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HomeMy WebLinkAbout0161 MAPLE STREET - Health (2) 161 MAPLE STREET, W. BARNSTABLE A=1�2-008 COZY NEST ti o McKean, Thomas From: McKean, Thomas Sent: Wednesday, January 29, 2014 10:45 AM To: Dabkowski, Cindy Subject: RE: 161 Maple Street The original e-mail is below. It describes two rooms, not one, that are considered a"bedrooms." (the family room and the den). The owner is only proposing to provide one five feet opening to only one of the rooms? -----Original Message----- From: McKean,Thomas Sent: Friday, November 08,2013 8:25 AM To: Dabkowski,Cindy Subject: 161 Maple Street I received an amnesty application regarding 161 Maple Street West Barnstable yesterday. The floor plans show two bedrooms plus a den on the first floor. The den appears to be designed as a bedroom with privacy at the end of a hallway. The downstairs "studio apartment' includes a kitchen within it(outlined in green) along with a separate large "family room " in the basement with privacy walls and door. The septic system is designed for three bedrooms, with no additional capacity to spare. The onsite well is 130 feet away from the leaching area (NOTE: Barnstable requires 150 feet minimum). There are two extra rooms on the plan which are designed to provide privacy and are therefore considered as "bedrooms;" the family room and the den. Therefore,please ask the applicant to remove the doors to these two rooms and to open up the walls with a minimum five feet openings. The other option is to upgrade the septic system to accommodate the two additional bedrooms. However, additional leaching cannot be designed closer to the well, which might present a challenge. 1 Message Page 1 of 1 McKean, Thomas From: Dabkowski, Cindy Sent: Wednesday, January 29, 2014 10:13 AM To: McKean, Thomas Subject: FW: re 161 Maple Street WB Mr. McKean Ms. Keller has agreed to open the doorway to a minimum of five feet. With this change is the property eligible for Accessory Apartment Program? If so, will you be able to provide sign off for the site? Cindy Dabkowski Affordable Accessory Apartment Coordinator Growth Management Department 367 Main St Hyannis, MA 02601 508-862-4743 -----Original Message----- From: Edith Keller [mailto:edithkeller40@hotmail.com] Sent: Tuesday, January 28, 2014 12:35 PM To: Dabkowski, Cindy Subject: Dear Mrs.Dabkowski, Sorry,that I didn't write sooner,l was sick with an ammonia and couldn't do anything.Now this is behind me and I want to go ahead with the apartment. I am willing (reluctantly) to make that 5 feet opening in the basement with the family room.ls there a possibility that I could talk to the gentleman from the Health Department? I am worried a little bit about the cost's too,but I worry about that,when I get there! Thanks for your help! Sincerely Edith Keller 1/29/2014 McKean, Thomas From: McKean, Thomas Sent: Friday, November 08, 2013 8:25 AM To: Dabkowski, Cindy Subject: 161 Maple Street I received an amnesty application regarding 161 Maple Street West Barnstable yesterday. The floor plans show two bedrooms plus a den on the first floor. The den appears to be designed as a bedroom with privacy at the end of a hallway. The downstairs "studio apartment' includes a kitchen within it(outlined in green) along with a separate large"family room " in the basement with privacy walls and door. The septic system is designed for three bedrooms, with no additional capacity to spare. The onsite well is 130 feet away from the leaching area (NOTE: Barnstable requires 150 feet minimum). There are two extra rooms on the plan which are designed to provide privacy and are therefore considered as "bedrooms;" the family room and the den. Therefore,please ask the applicant to remove the doors to these two rooms and to open up the walls with a minimum five feet openings. The other option is to upgrade the septic system to accommodate the two additional bedrooms. However, additional leaching cannot be designed closer to the well, which might present a challenge. 1 I Town of Barnstable Health Inspector oFt"e rayti Regulatory Services Office Hours 8:30—9:30 Thomas F.Geiler,Director 3:30—4:30 i , STAB , # Public Health Division y MASS. �A 039 p�0 Thomas McKean,Director r E V D MA 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE. Date: October 31,2013 1. General Information: Size of Property: 1.16 Acre Address: 161 Maple Street West Barnstable MA 02668 Map 132 Parcel 008 F Name: Edith G. Keller Phone#: 508-362-4218 2a. How many bedrooms exist at your property now? - 1yl f t u SG — +� 2b. Are you planning to add any bedrooms? 'c7 If yes,how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all existing rooms in the home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label each room clearly. 3. Is the dwelling connected to public sewer? YES or ONO If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is OUTSIDE a Zone of Contribution to public supply wells? 6. Is the dwelling connected to an ONSITE WELL 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY 24 iq._3;) The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: I( Z TOWN OF BARNSTABLE07 / LOCATION10ajole-_ SEWAGE VILLAGE/,dl?,, ASSESSOR'S MAP.&PARCEL � U INSTALLER'S NAME&PHONE NO. / p V1 ,5 �Se� I've a �o B SEPTIC TANK CAPACITY LEACHING FACILITY.