 774-28 3 F
46=204-_693-L.
'Ff d4�,�rt�#+'�8
ca s.
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��-- 509_775-3336
5�0�8-2�9i2g-741R4762—
iO4 QuaCerad, $ yanrzas
OlgaRyb4.keva J
?G u
u146 .
�:l`) Pr fi lease contact�e'at 508-775-3�.,6- l
I you havp any diis2culties comae,these people,p
Thank yoc:. Ti .
!, Yours truly,
i
Nancy jc:vski,
.. Property 14.xnager
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'7 o ri Fi3t- - -
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TOWN OF BARNSTABLE Approved:
BOARD OF HEALTH MLD Cert.
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date 1'31-c- . ZG 2-005 Time: In 0,'20 Out
Owner ?--,u O Tenant ®T t, �D t n.v,-/L
Address /�� l�l/X Z �/� Address kcx— gZ o
��I �N N'r S Two oZ�o► � h''U�- �
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities l/
f
4. Water Supply
5. Hot Water Facilities i t o o
6. Heating Facilities �45
7. Lighting and Electrical Facilities
8. Ventilation ✓/
9. Installation and Maintenance of Facilities ^-1r,-x"
10. Curtailment of Service (2-
ti
r-Z .
11. Space and Use )--4A"rn G fit R
�f ti N 4• � �,C.PZ.�.
12. Exits
13. Installation and Maintenance of Structural
Elements ✓
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal ✓
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling; N �, (.�I N ct
Removal of Occupants; Demolition
Number of Bedrooms Z Number of Vehicles Allowed (max) 3
Number of Persons Allowed (max) 1
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
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Town of Barnstable
o� Regulatory Services
BARN SfABLE.
Thomas F. Geiler,Director
9`bAtEnMn�"N Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
June 25, 2007
Attn: Hyannis Fire
Health Inspector Meredith E. Morgan conducted a rental inspection in accordance with
Chapter 170 of the Town of Barnstable Code. In accordance with the State Sanitary
Code, 105 CMR 410.482, the Health Department is required to notify the Fire
Department if there is a smoke detector violation, or possible smoke detector violation.
The following property had possible smoke detector(and\or CO detector) violation(s):
63 Quaker Rd. Assessors Map-Parcel: (310-384):
Smoke detector on main floor not operable.
9 eredith E. Morgan -Health Inspector
Q:\Order letters\Housing violations\Rental ordinance\\Fire ViolationsTIRE TEMPLATE.doc
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FORM30 C&W HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOA. D OF H LTH
10
CIT /TOWN
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o EPA T NT
1 &Z 41"0%.It I, !s H& , -
<c AD ESS b�,a&
SV e
TELEPHONE
Address(03 QOCVAY I?ci, --Occupant A41-
Floor Apartme )No. No. of Occup ' w �lv/a�va/
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units No. tortes
Name and ac dress of owner
i
D Remarks Reg. Vio.
YARD ut Id s.: Fences:
Garbage and Rubbish
Containers:
Drainage
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:
CentralA:i
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.:
❑ 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
Living Room
Bedroom 1
Bedroom 2
Bedroom 3.
Bedroom 4
Hot Water Facil. Sup. en.,Gas,Oil, Elect.:
Stacks, Fluea,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 INSPEC EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTANMX J "
MINSPECTOR TITLE
/
DATE TIME / 1 _ •M•
A.M.
THE NEXT SCHEDULED REINSPECTION7, P.M.
a
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to'always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter II, 105 CMR 410.100 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 leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to 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. _s
(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
FORM30 C&W HOBBS&WARREN'M THE COMMONWEALTH OF MASSACHUSETTS
BO D OF HEALTH
�PtARENT
/TOWN
V
A
a IW.
ADDRE
LEPHONE
Address(ACT 0iXI-VOY U Occupa
Floor Apartm nt No. No.of 0( is ^
No.of Habitable Rooms No.Sleeping Rooms_ Nd act
No.dwelling or rooming units_ N .Stories
Name and address of owner /'
l\�I Remarks Reg. Vio.
YARD Out BI s.: Fences: Ll
Garbage and Rubbish
Containers:
Drainage
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 Equip. Repair
TYPE: Stacks, Flues,Vents:
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
—Living 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 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 IN CTI EPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI R R ."
INSPECTOR TITLE
A.M.
