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2135 MEETINGHOUSE WAY/RTE 149 - Health (2)
t k lL 2135 Meetinghouse Way West Barnstable , A= 130-012 Of f ' Massachusetts Department of Environmental Protection LiBureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well —� Street Number: Street Name: 2135 MEETINGHOUSE WAY Please specify well type:_ Building Lot#: Assessor's Map#: Z Irrigation Assessor's Lot#: ZIP Code: Number Of Wells: 02668 Cityrrown: Well Location BARNSTABLE In public,right-of-way: GPS f"Yes f-No North: West: 41.70054 70.38209 Subdivision/Property/Description: Mailing Address: r click here if same as well location addres Property Owner: Street Number: Street Name: MEETINGHOUSE FARM 2135 MEETINGHOUSE WAY City/Town: State: Engineering Finn: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: t.Yes (".Not Required Permit Number: Date Issued: W2021012 03/11/2021 —� Massachusetts Department of Environmental Protection -� Bureau of Resource Protection-Well Driller Program Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock quge� r Choose Bedrock- WELL LOG OVERBURDEN LITHOLOGY [From(ft) TOM) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid 20 Silty Sand Brown Fast('Slow •--•--• YES NO � .._.� Loss Addition 20 30 Silty Sand Fast(`Slow �� YES NO Loss Addition ...._.. - .... ...... ........ ... 30 45 Fine To Coarse S;± Brown f,Fast( Slow Mu [YES�NCOJ �� Loss Addition WELL LOG BEDROCK LITHOLOGY Drop in Extra fast or Loss or Visible Rust Extra From(ft) To(ft) Code Comment Large addition of drill stem slow drill rate fluid Staining Chips p (Choose Code Yes Yesi (- - LL:� t ......... _.._- =YESNO � r[last Slow L--A- ADDITIONALs ddition__—] WELL INFORMATION Developed :Yes C No Disinfected r Yes t:Noo Total Well Depth 45 Depth to Bedrock 111 Surface Seal Type ((None racture Enhancement C-Yes t:No CASING jr-.Is Casing above ground — ..................... .......... ....... —..._.- From To Type Thickness Diameter Driveshoe �� ((Schedule 40 olyvin I � � r Yesl 41 LPyl Chloride l_. ................................................ SCREEN r No Screen Fn,= To Type Slot Size Diameter Stainless Steel Well Point 0 012 j4 --` WATER-BEARING ZONES I-!DRY WELL From To Yield(gpm) PERMANENT PUMP(IF AVAILABLE) _ Choose Pump � Choose Pump Description Horsepower Description- Horsepower--- Pump Intake Depth(ft) Nominal Pump Capacity(gpm) f WNW Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material 2 Weight Water Batches Method Of (gal) (count) Placement C= Choose Material Choose Material —Choose One— WELL TEST DATA Date Method Yield(9p m) Time Pumped Pumping Level(ft Time To Recover Recovery(ft (HH:MM) BGS) (HH:MM) BGS) — ... .............. .. ... — O5/19/2021 Constant Rate Pump [15 � 3 11.5 0 01 10 WATER LEVEL Date Measured Static Depth BGS(ft) Flowing Rate(gpm) 05/19/202J10 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. DESMOND THOMAS E Monitoring IN Supervising Driller Signature III, DrillerDESMOND III Registration# 764 THOMAS,E DESMOND WELL Firm DRILLING INC. Rig Permit# 0089 Date Job Complete 05/19/2021 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. h ENVIR 0 TECH LA BORA TORIES,INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02.563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond Well Drilling Location : Meeting House Farm Address: PO Box 2783 2135 Meetinghouse Way Orleans, MA W.Barnstable,MA 02653 Lab Number: DW-211709 Collected By: DWD Date Received: 04/29/21 Sample Type: Well Well Specs: Irrigation 45710' Locations Source. - 'Date Collected Time Collected Comments S4 A4128121, Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By pH pH units 6.5-8.5 5.95 SM 4500-H-B 04/29/2021 SD _ ..... _..... .:_w _._._ Specific Conductance° umhos/cm 500 865 EPA 120.1 05/06/2021 SD Nitrite-N mg/L 1.00 <0.006 EPA 300.0 04130/2021 SD - _.. ---— --- —_ _., .. . _m.... ------- Nitrate-N mg/L 10.0 3.80 EPA 300.0 04/30/2021 SD Sodium mg/L 20.0 170 EPA 260.1 061011 021 KB Total Iron mg/L 0.3 0 03 EPA 200.7 04/30/2021 KB Manganese ...._. mg/L 0.05 0.082 EPA 200.7 04/30/2021 KS . Total Coliforrn(Presence/Absence) Present/Absent Absent Absent SM9223B 04/29/2021 RL @ 16:00 Comments: Low pH indicates high corrosive characteristics. Drinking water may naturally have manganese and,when concentrations are greater than 0,050 mg/L,the water may be discolored and taste bad.Manganese is not a health hazard at levels 0.05-0.300 mg/L. Sodium indicates possible salt water intrusion or road salt run off. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. ► Date 5/6/2021 Ronald J.Saari Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 ❑Certification is not available for this analyze for potable water samples.. No. V v mt — w L Fee BOARD OF HEALTH TOWN OF BARNSTABLE ZippYication for Vern Cott!6tructton Permit Application'is hereby made for a permit to Constct Alter( ), or Repair( ) an individual well at: 2 i 35 M �-fi i► j l/7 ll& wcw hAS)/ 0 tz. L ation-Address Assessors Map and Parcel 'Town of ,6arlis7it-%i 5&7 MW-P? � M/Iq-n 4.� 114-A 02(�01 QS rnovlvl OwneT/l�l r l ' 1 he, 7$3 Y�I�Sr16 . (3z[v q3 Installer-Driller T Address Type of Building Dwelling X Other-Type of Building No. of Persons Type of Well �JLG� 4vL - ,, Capacityty Purpose of Well 1 Y Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Compliance has been issued by the Board of Health. Signed Date Application Approved By ate Application Disapproved for the following reasons: Date i A ,-� �7 Permit No. �+v I/V y�—D' L Issued 1 2 1 Date -------------------------------------------------------------------------------------------------------. BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed W, Altered( ), or Repaired( ) byS'►�'1 t)vV.d y��e i I ► I l I vt.0 ,,1 vac.. Installer at ( �'V1 P,P✓�'I I�lfJi �� , �Ct0if�l7S�ZZ,b/.