(type) `L. 500 x Z (size) ��J Zs X Z. NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /yFeet FURNISHED BY t ! P• - J �s J r No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppliLation for Misposal 6pstem Const union 3PErmit Application for a Permit to Construct( ) Repair X Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 4` - Owner's Name,Address,and Tel.No. Assessor's �Ma /Parcel dairA j 6 t p -o Installer's Name,Address,and Tel.No. ^1 5J/'D.,-C Designer's Name,Address,and Tel.No. Type of Building: /f Dwelling No.of Bedrooms Lot Size `7 sq.ft. Garbage Grinder( ) Other Type of Building j�' ,� /c No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme Code and to place the ystem in operation until a Certificate of Compliance has been issued by this Board lth. d a Date '-/ 3 Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued No. ✓� v 't @ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Misposal 6pstem Construction Vermit Application',for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No./ CO s Owner's Name,Address,and Tel.No. le Assessor's Map/Parcel _G Q� ! �« Installer's Na�m'e,Address,and Tel.No. 1y1Q sh p_e Designer's Name,Address,and Tel.No. Q Type of Building: t Dwelling No.of Bedrooms Lot Size 15121 .�s sq.ft. Garbage Grinder Other Type of Building � No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) "gpd' Design flow provided gpd Plan Date Number of sheets, Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil �� ^� f�G P1 Nature of Repairs or Alterations(Answer when applicable) ..G el j i s Date last inspected: i ' Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in r accordance with the provisions of Title 5 of the Environment I Code and t to place the ystem in operation until a Certificate of Compliance has been issued by this Board qf.Hgalth. I'Si ed @ Date VY Application Approved by Date 4 Application Disapproved by Date 4 for the following reasons _ a Permit No. Date Issued --------------------------------------------------------------------------------------------------------------------------------------- Th E COMMONWEALTH OF MASSACHUSETTS ~ BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by e S F4 l ,�/(s AW i`r1 d -To at /�„/ /�pf1 1,0 CT has been construe a 'n acco ance j with the provisions of Title�5 and the for Disposal System Construction Permit No dated Installer r( 6 4 S 1� �({r/C�(//�T/i'1(t� Designer a .SG S .�- #bedrooms i� Approved design flow p gpd The issuance of t is ennit shall not be construed as a guarantee that the system wil�ction as de igned� C Date 3r Inspector /,-� A , , v �f. --------------------------------------------------------------- ----------------------- No. >� —J�7 / Fee_��r��/�i✓i"" r U THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal �&pstem Construction 3permit Permission is hereby granted to Construct( ) Repair( ) Upgrade- Abandon( ) System located at 14 S and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. r Provided:Construe on ust be co. pleted within three years of the date of this permit. Date Approved b � PP Y Town of Barnstable EVE Regulatory Services snxNsrns[.e. Thomas F. Geiler, Director Public Health Division Thomas McKean, Director _ 200 Main Street,Hyannis,MA 02601 Office: 503-362-464 4 Fax: 503-790-6304 Installer & Designer Certification Form Date: L413 Sewage Permit#ILV 1 Assessor's Map\Parcel e- 00 Designer: 4,4,� �l Installer: �/1�' Address: Address:M4 &--ts 402,011-0 i On ���,. /G/y �' .I�� v 1� vas issued a permit to install a (date) (installer) /��� V Ci s septic system at� / ''�`1��i �'j based on a design drawn by ,( (address) Q "urt A 1011 dated U 6 (designer) " [ certify that the septic system referenced above was installed substantially according to the design, which may include minor approved charips such as lateral relocation of-th:. 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 anv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF Mgss9c o D&RREN M. ys YE (Installer's Signature) N GISiE SO I TAR�I'� (Designer's Si(znature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COiNIPL1AiNCE WILL NOT BE ISSUED UNTIL BOTH THIS FORNI AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-adoc Aug 23 13 07:39a many 5084770177 Town of Barnstable JReplatory Services Thomas F.Geiler,Director $ '�a Public Health )Division Thomas McKean, Director • - Zf10 Main Street,I�y3nnis,�'I_� 020�1 lnstAller & Designer Certification Farm Dute: �m - Sewage Pcrrait# AssessiWs INIapTarwel_ 13esigncr; kddress: W / Address: � n lei ()1] •,--,,'...1�— , �/�L_.����(f�fl,� `dtZS .a�71C;.:;] �r!'��1i" .l: I!"tita�� i (Late/ �i:1St�I.I`C) s�:atic SvS:crr at ` eased on a des' r. drawn by . . (adcr�ssi that the septic SVSttm _e:er,-nced aoovt wits installed ,ubstamially ac-�ordin{ to which ma_; 'rlcLgud4 -nmor, approved Such as lil%e—al -eiocat:047 r :: I CC'tid t}l;]t the sCNtic 5V5e1'ri fr iGfCr CC'Q above �xaS IP.Stil�C'a kvlt!t T 1:?if?C SreatQr thar. 1,T laltlfal relQCat;orl of tue SAS or rcloca t'011 at'ap-V 'dill coadn: of C;he sept_c System) buz aocordar:ce with State i.ocal R.'.gulations, PI CLIviSi09 Of ce,ti`ied as-L)uii:by d(esitler w :cllow. s7gRREN (Installer's Sid=nalLre, N' ;'1'40 (De5'_gne,'s Si�-,,r-ature) (,AfEN Stamp Here) PLEASE RAT1.RN TO BARNSTABLE PUBLIC HiE.�LTH DIVISION, CERTIFICATE OF CCNIPi.IAVCF, 1Y11,;, JNOT 3l{ tJ, EL) UNTIL BOTH 'THIS FORM AND AS-13LUT CAAD ARE R.ECE.Iti'1<_D RYTHE 13ARti$T, BLU PVISL1£, HFALTH DIyifilt7l. 