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HomeMy WebLinkAbout2416 MEETINGHOUSE WAY/RTE 149 - Health (3) 2420 (aka 241.6) Meetinghouse VVa _ West Barnstable t. 155 - 030 f of ji s � e w J k {y c u � a r $ a - �- i. Yam ^ rn . P c• " ,t• '_ a `} . 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'� •'rtt,yam 6 -d �G - ; y'..�. .186 LS. c�?°xu "` ` 0�: '� fZ, 4'T w- .:a � c 4 44ar e' ,�� 4 pia .Ka x-. a ✓' 1 -'k 27!� 'F- r4 Aa' ��� " � ". � �.�r'z��3 D „a�a �. ,'tl .-�' t! � ..,.� w.•sza,%'+ � 'a'c� 'F-�`"' 1£ ?.fir �,,t� u a �i"a � J ,.t•,'�'.. -�r � ,��,y� �3*...w � F'�+.� �" y � �'�5� ,� ; ��.5 ��. '..+! `�3..r�„ �'� R"'•��"' .�d'❑_€ib ,d" :F 'Sk �s�� �m�� '� yr�jni �;� ,ar r ro •.s. ��. c �, a. .d'+' v }'�`�^' �s• 4� � ,'�: ��d� � � � � "r -•d + �r 6 �� �� a. '�7r "a:«i Y Ate" `' adz � � w ENMOTECHLABORATORIES, INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 �,'�r'asDyl Client Name Scannell Well Drilling Location A41son,24Y Route 149 Address 2366 Rte.28 W. Bamstable,MA Teaticket MA 02536 Sample Date 03/23/12 Collected By Scannell wells Sample Time NA Sample Type New Well Date Received 03/23/12 Lab Order Number DW-120599 Well Specs NA Location Source Date Collected Time Collected Comments A 3123112 NA UPSTAIRS BATH Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform Mooml 0 0 SM9222B 3/23/2012 RS Location Source Date Collected Time Collected Comments B 3123112 NA OUTSIDE SPIGOT Analysis Requested Units Recommended Limits Analysis Result Method Date Analyze Analyzed By Total Coliform /loom[ 0 0 SM9222B 3/23/2012 RS Comments: Date a .a Ronald J.Saari Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 ❑Certification is not available.for this analyte.for non-potable water samples.. ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Scannell Well Drilling Location Wilson,2414 Route 149 Address 2366 Rte.28 W.Bamstable,MA Teaticket MA 02536 Sample Date 03/23/12 Collected By Scannell wens Sample Time NA Sample Type New well Date Received 03/23/12 Lab Order Number DW-120599 Well Specs NA Locatton source- "d '� Date Co`Clectedr TtmeCollected= 1Comments s Analysis Requested Units Recommended Limits Analysis Result I Method Date Analyzed Analyzed By Total Colfform /100m1 0 0 SM9222B 323/2012 RS ltica`tton Sotiree Date Mierollected s CoinmenLs ,E ..e NAr tj N` - + OUTSIDE,SPIGOT >.... Analysis Requested Units Recommended Limits Analysis Result MethoTliateAnalyzel Analyzed By Total Colifonn /100MI 0 0 SM9222B 323/2012 RS ..Comments: --------- --------------- ------- ----------------- --------- Date Ronald:l:'Saari Laborn/on?Director y r> <, co I ; C" -0 rn G r� BRL=Below Reportable Limits *See Attached Page 1 of 1 oCertification is not available for this analyte for non potable water samples.. ~ �� � �� �� � � � � - � ��- ��� �� 9 ..� � � �� ; �� �� � �- ��� ��� .� � � B -.�� � � .� EAWROMMUMUrORWA INC MA CERZ NO.:M-M 063 8 inn Sle609on Dhw VON!? Sand"MA MW Oft""460 1.80"s-690 FAX(M8}8884446 Addrm 2=Rbk u W.ROMWO.MA raft*M du 02W Son*BNO am" cameew By CA GOWMAW*b S pie Thm +u spa was DAeRWgW MW 2 4f Atlas bteq ll� �iaell� Arb♦� dfEd1*d' lilt v Aa,��► 0 0 song t6C 1tWWIM=bAra wwftscaw irk goal NAVA twommmomod KOMVASaatf t labarmory ' 1�tL` � �taAlemeimd Repo 1 atf n bnoaaao0pptel6rNtba �.e�p , I --- ------ -°--- ------------- " No. Fee------ BOARD OF HEALTH , TOWN OF BARNSTABLE 6 ppiic tton for eCC Con�truction ermit PlA iL(V7 Appli atio is hereby made for a perm;t to Construct ( ), Alter ( ), or Repair )an individual Well at: �.0 Location — Address _ Assessors Map and Parcel - •--------!ALA-4-�--1-1•�-r-'-- ----- ------------------------------------------- Owner r- Address ------------------------------------------------------------------------ Installer — Driller Address Type of Building Dwelling ------------------- Other - Type of Building --_____—----____-------- No. of Persons------------------------_—__—_—_____ Type of Well— Capacity--- - - - --— -- - - ----— ------------------- 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 a Certificate .of Compliance