�a has been installed in accordance ith the provisions of the Town of Barnstable Board of Health Private Welj Pr tection Regulation as described in the application for Well Construction Permit No. W2AA—b 1 Z Dated 311112,1 THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector i No. Vyul` Fee BOARD OF HEALTH TOWN OF BARNSTABLE TippYication jf or Well Construction 3permit Application is hereby made for a permit to Construct/( Alter(y), or Repair O an individual well at: . hll I 1 �._ 1A/' . �;I Y l��1TE a�G I Z Location-Address s Assessors Map and Parcel e q Town DF 36,7 fW(a10 HJ,0YIP18.1 ,114A ©.z'?;-'ot Owner r CAddress QQ-cxrnOnd W61 ( (Ors1 kl 6OnX 2.793 ()r LOn hAA 62653 Installer-Driller r Address t Type of Building Dwelling X Other-Type of Building No. of Persons _ T'ypeofWelr— (�7(,kea . 4l� f)?1/�. .Capacity �t Purpose of Well I I' Y I Gf r) [I&Yj Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation-The undersigned further agrees not to place the well in operation until a Certificate of Comp liiaynce-has been issued by the Board of Health. Signed U! 3 Date Application Approved By 3 f I Z °Date Application Disapproved for the following reasons: t Date Permit No. Vy ' L Issued i Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(�), Altered( ), or Repaired(-) by 90S^N10 to ci \N-e 1 I y I I l i'Y)(A 11n(.. - Installer at 'I V)CA h n U CP:.. /q ri7s has been installed in accordance.`with the provisions of the Town of Barnstable Board of Health Private Well•Protection Regulation as described in the application for Well Construction Permit No. 1, , ,,, n{7 Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Yell Couttructton permit No. U 2-- Fee Permission is hereby granted to- h A IN N- A ( nr'l { I a V\CA I h C. � a. Installer to Construct O, Alter( ), or Repair O an individual well at: %. No. 2 1-5rn , '!'t Y1` ( J Street ` as shown on the application for a Well Construction Permit No. :Dated Date rove A } rr d B Y 6 � } Town of B -1 arnstable �# ' $ Department of Regulatory Services i a•ttuxrAa_,r,�„r Public Health Division Date IrABS t6;9 . 200 Main Street,Hyannis MA 02601 • �'"rFn t� r Date Scheduled A; / Time , Fee Pd. Soil Suitability Assessment for Sewage Disposal Performed Sr. Witnessed By: LOCATION&GENERAL INFORMATION Location Address a 13 J A�wki* '- W o!n• Owner's Name f �, rmi J 1 q Address 3�e+±`�.�M" 6�l 6'� 5't�"e-�Y . Assessor's Map/ParceL• 1-6 0 101-L Engineer's Nanti I�nd t(.61_r , NEW CONSTRUCTION REPAIR Te! hone# f SZ6 J eP '��O 812Z 6lo'`0p Land Use SIopes(4'0) Surface Stones Distances from Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other_ ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pere tests,locate wetlands i`n proximity to holes) 0 LV 00 r n Ii Parent material(geologic) �I Depth to Bedrock 9 G Depth to Groundwater. Standing Water in Hole: P Weeping ti'om Pit Face 2_(t Estimated Seasonal High Groundwater DETE ATION FOR SEASONAL HIGH WATER TABLE Method Used I r t Depth Observed stan ' g in obs.hole: _--in.in. Depth to soil mottles: Depth to weeping from side of obs.hole: ___--- In. Groundwater Adjustment fr Index Well# Reading Date: Index Well level „ Adj.factor........ Adj,draandwater Level, PERCOLATION TEST Date o LdII Thnalta04to Observation D Hole# �,P 2- Time at V co V c? _..� P L Depth of Pere 8 _ Time at 6" n�T_ Start Pre-soak Time@ End Pre-soak Rate Min.&ch L 2 rw A Site Suitability Assessment: Site Passed ., Site Failed: Additional Testing Needed(YIN) _ Original:Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conseirvation Division at least one(1)week prior to beginning. QISEPTICIPERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Sdil Color Soil• Other Surface(in.) (USDA) . .(Munsell) Mottling (Structure,Stones;Boulders. Consisterrm Warivell 0:•z LS l0�12'��1 N m ssty-c fg�d;-� J50-a C M5 c7�tfL��8 r �►�-c ,o' C , DEEP OBSERVATION HOLE LOG Hole#..�� Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) ' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. -consistency,% Gay l n 4 � 10111Z 1 b •^NA �o�� G O �t1Z 3 �J� ►1 �Y+v3�•t•K, f',a'�ZL DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Ocher Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders sistencz yg gmpj) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other` Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Con i en l r' I Flood Insurance Rate MR: Above 500 year flood boundary No_ Yes within 500 year boundary No Yes within too year flood boundary No— Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious miterial exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material?,,.....�..._ Certification I certify that on��N� 2= i (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai i ,ex 'se and experience described in 110 CUR 15.017. Date Signature • A Q.