'CE1,4yK Y011. �:�: Hc�IsivStFt.c:Dcsign:i t�vrl�1C5C;tIn F��rr�3-�6.4t"ecw Town of Ba'Mstable. P# Department of Regulatory Services j7r �"*KA� Public Health division Bate a639. ems$ 200 Main Street Hyannis MA 02601 ,ffil > Date Scheduled I WX Time Fee Pd i . ,foil Suitahility Assess mient fop SZe Disp�s(iJy Witnessed By VeD Performed By: �A/Y�`®i� \ ' "' - � - LOCATION & GENERAL INFORMATION 4 Location Address - Owner's Name ,(t0VV 115/t�G� ST- Address S4KQ-• `x Assessor's Map/P4rcel: 100$ I Engineer's Name NEW CONS1RUt�'CION REPAIR j Telephone* - l Land Use �L W 1 Slopes(55) J�/-�'ry��"�•• Surface Stones (J0 ft Drinking Water Well�_ft Distances from: Open Water Body20 D ft Possible Wet!Area i t)rainage Way >N a ft Propany Line ft Other ft s of test holes&perc tests,locate wetlands in proximity to holes) SKETCH:(street name,dimensiods`of lot,exact location Sty SUM �/,13 1�3 f31 . - , i i i i I Parent material(geologic) 4-014 J I Depth to Bedrock from Pit Face Depth to Groundwakdr. St, ding Water in Hole:' i Weepin B Estimated Seasonal1"igh Groundwater DtTERMINATION FOR SEASONAL HIGH WATER TALE Method Used: I in, Depth to sail mottle :~- Depth gbserved standing in obs.hole: i iin Depth l0 s0ll M0tt19ment Depth to weeping from side of obs.hole: ; Adj.{actor.. ..r.. Adj.Oroundwater Level.,.e. Index Well# Reading Date Index Well levdl Time—. PERCOLATION TEST' ' Date � 714ole# on I Time at 9" - Time at 6" .-..- -- Depth of Perc p� h i Time(9".6'�) - Start Pre-soak Time.@ 01L5_--- la� i End Pre-soak � Rate Min/Inch ssed Site Failed: Additional Testing Needed(Y/N) Site Suitability Assessment Site Pa Observation Hole Data To Be Original:.Public J141th Division Completed on Back-- ***If percolafiitin testis to be conducted within 100' of wetland,you must first notify the prior to beginning. Barnstable C6nservation Division at least one(1)wedk DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel Low DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) A. C, F,v�a, DEEP OBSERVATION HOLE LOG Hole# _ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel }� Cam tr 0 ivy" DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sail Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten to I d)�3 ' Zl- tmw�i _Flood Insurance Rate Map: Above 500 year flood boundary No Yes _-_-_- Within 500 year boundary No Yes- 4. Within 100 year flood boundary No! Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe vigl material exist,in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring p rvious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environnlentail Protection and that the above analysis was performed by me consistent with the requi aining,expertise and experience described in a10 CMR 15.01 . Signature V Date A3 3 Q:ISEPTICIPERCFORM.DOC r Town of Barnstable Health Inspector F114E r Regulatory Services Office Hours oti g or y 8:30—9:30 Q, Thomas F.Geiler,Director 3:30—4:30 STAB Public Health Division 9�p 1639. s`�� Thomas McKean,Director ED MA 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE. Date: September 24,2009 1. General Information: Size of Property: i GI�Qj Address: 161 MAPLE STREET WEST BARNSTABLE MA 02668 Map 132 Parcel 008. Name: EDITH G.KELLER Phone#: 508-362-4218 ' 2a. How many bedrooms exist at your property now? 0 2b. Are you planning to add any bedrooms? If yes,how many? co � 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? .O 2d.Please include a copy of the floor plans for the entire property. Neatly use a straight-edge. Show all xisting r"ms iVAhe home and the proposed amnesty apartment. Provide width measurements of any open doorways. Please label eaeVroom clearly. 3. Is the dwelling connected to public sewer? YES or (NOD If the dwelling is connected to public sewer,skip questions#4 through#9 below. 4. Location of dwelling is INSIDE or. OUTSIDE a Saltwater Estuary Protection Zone? 5 . Location of dwelling is INSIDE or OUTSIDE a Zone of Contribution to public supply wells? is th`S 6. Is the dwelling connected to an CED or to PUBLIC WATER? ?►v qe v-fi� el\� A0 7. Is a disposal works construction permit on file? YES or NO 8. If yes,how many bedrooms were approved according to this permit? Bedrooms. U 9. Were any building permits obtained for construction of additional bedrooms? YES or NO 10. Is there an engineered septic system plan on file at the Health Division? YES or NO 11. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO ------------------------------------------------------------------------------------------------------------------- tea�a FOR OFFICE USE ONLY / The Public Health Division has no objection to bedrooms at this property. Special Conditions: Signed: Date: Q:\GMD-Housing\Accessory Affordable Apartment Program\ADMIN\FORMS&LETTERS\Blank Forms amnestyappl.DOC —Fo ",)C L a;' ian /'2y rywJ— 1-2 -o FDiT� )<�t-�E.R TZ�S10E.ni F c � S ' 4 r� tl L m v o i_ -i o �V /• i C'-C1 r w O I , a I � mco� Y1U�lSe. B aI � h I I WAL-IL—D r�T Ba��EM��.aT Fi—A(`.I ILcI �ghp:F_ST. Ire.t'AKt�I�Yr�'E'LE� 1 9✓) E�LTMC' V I 1I: o �LpgiT U � vQ v . rc y 6c, 5 e yv%-e VII, l e v e e ,�.h` y �., 4 � �+�s �} k.- Cx� � � .� `�_ r� �` ., �, - ;�,, � G � d ' 2 ;,}. .. Shy s;.� �.Y TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE I1:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner Z�5Z- '� Ae Tenant e=s Address / �1� � Address jel—'l 41 '� ! Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply /I 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 ` 17. Temporary Housing PART 11 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed Inspect A o- If Public Building such as Store or Hotel/Motel specify here Hoses&WARREN,INC. TOWN OF BARNSTABLE BOARD OF HEALTHe� ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner Tenant Address - Address . /'�/ Z' 5 Complionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities J 4. Water Supply 5. Hot Water Facilities -4 c r d4 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 �Y 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal 17. Temporary Housing PART II - � Ppr/ 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition 1- Person(s) Interviewed Inspec t✓` r 2agZsuch If Public Buil as Store or Hotel/Motel specify here HOBBS$WARREN,INC. PERMIT NO TOWN OF BARNSTABLE 446 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: ROBERT AND EDITH KELLER D/B/A: COZY NEST Whose place of business is: 161 MAPLE STREET, P.O. BOX 736 , W. BARNSTABLE, MA 02668 Type of business and any restrictions: CONTINENTAL BREAKFAST ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE RESTRICTIONS IF ANY: SEATING: ANNUAL: SEASONAL: YESTEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Susan G. Rask, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT: RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: $30.00 Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: December31, 2000 � FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: Director of Public Health CATERER: �R � — TOWN OF BARNSTABLE BOARD OF HEALTH 7— S ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION C/ Date Owner Ga Tenant Address Address Compliance Remarks or Regulation$ Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply '' 5. Hot Water Facilities Z 6. Heating Facilities ✓ ©� f 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities ✓ t S 10. Curtailment of Service 11. Space and Use +� 12. Exits 13. Installation and Maintenance of Structural �r f Elements 14. Insects and Rodents r � i 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal S 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed Inspector If Public Building suc as Store or Hotel/Motel specify here Hooes&WARREN.INC. FORM30 Hiw HOBBS&WARREN THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN qt DEPARTMENT ADDRESS +� ,j p� �j(9 �" Y6 qy 1.y SVOy`0 (� `{ 11 TELEPHONE 00 Address r�/ ��� S'f� �4 �✓��'JOccupant Floor Apartment No. No. of Occupants G 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 4001 40 Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: a4A U_a," 1 GvAkuj Roof Gutters, Drains: Walls: Foundation: Chimney BASEMENT Gen.Sanitation: Dam ness: .✓ -10 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: e t I Stacks, Flues,Vents: PLUMBING: Supply Line: GiexG (y ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 0 L nY�4110 V9 220 Fusing,Grnd.: VVAMP: 0 p � 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 l/ ✓ Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.T en.,Gas Oi, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove ✓� Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: VQ.✓ Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other:.f/0 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 PENALTIES OF PERJJUU Y.' INSPECTOR/� TITLE ( ��t DATE TIME / f /S� P.M. A.M. THE NEXT SCHEDULED REINSPECTION P.M. � , , A •{dC'*s"��.i�• '� "�`�•:S- ,p„px ;*#:4: �..�.�: ��`t�C;,r�''�w+.. r . ��, ,� a °e"'(. ''�.15 tFA ..9�A�� .���`�y`'�i,j 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 @@ 196 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. FoRM30 �I W HOBBS&WARREN'm THE COMMONWEALTH OF MASSACHUSETTS . . BOARD OF HEALTH _ CITY/TOWN DEPARTMENT S-2 y 6 ? -' a�w• S cl�, /`f'i u-a ` ` ' ADDRESS GqM Sv 9 y`0� 96 Z.. y6 y y // TELEPHONE ;Poo k, A0 •, dress/61 44V� SJ � t(/,J&,(0 y Occupant— Floor Apartment No. No. of Occupants '1 No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner awti-ti uA Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish kcr, 40 F(,,,,4 ,S-f Containers vF.s lf, LoW Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: 1CV`Ou/ t Ah Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: /4/O Stairs: Li htin : STRUCTURE INT. Hall,Stairway: i Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: ($ rIf Stacks, Flues,Vents: PLUMBING: Su I Line: (Jt// Wa ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: d k "1110 �K 220 Fusing,Grnd.: AMP: p O +S O Gen.Cond. Distrib. Box: Gen. Basement Wiring: to-- 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.,Ga Q7Elect.: j(y0©F //C2 -170"/r /*0, I �t Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink �✓'" Stove ✓` Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: vP., y Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other:.(/d 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 OveF-) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PER L Y.' +� 9 INSPECTO Q TITLE DATE 6 f 3�( l TIME ' P.M. 