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Home My WebLink About0361 PARKER ROAD - Health --Siiibdivisibri# $IT Jenkins: Peter,Jr., Edwin &John P ` Map 176 Parcel 021 WB i 361 Parker Rd, W.Barnstable I i I i i 48420 30®f® P4 oPTNE Toh� Barnstable Town .of Barnstable AFL&Mca CPty RA MASS 3LE, _ Board of Health Q[y 5 9 MASS. m ( c s m O i 67 9• �� kkiiii �ArFD MR�� 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi April 21, 2008 Ms. Marlene Weir Definitive Subdivision#817 Chairperson, Planning Board Petitioners: Peter Jenkins, Jr., Edwin Jenkins 200 Main Street and John P. Jenkins Hyannis, MA 02601 Map 176, Parcel 021 361 Parker Rd, West Barnstable Land Surveyor: Cape and Islands Engineering Dear Ms. Weir: During the public meeting of the Board of Health held on April 8, 2008, the Board reviewed the above referenced subdivision and makes the following recommendations: • Prior to obtaining a disposal works constriction permit, the applicant shall obtain a well construction permit for each lot. Each well shall be sampled and analyzed for pH, coli form bacteria, nitrate-nitrogen, VOC's, and all the other parameters required per Board of Health standards. • Each septic system shall be designed and constructed in compliance with Title 5, the State Environmental Code, and all local Health Regulations. • Innovative-alternative (I/A) nitrogen reduction technology, such as sand filter systems, shall be incorporated into the design and construction of the septic systems on Lots 1, 2, 3, and 4. However, I/A technology will not be required on any specified lot(s) which will contain two (2)bedrooms or less. • Wastewater effluent testing shall be conducted, at each I/A testing port in accordance with the established standards of the Board of Health. The existing septic system located on Lot #5 may be used and maintained as it currently exists. However, when/if this system fails and/or when/if an increase in flow is proposed at this particular lot, innovative/alternative (I/A) nitrogen reduction technology shall be incorporated into the design and construction of the new or upgraded septic system on this Lot. Q:\Subd1vision817JenkinsDefin 2008.doe c • A quitclaim deed shall be recorded for each lot individually identifying the fact that innovative/alternative technology was incorporated into the septic system construction, requiring proper operation and additional maintenance and testing. G Each lawn area created must be covered by at least four(4) inches of loam. • All tree stumps, brush and building debris removed when clearing lots or roads must be disposed of at a licensed solid waste disposal facility. Chipping brush and tree stumps is an acceptable alternative. Burial on site is prohibited. • The Board of Health recommends that all drainage be contained onsite at each lot. • The applicant must receive an Order of Conditions from the Conservation Commission, where applicable. Very truly yours, Wayn filler, M.D. Chairman cc: Linda Hutchenrider, Town Clerk Joanne Buntich, GMD Conservation Commission Q:\SubdivisiodlUenkinsDefin 2008.doc - - •,t��.r�r_°vf`i S;i`-ate-- 6 �:►� DUNNING, KIRRANE, McNICHOLS & GARNER, L.L.P. COUNSELORS AT LAW MICHAEL A.DUNNING* EMAIL ADDRESS KEVIN M.KIRRANE SHELLBACK PLACE mdunning@dunningkirrane.com ELIZABETH A.McNICHOLS 133 ROUTE 28 BRIAN F.GARNER BOX 560 WEB SITE MASHPEE,MA 02649 dunningkirrane.com CHRISTOPHER J.KMRANE SUSAN SARD WHITE 508-477-6500 PATRICIA McGAULEY, FAX 508-477-7633 *Also admitted Illinois Bar OF COUNSEL March 17, 2008 Department of Public Health Town of Barnstable 200 Main Street Hyannis, MA 02601 Attention: Dr. Wayne Miller C/o Tom McKean RE: 361 Parker Road, West Barnstable,MA Property Owned by Peter Jenkins et al Dear Dr. Miller: Please be advised that I represent the applicant with reference to the above-entitled project,which came before the Barnstable Board of Health on Tuesday, March 1 ltn As you may know, I was unable to attend the meeting, but spoke to Thomas McKean this morning to review the Board's findings. Mr. McKean had indicated that the Board would require a shared innovative/alternative septic system. While I understand the need for an innovative/alternative system, given the small number of lots, I would appreciate reconsideration of the Board's decision so as to permit individual on-site innovative/alternative septic systems for each of these four new lots to be developed,which would have the same net effect as one shared system. I understand concerns with respect to testing and monitoring issues, but suggest they could be addressed as follows: • incorporation of conditions requiring mandated testing and monitoring on the approved subdivision plan; • incorporation of conditions in each individual deed; and • incorporation of conditions in the homeowner's association documentation. r F Request is hereby made that the matter be placed on the agenda for consideration of this matter for your April 8th meeting,which Mr. McKean indicated would be the next open meeting. Thank you for your attention to this. Very truly-yours, Michael A. Dunning MAD/jmd w:\dk8\winword\mad\clients\jerkins-board of health-miller ltr.doc 08 (12:42p Cape & Islands Engineeri 508-477-90i'2 p.1 c��ae�wotm� kie k960:6Cll1011k?W76L':JI 5i`.'1/VIEAFL-ID PARK i!9G EiAt.," IDUTf;ROAD,5U1TE301C ,.