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HomeMy WebLinkAbout0005 SETH GOODSPEED'S WAY - Health S SFTH GOODSPIEEb!S ' . .. 11� o b Certified Mail#7006 1680 0004 5458 4784 Town of Barnstable. o� Regulatory Services = BAMSTABLL 9� & `�g Thomas F. Geiler,Director p'f1639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 28, 2007 Virginia Faria 2845 Falmouth Road Osterville, MA 02655 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II— MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 5 Seth Goodspeed Osterville, was inspected on June 18, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. Broken storm door; slider screen with hole in it. You are directed to correct the violations listed above within thirty (30)days of your receipt of this notice by replacing storm door and slider screen door. You may request a hearing before the Board of Health if written petition requesting same is received within ten(10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. QAOrder letters\Housing violations\Rental ordinance\5 Seth Goodspeed.doc Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH omas cKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\5 Seth Goodspeed.doc FORM30 (H&w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOAROF -- H CITY/ OWN W PARTMENT ' sva� ADDRESS �°� TELEPHONE Address `Occupant_. Floor - Apartment No. No.of Occupants No. of Habitable Rooms_ No.Sleeping Rooms No.dwelling or rooming units o.Stories Name and address of owner ®�-- 415 Remarks Reg. Vio. YARD Out Bld 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: 0 Roof Q 10 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.: 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 - 10 Bedroom 2 ®G Bedroom 3lao Bedroom 4 ' Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: t s, lqes,.XXL feties: Kitchen Facilities Sink e 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 VIOLATION 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 R T IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES S OF PE 9 �^ INSPECTOR TITLE [0 ° r� A.M. DATE TIME •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 ll, 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). I Failure to comply with an provisions of 105 CMR 410.600, 410.601 or 410.602 which results in an accumulation of gar- bage, PY YP Y 9 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. L < I 4 r Parcel Detail Page 1 of 3 E,ARN1TA 1_t_it f »✓ ' .0 ,''��.•{ems t .:�� �.`. { �,/�� ,. � �. a.y- n ` {�� 61 t y_.yf'���''�4--LK.r __ .- _ �J� � � ��� '�il.��.�*�q:,%.C-� .li i �lY�':c !'/,.fd•. Logged In As Parcel Detail Friday, M< Parcel Lookup - Parcellnfo � '_"' .__�� — ---------- Parcel ID 122-067 Developer Lot[LOT 18 Location 5 SETH GOODSPEED'S WAY I Pri Frontage 94 Sec Road - -- - - -- - _I Sec4�`._-'..._� - --- -- --- - -- Frontage Village OSTERVILLE Fire District[C O-MM Sewer Acct _ I Road Index 1468 _ - - x Interactive --ram Owner Info Owner FARIA, VIRGINIA G & MARIA E - jI Co-Owner _ streets 2845 FALMOUTH RD Street2lf'�`— City ,OSTERVILLE state rMA� zip Countr Land Info _ Acres '0 37 _ Use Single Fam MDL-01 I zoning iRF J Nghbd 0105 Topography Level — I Road Utilities Public Water,Gas,Septic Location j Construction Info Building 1 of 1 Year " _ _ Roof - _- - - Ext,,_ Built 1976--.- --- structGable/Hip �I wall lWood Shingle Effect - ,� Roof - AC '— -- Area 1846 -- 1 Cover iAsph/F GIs/Crop Type,None Style Ranch , Int LD~wall Bed 3 Bedrooms wall l-rY - l Rooms -- --- -- Model 'Residential 1 Int g Bath 2- Full Floor Rooms - Full Grade'Average I Type Heat Hot Water Total Rooms 6 Rooms ---- ------ ----- — http://issql/intranet/propdata/ParcelDetail.aspx?ID=7696 5/18/2007 Parcel Detail Page 2 of 3 2U .1;4 FEP _16 <7.4 5 10 3 �7:a Heat Found- r , , �•, pps Found- stories 1 Story I Oil Poured Conc. 4, GAR-z' BA�:2, WBMT: - - ---- Fuel ation - 16 -'14_ d4, Permit History Issue Date Purpose Permit# Amount Insp Date COmml 10/1/1985 B28542 $2,000 1/15/1986 12:00:00 AM OS REI 9/1/1983 B25590 $4,000 4/15/1985 12:00:00 AM 8/1/1976 B18560 $0 1/15/1978 12:00:00 AM OS 1 S Visit History Date Who Purpose 1/23/2007 12:00:00 AM Paul Talbot Cyclical Inspection 11/10/1998 12:00:00 AM Frederick Stepanis Meas/Listed - Sales History Line Sale Date Owner Book/Page Sale P 1 3/31/2000 FARIA, VIRGINIA G & MARIA E C157125 2 10/15/1992 RISLEY, JEAN E C128068 3 7/15/1992 MASSACHUSETTS CO., INC C127085 4 10/15/1984 STEARN, ANDREW M &CAROL A C98687 5 9/15/1983 D'AGOSTINO, HENRY C93301 Assessment History Save# Year Building Value XF Value OB Value Land Value Total ParcE 1 2007 $172,200 $2,700 $400 $148,800 