\S.EPTIC\PERCFORM.DOC As3tli�.. Page 1 of 1 TOWN OF BARNSTABLF�. LOCATION r3 � 4 S� SEWAGE# VILLAGE W � �' ��� ASSESSOR'S MAP&LOT-!It b)� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LD INSPECTION LEACHING FACU rrY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDAT'E: 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) Feet Furnished by http://issgl2/intranet/propdata/prebuilt.aspx?mappar=130012&seq=1 7/2/2014 13 Complete items 1,2,and 3.Also complete A. Si at item 4 if Restricted Delivery is desired. X ❑Agent a Print your name and address on the reverse ❑Addresressee so that we can return the card to you. B. Received by(Printed Name) C-.Date a Attach this card to the back of the mailpiece, or on the front if space permits. 9— 7v 0 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No �R1G HOKA � g { P.o. PMpx �OCo tit a 3. Service Type (Mall 13 Express Mail �r. 0 Registered 0 Retum Receipt for Merchandise V 2 6O66 ❑Insured Mail 0 C.O.D. 4. Restricted WNW(&ft Fee) 0 Yes 2. Article Number 7006 2150 0002 1038 7367(Tiansl`er from service/abeQ PS Form 3811,February 2004 _ Domestic Return Receipt 102595-02-M-1540 ® ® .� . . t,- m CO i 3 3 f ! F try m r� Postage $ `YO ru Certified Fee [:3 Return Receipt Fee i;' postmark (Endor sement Bement Required) Here V' Restricted Delivery Fee p (Endorsement Required) ?/,q Lrl r-1 Total Postage&Fees Sent To P 0 --------- ------------ ---- O Street,Apt.No.;��y -------------•-•----_.._..._ N or PO Sax N-- -1- -- ----•--- ------------------• City,State,ZIP+4 -----------•---------------•--- 13'[ is � ��Q9L N(IQ 0 0 FORM30 &w HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS OARD OF HEALTH �,►�v S`C�a pa� ' CITY/TOW N DEPARTMENT o ` I H N ADDRESS U Aq TELEPHONE Ws 1 3�an,s�es .� Address Z i 3g' IE�R�r.� ,1.1essSfr. '�® —Occupant - Floor Apartment No. No.of Occupants No.of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner 76 w %J a S'tA 61 Remarks Reg. Via YARD Out Bld s.: Fences: Garbage and Rubbish K Containers: /r6AV.(Z1fLca i N 9b.1 W O S Draina e Infestation Rats or other: w nJ 4/L. FaAs S 1. e(,, STRUCTURE EXT. Steps,Stairs, Porches: PA IDO O 0 ^� Qtc4�-oe.t) Iv Dual Egress: and Obst'n .4AI 1 v 0 G w S. 1J EEO Z7 To so(4j ❑ B ❑ F ❑ M Doors,Windows: pE > j ijj 00 Roof tJ 0 R--t1A Cvoz F- k,sf_ '�'r-7 �A %-AC 6 A41ptaT Gutters, Drains: ffA WIE0 CLOAN\a Walls: #i t.,t ct "1-T10 C., 1 %,. L etc Foundatio "O SZ L AS-( �i®v I k S 1 17� Chimne LA. N1 GAL BASEMENT Gen.Sanitation: Dampness: Stairs: I V V 7 0 Lighting: STRUCTURE INT. Hall,Stairway: t L VD 1 dJ N'L k -t V 12. Obst'n.: --C f-t it fE_ Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair 0 U C e71Y2_r_ AsZ S C_E: V-)zW. TYPE: Stacks, Flues,Vents: G u1, 0 a A ijn Ja4 PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECT ON REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES O PERJURY." efx INSPECTOR r"" TITLE 'l"�S A DATE �A-3 d 6 G - - TIME 2 30 A.M. THE NEXT SCHEDULED REINSPECTION 7 P.M. r 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. 4 (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 y 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 fcr 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. +' �.. +}+'ti.-�.,Jy-.`+"a.r'f'i.',..:.=-,�r�ln.,n......'t-.,".,...:.,�...t,ra,....`'•--'"4+s+n-^"'*•, r3:r"!Rh'+„nrn„^+ti^•..-,_..w...�� y ..,_,; ..-.,...-. r. HOBBSE WARREN THE COMMONWEALTH OF MASSACHUSETTS FORM30 C&W BOARD OF HEALTH s CITY/TOWN ` , r W A�/�lP."t.A 410,4 b DEPARTMENT ADDRESS /// GSM SV•y`0c i _ -8) Lf�� TELEPHONE Address d Occu a t '+I'��. �..�5'IG P Floor Apartment No. No.of+►ccupants No. of Habitable Rooms No.Sleeping Rooms_ - No.dwelling or rooming units--No.Stories Name and address of owner "•U 6-11, _ 6 9- 5_ ej cIA,r_C_j& \ Remarks Reg. Vio. YARD Out Bld s.: Fences:✓j i Garbage and Rubbish Containers: %AV-A QL c, k N �� �+ �. 1-1 0 5, Draina ev" Infestation Rats or other: Ot%o w 4F A. A'Z 4-4 uti STRUCTURE EXT. Steps,Stairs, Porches: 1-'o P"T., V_ol f Aa VJC�0 Dual Egress:and Obst'nZ:-W ► 606 QvT`Cy ❑ B ❑ F ❑ M Doors,Windows: Q _I,,j X,;�'+( 00 T4LN� 4,t4t.S ; Roof 1.a 4 2"t 1 G a, e%r- ,�w e-If- '"T e—r .A 0A%,ta v Gutters, Drains: qr-e4 1�JL Ea C�t_6a nt�Nt. Walls: C% MI wt/a eL t. v 'rl r Dt n -C 4 Foundation, , KA u 5ra u t G Chimney: X, CLA Ns"( 1. Lt, n. t BASEMENT Gen.Sanitation: l Dampness: ._ Stairs: Lighting: ` STRUCTURE INT. Hall,Stairway: Obst'n,: -.->,..v -'t —T H --T 1, P�.. Hall, Floor,Wall,Ceiling: Hall Lighting: s%« d Hall Windows: HEATING Chimneys: "" `' `-"'•,, �. �- Central ❑Y ❑ N Equip. Repair C)wr G)0 1- x cj 7 Z W r V_�\, R_ TYPE: Stacks, Flues,Vents: C,W,a uLt V\ 'b A / ,,�, A�n �� 1,1.n ,,,sec r•_► . PLUMBING: Supply Line: v _ 1 ❑ MS ❑ ST ❑ P Waste Line. H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: " ❑ 110 ❑ 220 Fusing,Grnd.: 10 -., AMP: Gen.Cond, Distrib. Box: NI Gen. Basement Wiring: DWELLING UNIT Ventil. L to , Outlets Walls Ceils. Wind. Doors Floors Locks i Kitchen Bathroom j Pantry Den Livin Room 4 ! Bedroom(1), f 7 Bedroom 2 # =•` j Bedroom 3 , ! Bedroom 4 �+ Hot Water Facil. Sup.Ten.,Gas, Oil,Elect.: f , Stacks, Flues,Vents,Safeties: r Kitchen Facilities Sink Stove + Bathing-,Toilet Facil. Vent.,,Plumb.,,Sanit';n.: Wash Basin, Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress 0 Dual and Obst'n: General Building Posted -` Locks on Doors: ,. r ONE OR MORE OF THE VIOLATIONS CHECKEDABOVE.IS A CONDITION WHICH y ti MAY MATERIALLY 1MPAI,R THE HEALTH„OR SAFETY AND 'WEL'L BEING OF THE;e OCCUPANTtAS-DETERMINED_-BY 105CMR 410.750'OF THE CODE' OR2�THE AUTHORIZED INSPECTOR.(See Over) ' E, ' `' ' w 4' "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS'"AND PENALTIES OF ERJURY." t INSPECTOR " TITLE R� erg -�'�•+S dzct.ro(•• a DATE ATIME ++� �M• THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety,and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in.any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of 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. r I i •-....