(AShfP:rE,MA 02649 is 04,',;1;7-7272 FAX(50E)47i-4072 February 19, 2008 :IVL-. Tom McKean FAX 508-790-6304 'Barnstable Board of Health 200 Main Street 'Hyarmis,MA 02601 RE: Subdivisio.r'i #817, 361 Parker Road, W Barnstable, MA Dear .Mp. McKean: Per the request of Attorney Mike Dunning, we are hereby requesting a continuance Grp—ni tonight's hearing and to be rescheduled for the next available hearing. Thank vcu for your time and considerations- Sincerely, 6 ' Charlene Antrim Project Planner �7A 10:43" 5084777633 DKMG PAGE 01/01 AW DUNNING�, KIRRANE, McNICHOLS & GARNER, L.L.P. COUNSELORS AT LAW MICHAEL A.DUNNING* FMAIL ADDRESS KEVIN M,KIRRANE SHELLBACK ry(-ACIE mdiiniiinp)dunninglu'rrane.com ELIZABETH A.McNICHOLS 133 ROUTE 28 BRIAN F.GARNER BOX 360 WEB SITE MASHPEE,.MA 02649 dunnirigkirrane.com CHR.15570PHER J.KIRRANE SUSANSAR 1,VI-IITE U-j 508-477-6500 -j r?Aft-ICI�M C"_� LEY, RAX 508-477-7&13 'Also admitted Illinois Bar ca C�Ujr .I_n C:3 r-cbruary 19, 2008 VIA FACSIMILE LLB' Cn i�� 508-790-6304 '`)epggment 4FP ublic Health fovvt of Blajstable St_r. 00.min et f-.Iyan"nis, MA' 02601 Attention: Sharon RE 361 Parker Road, West Barnstable,MA Property Owned by Peter Jenkins et al Dear Madam/Sir: I am the Commissioner appointed by the Probate Court with reference to the above- ]e'reranced property, and representing the interests of the above referenced owners in connection with this Matter. CODBXrMin„my phone conversation this morning, request is hereby made to withdraw the t1.bCyllle referenced matter from the agenda today, February 1.9'h, and request is hereby made for ];-(,-scheduling of said matter before the Board of Health to your March I Vh meeting. Based on the foregoing, I trust that.no action,will be taken, and request that you call me 'I"Vit-th reference to any questions. Thank you ;for your attention to this. Very truly yours, /-A Michael A. DunninglUAVi N,IAD/jmd CC* Cape & Islands Engineering Crocker, Sharon From: Crocker, Sharon Sent: Friday, February 08, 2008 10:27 AM To: McKean, Thomas Subject: FW: BOH - Gbdivision 1 I spoke with Charlene, Cape & Islands Eng. I didn't realize they were on the Agenda in Jan and postponed until Feb. They said Growth Mgmt kept changing plan but the majority of the changes were dealing with the road(s). She didn't think the changes had much effect on us. I explained the BOH's desire to review without time pressure but that I would check with you again. She said she'd be happy to speak with you . 508-477-7272 -----Original Message----- From: Crocker, Sharon Sent: Thursday, February 07, 2008 4:00 PM To: McKean,Thomas Subject: BOH -Subdivision Subdivision #817, postponed in Nov 2007 because they wanted to revised their plans,just brought in new plans. As this is past the 14 day cutoff, shall I put it on March (or is Subdivision different?) Please let me know. Thanks. (,A � �I CAPE & ISLANDS_ENGINEERING , J, C11 SUMMERFIELD PARK 800 FALMOUTH ROAD,SUITE 301C MASHPEE,MA 02649 (508)477-7272 FAX(508)477-9072 November 6, 20041 Mr. Tom McKean Barnstable Board of Health 200 Main Street Hyannis,MA 02601 f -RE: Subdivision#817,Parker Road, W Barnstable, MA Dear Mr:-McKean: The above referenced subdivision plan is scheduled for a public hearing on November 13,2007 P g We are in the rocess of revisin the P 4 subdivision er the 'e nest of the:. Growth Management Board. : Please remove us from 'your agenda. We will refile a new plan when the revisions are completed. Sincerely, Charlene Antrim Project Planner _ I °FtHe tOW,y Town of Barnstable Planning Board * BARNSTABLE, * 200 Main Street Hyannis, Massachusetts 02601 1639. 10�' Tel: (508) 862-4687 Fax (508) 862-4725 prED MA'S A MEMO DATE: October 9, 2007 TO: 'a<ard of Health O Police Chief O Cable Television Company O School Bus Person O Conservation Commission O Telephone Company O Electric Company O Tree Warden O Engineering Division, DPW O Water Department Superintendent O Fire District Chief O Other O Gas Company FROM: Barnstable Planning Board SUBJECT: Subdivision Plan Number: 817 Plan Entitled: Definitive Subdivision Plan Located in West Barnstable Subdivision Location: off Parker Road, West Barnstable Village: West Barnstable Engineer/Surveyor: Cape &Island Engineering, Mashpee, MA Owner's Name: Peter Jenkins and others Assessor's Map 176, Parcel 021 Zone: Residence F/RPOD The above identified subdivision plan has been submitted to the Planning Board. A Public Hearing/action has been scheduled for October 22, 2007. Please forward any recommendations or comments to the Planning Board office before this date. Sincerely Yours, Marlene Weir, Chairman McKean, Thomas From: McKean, Thomas Sent: Wednesday, October 17, 