has been issued by the Board of Health. Signed �ll� ---- — — L� �-_--_ — — — date Application Approved By >�v�t! y4&✓-�2 � ------------- date Application Disapproved for the following reasons:---------------------------—------------_-------------_--------___---- _____—_________ --------------------------------- ----------------------------------------------------------------------- date - ------------ J� C Permit No. -lC�� 11� 7i --— -- -- Issued—�v-Y---------a�e _o� �� -------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of Compliance THIS IS TO CERTIFY, That the Individual Well Construc ed ( ), Altered ( ), or Repaired Installer at , .-Y__r —� y (ice, JS i/P------------------------------------------------------------- ------------------------- 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. -------------------------Dated---------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- —- — -- — - - --— — -- Inspector------------------------------------------------------------------------- �A) Fee----- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con-4tructionPermit Applicatio is hereby made for a permit to Construct ( ), Alter ( ), or Repair in individual Well at: Location — Address Assessors Map and Parcel - �' ----=- ----- ------------ ---- ---------- Owner Address r r.� Installer — Driller �� Address Type of Building n r Dwelling K [?.51 c 'aoJ/}A ------------------- I ' Other - Type of Building-------------------------- No. of Persons------------------------- e of Well-- --� �-- - I TYP 7 - , ---- -- - Capacity-- - - -- - - - - - -— — j Purpose of Well----- v a i 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 a Certificate .of Compliance has been issued by the Board of Health. Signed- �-------- date Application Approved By— l�—�C- "'C '� - ----- - -------------- date Application Disapproved for the following reasons:---------- ------ -- -- I , date f Permit No. - - '= V Z- ---— --- Issued — - ``- ------=--------- i date -----------------------------I --------+-- .,a-----------------------N--------;----5---� --- ---4---------- -%QARD OF.HEALTH j TOWN OF BARNSTABLE Certificate ®f Co�mpmnce THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (`') I! by- r a A✓ ' - i/_�J��/j�`�== ----------------- ------Installer i at-- -� - --- -- 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. -----------------------Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL j SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------------------------------------------------- - -- Inspector--------------------------------------------------------------------------- r---------- ----------------------------- f t~ BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con5truct ion Permit Ic4f� Fee----- �- Permission is hereby granted- _ f �! �!-- 'j/1C- fi.�Y�_.___________ to Construct ( ), Alter ( ), or Repair (.-J'an Individual Well at: J No. -n&/ --- ��1 - �l�c�f��rr«< r_ -- ----- ------------------------------------------------------------------------------------------------- `� , street as shown on the application for a Well Construction Permit No.------------------------------ -------- - Dated--------------------------------------------------------------------------------- --------------------- ' f Board of Health DATE i ENVIROTECH LABORATORIES PVC MA CE'RT:NO.:M AM 063 � 8 Aft Sabmiaa Didw unk 12 Sandtvldt,MA 02563 (S08)888-64G9 1-80&33fti6460 FAX(S/18)888 446 . Clint Nmme smwwl Weft D'alirg Lneaztlo t Wlgssat .2+414 Umft House Rd Addrew 2M RhL 28 W Bammwe.Me Ta2&*W UA aM6 saw*--Palo 1110tit 1 Collected By cfxem Sainte ThW NA So*k Type Now wed kmftcwrwm Date Received tmmi Lob Order Number OW rove Wt311Specs 83 ��1���` ����p�,irrlrtlll.r✓..o�it� _ 1��MwY�i�rt..i F17���Nrir nisi,*Regan r u+MAe 1? a uml A Me" - Ash aY _ TOM co i€atm tiott,M 0 0 st+�822ZE#_ tN?l� i RS - - P"unta a.&a5 —--6� --SM4500-"1112MI u SptfBsCtt:tdltrtarx�en umhostCm Nidta-M 400i EPAM0 f1AW11 tt00 i1t1 t:pAf2Q1 f1/tl4(t11 ` LL 1.00 . LL ---- NiirWe-N MOL tOEt 1.5i EPA300.0 1f13i�011 LL - Sodttrr► -- atpll 20.t? 14.4 EFA 800.7 i1/8r1t _MC te)Ta lt�ttu _�...PA_ --- ----- -- ..