2 2006 $158,700 $2,700 $400 $151,100 3 2005 $144,900 $2,700 $400 $137,000 4 2004 $117,700 $2,700 $400 $137,000 5 2003 $107,500 $2,700 $400 $45,400 6 2002 $107,500 $2,700 $400 $45,400 7 2001 $107,500 $2,700 $400 $45,400 8 2000 $84,100 $2,600 $200 $27,500 9 1999 $80,200 $2,400 $200 $27,500 10 1998 $73,900 $2,400 $0 $27,500 http://issql/intranet/propdata/ParcelDetail.aspx?ID=7696 5/18/2007 r Parcel Detail Page 3 of 3 11 1997 $80,900 $0 $0 $20,600 12 1996 $80,900 $0 $0 $20,600 13 1995 $80,900 $0 $0 $20,600 14 1994 $75,200 $0 $0 $24,800 15 1993 $75,200 $0 $0 $24,800 16 1992 $85,600 $0 $0 $27,500 17 1991 $87,000 $0 $0 $44,700 18 1990 $87,000 $0 $0 $44,700 19 1989 $87,000 $0 $0 $44,700 20 1988 $62,200 $0 $0 $18,300 21 1987 $62,200 $0 $0 $18,300 22 1986 $59,700 $0 $0 $18,300 Photos t http://issql/intranet/propdata/ParcelDetail.aspx?ID=7696 5/18/2007 _.. -.-.,,.,, ..r...y-...R ^,.*,.-.:•A.b,....Ma.r +�ny...- .'..'.mil ,.+.-•-r'^ nt... ,: r^ -,`.�+^.`tA4**r,�.!i. �^•.-m7.'_..F•" x.. TOWN OF BARNSTABLE BAR-W 5906 Ordinance or Regulation WARNING NOTICE a a � � ©f'� # g Address of Offender ORD e MV/MB Reg.# Village/State/Zip Business Name am/fipm, on / 20 a � Business Address f R I9, `'�E' Signature oft Enffoorcifi4 Officer Village/State/Zip Location of Offense- C ' ,�,� o �� � /�7L1 r� }� �+ EMAOrre nforciing DeptfDivision Offense {ti/(/ti l�► � .1 1�'t A 4� )41 "� ME 0 / Facts 0 U�`'"''k-�rWW1AJ( ' 1170 word ; 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 Townf 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. TOWN OF BARNSTABLE BAR-W 5906 4°�-- Ordinance or Regulation WARNING NOTICE O f Name of Offender/Manager � .� � ?�' �� ,�.. kF�_..- f Address of Offender :�t�` 171 'r� T DI MV/MB Reg.# Village/State/ZipY .. IrJ �`/� Business Name am/pm,) on , 20 Business Address y / P1" !11. Signature of EnforcingkOfficer Village/State/Zip Location of Offense �- f t Enforcing Dept/Division Offense ` 1 r �, i s r Facts /7 i�• «'d f u.. •{ s 4mi / .4"�� r' �/'"t l .! _ .r^" s '°i•i*w"` 1'"p ,....r`I ,jA.-„ f � y„^'' `� � » rF,r�' •` !` 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. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. 1 r I � i•ti V �, �. �' a fir; r .4 a m i w -4 r ijjw v 40 p Nit ♦ .. r aa.1�'4 b ' M1 ' p 13'�,✓, nsv:,r R lg k 3� P- T�{y Yti 4¢. �aG Y r w T d� - r Citizen Web Request Page 1 of 2 P f --� 7,4Citizen Request Management Request ID: 20621 Created: 1/2/2007 2:05:09 PM Miorandi, Donna Status: Assigned To Staff Assigned To: Health Office Anonymous: Yes Category: Section 353-1 GarbagE and Rubbish E.C. Date: 1/4/2007 } 121111Created By: Fontaine, Tina Citations: Health Office Time Worked: 0 Response Time: 0 ,mom Requestor Details: My ybf —Email: Request Location: 5 SETH GOODSPEED'S WAY Osterville, Ma 02655 Parcel Number: Map: 000 Block: 000 Lot: 000 1 Request: trash bags all in the front lawn. This person believes there's nobody living there. -Request Work History: -Internal Note History: System entry on 1/2/2007 2:04:28 PM: Assigned to Miorandi, Donna http://issql/IntemalVVRS/WRequestPrint.aspx?ID=20621 1/2/2007 TOWN OF BARNST LE LGCA'I N _ SEWAGE # VIt.,LAGE � ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK. CAPACITY -�/ LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Ma,-dmum 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 L n� 133 A3 T 2 a 3 TA No. I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS �� r ZippYication for Migpogal *pgtem Cow5tructfon Permit 1-1 Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) El Complete System kIndividual Components Location Address or Lot No. I b.5 Owner's Name,Address and Tel.No. t Assessor's Map/Parcel 6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ti5�O�t �_ Src `( Type of Building: Dwelling No.of Bedrooms 72 Lot Size - sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow y gallons per day. Calculated daily flow �3�fi gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank SA-,kot, Type of S.A.S. �— Description of Soil clfowy=,e._5 Nature of Repairs or Alterations(Answer when applicable) b"&-y fV_ v t2 &,4\Cc�� c� lY>-e_s —t- 1'%Ok UAAz,�sM 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 ue y eal^ th.. ---' Signed Date Application Approved by Date{� -.17-a... Application Disapproved for th ollo ' g reasons Permit No. 2&na? 1?C) Date Issued TOWN OF BARNSTABLE LOCATION 1 ��Cyhg��s� SEWAGE # VILLAGE_('0/7 lI� ,/6 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE N0. RO�� 1, q A SEPTIC TANK CAPACITY 10 I LEACHING FACILITY: (type) (size) NO.OF BEDROOMS 1 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: 3/"10 