2007 8:44 AM To: Etsten, Jackie Cc: 'ciengineering@aol.com' Subject: RE: Subdivision #817 During the public meeting of the Board of Health held on October 9, 2007, the Board vote to recommend disapproval of the proposed Subdivision #817 located off of Parker Road West Barnstable due to the following: -The application "Form C" is erroneous by indicating that the development will be served by"public water." -The application form indicates the subdivision area as having 87,120 square feet with five (5) lots. This appears to be erroneous. Sincerely, Thomas McKean INFORMATIONAL NOTE: The Board of Health may require or request additional information. The applicant or representative was not present during the public meeting on October 9th. The application indicates that the proposed development lies within both a GP Zone and a WP District. According to Section 360 -38, Town of Barnstable Code, the Board of Health may require a shared innovative/alternative system (copy of section below): 360-38. Innovative/alternative systems and shared system requirements. A Consistent with the applicability provisions set forth above, the Board of Health may require any new development, and the expansion, alteration or modification or change in use of an existing development, to utilize an on-site innovative/alternative septic system or a shared innovative/alternative septic system. If an innovative/alternative shared system is required, where would it be sited? 1 a wianus cnyineen DUO-4tI_11ju(/_ P.L _ c SUBDNISION REGULATIONS 44 TOWN OF BARNS ABLE SUBDNISION RULES.AND REGULATIONS FORD C i3 APPLICATION FOR APPROVAL OF A DEFINITIVE PLAN QUM; Date: i o the Planning Boat in to Town of 5amstaole,tte un.ersigned audto, c appficanf(si of awner(s)a all tP� a° the a=rncanying Deiinibve Suhdirsiaa pan loceied and de-Mired-as follows: ?lar T de: D-f ini ve Subdivision Dlan located ir. W B Ae.. PA pr✓pared =0r vegr jef-iKlns, .Jr. rjawtIl JEI7tC1i75 JOC7L7 L . J:?G2`'.'i Plan?at: 7/25/0 7 Asessot's Mac and Farcei Numcer(sj: Mao 176 parr4 21 r` Zoning: � Prey .�'I "'S.V zer of Las 3 771�1) Drag Y42 e &_ ?glands EnzineerinC Address: .l rtOdn. JU1 S i0 �i '=5 6;7 Phone: 4 i = nerepy suomia su plan as a Definitive Suedivisior,plan in a=rdanze wi'lrr-F r;.ules and . Regular ns of the Bamstat;le?;arming,3oard. { he undersigned's HE-to said land is derived as idlows- PLEA COM?'=ire rOLLOWINu P_-rss he devetccment is onxsee from the btowrng sueegs?: Par k-r Road 2 "aye any cf the or000sec as-_-m.maos peen aesicnated as Scenic Rcacs7 yes k no ;f yes.wrjci one;sl? B. The deveioamentwil:be served:)- whirr Water sucoty Private Was i rnm Sewers Oh-Site sewne Dwasai Svsmm-s Pace Sewage Treatment=aclity 4. Is any pa.:of the deveicpment wimin tre following Laing Grouncwater Proton Overay G?znne k vas— no V one yes_;to c �W- 27- 2�2 7Z�_ , C 801 Attachment 2:9 ' TI-ol-2004 o Y ai �� voj v.�SN �a�e a isiancrs r=nymeei i ouo-�+r r-yu r P. BAMSTABLE CODE 5. Pus there: a• Awetlan� watRr'oodres en ft site? yesly,D-"'t SF no b• WIrds or inland watetmodles within 2DD feet of the perimeter of the subdivision? _..ye5 no 6. ;s any part o.`the site%tihin the MA 100 year flood piain7 yes no 2 flood plain? yes X no € I no year Vabc rly Zone? yes no 7. Is he subdivision inan Kistoric D-Wid? M X no C. In a Disst of Critixl Planning Concern as designated by the Cape Cod Cornrt L r. yes X no S. Ina location within a Cd,-A habitat as designated by the AP=19W publication'Cape Cod Critical Ha cats Atlas y85 no To the best off my imowiedga the information submitted harrMth is complete and aceurata. 453 Church Street. W Barristable, Ma 0266,'._ n�ruie Dwner Address 'ie�i�prd�rrr Peter Jenkins ;'nnt Name of Owner S' nature of Amer address Y"eleghorre g � Print Name of Owner 5igr>ahrre of Address i eleutio ie A.utharLed Applicanr PsM Name of Applr-ant Ain*nnts Authorization: 0 Y File mpy of notice wtth Tow Cleric Fle Definitive Plan with Board of Reafth °lesse,make checks psyahle to the Town of Bamstabfe Q i 801 Attachment 2:10 os-t s-zoos j � a v . � 40 .:an 32 08 03:39P Cape & Islands Engineet-i 508-477-90ir" P.1 "Imv ffam ,e— A _%'k'_/'APE & ISLAOVDS ENGINEERING PARK 800 F,6,1mOUTHROAD,Su7YE307C f',,1A_5HPFE,AAA 02649 1505)477-7272 FAX(506.1477-9072 TRANSMISSION COVER SHEET DATE SENT TO: "J-� (Firm name if any) ATTrq I"jk L FAX NO: (including area code, L r,e OF PAGES! (including cover sheet ) 11,, LU 'n -SENDER. LE, t ADDITIONAL MESSAGE: CL1 C:) C%j ifs Please carp a.ct the SEL".'DER at (508) 477-7272 immediately if b!!:.s khan the required cxz� Cj 0 ORIGINAL CONTRIBUTION i Nonpharmaceutical Interventions i Implemented by US Cities During the 1918-1919 Influenza Pandemic Howard Markel, MD,PhD Context A critical question in pandemic influenza planning is the role nonpharmaceu- Harvey B. Lipman, PhD tical interventions might play in delaying the temporal effects of a pandemic, reducing J.Alexander Navarro, PhD the overall and peak attack rate, and reducing the number of cumulative