DATE TIME D - P•M•
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
1
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 leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to 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.
TOWN OF BARNSTABLE
LOCATION63-65 QUAKER ROAD SEWAGE# 2005-401
vu..LAGE HYANNIS ASSESSOR'S MAP& LOT 310 384
INSTALLER'S NAME&PHONE NO. ELLIS BROTHERS CONST. CO. 362-62u
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type) 3<SG a G'L eCJ?A/nk e (size) / k 3 3
NO.OF BEDROOMS__
BUIL.DEROROWNER RICHARD -ARENSTRUP
PERMITDATE: 8/16/2005 CO LIANC , DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and 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 � ,Z ;22-Cc-& ,
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No.�Q.�— nn .EiCe �vi ( C9` */ Fee UU
THE COMMONWEALTH OF MASSACHUSETTSs` E ter d in computer:
// Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MA�SAI8- TTS
Ztpprica.tion for nt5po5a[ *pgtem Contruction Permit
Application for a Permit to Construct( )Repair( Upgrade )Abandon( ) -9complete System El Individual Components
cafi Address or Ut No. ��++� �114 Owner's Name,Address and Tel.No.
�J `�/Cla�.iLU'r ti�s✓ ✓J� 6b °�/� /ii�l *� ��Pi�JrT1� �
Asses is Map/Parcel
Pig -:3- V
Installer's Name,Address,and Tel.No. a�` �' b ��a�. Designeerr�'s/Name,Address and Tel.No.
Type of Building:
Dwelling No.of Bedrooms Lot Size 1<<sq.ft. Garbage Grinder(�®
Other Type of Building ka� + No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow `T gallons per day. Calculated daily flow gallons.
Plan Date �� �=� Number of sheets Revision Date
Title �' �r 'Z` Ali" s �; . 04ZQtS
Size of Septic Tank 11�5 Type of S.A.S.
Description of Soil: ���✓ 160 � iAJ
Nature of epairs or Alterations Answer when applicable) io
Date last inspected:
Agreement:
The undersign agrees to ensure t onst 'ion and in ' tena e of the afore described on-site sewage disposal system
in accordance with the ovisions rtl the Environm I e and not to place the system in operation until aa Certifi-
cate of Compliance has been ue by this Board of Hea
S' j Date
Application Approved by Date ��^�S
Application Disapproved for thY following reas
Permit No. Date Issued (6 "USr
�. < y s+ /,
�� Fee vU
I'll
ThtE COMMONWE LTH OF MASSACHUSETTS� Ent d in computer
���� Yes
PUBLIC HEALTH IVISION - TOWN OF,BARNSTABLES MASS�AG�HI&SETTS
hi �'
Z[Pplication for Miqozal ztem Con!5tructiott Permit
Application for a Permit to Construct( )Repair�K)Upgrade )Abandon( ) Complete System O Individual Components
Locate n Address or of No. �7h S Hfill Owner's Name,Address and Tel.No.
�Ass�esor's Map/Parcel
Installer''sss Name,Address,and Tel.No. 50 4 $6 2 -6m-3 Designer's Name,Address and Tel.No.
z 3 SG!/Elr� G ti d/.Ifs n
Type of Building: �'
Dwelling No.of Bedrooms Lot Size ' � 5�J sq.ft. Garbage Grinder('��
Other Type of Building &&n No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow ? i 7 gallons per day. Calculated daily flow gallons.
1' Plan Date %-' Z 5 Number of sheets / Revision Date
3 '
Title
Size of"Septic Tank /5 Type of S.A.S. 2 1- v
Description of Soil
Nature o Repairs or Alterations(Answer when applicable) 14/S�s(� 1&4� G,� s .n�✓,�s ��-
ST
Date last inspected:
d,
Agreement: `� ~•'�� �--N-�
The undersigned agrees to ensure the cons' tion and in nti' enan'ce of the afore described on-site sewage disposal system
in accordance with th�e�provisions af-`Tit1e.5-oft e Environm nt 1 C�e and not to place the system in operation until a Certifi-
cate of Compliance has beeni7 sue b this Board of Healt // 1
p S.igrtd'^"_"fin, 1 Date �4�`���
Application Approv d by. , j ' Date S-
Application Disapproved for Re following rea s
Permit No.0o0 C-,=VT)f Date Issued
---------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS j
(Certificate of (compliance
f THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired Upgraded( )
1 Abandoned( )by 4-ems.
?; at has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.iaY 5--y0( dated ?-j(,,-0 C
Installer Designer
The issuance of this permit sllaall of be construed as a guarantee that the�ys em vi 1'{t ct'on as desigrie .