-�' -- --- -� 0'� _.. . --.._._ 0-?3 E200.7 1113f1Et41 - me �. c - - -- MOIL � .____ - __0.0 0.10 EPA ZMT 11=11 Cammena. . ._..._ -__-_ _--_ _-- — MMnganasa is not a b8db NMWd.but may arse abb**WOW qua w� t;9W an W cr WW. Low pH W rd9h oonr�cva ultea. WOW moats EPA sbndoM and is aft"for&*Aft tbrps�sn bm Kturatd attrf Labomimy i 'aid-6edvw&pw ttbk tmta '�eeAketehtd PW i Of 1 tiCarlJ�rtoh tr gnt e+ra€tmMsfe.dlGv er�el��oaablew�rrar�ha. 07/23/2009 14:33 FAX 508 888 6446 ENVIROTECH LABORATORIES R 0001/0001 ENMOTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 ' (508)888-6460 1-800-339-6460 FAX(5rolechla 446 s.c www.en virotechlabs.com r- Client Name Scannell Well Drilling Location 2416 Route 149 Address 2366 Rte.28 W.Barnstable,MA:,; Teaticket MA 02536 Sample Date 05/11/06 Collected By DA Scannell Sample Time Sample Type New Well Repair Date Received 05/11/06 Lab Order Number DW-2006-1578 Well Specs 58' Loeatton SosRrce' Ante Collected; 7Yme Collected Comtne�:..rs - A SJ11l0ti `, NA , Analysis Requested Units Recommended Limits Analysis Result Method Date Analyze-dj Analyzed By Total Coliform /100ml 0 0 9222E 5/11/2006 MC - .._.... ..._............... -......................._._....-_.........- ............_... - .. -- - ....__._......._........._......... pH pH units 6.5 8.5 5.81 4500-H-B 5/11/2006 LL .......... ....._...- - --... -- - ......._.........-..._._....._._.........._._..----._.._._.......... ......... - - -..........- ---- ..:.. - -- .._........._.._.._...._.._._.._... - Nitrite-N mg/L 1.00 <0.004 300.0 5/11/2006 LL --- ---- .._.._.... -- .......__......- -- ._................._._.._..._...,....._......... ---- -.._.... .... ......_-..._.............--... Nitrate-..._..._.._ ..._.._............ .. ._..- - - _.L . Sodium --......--._._. _.... .-- mg/L-------.....__........._.._..._- -�_-..._.__..... -_......10.6 -I........_.......200.7 5/11/2006---- --MC........._. - g Total Iron m /L 0.3 <0.1 200.7 5/11/2006 MC _..............---- ._._._. .._..._...._........ .........._......- — .._._.._._..............._....._.......__..... .................._......_._.._..---... _.. ...._....._....... Manganese mg/L 0.05 <Q.... ... .. ,------- Specific Conductance umhos/cm 500 137 120.1 5/11/2006 LL ..........._................. - ..._._.__......._.. - --.............._.........-- --...... _._.._......._.......-- --- __._._...........__._._... --- ...... __-_._..._...... - Comments: Low pH indicates high corrosive characteristics. Nitrate level should be monitored periodically. Water meets EPA standards and is suitable for drinking for parameters tested. Date Ronaldkri Labora ❑Analyte certtAcation is offered onlyfor nonpotable samples. Page 1 of 1 *See Attached I Town of Barnstable • ➢ARNb'rAESM 9� b 9 Board of Health Atfb MA'S A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanagi May 22, 2007 Elizabeth Nilsson PO Box 3 West Barnstable, MA 02668 RE: Variance Request to Maintain Ceiling Height at 2420 (a.k.a. 2416) Meetinghouse Way, West Barnstable Dear Ms. Nilsson, You are granted a variance from Section 105 CMR 410.401, of the State Sanitary Code, Chapter 2, Minimum Standards of Fitness for Human Habitation. This variance will allow you to continue to utilize the dwelling at 2420 (a.k.a. 2416) Meetinghouse Way, West Barnstable for human habitation with the lower floor-to- ceiling height currently in existence there. The State Sanitary Code requires a minimum floor-to-ceiling height of seven feet (84 inches) in every habitable room. However, at this dwelling, the existing floor-to-ceiling height is 80 inches within the original part of the house. You stated the original part of the house was constructed approximately 100 years ago. There is no way to structurally modify the ceiling height within the entire dwelling without expending a large sum of money. Although the lower ceilings could be a safety issue for taller individuals, the Board is of the opinion that the lower ceilings