deaths. Such measures could potentially provide valuable time for pandemic-strain vaccine and anti- Alexandra Sloan,AB viral medication production and distribution. Optimally,appropriate implementation of Joseph R.Michalsen, BS non pharmaceutical interventions would decrease the burden on health care services and Alexandra Minna Stern, PhD critical infrastructure. Martin S.Cetron, MD Objectives To examine the implementation of nonpharmaceutical interventions for epidemic mitigation in 43 cities in the continental United States from September 8, HE INFLUENZA PANDEMIC OF 1918,through February 22, 1919,and to determine whether city-to-city variation in 1918-1919 was the most deadly mortality was associated with the timing, duration,and combination of nonpharma- contagious calamity in hu- ceutical interventions; altered population susceptibility associated with prior pan- man history.Approximately40 demic waves;age and sex distribution; and population size and density. d million individuals died worldwide,in- Design and Setting Historical archival research,and statistical and epidemiological cluding 550 000 individuals in the analyses.Nonpharmaceutical interventions were grouped into 3 major categories:school United States.1-4 The historical record closure;cancellation of public gatherings;and isolation and quarantine. , Main Outcome Measures Weekly excess death rate(EDR);time from the activation r demonstrates that when faced with a Y devastating pandemic, many nations, of non pharmaceutical interventions to the first peak EDR;the first peak weekly EDR;and communities, and individuals adopt cumulative EDR during the entire 24-week study period. what they perceive to be effective so- Results There were 115 340 excess pneumonia and influenza deaths (EDR, 500/ cial distancing measures or nonphar-. 100000 population)in the 43 cities during the 24 weeks analyzed.Every city adopted maceutical interventions including iso- at least 1 of the 3 major categories of non pharmaceutical interventions. School clo- sure and public gathering bans activated concurrently represented the most common combination implemented in 34 cities (79/o); this combination had a median dura- of those suspected of having contact tion.of 4 weeks(range, 1-10 weeks)and was significantly associated with reductions with those who are ill,school and se- in weekly EDR.The cities that implemented nonpharmaceutical interventions earlier lected business closure,and public gath- had greater delays in reaching peak mortality (Spearman r=-0.74, P<.001), lower ering cancellations.','One compelling peak mortality rates(Spearman r=0.31,P=.02),and lower total mortality(Spearman question emerges:can lessons from the r=0.37, P=.008). There was a statistically significant association between increased 1918-1919 pandemic be applied to con- duration of non pharmaceutical interventions and a reduced total mortality burden(Spear- temporary pandemic planning efforts man r=-0.39,P=.005). to maximize public health benefit while Conclusions These findings demonstrate a strong association between early, sus- minimizing the disruptive social con- tained,and layered application of nonpharmaceutical interventions and mitigating the sequences of the pandemic as well as consequences of the 1918-1919 influenza pandemic in the United States.In planning those accompanyingublic health re- for future severe influenza pandemics,non pharmaceutical interventions should be con- , p sidered for inclusion as companion measures to developing effective vaccines and medi- cations for prophylaxis and treatment. Most pandemic influenza policy IAMA.'2007;298(6):644-654 www.jama.com makers agree that even the most rigor- ous nonpharmaceutical interventions are unlikely either to prevent a pan- Author Affiliations:Center for the History of Medi- vention,Atlanta,Georgia(Drs Lipman and Cetron). demic or change a population's under- cine,University of Michigan Medical School,Ann Ar- Corresponding Author:Martin S.Cetron,MD;Divi- lying biological susceptibility to the bor(Drs Markel,Navarro,and Stern,and Ms Sloan sion of Global Migration and Quarantine,Centers for and Mr Michalsen);and Division of Global Migration Disease Control and Prevention,1600 Clifton Rd,Mail- pandemic virus. However, a growing and Quarantine,Centers for Disease Control and Pre- stop E-03,Atlanta;GA 30333(mcetron@cdc.gov). 644 JAMA,August 8,2007—Vol 298,No.6 i VACCINE FINANCING FOR US UNDERINSURED CHILDREN i i Statistical analysis:Lee. cines&Immunizations:Programs&Tools:CDC Vac- of heptavalent pneumococcal conjugate vaccine.Am Obtained funding:Messonnier,Lieu. cine Price List. http://www.cdc.gov/nip/vfc J Public Health.2006;96(7):1308-1313. Administrative,technical,ormaterialsupport:Hannan, /cdc_vac_price_list.htm.Accessed January 12,2007. 