Date Inspector, 1
Y
No. cv ^.,qlJ! -------------- Fee
lJ! THE COMMONWEALTH OF MASSACHUSETTS
{ PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpoga1 *pgtem Con5truction Permit
Permission is hereby granted to Construct( )Re air( )Upgrade( )Abandon( )
System located at /.-� -a-/.� - /,Q �.CjAI/474— z/
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. /1
Provided: Consst ct ofio must be completed within three years of.the date his it. 1
Date:_- O Apprbved �nJ
.�`"E'"� Town of Barnstable '
E AZU e
Public Health Division
200 Main Street
�FD,�►+� Hyannis, MA 02601
Notice: This Form Is To Be Used For,the Repair Of Failed
Septic Systems Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
h%f1 Par��rn 11tt0Y►CcS, S hereby certify that the engineered plan signed by me "i
dated:]J(4 d5 (2CO,5 concerning the property located at
63 5 c tCLkej_- RN Hub olVt(-S meets all of the
following criteria:
• Two soil evaluations excavated for detailed examination(no hand augering)and two
percolation tests shall be conducted.
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than orequal to 5 minutes
per inch.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the,
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information) 1, � '
�'-- ',B) G.W.Elevation +adjustment for high G.W. N OF hfis 9
sc
C DIFFERENCE BETWEEN A and B T.A. y16h
DUMAS v
No.619
SIGNED : DATE: ? &hul- as_ •p o
' F01STE��
sgNITAR�
NOTICE (�{
Based upon the above information, a repair permit will be issued for Fo fd(r bedrooms
maximum. No additional bedrooms are authorized in the future without engineered septic system
plans.
gASeptic\percexemp.doc
`
- �
SWEET'SER ENGINEERING
P.O. BOX 713—SOUTH DENNIS—MASSACHUSETTS 02660
TEL(508) 398-3922 FAX(508) 398-3063
LAND SURVEYING—ENGINEERING—TITLE 5 SEPTIC SYSTEMS
SEPTIC DESIGN PROPOSAL PAGE 2
PROPERTY SURVEY AND FLOOR PLAN SKETCH
Please fill out this form,includink,the floor plan sketch,and return to us with the signed proposal and retainer.
This information is necessary to properly prepare your Septic System Design.
IF YOU ARE PLANNING AN ADDITION PLEASE INCLUDE THAT INFORMATION ALONG WITH THE
FOUNDATION DIMENSIONS AND LOCATION FOR THE NEW ADDITION.
Total#of Rooms C/' Year Round Home Seasonal Home Owner Occupied Rental
`f #Bedrooms Family Room/Den of Living Room Dining Room #Bathrooms
-1_Washer/Dryer ol- Dishwasher Garbage Disposal `� Gas Service Town Water
In-ground Electric Wires* PO In-Ground Oil Tank* In-ground Sprinkler* In-ground Gas Pipes*
*Please note on sketch where located. Sweeiser Engineering assumes no responsibility if in-ground components are
damaged during Soil Testings, Inspections,Locations of and/or Installation of New Septic System.
Cellar: Full Partial(Crawl) Slab
Wells: ll3r Main Use �Irrigation Only (please provide location of all wells)
PLEASE USE THE SPACE BELOW AND THE BACK OF THIS SHEET TO PROVIDE US WITH A ROUGH SKETCH OF
THE EXISTING FLOOR PLAN(ALL FLOORS). Also include any items that should be avoided,IF FEASIBLE,i.e.shrubs,
trees,patios,electric lines,tanks,etc.
IF YOUARE PLANNING ANADDITION,PLEASE PROVIDE THE LOC�TIO D F UNDATION DIMENSIONS
-4- P�►5
7-APx
e'4
Vs
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1,%U Rm BecQ deb
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1
(QU..CLke_r ��2�rL,�
4.4ua rntW
I
Town of Barnstable
a �FIKE T o Regulatory Services
s Thomas F. Geiler,Director
Public Health Division �-
'°iFn ate Thomas McKean,Director
200 Main.Street,Hyannis,MA 42601 -
»i Office:.508-862-4644 Fax: 508-790-6304
_1/ Installer&Designer Certification Form
Date: ' A v
Designer: SWEETSER .ENGINEERING Installer• ELLIS BROTHERS CONST.