�-._..; _.. ._,r`.-n..�.n.N. ... .•Z..,vf�.v-.-`r.-..�s�..rvt...'.y.-z��_.�« ..%4`•.,�..r-.:..rr'.�.-.-i.:w�r`""'"'."""•'r^._.�+rY''r*-..t'i•".r•^t7+.°r.Y.n.:ry.e,,.......n F±�Y�'r.�,�,,. r •-• .. HOBBS&WARREN THE COMMONWEALTH OF MASSACHUrSETTS FORM 30 Caw BOARD OF HEALTH CITY/TOWN .k o DEPARTMENT A ADDRESS I GSM Syey`0 �,'s$.��.ip F +F..✓� � -I iy� TELEPHONE F Address 2- 11(' c� +.� a'"ic:�S tno—" Occ pant_ Floor Apartment No. No.of Occupants - ,.-No. of Habitable Rooms No.Sleeping Rooms No.dwelling or rooming units No.Stories Name and address of owner + r �i.�.ti.► cs *t N_ +.. Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish/ r Containers: tZ I 4 Aj y_> Draina e;/ V Infestation Rats or other: .] T�4 4 ,-7 STRUCTURE EXT. Steps,Stairs, Porches: ;�V-�a rJ ,�t� .. � �S:#cr sf «is " A 0D Dual Egress:and Obst'n� -- f EO PJ* `�',f WO Pz A) ❑ B ❑ F ❑ M Doors,Windows: , ,; �;if t_aw r V,61 Qj 0 sj TI i t€.L.S Roof �j (0 0- t yf. .s r I �,-A Gutters, Drains: . jj-t! .JT(C3 Walls: '4 ; �t�� c r5 m °W 4x 1-1f.4 txCI cT Foundation cs s n �..>e _ �� !:0,4 v Chimney: t�:�� ��t, ar 1' �<r_of_,. OF . h BASEMENT Gen.Sanitation: Dampness: 4 1 Stairs: r �,. E3 Li htin : STRUCTURE INT. Hall,Stairway: t L y;r t Obst'n.: A--i " C ; �� `"T C"- Imo Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: w. Central El ❑ N Equip. Repair Oti" ;j TYPE: Stacks, Flues,Vents: t-i r'i4k,f\ 1!►IS e,,,, J Ga,k A Nit, , r �' E t�es�I f-^_ PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent s ELECTRICAL Panels, Meters,Cir.: Ly ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: ` Gen. Basement Wiring: " DWELLING UNIT / Ventil. L tog. Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 ` Hot Water Facil. Sup.Ten., Gas,Oil, Elect.: r Stacks, Flues,Vents,Safeties: - Kitchen Facilities Sink ,. Stove Bathing;Toilet Facil. Vent.,'Plumb.,.Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress s' Dual and Obst'n: %General Building Posted Locks on Doors: t ONE OR MORE OF THE VIOLATIONS CHEC.KEDr.,�ABOVE IS',A CONDITION WHICH MAY MATERIALLY,IMPAIR THE HEALTH ORSAFETY AND WELL-BEING OF, THE,-- OCCUPANT,AS*,DL_T_ERMINED BY 105CMR 410.750` OF THE:CODE OR' THE , AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS•AND M1'ti A - < =.ice PENALTIES 07PERJURY." , .✓ rf .t f' INSPECTOR n TITLE 1) DATE 17A 0X0 2� 6. TIME 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. (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. OFIHE r, Town of Barnstable Barnstable Administrative Services Procurement&Risk Management All-America City sAMSTABLE, : 230 South Street,Hyannis,MA 02601 9 MASS• m www.town.barnstable. a.us 1639. �ArFD MA't a 2007 David W.Anthony Tel 508-8624652 Chief Procurement Officer Fax 508-8624717 David.anthony@town.barnstable.ma.us May 2, 2008 Community Preservation Committee Attn: Ms. Theresa M. Santos Growth Management Division 367 Main Street Hyannis, MA 02601 Ref: Application To Community preservation Committee—for Historic Preservation and Affordable Housing unit in West Barnstable. 2135 Meetinghouse Way. Dear Ms. Santos, Please accept this letter as a letter of interest to request and secure funds needed to preserve an historic house located on meeting House way at the property known as Meeting house farm. This house built in 1825, and known as the Payne Black House, was purchased by the Town through its open space program in 2000 when the Town purchased the 22 acres of land known as the Conant Farm. The tenant at this house lives under a life tenancy and qualifies as unit of affordable housing in the Village of west Barnstable. Since the property was purchased, the Barnstable housing authority and Town have provided small repairs and maintenance to the house, the well and the surrounding grounds. The tenant has also contributed to the maintenance of the house by painting the interior and doing small repairs inside the home. However,the house continues to deteriorate and the repairs needed now are beyond the means of the Town and the Barnstable housing Authority to address. The windows, doors, shingles and roof all need to be replaced in order to preserve the house and make it sound for the next 15+years. The amount being sought to replace these items and secure the outside of the house is $75,000. The investment made into this century old home to preserve this example of Cape Cod Architecture is critical. In addition, as this home serves to meet Affordable Housing goals we hope that the committee will give this due consideration for funding. If you have any questions please feel free to call me directly. Sincerely, David W. Anthony Chief Procurement Officer Town of Barnstable v low No.