12. Miles MB, Huberman AM. Qualitative Data Messonnier,Rusinak,Gay. Prices last reviewed/updated June 21,2007. Analysis.2nd ed.Thousand Oaks,CA:Sage Publica- Study supervision:Lee,Rusinak,Lieu. 3. Centers for Disease Control and Prevention(CDC). tions Inc;1994. Financial Disclosures:None reported. National,state,and urban area vaccination coverage 13. NVivo version 2.0[computer program). Mel- Funding/Support:This study was funded by grant among children aged 19-35 months-United States, bourne,Australia:QSR International Pty Ltd;2002. lUO11P000029-01 from the Centers for Disease 2004. MMWR Morb Mortal Wkly Rep. 2005; 14. Centers for Disease Control and Prevention.Vac- Control and Prevention, National Immunization 54(29):717-721. cines&Immunizations:Programs&Tools:CDC Vac- Program. Dr Lee was supported by grant K-08 4. Centers for Disease Control and Prevention.Press cine Price List. http://www.cdc.gov/nip/vfc HS013908-01 Al from the Agency for Healthcare release:racial disparities in childhood immunization cov- /cdc_vac_price_list.htm.Accessed June 7,2007. Research and Quality. erage rates closing.http://www.cdc.gov/od/oc/media 15. Maciosek MV,Edwards NM,Coffield AB,et al. Role of the Sponsor:The Centers for Disease Control /pressrel/r060914.htm.Accessed June 8,2007. Priorities among effective clinical preventive services: and Prevention participated in the design and con- 5. Financing Vaccines in the 21st Century:Assuring methods.Am l Prev Med.2006;31(1):90-96. duct of the study,in the interpretation of the data, Access and Availability. Washington,DC:National 16. Davis MM,Ndiaye SM,Freed GL,Kim CS,Clark and in the review and approval of the final manu- Academic Press;2004. SJ. Influence of insurance status and vaccine cost script.The Agency for Healthcare Research and 6. Centers for Disease Control and Prevention.VFC: on physicians'administration of pneumococcal con- Quality had no role in the design and conduct of the the ACIP-VFC vaccine resolutions.http://www.cdc jugate vaccine.Pediatrics. 2003;112(3 pt 1):521- study,in the collection,analysis,and interpretation of gov/vaccines/programs/vfc/acip-vfc-resolutions 526. the data,or in the preparation,review,or approval of htm.Accessed June 11,2007. 17. Arnold PJ,Schlenker TL.The impact of healthcare the manuscript. 7. Santoli JM,Rodewald LE,Maes EF,Battaglia MP, financing on childhood immunization practices.Am J Additional Contributions:We thank all the state and Coronado VG.Vaccines for Children program,United Dis Child.1992;146(6):728-732. city immunization program managers who partici- States,1997.Pediatrics.1999;104(2):el5. 18. The Kaiser Family Foundation.Employer Health pated in the study.We also thank Lance Rodewald,MD, 8. Centers for Disease Control and Prevention. En- Benefits 2006 Summary of Findings.http://www.kff National Center for Immunization and Respiratory Dis- rollmentof public and private healthcare provider sites. org/insurance/7527/.,Accessed January 2,2007. eases,Centers for Disease Control and Prevention,for http://www.cdc.gov/nip/`vfc/st_immz-proj/data/enroll 19. Committee on Child Health Financing;Ameri- his advice and input on this study.Dr Rodewald did not _hcpsites.htm.Accessed February 15,2007. can Academy of Pediatrics,Johnson AD,Wegner SE. receive any compensation for his contribution. 9. Fairbrother G,Kuttner H,Miller W,et al.Findings High-deductible health plans and the new risks of con- from case studies of state and local immunization sumer-driven health insurance products.Pediatrics. programs. Am J Prev Med. 2000;19(3)(suppl): 2007;119(3):622-626. REFERENCES 54-77. 20. Himmelstein DU,Woolhandler S.Care denied:US 10. Banthin JS,Bernard DM.Changes in financial bur- residents who are unable to obtain needed medical 1. Davis MM,Zimmerman 1L,WheelerJR,Freed GL. dens for health care:national estimates for the popu- services.Am J Public Health.1995;85(3):341-344. Childhood vaccine purchase costs in the public sec- lation younger than 65 years,1996 to 2003.JAMA. 21. Freed GL,Clark SJ,Pathman DE,Schectman R, tor: past trends,future expectations.Am J Public 2006;296(22):2712-2719. Serling J. Impact of North Carolina's universal vac- Health.2002;92(12):1982-1987. 11. Stokley S,Shaw KM,Barker L,Santoli JM,Shefer cine purchase program by children's insurance status. 2. Centers for Disease Control and Prevention.Vac- .A..Impact of state vaccine financing policy on uptake Arch Pediatr Adolesc Med.1999;153(7):748-754. i P c I I i JAMA,August 8,2007-Vol 298,No.6 643 S INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC body of theoretical modeling research ies.These 43 cities were among the 66 that era, as well as a recent retrospec- suggests that nonpharmaceutical inter- most populous urban centers according tive statistical analysis,we estimated that Nventions might play a salubrious role to the 1920 census,and all had a popu- those who succumbed to influenza con- in delaying the temporal effect of a pan- lation greater than 100 000. Of the 66 tracted it 10 days earlier.3,24-27 demic; reducing the overall and peak most populous cities,the remaining 23 The onset of the epidemic in a par- attack rate; and reducing the number hadincomplete archival and mortality rec- ticular city was estimated as either the of cumulative deaths."