Address: P.O. BOX 73 SOUTH DENNIS, MA 0266&ddress: 23 ENTERPRISE ROAD, YARMOPUTH PORT
On 8/16/2005 t ELLWBROTHERS CONST. � �=
was.issued a permit to install a
(date) ..(installer).
4
septic system at 63/65 QUAKER ROAD, HYANNIS, MA based on a design drawn by
(address)
dated �,1,. .Z S 0 C2
(designer)
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 system)but in accordance with State &Local Re rulations. Plan revision or
certified as-built by designer to follow.
H Of AtASS9
' O
o
T.A.
WMAS y
(Installer's Signature) No.619
- _ S'�1V1tAR11N
r t'
igner's i afore) < (Affix Designer's Stamp.Here)
,A
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
N
TOP OF F`FOUNDATION20 FT. MINIMUM FROM CELLAR SOIL TEST
ELEV. 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE DATOILETaST DONE BY S_1F SOIL TEST �N_E DER ENGiNE'ERING
CLEAN SAND
(ASSUMED) CONCRETE WITNESSED BY -----------
COVERS 4" SCHEDULE 40 PVC PIPE LOAM AND SEED 08SERVAT10N HME 1 ELEV. 98.50
--- 08SERVATION HOLE 2 ELEV.=_ 98.50
MIN. PITCH 1/8" PER FT. PERCOLATION RATE _< 2__ MIN,/INCH AT 68 INCHES PERCOLATION RATE 4��� MIN./INCH AT y 72 INCHES
2 LAYER OF
1/8" TO 1/2" DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER
WASHED STONE
44* 4" CAST IRON PIPE MAX. 9a.50 MAX. VENT 0-6 A LOAMY SAND 10YR4/1 NO ROOTS 0-8 A LOAMY SAND 10YR3/1 NO ROOTS
(OR EQUAL) MINIMUM
MIN. NOT REQUIRED
PITCH 1/4" PER FT. z 6-33 B LOAMY SAND 10YR7/6 ROOTS 8-27 B LOAMY SAND 10YR7/6 ROOTS
FLOW LINE Q, 33-132 C MEDIUM/ 2.5Y8/4 COBBLES 27-132 C MEDIUM/ 2.5Y7/4 COBBLES
" COARSE SAND
D
ELEV. _ �6.33� 10 COARSE SAND
MIN, o ° ❑ ❑❑ ❑❑ O ❑ ❑ ❑ ❑ ❑
°
LEV. _ - - LEVEL ° ❑ ❑❑ ❑❑ ❑ I� ❑ L7❑ ❑' °95.42 °
ELEV. _ _6t67- GAS ELEV. = 95�11 6„ SUMP ELEV. _94.94_ o o °
BAFFLE - o o ❑ ❑❑ ❑❑ ❑ ❑ ❑ b ❑ ❑ 2' 0
DISTRIBUTION ELEV. ° ° ° ❑ ❑ ❑ 13 ❑ ❑ ❑ r ❑ ❑ ❑ ° °
LIQUID OUTLET BOX ° °o o ° ° ° ELEV.DEPTH JEE
(TO BE PLACED ON FIRM BASE) $�Z� 3 - 500 GALLON GALLEYS WITH
4 FEET 14 INCHES TO BE WATER TESTED
5 FEET 19 INCHES /�� /� IF MORE THAN ONE OUTLET STONE IN AN
6 FEET 24 INCHES 1500 GALLON NO WATER ENCOUNTERED AT -..,1,32 ELEV. _ NO WATER ENCOUNTERED AT ___,1 2,"_ ELEV.
7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13 X 33 X 2 TRENCH FORMATION z WELL N A
8 FEET 34 INCHES SEPTIC TANK N p �p � 25 ZONE
3/4" TO 1 1/2" CLEAN SOIL ABSORPTION -,r, INDEX
DOUBLE WASHED STONE ADJUST
FREE OF FINES SILT SYSTEM (SAS) DESIGN CALCULATIONS
USGS PROBABLE WATER TALE ELEV. = __ NUMBER OF BEDROOMS 4J'
SEWAGE DISPOSAL SYSTEM PRO ILE OBSERVED WATER TABLE ( / f 7 ELEV. = GARBAGE DISPOSAL UNIT
NOT TO SCALE BOTTOM OF TEST HOLE ELEV. _ _QL� TOTAL ESTIMATED FLOW
( 110 GAL/WL/DAY X 4 _ BR.) _AM- GAL./DAY
REQUIRED SEPTIC TANK CAPACITY GAL.