--- - ----- --- Fee ---- BOARD OF HEALTH TOWN OF BARNSTABLE 2pplicationArVellCon9tructionPermit Application is hereby made for a perm t to Construct Alter ( ), or Repair ( )an individual Well at: _o i 3s_ LocaGon — Address C Assessors MaP j d Parcel q� S7, �066/ a zc= `` '�`• - -- -�u Te ' ' �S ----- - Addres a M3 aV16W/VS J/-4 (-f 5 3 - - - _ -- -- ---- - - - - - ------------------- Installer Driller Address Type of Building Dwelling----------------------------------------------------- Other - Type of Building--------------___-------- No. of Persons---------------------- Type of We — - --== - -- - - -- Capacity— �= - —�-�--------------- Pur"pose of Well`-�"-`5- ® ,�f/�---- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until Certificate f C pliance has been issued by the Board of Health. Signed - -- date Application Approved By - -- — -- -- � — ---------- date Application Disapproved for the following rea s:------------------------------------------- -- date Permit No. ------- Issued____----------------------------- --- ------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS,1S TO CERTIFY, That the Individual Well Constructed (-I, Altered ( ), or Repaired ( ) Wit- �5 a > td&ZL D,g /c�//v b ——-- ,/ Installer has been installed in accordance with the previsions of the Town of Barnstable Board of Health P ' a e Well Protection Regulation as described in the application for Well Construction Permit No. -! a eed THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--- Inspector f ;•�' f 9,4� __- _-- a� o e_45 -----____-- No. --- Fe - l BOARD OF HEALTH �T OW N. O F B'A R.N.StA B LE A.pp[ication Ar V e [.Con0ruction 3permit Application is hereby made for a permit to Construct Alter.( ), or Repair ( )an individual Well at: a 35 /�IePTi� / -� Q/-ate�414i --= --/- Locatori="Address Q_nf ` Assessors Map. nd Pazcel Al ST ---------- ------- ---- �i' . Own Addres/ ------ mil. 5 rn<rry G</ // : �2��c �r T c..-- Y a 743 - -- ---- - Installer - Driller Address Type' of Building Dwelling----- -.-- - — - --; a- Other - �Tyyppe of Building---------- ------ No. of Persons---- ---------------A—____ + fr Type of Wel _ TQ M- 164G- � ry/� 27/L — - Capacity-_/0 /' Purpose of Well ��---- — ---- -----=- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town'of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until Certificate.of C pliance has been issued by the.Board of Health. .' Signed Application Approved BY date -- —_ - Application Disapproved for the following rea , s: ----=- - ------ ------ -_ date---- 'Permit No. -- Issued---= --- - --- ---—=- date — �al�!!w'ea'Fi?b'ei4ihla!i>vi(ie6'i�ei�G?e�beb@G!3la_eleMley tw4f1.4dpaea+.m7rea.?ier!lassoefases�eY+ii+itpESLt'�a+6e+�trepweeiiYRaemxe54sxswedT.axaC;seivaea+axa+�,.tae�va4�Peasx�eaTaes�tw.� BOARD OF HEALTH TOWN , .OF BARNSTA.BLE Certificate Of Compliance THIS` S TO CERTIFY, That the Individual'Well Constructed ( Altered ( ), or Repaired ( : ) /// ///------ Installer /. at` !.a CPT/ O lG _cfl [ICJ /cri�a» — --------_l .03/G0.7Z — -- has been installed in accordance with the p�of the Town of Barnstable BoarO pf Health P ate Well Protection Regulation as described in the application for Well Construction Permit No: ��!�7a ---- ---- ll Ped THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION,SATISFACTORY. DATE Inspector--=--=--- --_-_ -- BOARD OF HEALTH _, _ TOWN OF _ BARNSTABLE I 'well Congtruct on,berm t No. O-W Fee I Permission is hereby granted ----------- to Construct (✓), Alter ( ), or Repair ( ) an Individual Well/at: No. d%3S. /1Je 7i���iho�cQe �(/ '�-�c-� 1Crr , T--street ---------- —-- ----- -------- ------- as shown on the application for a Well Construction Permit L/. No.- Dated _._ / ------------- -- _ _ --------. . --- `�� _ Board of Health DATE—T ---- '"'"`—`'' 1"1r R—Cf—CC'JCJl 11•GCJ Lnly lrllnlA.Lssw.J ailu-- •wv� .ter.... ...� F:u=<-0o 17:51 From-IQWL DEPT 1501/62024 `T-251 ,F.11/12 F-462 PART C ' sVSTEM WFoRIuY►TION( F*"MY Addf4W: 2135 MEET NNO HOUB9�RD.. RNMGT Nang Of Owrm TWO OF SAP40TANA ad*of kwpoco n: low . fllitQl CM OF-SVPM WWOSAL SYSTEM: f�Mri oo al M�Mt�w0 pM11Nf1Mt rafMv�Nn0al1a1S or IOoval waftwMwn IM(LaCabWws �{Cwa1 ooRNs in0o tiaras) A � k" Aa P t s f4, . C� £ r s• � t �.'1 Z ��F3i .t _ V � a t'S� fi F1f'L J. r 27-2001 11:00 BARNSTABLE HOUSING 150877Er-13'12 P.02 1 Fib-N-00 11:51 From-IELAL 01PY P-411 MUI MLWACE OWNE WOM SYSTEM 1MSl%LTM FORM FAWC 86'CTEEM ATWN ieoralrwadl V►opar�gd®gaa: Zi n MELTING MOtS •gB1i89ptSTAd9Lis,MA OZBSO =IN of*WW TOWN OF SARNSTAMM Oste of Iaepabm S/OrOs livW"SE1MlR:$ (Lac*oft alb Pam+) Dooh bW"®red®: W cow{ettglEan} mom of QeraRfNeboA: _ twat iron X 40 F'YC Dle E=hem ,adder strpy Wo of su�tten Iota: 0- D rlae of kfalwpe.etc.} -" ( at jo0tb.ventin8-a,, 77fE 1wE11.is T/°m MMt 6ESSPOO� r SWM TAW V I (locate on u OW►) Dgo bsbw Irlft Z' ms0al Fltferytass_ �►_*W M{la m of ow*nxW; X GRKr�e a mow; R% NO if M4 b wow,me age is op=1f Vexed b/ Ago' Will olm oorw r x r sLom CIGsSFOw or ueeft ta0,of studfla to boftm aoAst We Or baffle; so" pgbnw Goa!loE►d awm b�R of ou0ertee"a.tb�� `" OiWnoe trap Oaiflan of WWI V b", of W*We a baffle: W HardimenaiW%wets tnsd- MlAS�O COm tn61t au+d alWt LgYe or(alffl0i,aep tigWO layb in b o (Nett.abuctura!tnmeSritY,erf8er of ice , irecollenevWWn fa ptpn�.a0ndit10f1 etcl S1fST1EG4 iA1t.S.TiiE M IS rOfWDr 4 TQ T"g SUWACE.3YSTEM K"NO gfrfECT1YM UAC"W-LPT. aReASE TRAM" - Depth bd*wWgdL W* Explain: VA owwrmm PxW on ON PM) own vocoir m Wa Do&=from op of fiat W u0 Of am tw or ba1A0: W4 Oraana hM boawn ofWWto bat601r►of pse o,balk ara to omio w"ov: Ma Cemn+w+ts: oft uei level itt rebi►on to ouWtt wveR.at►vC�s!1nte4fttY.eYlCer+ea of laakege, {f� y�uapb9p,eo►+Ol m of MW and Wm bees or baffles.080A o>r.) ate Pays 7 of 11 .^pip" TOTAL P.O . - WEST BARNSTABLE FIRE DEPARTMENT Lin 2160 MEETINGHOUSE WAY [[ P.O. BOX 456 lam/ �rJ WEST BARNSTABLE, MA 02668 • JOHN P. JEN KINS Chief of Department EMERGENCY. 362-3131 BUSINESS: 362-3241 FAX: 362-3683 January 10, 2000 Thomas A. McKean, Director Health Department Town of Barnstable 367 Main Street Hyannis, MA 02601 J3 O C� RE: Underground Tank Removal Notification Dear Mr. McKean, This is to notify you of the removal of an underground storage tank. The following information is provided for your convenience. WBFD Reference: #2000-001 Date of Removal: January 6, 2000 Street Location: 2135 Meetinghouse Way Property Owner: Conant Realty Trust Type of Tank: Steel, round,. 