-" Such mea- ords.No city with a comprehensive ar- day of the first reported pneumonia and sures could potentially provide valu- chival record of nonpharmaceutical in- influenza case, or the calendar day of able time for production and distribu- terventions was excluded. The Weekly the first recorded pneumonia and in- tion of pandemic-strain vaccine and Health Index is the most complete extant fluenza death minus 10 days, which- antiviral medication.Optimally,appro- compilation of weekly pneumonia and ever was earlier. Information on non- priate implementation of nonpharma- influenza mortality data in US urban areas pharmaceutical interventions was ceutical interventions would decrease during the 1918-1919 pandemic. captured by reviewing at least 2 daily, the burden on health care services and In addition, we captured all of the high-circulation newspapers for each critical infrastructure. available public health documents on city and available municipal or state The historical record of the 1918- nonpharmaceutical interventions imple- health reports.Nonpharmaceuticalin- 1919 influenza pandemic in the United mented by these 43 cities during the 1918- terventions were grouped into 3 ma- States constitutes one of the largest re- 1919 pandemic, including municipal jor categories: school closure; public corded experiences with the use of non- public health department annual and gathering bans;and isolation and quar- pharmaceutical interventions to miti- monthly reports and weekly bulletins; antine. We also considered an addi- gate an easily spread,high mortality and every state and federal report on the 1918- tional general category of ancillary non- morbidity influenza virus strain(ie,a cat- 1919 influenza pandemic published be- pharmaceutical interventions (eg, egory 4-5 pandemic using the Centers for tween 1917 and 1922;US Census pneu- altering work schedules, limited clo- Disease Control and Prevention Febru- monia and influenza mortality data from sure or regulations of businesses,trans- ary 2007 Interim Pre-Pandemic Planning 1910-1920;the corpus of published his- portation restrictions,public risk com- Guidance).16 Our study focused on this torical,medical,and public health litera- munications,face mask ordinances). data set by assessing the nonpharmaceu- ture on the 1918-1919 pandemic;86 dif- Nonpharmaceutical interventions tical interventions implemented in 43 cit- ferent newspapers from the 43 different were considered either activated("on") ies in the continental United States from cities;records of US military installations or deactivated("off'),according to data September 8,1918,through February 22, between 1917-1920;and additional hold- culled from the historical record and 1919, a period that encompasses all of ings housedin several major libraries and daily newspaper accounts. Specifi- . the second pandemic wave(September- archival repositories(the complete bib- cally, these nonpharmaceutical inter- December 1918)and the first 2 months liography of the 1144 primary and sec- ventions were legally enforced and af- of the third wave(January-April 1919) ondary sources is available as an online fected large segments of the city's and represents the principal time span supplement at http://www.cdc.gov population.Isolation of ill persons and of activation and deactivation of non- /ncido(l/dq/index.htm).17-23 quarantine of those suspected of hav- pharmaceutical interventions.The pur- ing contact with ill persons refers only pose was to determine whether city-to- Data Analysis to mandatory orders as opposed to vol- city variation in mortality was associated From the census reports,we extracted untary quarantines being discussed in with the timing, duration, and combi- the weekly pneumonia and influenza our present era.School closure was con- nation(or layering) of nonpharmaceu- mortality data-covering the 24 weeks sidered activated when the city offi- tical interventions; altered population from September 8, 1918, through Feb- cials closed public schools(grade school susceptibility associated with prior pan- ruary 22, 1919, for the 43 US cities. In through high school);in most,but not demic waves;age and sex distribution; 1920, these 43 cities had a combined all cases,private and parochial schools and population size and density. population of approximately 23 mil- followed suit. Public gathering bans lion(22%of the total US population).A typically meant the closure of saloons, METHODS small number of missing values (846 public entertainment venues, sport- Data Collection [0.6%] of 136 563 deaths) was im- ing events,and indoor gatherings were . We combined systematic historical data puted.Using estimated weekly baseline banned or moved outdoors; outdoor collection and contemporary epidemio- pneumonia and influenza death rates gatherings were not always canceled logical and statistical analytic tools.Mor- generated from the 1910-1916 median during this period(eg,Liberty bond pa- talitydata were obtained from the US Cen- monthly values found by Collins et al,18 rades);there were no recorded bans on sus Bureau's Weekly Health Index"for weekly excess death rates (EDR) were shopping in grocery and drug stores. 