should not be a health issue for most individuals and it would be manifestly unjust to order you to raise the ceiling height in this dwelling constructed approximately 100 years ago, considering the projected cost to raise the ceilings. Sincerely yours, Wayn Miller, D. Chairman Q:/WP/NilssonCei lingVariance07 Town of Barnstable f r 13h12N5'CABL.L. r Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanji May 22, 2007 Elizabeth Nilsson P.O. Box 3 West Barnstable, MA 02668 RE: Variance Request to Maintain Ceiling Height at 2416 Meetinghouse Way Dear Ms. Nilsson, You are granted a variance from Section 105 CMR 410.401, of the State Sanitary Code, Chapter 2, Minimum Standards of Fitness for Human Habitation. This variance will allow you to continue to utilize the dwelling at 2416 Meetinghouse Way, West Barnstable for human habitation with the lower floor-to-ceiling height currently in existence there. The State Sanitary Code requires a minimum floor- to-ceiling height of seven feet (84 inches) in every habitable room. However, at this dwelling, the existing floor-to-ceiling height is 80 inches within the original part of the house. You stated the original part of the house was constructed approximately 100 years ago. There is no way to structurally modify the ceiling height within the entire dwelling without expending a large sum of money. Although the lower ceilings could be a safety issue for taller individuals, the Board is of the opinion that the lower ceilings should not be a health issue for most individuals and it would be manifestly unjust to order you to raise the ceiling height in this dwelling constructed approximately 100 years ago, considering the projected cost to raise the ceilings. rely ur ,Si , aye Miller, M.D. Cha man Q:/WP/NilssonCei lin g V ari ance07 �'za. �vaLcL �. rJ�liLs.son fox 3 (14Isst EamitaflE, -Aaiiac9uastL 02;N6`8 40 �v /ram•.� �.� �� i � -�zo -� -� .��. y d�� �o. �� �, oz� G `J' '$,..z ..E C,'i,,,,!0 f o--t ci 'tee > e ' a� ��"7!tlit/?�IIiF!(.71tt,!I!�'f�d:'t1�FP!-i-7FiFF-I�I�'1'lti7�1{I:i.!-I�II J�. Co. Eox 3 .. \ VV E1t LJQrIn'S.fC1L7LE:�:. aiiac4u4.F-tL 0,2668 „ � f i FFF Fi i iF i3iFF f : F •i j i :ii i tlf tF i !. i t f fit it f if i SF i 1fi t fEi Fi # r d Certified Mail#7006 0810 0000 3524 8233 P�OfjTalyti Town of Barnstable Regulatory Services rt + BARN STABLE. ` r IMASS• Thomas F. Geiler,Director 039. 0MA1A Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 30, 2007 Elizabeth Nilsson P.O. Box 3 West Barnstable, MA 02668 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE 11 — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 2416 Meetinghouse Way, West Barnstable was inspected on January 22, 2007 by Timothy O'Connell, Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.401 (A)- Ceiling Height—Observed living room height at 6'8". 105 CMR 410.484 - Building Identification—Observed that there was no building number affixed to building. You are directed to correct the violations listed above within thirty(30) days of your receipt of this notice by affixing proper building number to building; by bringing ceiling height up as required by 105 CMR 410.401(A). You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Q:\Order letters\Housing violations\Rental ordinance\2416 Meetinghouse Way.doc n Non-compliance will result in a fine of $100.00 per violation. Each days failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH 0ean., S., CHO Director of Public Health Town of Barnstable Cc: Danielle Beausang, Tenant Cc: Timothy O'Connell, Health Inspector QAOrder letters\Housing violations\Rental ordinance\2416 Meetinghouse Way.doc Certified Mail#0000 0000 0000 0000 0000 r Town of Barnstable • vsrna�. .+. Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 /� date nut na �t �o 3 �^ address city,state,zip o NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at ti e o\.A was inspected on-L_/22� b'I by —� (Address) , Health Inspector for the Town (date) (inspector's name_ ) of Barnstable, (Reason for inspection) The following violation(s) of the State Sanitary Code were observed: State code violation number-violation de ri tion 105 CMR 410.W84 105 CMR 410.1 6 �A 105 CMR 410. - 105 CMR 410. - Q:\Order letters\Housing violations\Rental ordinance\template.doc . 