1,000 gallon capacity Product: #2 heating oil Tank Reg. Tag#: None Lieutenant Paananen from this Department observed the removal of this tank. The tank was solid and there was no indication of any leakage from the tank. To the Department's knowledge, with the exception of another tank removed on this date {WBFD reference #2000-003}, there are no other underground tanks on this property. No application has been.made for the installation of any new underground tank on this premises. Sincerely, J h �P. Jenkins, Chief of Department JPJI , WEST BARNSTABLE FIRE DEPARTMENT �We 2160 MEETINGHOUSE WAY P.O. BOX 456 WEST BARNSTABLE, MA 02668 • JOHN P. JENKINS Chief of Department EMERGENCY. 362-3131 BUSINESS: 362-3241 PAX 362-3683 January 10, 2000 Thomas A. McKean, Director Health Department Town of Barnstable 367 Main Street Hyannis, MA 02601 RE: Underground Tank Removal Notification Dear Mr. McKean, Thisi t notify f s o o y you o the removal of an underground storage tank. The foflowmg. information is provided for your convenience. WBFD Reference: #2000-003 Date of Removal: January 6, 2000 Street Location: 2135 Meetinghouse Way Property Owner: Conant Realty Trust Type of Tank: Steel, round, 500 gallon capacity Product: #2 heating oil Tank Reg. Tag#: None Lieutenant Paananen from this Department observed the removal of this tank. The tank was solid and there was no indication of any leakage from the tank. To the Department's knowledge, with the exception of another tank removed on this date {WBFD reference #2000-001}, there are no other underground tanks on this property. No application has been made for the installation of any new underground tank on this premises. Sincerely, Jo n enkins, Chief of Department JPJlJ TOWN OF BARNSTABL, 1 LOCATION 2-I35 ��i�o�S� SEWAGE # VILLAGE ����' ASSESSOR'S MAP & LOT 1 Yo OIL PHONEINSTALLER'S NAME& N0. SEPTIC TANK CAPACITY FAIE® INSPECTIONv LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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) Feet Furnished by a 00, e COMMONWEALTH OF MASACHUSETTS G �` EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS g`I DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET BOSTON MA 02108(617)292-3500 TRUDY CORE Secretary AROEOPAULCELLUCCI DAVID B.STRUHS Ooverrar Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 13 Q 6 1 2� Name of Owner TOWN OF BARNSTABLE Address of Owner: ATT.TOM MCCAN BOX 634 HYANNIS MA.02601 J Date of Inspection: (:� 9100� Name of inspector: GRACI I am a DEP approved system Inspector pursuant to Secdon 15.340 of TRIO 5(310 CMR 15.000) Company Name: JOHN GRACI SEPTIC INSPECTIONS Mailing Address: P.O.BOX 2119 Telephone Number: 508-664.6813 CERTIFICATION_STATEMENT I certify that I have personally Inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the tune of Inspection.The Inspection was performed based on my training and experience In the proper function and maintenance of on-site sewage disposal systems.The system: _ Passes _ Conditionally Passes _ Needs Further Evalua o By the Local Approving Authority X Fails Inspector's Signature: Date:2111100 The System Inspector shall su ft a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this Inspection.If the system is a shared system or has a design now of 10,000 gpd or greater,the Inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS "The inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is performing at the time of inspection.My Inspection does not Imply any warranty or guarantee of the longevity of the septic system and any of Its components useful life." THE SYSTEM FAILS TITLE V INSPECTION.THE SYSTEM CONSISTS OF TWO 9'X 6'BLOCK CESSPOOLS,THEY HAVE NO EFFECTIVE LEACHING LEFT.THE OVERFLOWCESSPOOL WAS PONDING TO THE SURFACE. revised 912/98 Page 1 of 11 f t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Dale of Inspection: 219100 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any Information which Indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are Indicated below. B. SYSTEM CONDITIONALLY PASSES: One or more system components as described In the"Conditional Pass'section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all Instances.If"not determined",explain why not. DIA The septic tank is metal,unless the owner or operator has provided the system Inspector with a copy of a Certificate of Compliance attached)indicating that the tank was installed within twenty(20)years prior to the date of the Inspection;or the septic tank, whether or not metal,Is cracked,structurally unsound,shows substantial infiltration or exriltration,or tank failure is imminent.The system will pass inspection If the existing septic tank Is replaced with a complying septic tank as approved by the Board of Health. WA Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.The system will pass Inspection if(with approval of the Board of Health). _broken pipe(s)are replaced obstruction Is removed _distribution box is levelled or replaced D& The system required pumping more than four times a year due to broken or obstructed pipe(s).The system will pass inspection if (with approval of the Board of Health): broken pipes)are replaced _obstruction is removed Lrevised 9/2198 Page 2 of 11 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 2/9100 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health In order to detemm�ine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 16.