1918-1919,a series of reports listing total computed.Based on available mortality Based on an estimated 10-day time k deaths and death rates for 43 large US cit- data and epidemiological reports from frame between disease onset and death, JAMA,August 8,2007—Vol 298,No.6 645 C � a 1 INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC j we estimated that the association of ever,most cities had positive PHRT in ies above and below the median of each nonpharmaceutical interventions with that they reacted after the 2 X baseline independent variable. reductions in EDR occurred 10 days mortality threshold,indicating that the We also generated scatterplots and after their actual date of implemen- epidemic had already entered its accel- Spearman rank correlation coefficients 3 24-27 tation. • eration phase. The second indepen- to explore other potential or confound- j To test the association of the layering dent variable was total days of non- ing associations(as independent deter- and timing of nonpharmaceutical inter- pharmaceutical interventions, which minants): (1) EDR in the 4 successive ventions with mortality,an analysis of was defined as the total cumulative waves of the pandemic;(2)city-specific variance (4NOVA) model was con- number of days that nonpharmaceuti- population size vs EDR; (3) city- structed with weekly EDR as the gepen- cal interventions from the 3 major cat- specific population density vs EDR; (4) J dent variablre and epidemiological'week, egories were activated during the en- city-specific population age distribu- city,and the status(on/off)of every com- tire 24-week study period. tion vs EDR;and(5)city-specific sex dis- bination of nonpharmaceu ticalinterven- The ANOVA models were based on tribution vs EDR. Analyses were per- tions as the independent variables.In the the study design of a 43 (city)X 24 formed using SAS statistical software ANOVA model,each possible combina- (week)factorial design without replica- version 9.1(SAS Institute Inc,Cary,NC). tion of nonpharmaceutical interventions tion.Because there is no replication,the was treated as an independent variable city X week interaction term was treated RESULTS to test for layering effects.Any factor with as the error term in the multivariate analy- There were 115 340 excess pneumonia a P value of less than.10 was included sis.We considered 4 different nonphar- and influenza deaths (EDR, 500/ in the model.Because there is ambigu- maceutical interventions. Hence, there 100 000 population)in the 43 cities dur- ity over the rigor with which the category are 15 different combinations of these ing the 24 weeks analyzed. TABLE 1 of ancillary nonpharmaceutical interven- interventions (excluding the no inter- shows considerable city-to-city varia- tions was applied,enforced,and deac- vention combination).Each of these 15 tion in mortality profiles and interven- tivated,we focused primarily on the 3 combinations was either implemented tion characteristics;lists the earliest re- major categories of nonpharmaceutical (on) or not implemented (off) in each ported dates of the first pneumonia and interventions discussed above and we city for each week. Thus, the effects of influenza cases by city,mortality accel- included the ancillary nonpharmaceu- each of these combinations of nonphar- eration(2 X baseline EDR),first imple- i tical interventions in the multivariate maceutical interventions are included in mentation of nonpharmaceutical inter- model for purposes of completeness. the city X week interaction term.Each of ventions, and first peak EDR;and lists We defined additional outcome(de- these terms(along with their X city and the values for each of the independent pendent)variables:(1)the time to first X week interaction terms)were extracted and outcome variables described above. peak as the time in days from the acti- from the original city X week interac- TABLE 2 shows the categories of non- vation of the first major category of non- tion term. The remaining unexplained pharmaceutical intervention combina- pharmaceutical interventions to the date variation was used as the error term in tions,the number of cities implement- of the first peak EDR; (2) the magni- the ANOVA model.The remaining error ing those combinations,and the median tude of the first peak as the first peak term is likely to be larger than a true error and range of duration of implementa- weekly EDR;and(3)the mortality bur- term generated through replication so the tion by each of the 43 cities during the den as the cumulative EDR during the analysis of any effects using this error study period.Every city adopted at least entire 24-week study period. term can be expected