105 C _ MR 410. The following violation(s) of the Town of Barnstable Code were observed: Town code violation number-violation description) §170-_- §170-_- You are directed to correct the violations listed above within 3 ( ) days (written#) (#) of your receipt of thin`notice by y10. to I A�- You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean,R.S., CHO Director of Public Health Town of Barnstable Cc: (Name,tenant,owner,Fire Dept.,Building Dept....) Cc: Tb (Health inspector's name) (Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DOC) Q:\Order letters\Housing violations'aental ordinance\template.doc �'(1ST e�.�o n _ _ 1 '� l�inn t �a� ��: _ �. � �J '� ,�-, �, �� � -��� I ��i � . r� ��� Date 101,311 C)(D To Whom It May Concern: I, 1)CA n'l e lie 22,d o5cn i voluntarily grant permission to the Town (Tenants name) of Barnstable Health Department to inspect my dwelling unit located at (House#,Apt\Unit.#) (� (,U� lien. in accordance with the Town of Barnstable Code toA) treet name,villag ) (Chapters 59 and 170) and the State Sanitary Code (105 CMR 410.000) on ZZ )01- I p , (Date.o inspection) I hereby authorize and name � V)Z-a 1 �" I55�� to be my tenant (Tenant representative) representative for the purpose of this inspection. �:)1z,A will (Tenant representative) be accompanying the Town of Barnstable Health Department for the inspection, granting access to any and all locations (including bedrooms,bathrooms, closets, etc) including allowing the use of photographs in my rental unit and answering any legal questions on my behalf which may be asked of them. This authorization is only valid for the inspection date specified above, and must be renewed for any future inspection(s.) Tenants Signature Date \ a oG /Tjens Representative Si e \ Da Q:\Rental Ordinance\inspection.permission 2.doc FORM30 .F+ w HOBBS&WARREN'M ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF JiE ALTH CITY/TOW DEPARTMENT ADDRES GSM sey`0 O E ti -Litt TELEPH Address ___ � ---Occupant---- Floor ��ment No,— ____ No. of Occupants__ No.of Habitable Rooms_ lo.Sleeping Rooms_/-_._____ No. dwelling or rooming units_0''_( _ __N t es Name and address of owner _ T ® emarks Reg. Vio. YARD Out Bld s.: Fences: Garba e and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: t ° Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters, Cir.: ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Sta s, Flues,Vents $3feties: Kitchen Facilities 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 INSPECTION REPORT IS S NED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY " 1` INSPECTOR TITLE DATE A.M.TIME _��_ �� A.M. THE NEXT SCHEDULED REINSPECTION I�� P.M. . y. . .v.=a�^;.. .+��_.�, ....; .,_,.,__.,X y+r:+k .a. -;:.+-+,:V �rM�....:.sty, 'r,,,'` k i.r � .°� ,r'eta 4 .. .+:t 9•ae ...... .«. ...M u .. 'P _ .. . ''4� iR. f 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, 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 iQ5 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. i I t _-7C � � _ LOCUTION ' SEWa /PERMIT MO. IM57ULLER5 U&ME ADDRESS BUILDER 5 Q &MF- ADDRESS DNTE PERVAI-T ISSUED DATE COMPLI &NACE � _ _ __ ���g ��. t. I _,�S �6 � as � i .. � No.. .®... Fps..... :" _ THE -7 � q0 BOARDAOF LTH FHEALTH Ts _ OF................/ / .. .................................... Appliration -for Rapwial Works Towitrurtion Vantit Application is hereby made or a Permit to Construct or Repair an Individual Sewage Disposal PP � Y P ( ) b P / (system AQ4 \ ......................................................... wj �. ocjon dd s Y " or Lot No: , , C PPP .. caner 2 Address a ---------- -- ---------------------------------------------------------------------- ------- Installer Address ` Type of Buildi g Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms.............................................Expansion Attic ( ) Garbage Grinder. ( ) `4 Other—Type of Building ............................ No. of persons.........._................. Showers Cafeteria Other fixtures ---------------•--•-------------------------------- --------..----•--------------------------•------•----•--------- -------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. r, W Septic Tank—Liquid capacity-----.------gallons 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 ( ) Percolation Test Results Performed bY--------------------------------------------------------------------------- Date.--..----------------------------.----- ,a Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...-_.----_-.__._-.-. - �14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.----..--__--.-----..--. Description of.Soil---------------------------------------------------------------- U ---------------------------------------------------•-...----••---•-•----'-•-'---...---- ---------------------------------------------------------------------------------------------------------------- ------------ -------------------------------------------•---.............---...--------------•-'-' _ U Nature of Repairs or Alterations—Answer when ap- plicable.-�.._ ........... .:........... ------ �._ . ---- Agreement: z The undersigned .agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article NI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued by the rd of health. gned • --• -- --- Date Application Approved BY--------- --- ---- ---------_- --'•- --- -- Date Application Disapproved for the following reasons:............................................ . ------------------------------........................... ••-------•--•----•-•--------'----'------------------'----••--"----------••-•••---"-•-•--'---'--'-------....--'--•-•----•--...---'-----'--'---"'-'--------••------'-'-'----------------'-------•'----. Date Permit No. Issued....... ..--''Z ---- ........ Date No.. ....... .. Fina...... �:................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .... / l.. ..--....OF................. -: .........................--------•- Appliration -for Ui,ipootti Works Tonitrurtion Prrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System t: , f _..... :... ....................................................... ocat on Addre s or Lot No. . .. . I.... ---•-•--� `Owner `�'i' Z � --------------•----...-------•-•---•--.._...Address F V Installer Address l Q Type of Buildiri Size Lot............................Sq. feet Dwelling—No. of Bedrooms---------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building _______________________--- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ....------------------------------------------------------------------------•------------------.------_----•-----------------------------------.---- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons 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. X Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water........................ 0:4 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water--.--.---__----_---_---- a ---•-------------------------------------------------------------------------................................................................................ ODescription of Soil----------------------------------------------------------------------------------------------------------------------------------- ----------- ........................ x U ----------------------------------------------------•-•-------•--•----•-••-•-•••••------•-----•-------------------- -••---•----••••-----•---••••----.....------•-------------------------------------- x ------------------------------- ---------•-----------------.. .................................................................................................................. ------............---------------------�------------ -------- Nature Nature of Repairs or Alterations—Answer when applicable..-.!t--- �".' _� ���____.