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy Is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUS=FLIER.IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS 11s within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS Is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is withli,50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS Is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds Indicates that the well Is free from pollution from that facility and the presence of ammonla nitrogen and nitrate nitrogen Is equal to or less than 5 ppm,Method used to determine distance n1a(approximation not valid). 3) OTHER n/a revised 9/2/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 2136 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 219100 D. SYSTEM FAILS: You must Indicate either*Yee or'No'to each of the following: A I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is Identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ X Backup of sewage Into facility or system component due to an overloaded or clogged SAS or cesspool. X _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet Invert due to an overloaded or clogged SAS or cesspool. X Liquid depth In cesspool Is less than 6"below Invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times In the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 4. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy Is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy Is within 50 feet of a private water supply well, X Any portion of a cesspool or privy Is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysts for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must Indicate either'Yee or'No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system Is within 400 feet of a surface drinking water supply X the system Is within 200 feet of a tributary to a surface drinking water supply - X the system Is located In a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall upgrade the system In accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further Information. revised 912198 Page 4 of 11 r .- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 CHECKLIST Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner: TOWN OF BARNSTABLE Date of Inspection: 219100 Check If the following have been done:You must indicate either'Yee or"No"as to each of the following: Yes No X - Pumping information was provided by the owner,occupant,or Board of Health. X - None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note If they are not available with N/A. X _ The facility or dwelling was Inspected for signs of sewage back-up. X _ The system does not receive non-sanitary or industrial waste flow. X - The site was Inspected for signs of breakout. X - All system components,excluding the Soil Absorption System,have been located on the site. X - The septic tank manholes were uncovered,opened,and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X _ Existing Information,For example,Plan at B4O,H, X - Determined In the field(if any of the failure criteria related to Part C is at Issue,approximation of distance is unacceptable)i 5.302(3)(b)) X - The facility owner(and occupants,if different from owner)were provided with Information on the proper maintenance of SubSurface Disposal Systems. revised 912198 Page 5 of 111 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 219100 FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom Number of bedrooms(design): 3 Number of bedrooms(actual): Total DESIGN flow: 330 gpd Number of current residents:1 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate Inspection required Laundry system Inspected(yes or no): NO Seasonal use(yes or no): NO Water meter readings,If available(last two year's usage): n/a gpd Sump Pump(yes or no): NO Last date of occupancy: n1a COMMERG ALnNDUSTRIAL Type of establishment: n/a Design flow. n1a gpd(Based on 15.203) Basis of design flow:n/a Grease trap present:(yes or no): NO Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NO Water meter readings.if available: n1a Last date of occupancy:n/a OTHER: (Describe) n/a GENERAL INFORMATION PUMPING RECORDS and source of Information: n/a System pumped as part of Inspection:(yes or no):NO If yes,volume pumped n/a gallons Reason for pumping:n/a TYPE OF SYSTEM X Septic tank/dlstributlon box/soil absorption system _ Single cesspool _ Overflow cesspool _ Privy _ Shared system(yes or no)(if yes.attach previous Inspection records,if any) I/A Technology etc.Attach copy of up to date operation and maintenance contract _ Tight Tank Copy of DEP Approval Other:Na APPROXIMATE AGE of all components,date installed(if known)and source of Information: THE SYSTEM IS OVER 50 YEARS OLD. 8ewege odors deleoled when anivind it the olh:(Yee or no) NO revised 9/2198 Page a of t t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2136 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 219100 BUILDING SEWER:X (Locate on site plan) Depth below grade: 14" Material of construction: _ cast Iron X 40 Pvc _ other(explain) Distance from private water supply well or suction line: 0" Diameter: 4" Comments: (condition of Joints,venting,evidence of leakage,etc.) THE WELL IS 77'TO MAIN CESSPOOL SEPTIC TANK: X (locate on site plan) Depth below grade: 2" Material