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 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. (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. r protective railing for every stairway, porch balcony, r f r similar l 4 Failure to maintain a safe handrail o p otect e a g o e y y, p o0 o s apace 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. NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS 5 TQ N of RARNSTABT,E Board of Health of PERMIT TO OPERATE A FOOD ESTABLISHMENT Permit No. T :PTrALr?' i 19 In accordance with Regulations promulgated under authority of Chapter 94,Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: AIM EDITH KET-,'j i11t i;! i� F, 2:i' Whose place of business is P.O. B£JK� STABLE Type of business and any restrictions To operate a food establishment in TQTTN OR RA-RNRTAP..T.R (City or Town) Permit Expires -D V C F'i RRR 31, 19 91) Copy Board This Copy To Be Retained By Local of Board of Health Health FORM 738 Rev.7986 AGENT 1 ,.....,�.:•�e,.; ;. .:M.. _._ .. �.�: ...:...,�.._r`—..+,r:..�vr ......s�,..:.a �..--v.+...,...q.`�»mow «_ i...c. r ....,+.. - i-soa .....• .,-.. 9..a.... ..- _ ...-. ^J e j TOWN OF BARNSTABLE BOARD OF HEALTH I ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date Cbv�er � Tenant Address Cn41 ST, Address �I Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities ` 4. Water Supply 5. Hot Water Facilities - 6. Heating Facilities 7. Lighting and Electrical Facilities ✓f 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 .a 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal. 16. Sewage Disposal {, 17. Temporary Housing PART II � C 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition i Person(s)Interviewed Inspector ND If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN.INC. / I FEES RETAIL FOOD STORE: FOOD SERVICE ESTABUSHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST $36.00 SEATING: MOBILE FOOD UNIT: ANNUAL: TOBACCO SALES: SEASONAL: YES CATERER: TEMPORARY: FROZEN DESSERT: .. MILK: TOWNClI*BARNSTABLE--,, y 4 BOARD-OF.HEALTH -�, PERMIT_TO OPERATE A FOOD ESTABLISHMENT PERMIT NO: 446 MARCH 1, 1998 o 5p A. In accordanddiWith regulations promulgated1 under authority of.Chapter 94, Section 395A andfChapter 11't, Section o the General Laws,'a permit is hereby granted to: ROBERT AND EDITH KELLER D/B/A: COZY NEST Whose place of business lS 16.1�,MAPLE S1rR15ii BOX 736 � 3BARNSTABLE, MA 02668 Type of business and any`restractlons: CONTINENTAL BREAKFw k9TABLISHME ---tt to J �3 To operate a food establishment nth TOWN OrBARNSTABL15 Permit expires: December 3t-s1998 `' v Mi. � Y � ��``�°•�,� ��, BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumner Kaufman, M.S.P. . Thomas A. McKean, RS,CHO Director of Public Health 0 tf- TOWN OF BARNSTABLE l� BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date V- 1 Owner V AkcTenant Address 94 d e Com lionce Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply IV/ 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 V. , 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 0 15. Garbage and Rubbish Storage and Disposal ./I-0 9,'�A, 16. Sewage Disposal 17. Temporary Housing PART III 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here HOBBS IN WARREN,INC. FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE RESIDENTIAL KITCHEN FOR BED+BREAKFAST $30.00 SEATING: MOBILE FOOD UNIT: ANNUAL: TOBACCO SALES: SEASONAL: YES CATERER: TEMPORARY: FROZEN DESSERT: MILK: _,,TOWN OF BARNSTABLE. 3I '3: BOgRD'>OF3HEALTH, � . PERMIT TOOPERATEA FOOD ESTABLISHMENT PERMIT NO: 446 �. . In accordance withiregulations promulgated under authority of Chapter 94, Section 395 ► and Chapter 111;Section 5of thp General Laws, a;permit is hereby gra,+ ed to"''y ROBERT AND EDITH KELLER D/B/A: COZY NEST Whose place of business is '161 MAPLE STREET, P.O BOX 736x; W BARNSTABLE, MA 02668 Type of business and any restrictions: CONTINENTAL BREAKFAST ESTABLISHME :s To operate a food establishment in the TOWICOF BARNSTABLE Permit expires: December,31y 1999 . Ai iii3 BOARD OF HEALTH Susan G. Rask, R.S., Chairperson ,r Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumne Kaufman, M.S.P Thomas A. McKean, RS, CHO Director of Public Health FEES' RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING' RESIDENTIAL KITCHEN FOR BED+BREAKFAST $30.00 MOBILE FOOD UNIT: ANNUAL: $ TOBACCO SALES: SEASONAL: :S CATERER: , TEMPORARY: FROZEN DESSERT: ot MILK: i TOWN"O��.BARN',TABLE _1-0yBQA, HEA ; , PERMIT'TO O. E AT O€I T, ..B .IS IMENT PERMIT NO: 446 �, , JANUARY 1,1997 In accordance wi illations promulgated under al 10 -Zha ter 94, �9 P 9 ' Y P Section 395 n` pter 111, 5 . the General` aws, a permit is �� hereby ra t d-to: - ROBERT AND EDITH KE LE ° } e D/B/A :COZY NEST + q r 3 45 place of busines il 161 MAPLE ' . 36 , AR SrTABLE MA 02668 2. Type of business-and any jam,, s: C77 FAS ISHME �1 "�� � '°� ^•1..'.' - >rr r a: s.'is -�,�.. .Y. i�' ;aa, a~ aN. ,'.jr'i»,cr. 4�,. 3a .S n , � ,.". < .. :�... -n u �.: M.-. :} la✓ J�'` .} ...� .. i:. d`,. " .3-�' .;r. , � >s!..�� t, t�'•2 ap..x �rx3�.� .... -: w r�-.. s f-;`..r erate a:food•establish n :in TOW O TABL _ = r Iy �` P . a �7 yy� nlvr• .� '� ,d.:ur^+ e _ r.:,i%.r,?• ^"n., " :.:.:: , .�r=+ta 'v.1r.'ass,- i S•q`�ti:. 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F 'a�.. fit.. .�:r ,.. r.,`5:�.:.'t.', x • M'124>..Y`". ':{pk „�,s _'v 3-.,a k �'S.,t. £.l�.f{•,->:t{.J rC- -n".:�'1+•.a .,�:.ru,-.�'-?�._ .%fiJS~r��!-iX�•-r�"...:e<'!-..._.�''��.-�.s �5�.. - *,k>. .v.¢,........,�`.,«�:-�-:}-a..tr:t�'�_:'��r..g.r,.5•,".:+ti�r-:... .,....