Separation Distance Between the: j 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 i Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 'I i I i 0 etWV 7190 1-6 do 3V0. Fee j THE COMMONWEALTH OF-MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Zigponl 6pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade(- 'Abandon( ) El Complete System :�7 Individual Components Location Address or Lot No. � �c� v Owner's Name,Address and Tel.No. (\ t i Assessor's Map/Parcel 0 tJ r'(�/vl`�r-� l S Ile Installer's Name,Address,and Tel.N67 Designer's Name,Address an el.No. Type of Building: `'` Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow_::4"C_ gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. 1` -� n Description of Soil Nature of Repairs or Alterations(Answer when applicable) _rsc is 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 been issue this Board o� ealth. Signed Date ..� Application Approved by Date �o Application Disapproved fort o low reasonsS": Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS i BARNSTABLE, MASSACHUSETTS Certificate of Compliance , THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded Abandoned( )by j_ at ' has been constructed in accordance ' wl with-thg provisions of Title 5 and a for isposa Sys e Construction Permit o. dated Installer Designer , The issuance of this permit shall not a construed as a guarantee that the system will function as designed. (i ` J Date �� �/`:? Inspector 11"I)A AA G/ � ,1 ,41 ^ ————————————————————————————7/�———————— No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mwtoogaf *pgtem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(, ,yAbandon( ) System located at v t v - F 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: Construction must be completed within three years of the date of this permit. Date: Approved by f _./ F 1/6/99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated — v��' , concerning the property located at S`�'�nG � _ meets all of the O�T�v r following criteria: `-• 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 or equal to 5 minutes per inch. There are no wetlands within 100 feet of the septic stem proposed p Y 6ZThere are no private wells within 150 feet of the proposed septic system ;/There is no increase in flow and/or change in use proposed /•There are no variances requested or needed. l/ 'The bottom of the proposed leaching facility will not be located less than five feet above the maximum (% adjust - groundwater table elevation. [Adjust the groundwater table using the Frimptor method when a icable] • If the S.A.S.will be located with 250 feet of any vegetated wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top.of Ground Surface Elevation(using GIS information) B) G.W. Elevation +the MAX.High G.W.Adjustment.310 = ` �� d DIFFERENCE BETWEEN A and B SIGNED : DATE: [Please Sketch propo - plan of system on ack]. NOTICE Based upon the above information,a repair permit will be issued for bedrooms maximum. No additional bedrooms are authorized in the future without engineered septic system plans. q:health folder:cert ..�-. _r. r . ., Q v z ; - I No. — 8 L Fee 11-;�) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIppYication for Miopaal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Womplete System ❑Individual Components Location Address or Lot No. `,� P� a � Owner's Name,Address and Tel.No. c� Assessor's Map/Parcel �.- Installer's Name,Address,and Tel.No.V Designer's Name,Address and Tel.No. 1-5 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ( [ g�, Design Flow l gallons per day. Calculated daily flow "1 U / gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil fM, p�tLLA J Nature of Repairs or Alterations(AnsweT when applicable) W So I r C f L =r- ®t..c., 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 d 1 Signed i Date Application Approved by Date -� Application Disapproved for t e following reasons Permit No. 2ov Date Issued t , No. — , ., ..,_. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH: DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIPPYfcatton for Mtopooar 6peum Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Location Address or Lot No. Pl C. — N �,` G Owner's Name,Address and Tel.No. Assessor's Map/Parcel _ 0�Ot S ct r"�j I ft�- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Yilt ( —cip(2-- Se 0-4 V5 `CV t S Type of Building: t'" Dwelling No.of Bedrooms �f Lot Size sq.ft. Garbage Grinder( ) )Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow r gallons per day. Calculated daily flow gallons. "Plan Date Number of sheets Revision Date Title Size of Septic Tank 1!507) _5x T Type of S.A.S. Lt Cr !x C`kA 1r mac=, L Description of Soil C JOW A6 Nature of Repairs or Alterations(Answer when applicable) dt < t C�7�✓ ( pot Date last inspected: Agreement: r 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 been issued.by-thi 6 and o - Signed Date Application Approved by Date d ` Application Disapproved fort e,following reasons Permit No. �0 Date Issued ' -------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS `. BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded(y� Abandoned( )by AAi PMCO at has been constructed in accordance with the provisions of Title 5 d the for Disposal System Construction Permit No. _ dated Installer Designer s-- 0 The issuance of this pe t shall not be construed as a guarantee that the sy tam will, as d VnedV Date Inspector V ^4. /P & .11 J No.�`,' Fee "^ THE COMMONWEALTH OF MASSACHUSETTS ' PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i� o�aY Stem (Construction "-�. �'ermtt Permission is hereby granted to Construct(� )Repair( )Upgrade(L-,-,Abandon System located at 1 1�ti— Gwkr=0� 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:Construction must be completed within three years of the date of this permit. Date: Approved by TOWN OF BARNSTABLE LOCATION c e L SEWAGE # VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �d c 77� Oldy� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) _/,/�%>�,�/id7� (size) j NO.OF BEDROOMS BUILDER OR OWNER/ I i PERMITDATE: COMPLIANCE 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 L r— `t . � � i j f r E I 1i6i99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS I, Q hereby cent' that the application for disposal wo rks construction permit signed by me dated ( ��'`l � concerning the r-- property located at (� S� ( �� ( meets all of the following criteria: (/• The 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 or equal to 5 minutes per inch. There are no wetlands within 100 feet of the proposed septic system /There are no private wells within 150 feet of the proposed septic system •/ There is no increase in flow and/or change in use proposed are no variances requested or needed. �,/There ' The bottom of the proposed leaching facility will not be located less than five feet above the maximum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor Z1f ethod when applicable] the S.A.S. will be located with 250 fee,of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than fourteen(14) feet above the maximum adjusted goundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) vL- B) G.W. Elevation �r V the NIA-K High G.W. Adjustment ./I DIFFERENCE BETWEEN A and B SIGNED : �. DATE: (Sketch proposed plan of system on back]. q:health folder.cent C F- d i .............. THE COMMONWEALTH OF MASSACHUSETTS i BOARD O HE OF............... .... ...-- .----.......------.........-------- Appliratinn -fur KIWpoiittl Works Tnnitrnrtion Prrntit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal - System at• 4A e L ition- ess or Lot No. - - e-------•----•- � Address --------------- Installer Address UType of Building 2, Size Lot...... _.._._�`�Sq. feet Dwelling—No. of Bedrooms--___---�/..............................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—Type of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ------ W Design Flow............................................gallons per person per day. Total daily flow............3 a_C--____-.-._----.-gallons. WSeptic Tank—Liquid capacit/GM®gallons Length................ Width................ Diameter........._...... Depth---.--_-_.-..... x Disposal Trench—No------------- 1• th.......... al Length_._____-•__ _...... tal leaching area_ .e-2-_-_sq. ft. Seepage Pit No. -M f_ pt t 1. ------ �' t al leach' area. -------sc ft. Z Other Distribution box ( Dosing tank ( ) 10'/a C aPercolation Test Results Performed by-------------------------------------------------------------------------- Date---------------------------.----------.. Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-----------.__.._._-__-- L�' Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ O ••----- , ------------------------- a----- ------ W­-----------$-.---- x Descriptio 6f Soil = ✓ '.�� '° / Gv�- � d` U •----•----1- ----- " .Q.._.._ fi ��, W -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._--------------------------------------------------------------------.......--------------_--. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued�yne,,�,d b of he Ith. / ate Application Approved B : _ Date Application Disapproved for the following reasons:--•-•---------------------------•--------------•------••------•-•-••-------=---- — Date --------- ----- Date PermitNo......................................................... Issued: i�: Date- No......................... Flcs.... ....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH _- .. ).. 4�-�' .. ..OF.............................�.:.................�.....................---- Appliratiun -fur Uhipoii l urn Chun nrtiun frxn�it Application is hereby made..fora Permit to Construct (i`) or Repair ( ) an Individual Indi�iduua-1 Sewage Disposal System at ===',--t��.--- ------------=�...--- -----�--G��---�/-�--�-.------.U�?-'�.:._.._...----)---------------------- i Lo tion-A dress L� or Lot No. Owner r fr Address j' Installer Address Type of Building Size Lot....... feet Dwelling—No. of Bedrooms------------ _______________•___.---------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures r- ------------------------ W Design Flow............................................gallons per person per day. Total daily flow-------------3__?---..____..........gallons. W Septic Tank—Liquid capacity/G�Vgallons Length................ Width................ Diameter_-_---_-------- Depth....-_--_-.----- x Disposal Trench—No..................... NNh___.______..______.. tal Len th_._.._._._._ ....... tal leaching area... �i�-.sq. ft. Seepage Pit No..__lam/ 1�. rie r_- '4......_..._ t tal leaching are a------------------sq. ft. z Other Distribution box ( )� Dosing tank ( ) aPercolation Test Results Performed by------------ -•------ .................................................... Date--------------------------------------- 1 Test Pit No. 1................minutes per inch Depth of Test Pit-------------------- Depth to ground water-------- ........ (3:4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------- -------------------------------- ------------------------- .._. c- Description of Soil .` �� Cam- ;�, — ? U---- -- ------- - U --------------------------------� -- 4 - ------ -t--- . ..u-�-p- ---i------------------------------------- W VNature of Repairs or Alterations—Answer when applicable......-----------------------------------------------------------------------------------------. ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the bod of he th. 41 ale Application Approved By------- (�-----_ ...�_ _.._•---- -/� Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------•---------•--•-------- ---------------------•----------•-------_------_---.-.--•--•----•---------------•-•----•--••-•----------•------------------------------------------•-----------•----------------•---•------------------- Date PermitNo.............................---•........................ Issued........................................................ Date �y THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH y i .............1� ✓. -- ......OF..... .. 01rdifiratr of 101111whaurr THIS IS TO CERTIFY' Th�he Individual Sewage Disposal System constructed r ) or Repaired ( ) b ��-+ ....... -��Y ---- -,C (� Inst111er at = ---/ 1.....-=.. ••--=---- �-- ---------- - C/ -----•----•-- - has been installed in accordance with the provisions of icl of�FJaPtate- --- ---- - Sanitary Code as described in the application for Disposal Works Construction Permit No... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. _ DATE------ Z: .✓y ..................................... Inspector--------- ----------•-----------•--------------•-- I THE COMMONWEALTH OF MASSACHUSETTS 7 BOARD,_OF HEALT .... /w ........OF ��Iliv!/...................................••. / No.......�7/, FEE__ .................... O �i��au�ttl � rk,� �un�trn ��iun rruti# /�Permission is e ranted--------- �= to Construct ( or Repair ( )�a-nn Indiviiiddual Sewage Disposal System atNo. _ �----'� -----��'-•-•--------- `-•---------------- Street as shown on the application for Disposal Works Construction Permit No ____ ______ ated------------------------------------------ ---•••----------------- --- ------------...- oa DATE.......................................................................-........ B rd df Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r • � �.a t c - 1 1 F tr Y lY x x. , �l.G.�/.: . �/ � e��0�—_, /7, t it ' r <l'2 h ��r3.Y�1��"$rn� �•�': , s Yip �1pt,� lZ:�� t s.. `• �� 1 � �.: O Q`\ y -.F�xYrr� �� ,. 1.� ��yV�':t �v+ �t sw i'S,-c /f�1�^• �: <�r s� I:�. '1 t -�"t f�' •� } -4 .(�y�,Fl�'�2r 4'y. r �,� t<�,r s� r� frh, ��•. ' I •:���...-;g, �� :f �a4 3 i. v :, a{Y d��+I�.�"c.: ,1.1•ec:r'a:0�.: . �a b x �'• 1 - x P M .•� t'+t R . ."PA. 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