of construction: X concrete_ metal_ Fiberglass_ Polyethylene_ other explain: n/a If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): NO Age: n/a Dimensions: 6'X 6'BLOCK CESSPOOL" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 19" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level In relation to outlet Invert,structural Integrity,evidence of leakage, etc.) THE SYSTEM FAILS,THE OVERFLOW CESSPOOL IS PONDING TO THE SURFACE.SYSTEM HAS NO EFFECTIVE LEACHING LEFT. GREASE TRAP: _ (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_ Fiberglass _ Polyethylene_other Explain: n/a Dimensions:n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle n/a Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet Invert,structural Integrity,evidence of leakage, etc.) nla revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 219/00 TIGHT OR HOLDING TANK: _ (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: n/a Material of construction: _concrete_ metal_Fiberglass _Polyethylene _other Explain: n/a Dimensions: n1a Capacity: n1a gallons Design flow: n/a gallons/day Alarm present: NO Alarm level:NIA Alarm in working order:NO Dale of previous pumping: n/a Comments: (condition of Inlet tee,condition of alarm and float switches,etc.) n/a DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet Invert: n/a Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage Into or out of box,etc.) n/a PUMP CHAMBER: _ (locate on site plan) Pumps In working order:(Yes or No): NO Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) n/a revised 912198 Page 4 of 11. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2136 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 219100 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number:(n/a)Na leaching chambers,number: (n/a)n/a leaching galleries,number: (n/a)n/a leaching trenches,number,length: (n/a)n/a teaching fields,number,dimensions: (n/a)n/a overflow cesspool,number: (1)6 X 6 BLOCK CESSPOOL Aftemative system: n/a Name of Technology: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) . THE OVERFLOW CESSPOOL HAS NO EFFECTIVE LEACHING.THE CESSPOOL IS PONDING TO THE SURFACE. CESSPOOLS: _ (locate on site plan) Number and configuration: n/a Depth-top of liquid to Inlet Invert: Na Depth of solids)ayer: n/a Depth of scum layer. n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater: n/a Inflow(cesspool must be pumped as part of Inspection)NO Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a PRIVY: (locate on site plan) Materials of construction: We Dimensions: nla Depth of solids: n/a Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n/a revised 912/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Properly Address: 2136 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: V9100 SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes Into house) I� A 00 AA IL OD revised 912198 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 2135 MEETING HOUSE RD. BARNSTABLE, MA 02630 Name of Owner TOWN OF BARNSTABLE Date of Inspection: 219100 NRCS Report name: nla Soll Type: nla Typical depth to groundwater: nla USGS Date websfte visited: nla Observation Wells checked: NO Groundwater depth: Shallow_ Moderate_ Deep_ SITE EXAM _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet Please Indicate all the methods used to determine High Groundwater Elevation: NQ Obtained from Design Plans on record NO Observed Site(Abutting property,observation hole,basement sump etc.) NQ Determined from local conditions NQ Checked with local Board of health NQ Checked FEMA Maps No Checked pumping records RO Checked local excavators,Installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS revised 9l2l98 Page 11 of 11 TOWN OF BARNSTABLE UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEMS NAME f /2-�/l�il�,/!�� 3�•Z-�o/P1.7 ADDRESS f 1--07?" h/da2f Y VILLAGE �✓' /✓ ��� ���� LOCATION OF TANKS: CAPACITY: ' TYPE OF FUEL AGE: TYPE: OR CHEMICAL (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: t D TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS Am 44 x;- .. ""f. • - F�'4 F..�#t °S,i,.�, T• G'F, `�+ � �r s ..Mayt28- 198d! ,q G` r `� • ; - - �.:, _ � F• I'fir .' � .4' f !� 'Fred.D ' •Y� i§t $3r11stab'le. T •Dear Mr.'•Conant`�� � - � + �, o'P �;.fly ' .� � y�•� �*rr f. �., t .,.z�'�' � Wet have `jrust been notifed by:,`the``Selectmen!s;O ffice that Nyo ' • 53,. * ,q.. ,S a .. •.ee '"i:.-� ^`^,. .', !v 'b �,. •_� .•~ lac «� - :,A.. �•� r,. n,_ «ij. • have replaced your underground, f'ue;., storage tank located on` g...�_. the t�'est side. of Center Street 'West .Barri's'tabl'e }§y� . 'Please complete 'the,-,bnclosed card and -return to us ,as soon as-•possible. to Gomp1"ete our 1Y ' r y uri cThank youfo ooP erati.o "Very truly.-yours-j John M,e•Kelly D .rector of UPublic, Health r { }.: < t -. V i'�,mm ,. r� .�; x * .1r t• . .. '2 r w3' i 1¢ t J 4`.... `� S ,nc y .`r.x. 9', b �� � <-4• * `2'.' es• � '•.F- t`* " � t � � t.�•* i w t t .. as •te w at� ��., q s 5 '; � s •fit tq 54'.� l• �. Na .. .ten• - �` a :� s,. - 3 c �. tw� 'v: + a F , .mac y • � ., �� • `:,e.. a. • a . A, f f 4 h � iy- •{ •� 3 f '. .tie � � "� * �' 9 NAME LOCATION Conant, Fred D. West side of Center St. West Barnstable W. Barnstable Mass, BOOK & PAGE - DATE GRANTED AMOUNT STORED 37/249 August 28, 1947 Under ,- 1 tank 1,000 gals. Gasoline 0; DATE PAID \ 973 1 March 28 MAR 2 , . 1978 , , MAR 11 W4 - MAR � � �q75 MAYON MAR 12 1976 FEB 2 5 1980 MAR 9 ` 1977 �Meetingl�ouse Way,W,Barns