�v.:sS.'4_' _- TOWN OF BARNSTABLE o 1 l BOARD OF HEALTH . � I ARTICLE 11:MINIMUM STANDARDS FOR HUMAN HABITATION Date Owner Tenant Address ® A i Address Compliance Remarks or Regulation# Yes f No Recommendations 2. Kitchen Facilities 3. Bathroom Facilities / 4. Water Supply 5. Hot Water Facilities �� I 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 01 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents D 15. Garbage and Rubbish Storage and Disposal I Nv�� 16. Sewage Disposal MACOJIL`9&�' 17. Temporary Housing PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition 0 a Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here Hoees&WARREN.INC. .0 TOWN OF BARNSTABLE 13ANSTAELE, 0: 0 ynY aBUILDING . INSPECTOR APPLICATION FOR PERMIT TO ..........1. ........................................................................................ TYPE OF CONSTRUCTION ........... ......1913 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following informations Location d b ............ ............ . ..................... .............................. . ............. .............................. ProposedUse ....... ........................................................................... Zoning District .............. District ...... ............ .............. ... :.....................................Fire Distri .... ...... .. .. .... .. ..... .. .... C K-x,a 1',. ..... P' "-r.............. Name of Owner .............. .. ..........Address ..........4L. ai►t S . . . Name of Builder ..................................................Address.. ........ ...7 Nameof Architect ............... .. Address .................................................................................... Number of Rooms ................... .............................................Foundation .... cczf C 4-e .. ............................................. k/ Exierior ....................................................................................Roofing ........ .....a........:............................................. w 41 Floors ..... Interior ...... ....... 7..................................................................... Heating ............:,!!f...A� L. .................... ...............Plumbing ........... .............................................. Fireplace ................./........................................................;.....Approximate Cost ....r-�T el.. ................................................. Definitive Plan Approved by Planning Board ----------------------------- Diagram of Lot and Building with Dimensions C SUBJECT TO APPROVAL OF-BOARD .OF HEALTH -PC- 0­W PTIC S-(STENI MUST BE SE MP1_1f\,,AGF- I N CO MSTPj_j_ED TICI-F 11 STPTE AV/ s soll-mV CODE EGULAT'OlqS' 73 -13 lie S A 6 14- I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ""I j_L_1 Name ................... "�j......................................... � � No .-160-28... Perm for #z� ..stcry——— .— — �-'.... single zazollyc#oelling ---------'----'---------'--'— cj Uo� �t��et Loco�on [�-'..������-.---.--------.— ' �West Barnstable ---------------------------- J—° I�.—Jabbzoa�a Owner ---- .-- ----- ------- � Type of Construction ........ ....................... / ' ............................ � � Plot ............................ Lot ................................ ! � ' ' � , D�cr�b 7� ' Permit' Granted— ---r- ' n�w� Date of "'"pe""`^' «��� Dote Completed � - ` -PERMIT REFUSED ._—_—.._-.^..------------.. 19 � -------.--.---------------.— ` 2110^____.____`____..�-------------.. � ��' �� ' -- -^-----'--------------''----'' ` -------'--'---'------------'- Appruvo6 ---------------' lA � ' ------------------------~—. ---------------------.---..' | | | Fimic THE COMMONWEALTH OF MASSACHUSETTS BOARD O H EA -- --- ---.....OF........ .. . -------------- ............ ------.,-- Appliration for Ubposal 10or '� nnfitrnrtivn rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: - ��%-----•- --���--^---..�...... ocation ddress or Lot o. O er �..� ddress Inst le "Address Type of Building Size Lot____ ---------Sq. feet Dwelling-PNo. of Bedrooms------------------------------------- -------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other F.xtu'res d W Design Flow.. . .. _...... .._.gallons per person per day. Total daily flow---------------------------------------------gallons. WSeptic Tank—Liquid capacity/ v(_'gallons Length................ Width---------------- Diameter---------------- Depth_-__--_-__-__--- x Disposal Trench—No.:................... Width.................... Total Length-------------------- Total leaching area ._ .__ sq. ft. Seepage Pit No......fe......... Diameter____________________ Depth below inlet.................... Total leaching area_3�4_?--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_.-___--_-_-----_-_----- f� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--_--_---_-.----_-.-._.. a ----------•-----------------------•-------•----------------•-•-------•---•-----•-••--•-••----•-•-•-•......................................................... 0 Description of Soil........................................................................................................................................................................ W UNature 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 XI 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 board of bealtih Signed........ .AM.G!