___ _ . - �t1 --------------- ----- _.. --------------------------------------------- ------------------------------------------------------------------•---•--------...----•----------•-------------------------------------------------------- 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 botrd of health. jj '"' "1 } ff.t. ! .f 111 i Date Application Approved B --!'` "�/X__� " �• ..- .f E -*f ...-" °"r ----'•......... t--.7-,,e PP PP y-------- . ----------------------------•---------Date Application Disapproved for the following reasons______________________________________________ _ .............. --••--•-••-------•.................•--•---•--•---._...-----------------•-•-•--------•-•--------------•---....._..--------•--•------•----------------------------------------------• ----•-------...---- Date -1 � 7 Permit No. Issued ........... ... ... . �+' Date THE COMMONWEALTH OF MASSACHUSETTS BOARD/F HEALTH 14,0777...................oF....... ...................... .... .. ...'..................... 0rdifiratr of TontPaurr I IS TO CERT That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...... . ..... /� 3. ------ 19-w at a �� i`7iry_ler 'Y �...v!�' wC6_� has been installed in accordance with the provisions of�A�r I XI of Che StaSanitary Code as describe in the application for Disposal Works Construction Permit No._ -------- -------------- dated...__ ___2.�...__7.�_........... THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED GUARANTEE THAT THE SYSTEM WI FUNCTION SATISFA TORY. DATE----------- -•••--. v -----------•••-•-- Inspector --- ----- -_ THE COMMONWEALTH OF MASSACHUSETTS BOARDf•; F HEALTH ............t ..OF...... ..........................................:................................ No......................... FEE----•-•--............... inottifor _ ( onrfi>anrruti Permission is hereby granted_______ "'°....° �"' '. ' Aisl__ �',.to Construct ( ) r epair ( 4anlIndividual Sewage osal System �,(� ", .� at No.-."--!�'!!r�1... -.__._..__._�... . -----�.t�s �.------------------------------------------------- Street ^s f, as shown on the application for Disposal Works Construction Perm�t;..N,o. ___. __: Dated. -._ 7-'>:�_.__.... / - . .......It ✓ r ..................... ............. Board of Health DATE...... ---------..---------------------•----- f. 1 FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS AsBuilt Page 1 of 1 •7 C �. L CATION ' 5EW0, PERMIT 1aO. IWSTQLLER 5 W&ME ADDRESS BUILDER 5 Q&MF— &.DDRE SS DATE PERMIT 1155UED DATE COMPLI&DICE http://issgl2/intranet/propdata/prebuilt.aspx?mappar=l 55030&seq=1 10/28/2011 i - EXISTING HOUSE �#2454 \ �*\ EXISTING HOUSE APPROXIMATE SEPTIC SYSTEM . Q EXISTING S 52'16'05" E VENT PIPE 404.86' J 4 \ Z .GARAGE, \ OLD BALn RN: \ U' PROPOSED \ \ OD \\ \ \ \ cry WELL \ v�i, ` \ APPROXIMATE EXISTING _ SEPTIC SYSTEM m EXISTING HOUSE WELL :. #2429 �\ LOCATION OF SEWER LINE TAKEN FROM HOME OWNERS RECORDS e \ \\ \�. PAVED DRIVE WAY O ---t 5 IX - \ .. . . y 0 2414 \ \ EXISTING HOUSE • EXISTING # ,`\ � \ �'\`\ GARAGE #2416 WELL Q \ \ `e e \\ `�\ 0 Z W w J BULK HEAD bo Z 0 N x APPROXIMATE z M SEPTIC SYSTEM W a e E eetinghouse Road ✓ — /�J`� ��� Birn table, Massachusetts PREPARED FOR © r-- S— S S— S S o00 . �,N' EXISTING HOUSE ` 272.01' ELIZABETH NILSSON #2415 N 45-45'00" yy TITLE \ o 0 o S PROPOSED WELL LOCATION PLAN \N, APPROXIMATE J.K. HOLMGREN ENGINEERING INC. SEPTIC SYSTEM \EXISTINIG� HOUSE . 6 i`' -- _S g Y j \r Registered Professional Engineers and Land Surveyors • \\` \ `�\` \� \ \- ee.e \ _ 942 West Chestnut Street Brockton, MA. 02301 NOTES: \#z V12 ,`\\` \. �`` , r _ _ Phone- (508) 583-2595 Fax - (508 -588-7518 ��"'��q� \ \ \�\ �s �\`�,�GARAGE\.� 1. . . : Email � ���JoHN \XN ` — : admin@jkholmgren.com '< HOLMGREN SEPTIC SYSTEM LOCATIONS ARE AS SHOWN IN \ , `\ \* ` \, -- C� 1 s_ CIVIL —'i BOARD OF HEALTH FILES. \\ 20 0 20 40 No 303 THIS PLAN IS BASED ON AVAILABLE RECORD INFORMATION AND SCALE IN FEET Vie' AN ON THE GROUND FIELD SURVEY BY THIS FIRM ON 10-31-11. SCALE: 1 "=20' ATE: 11-1-11 Cmi N0. BY I,DATE I REMARKS DRAWING NUMBER 1-1:201 1/NILLSON/NILLSON.DWG 2011-032