ACTUAL SIZE OF SEPTIC TANK 1xA GAL.
SOIL CLASSIFICATION
DESIGN PERCOLATION RATE S_6 MIN./IN.
EFFLUENT LOADING RATE GAL/DAY/S.F.
LEACHING AREA a1 SQ. FT.
(13X33)+(46X=)
LEACHING CAPACITY (AREA X RATE) GAL./DAY
613.00 X 0.74
RESERVE LEACHING CAPACITY 61 GAL./DAY
NOTES:
1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P.
TITLE 5 AND THE TOWN'S RULES AND REGULATIONS FOR
THE SUBSURFACE DISPOSAL OF SEWAGE.
2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO
WITHIN 6" OF FINISHED GRADE.
3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF
�6pUa• WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN
10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE
SOIL 98.5 USED UNDER OR W€THtN 10 FT, OF DRIVES OR PARKING AREAS.
1 O TEST 24 Dt1' �/I�j 4. ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL
� . ,
BE MORTARED IN PLACE.
1`.,
r_� �.O D M144A110N HAS BEEN MADE AS TO COMPLIANCE WITH
r._
�"• f DEEDED OR ZONING REGULATIONS. OWNER APPLICANT IS TO
OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY.
6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR
D. IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS
BOX 97.4 8. PRIOR TO COMMENCING WORK ON SITE.
� r'�/
'.r„ .5 �� �] 97.5 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS
SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE, ANY VARIATION
8 99.0 99.2 -� IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER
BH: 97.5 IMMEDIATELY.
tb t Ir J 8. PARCEL IS IN FLOOD ZONE C
t t SO L / 9. LOT IS SHOWN ON ASSESSORS MAP 310L_ AS PARCEL - 384
t t TE;T 1 18.6 10. EXISTING CESSPOOLS ARE TO BE PUMPED AND BACKFILLED UNLESS
r1 00 GALLONIT S WI HIN 5' F I
I T O SO L ABSORPTION SYS M TH N
� 11: E IT SHA
LL LL BE
�EPTIC TANS %y y 99.1 ''� ' REMOVED ALONG WITH ANY POLLUTED SOILS.
1t / 5
C tj
:✓ Fps
97.3 PLAN 4 tN OF Iygs
EXISTING DUPLEX jBIN
t Yn 11 2 BEDROOMS EACH SIDE :: 1 IL._'I�,t�l ; � � T.A.
4 BEDROOMS (TOTAL) OQ c,
x 1331t No
PPROVED. BOARD OF HEALTH
P $.2 , 63 J t S� 4FG
99.1 9', / Q I DATE AGENT
99. / a 8.4 PROPOSED SEPTIC DES��N
FOR
.6 / _`96.9
PI {
CIU AM J .
LOC. '
TS x 98.28.4
98.3 m 96.6 r��t H YA/ N l
LVV Vas
w
x 96.6 235 GREAT WESTERN ROAD
5 508- P. O. BOX 713
- SOUTH DENNIS, MASS.
LEGENO Pe
398 3922 0286t3 »-
EXISTING SPOT ELEVATION 00,,0 ,
EXISTING CONTOUR «.---Op---- DATE LfULY 250
2�Q SCALE " '
FINALPOT 5 ELEVATION`
FINAL-CONTOUR
SOIL TEST,LOCATION _ f J) REVISED JOB NO.
ISC `Y
UTILITY POLE -0- y VLI
Fr ....
TOWN WATER �W O v�
CATCH' BASIN ® 1`
-- VI
GAS LINES RE SED
LOCATION MAP
c SHEET 1 OF, �1.
CLEAN OUT
CESSPOOL C P.
C. S8 PROM 82?9 00 'd 22 s 6 � ct !JW 02005 Sft-E:I aER INOINEERiNG
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