�- 1 Za Application Approved By.... / ...... . a"17-3------ Application Disapproved for the following reasons-------------------------- ----- - ---- -------------------••----•--•-•-----------------------------......--- -------•-•-•-•••--•----------------------•-•-------------••--•--•---•------•---••---......----•----•----------•--•••---•--•----------------=---••------ ------ -------------------------------- Da e Permit No. l _ Issued. / ----- �� ........ D e a Noh....... : ........ FEE.... ,. ... . THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEA : .......... Ap ration for Dhipotittl Works onstrurtton Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at •------ --- - -•--- -- •. -• ---- --- '---� _ l . ocation ddress or Lot o- y Owner Address Inst Address d Type of Building Size Lot__.j4._ . .........Sq. feet Dwelling No. of Bedrooms------------ __..............Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria 0.1 Other fixtures __ ------------ ----------------------------------- ------ Design ______________gallons per person per day. Total daily flow.........................:...............---gallons. Desi Flow___,__________________ WSeptic Tank-4 iquid capacit ._ allons Length................ Width................ Diameter................ Depth---------------- x Disposal Trench—No...................... Width.................... Total Length--------------_--- Total leaching area sq. ft. Seepage Pit No.___._�:_________ Diameter____________________ Depth below inlet.................... Total leaching area " sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date.................................... Test Pit No. 1................minutes per inch Depth of Test Pit...............:---- Depth to ground water__-___:_______________-. �L4 Test Pit No. 2................minutes per inch Depth of Test Pit---_................ Depth to ground water------------------------ --------------------------------------•------------------------------------------------•--•-•-------......................................................... 0 Description of Soil......................................................................................................................................................................... x 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:XI 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 board of health. Signed - ------------------ Date Application,Approved BY =ga t------- -- - � }' fiac ------= 7------------------------------------------------------------------------------- APPlication Disapproved for the following reasons:.--=-------<-------- .............................................................--•--••••••------------------•---•-----•-----•---•------•-•••--•--•••-•---•-•-------•---f-•-------------------........................ Date j_�`-Permit No..... -- --------------•-------=---.........---• .: Issued---1 ( --- ...... Dat THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ¢. �n ................OF...... A ',�P' /�% ''' d•• L • •tc0...-..--..------..--..-...... Wntifiratr of 'nntplianre TH IS TO CEP -IFY, That t1fe ndividual Sewage Disposal System constructed (L or Repaired ( ) •--------------_------------------ to ns alter I t / at a{ r - , ----- r r� &r"c ✓ a�"�T�rc� a---< _-- � �°? "' has been installed in accordance with the provisions of Article XI of' The State Sanitary Code as described in the Application for Disposal Works Construction Permit No..........4f.3...._-------------- dated._- __ _z_ _ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUAR ;WEE THAT THE SYSTEM WI FU CTION ATI•SFACTORY. �„ ? r DATE------- ! "S . . (� Inspector- s •------------------------••-•----=-------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH / .✓ ................OF...... .......................... No: -- ••• FEE,. �•:---•. • � �i��.���� ork,� � n,�t�ttr � n prntit � � � Yg � _'� Permission is he' ranted---- - to Constru ct (4011 or Repair ( )_„an Individual Sewage is oral System, Street as shown on the appli�tion for Disposal Works Construction Pe it No. _______________ Dated_,��/� - . �S .Y6 ` ----------------- ----- Board of Healtk ° '' -�'� _� DATE-- ------- -----�-----•------------------------- FORM 1255�HOBBS'& WARREN, INC.. PUBLISHERS U y� _ " + x y -NInI Aa-wez^3 1 l , 10 `I =— „ L f f �• ��`o` j �_ C2 v I u ; GC � � � '�� KF k. S I' E LV): 7 X- i 061, 0-1 ` VIA � � 0 X.. ~ �'•.- - +� _ - iP S - f i y 1 WEST BARNSTABLE LEGEND PROPOSED CONTOUR 4,7 ® PROPOSED SPOT GRADE ; PARCEL ID: 1�0���� -- 98 -- EXISTING CONTOUR 1 132/037 + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE N O 8'1011, R o� 3,3• N LOCUS op TEST PIT £r CIV r,\ �, �� LEACHING c co \ \ 6' SHOWN ON ABUTTING SITE PLAN v'�O S �� MI POND \ 26 6,5 96 o PARCEL ID: � � \ - ;--- - - 2 � LOCUS MAP 132/048 PI S . '� % --- ic�, ; EXIST. 1`000 O T -` ��,�s__----- LOCUS INFORMATION SEPT. TANK --- ►� i i / I - cur 28 PLAN REF: 256/39 c 2g TITLE REF: 15916/041 •\, PARCEL ID: MAP 132 PAR. 008 h`-- -- ZONING: "RF" ' --- -i------ 30 (o W FLOOD ZONE: "C" '�(J COMMUNITY PANEL: 250001-0011-D DATED:07/02/92 ` TBM: DOOR•SILL' to __Un�s 3i EL=29.00 SLAB ® EL. 9.0 ---------- SEPTIC SYSTEM #16 ---`'�:2 REPAIR PLAN SHED LOCATED AT: 161 MAPLE STREET FRO to WEST BARNSTABLE, MA. ____________ PREPARED FOR BR w`r PARCEL ID: EDITH G. KELLER 132/008 t, N AUGUST 13, 2013 REV: AUGUST 15, 2013 - 3BR N AREA=50,435t S.F. ' GA AGE �O� SCALE 1"=30' .� ; ' j / to L OF��� Mqs�, -j� ti 0 E M. h, 44 qY (/� y WELL , - O. 1140 DESIGN CRITERIA ,,,,�•, � , '�, ' `� �/ �CjTA�p� �'l'/13 NUMBER OF BEDROOMS: 3 BEDROOM EXIST Q SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) l� DESIGN PERCOLATION RATE: <2 MIN/IN S52 45'10,, �• ONLY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. GARBAGE GRINDER: NO (not designed for garbage grinder) OR _ SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXIST. 1,000 GAL. SEPTIC TANK \\ MEYER & SONS, INC. (330) = 44594 S.F.. �� V�� 25,3•09 , LEACHING AREA REQUIRED: 1 ' P.O. B 0 X 981 -74 F�� PARCEL ID: r ; ,� USE TWO (2) 500 GALLON H2O PRECAST LEACH CHAMBERS W/ 4' ., ���r'S EAST SANDWICH MA. 02537 132028 STONE ON ENDS & SIDES: 25' L x 13' W x 2'D / ' ' BOTTOM AREA: 25' x 13'= 325 SF O SIDE AREA: (25 + 13) X 2 X 2 = 152 SF �F ' (S 0 8)3 6 2—2 9 2 2 TOTAL SQUARE FEET PROVIDED = 477 vs. 445.94 REWD DESIGN FLOW PROVIDED: 0.74(477 S.F.) = 352.98 G.P.D. vs. 330 G.P.D. req'd SHEET 1 OF 2 J 1570 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: PLACE RISERS OVER ALL COVERS W/IN 6" OF GRADE FINISHED GRADE (28.0) F.G.EL: 30.0 F.G.EL: 29.0 F.G. EL: 29.0 VENT a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" TOP TANK=EL. 27.78 STONE OR FILTER FABRIC DOUBLE WASHED STONE 6,. « 4" SCH 40 PVC 4 10"1 6 (MIOF. ®®®®®®®®®®® A. 14 IINV.25.80 1 �®®®E3E3El ® :e 4'E'SCHR40 PVC BE INV.26.0 2 DEPTH ®®®®®®®®®®® I NV.26.45 4' 2 X 8.5' "41 GAS PROPOSED DB-3 EXISTING OUTLET BAFFLE EFFECTIVE LENGTH = 25' •. . .. . DISTRIBUTION BOX INV. 26.70 (H20 LOAD) INV. ELEV.= 22.0 EXIST. 1 ,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ����' �F �Assq�ti BREAKOUT OUTLET TEE AS MANUFACTURED BY z D RREN M. TOP CONC. ELEV.= 23.0 ELEV.= 23.00 TU F-TITE, ZAB EL, OR EQUAL Y , / NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING INV. ELEV.= 22.0 •®®~ PIPE INVERTS PRIOR TO CONSTRUCTION ®®® 2) D-BOX SHALL BE SET LEVEL AND TRUE TO qf�/$T ®®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX S�IVITAR�a� BOTTOM EL.= 20.0 ®®®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' 5 FT. 4' 310 CMR 15.221(2) 3) REPLACE EXISTING 1,000 GALLON SEPTIC r 13 SEPARATION 5.00 FT. EFFECTIVE WIDTH = 13.0' TANK WITH 1500 GALLON SEPTIC TANK SEPTIC SYSTEM PROFILE O F I L E IF FAILED, DAMAGED, OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION) 4) INSTALL INLET & OUTLET TEES W/ ZABEL BOTTOM OF TESTHOLE EL: 15.0 _ FILTER AND GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: DATE: AUGUST 8, 2013 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOGS P#: 14096 SOIL EVALUATOR: DARREN MEYER, CSE 1614 BOARD of HEALTH AND THE DESIGN ENGINEER. WITNESS: DONNA MIORANDI, BARNSTABLE HEALTH 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE TP-1 Depth Elev. LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: Elev. TP-2 Depth Elev. TP-3 Depth Elev. TP-4 Depth - 310 CMR 15.405 (1) (8): 27.00 0" 28.00 0" 27.80 0" 28.30 0" 25 1) A 2.00 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING 24.00 FILL 36" FILL 36" 24.30 FILL 30" 25.63 FILL 32" TO BE 5.00 FT (MAX) BELOW GRADE VS REQ'D 3 FT. A LOAMY SAND .00 A LOAMY SAND A LOAMY SAND A LOAMY SAND (H20/VENT PROVIDED) 23.42 10YR 3/2 10YR 3/2 10YR 3/2 10YR 3/2 B 43" 24.42 B 43" 24.05 45" 24.63 44" 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND B B TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 22.00 10YR 6/8 60" 10YR 6/8 LOAMY SAND LOAMY SAND DESIGN ENGINEER. C FINE 23.00 C FINE 60" 22.45 C FINE 63" 23.13 C FINE/ 62" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING PERC ® EL. 20.67 SAND SAND SAND SAND FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 2.5Y 6/4 ENGINEER BEFORE CONSTRUCTION CONTINUES. 2.5Y 6/4 2.5Y 6/4 2.5Y 6/4 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 18.00 108" 19.00 108" 18.97 106" 19.14 110" 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF MED-COARSE MED-COARSE MED-COARSE MED-COARSE THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. SAND SAND SAND SAND 7. WATER SUPPLY PROVIDED BY PRIVATE DRINKING WATER WELL. 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 2.5Y 7/4 '0 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 15.00 144" 16.00 144" 15.80 144" 16.30 144" TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. y 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 10- THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING PERC RATE <2 MIN/IN. ("Cl" HORIZON) PROPOSED SEPTIC SYSTEM UPGRADE PLAN CONSTRUCTION. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. NO GROUNDWATER OBSERVED 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 161 MAPLE STREET, WEST BARNSTABLE, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY Prepared for: Keller AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO ABUTTING PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Engineering by: Surveying by: SCALE DRAWN DATE 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 AfEYER-&SONS,INC. J180BOugaB Survey N.T.S. DMM 08/13/13 to conduct soil evaluations and that the above analysis has been performed me consistent with the ISO BOX 981 15. ALL PIPING TO BE 4" SCH 40 ® 1/8"/Fi (UNLESS SPECIFIED) Y ' by requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam In October. 1999. EAST SANDWICH,MA 02537 (508) 419-1086 DATE CHECKED SHEET NO. 16. KEEP PIPING LEVEL FOR 2 FT IN AND OUT OF ALL COMPONENTS. 508382-2922 08/15/13 DMM 2 Of 2