to be conserva- 1 of the 3 major categories of nonphar- We also defined the following inde- tive.Such a factorial model without rep- maceutical interventions;15 applied all pendent variables. The first was the lication can be used to test hypotheses 3 categories of nonpharmaceutical in- III public health response time(PHRT)as but the lack of natural error in the model terventions concurrently. School clo- the time in days(either positive or nega- makes estimates or predictions from the sure concurrently combined with pub- tive) between the date when weekly model such as effect size measures and lic gathering bans represented the most EDR first exceeds twice the baseline confidence intervals nonestimable. common combination,implemented in pneumonia and influenza death rate We also generated scatterplots and 34 cities (79%) for a median duration (2 X baseline;ie,when the mortality rate Spearman rank correlation coefficients of 4 weeks(range,1-10 weeks).School begins to accelerate) and the activa- to explore the associations between closure was ultimately used in some tion of the first major nonpharmaceu- PHRT and each of the 2 additional de- combination with the other categories tical interventions. Interventions that pendent variables and associations be of nonpharmaceutical interventions by 1 occurred prior to this reference point tween total days of nonpharmaceutical 40 cities (93%). Three cities never of- are recorded as negative PHRT values, interventions and mortality burden.We ficially closed their schools(New York indicating that public health officials re- further investigated these associations by City,New York,New Haven,Connecti- sponded to events prior to the accel- using box plots and Wilcoxon rank sum cut,and Chicago,Illinois,although the eration of weekly death rates. How- tests to compare the outcomes for the cit- latter reported a student absenteeism 646 JAMA,August 8,2007—Vol 298,No.6 i INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC rate of >_45% at the peak of its epi- sas City,Missouri)closed its schools 3 The ANOVA multivariate model had demic); 25 cities closed their schools times. Schools were officially closed a an r'of 86.7%(P<.001).Nonpharma- once,14 closed them twice,and 1(Kan- median of 6 weeks(range,0-15 weeks). ceutical interventions were a significant Table 1.Characteristics of Influenza Pandemic for 43 US Cities Between September 8,1918,and February 22, 1919 ' Excess Pneumonia Magnitude of and Date of First Peak, Influenza Public Peak Excess Mortality, First Mortality Date of First Health Total No.of Days of Excess Deaths/ Deaths/ Case Acceleration Nonpharmaceutical Response Nonpharmaceutical Death Time to 100000 100000 City Date Datea Intervention Time,db Interventions Rate Peak,d Population° Populationd Albany,NY 9/27 10/6 10/9 3 47 10/24 15 161.8 553.2 Baltimore,MD 9/18 9/29 10/9 10 43 10/18 9 182.1 559.3 Birmingham,AL 9/24 9/30 10/9 9 48 10/22 13 70.9 591.8 Boston,MA 9/4 9/12 9/25 13 50 10/3 8 159.9 710.0 Buffalo,NY 9/24 9/28 10/10 12 49 10/22 12 140.9 529.5 Cambridge,MA 9/4 9/11 9/25 14 49 10/3 8 125.5 541.0 Chicago,IL 9/17 9/28 9/26 -2 68 10/21 25 84.8 373.2 Cincinnati,OH 9/24 10/4 10/6 2 123 10/24 18 67.6 451.2 Cleveland,OH 9/20 10/7 10/5 -2 99 10/31 26 83.6 474.0 Columbus,OH 9/20 10/6 10/11 5 147 10/24 13 47.3 311.7 Dayton,OH 9/20 10/5 9/30 -5 156 10/20 20 87.8 410.0 Denver,CO 9/17 9/27 10/6 9 151 10/20 14 55.0 630.9 Fall River,MA 9/9 9/16 9/26 10 60 10/12 16 165.2 621.3 Grand Rapids,MI 9/23 10/2 10/19 17 .62 10/25 6 15.0 210.5 Indianapolis,IN 9/22 9/30 10/7 7 82 10/18 11 38.8 290.0 Kansas City,MO 9/20 9/26 9/26 0 170 10/27 31 58.1 579.8 Los Angeles,CA 9/27 10/6 10/11 5 154 10/30 19 64.2 493.8 Louisville,KY 9/13 10/1 10/7 6 145 10/20 13 74.8 406.4 Lowell,MA 9/9 9/16 9/27 11 59 10/10 13 123.1 522.9 Milwaukee,WI 9/14 10/6 10/11 5 132 10/23 12 36.4 291.5 Minneapolis,MN 9/21 10/6 10/12 6 116 10/24 18 37.6 267.1 Nashville,TN 9/21 10/6 10/7 1 55 10/16 9 160.1 610.4 New Haven,CT 9/14 9/23 10/15 22 39 10/24 9 109.5 586.5 New Orleans,LA 9/10 10/1 10/8 7 78 10/20 12 172.9 734.0 New York City,NY 9/5 9/29 9/18 -11 73 10/23 35 90.1 452.3 Newark,NJ 9/6 9/30 10/10 10 33 10/22 12 101.5 533.0 Oakland,CA 10/1 10/8 10/12 4 127 10/30 18 107.0 506.2 Omaha,NE 9/18 10/4 10/5 1 14Q 10/18 13 81.7 554.0 Philadelphia,PA 8/27 9/25 10/3 ' 8 51 10/16 13 249.7 748.4 Pittsburgh,PA 9/4 9/27 10/4 7 53 11/5 32 130.7 806.8 Portland,OR 10/2 10/7 10/11 4 162 11/2 22 59.4 505.2 Providence,RI 9/8 9/17 10/6 19 42 10/17 11 105.2 574.2 Richmond,VA 9/21 9/29 10/6 7 60 10/16 10 112.2 508.3 Rochester,NY 9/22 10/6 10/9 3 54 10/26 17 70.2 359.1 St Louis,MO 9/23 10/7 10/8 1 143 10/29 21 30.0 358.0 St Paul,MN 9/21 10/2 11/6 35 28 11/12 6 55.6 413.2 San Francisco,CA 9/24 10/7 10/18 11 67 10/29 11 143.0 672.7 Seattle,WA 9/24 10/1 10/6 5 168 10/23 17 49.5 414.1 Spokane,WA 9/28 10/9 10/10 1 164 11/5 26 66.0 481.8 Syracuse,NY 9/12 9/18 10/7 19 39 10/14 7 145.4 541.4 Toledo,OH 9/21 10/13 10/15 2 102 10/25 10 54.8 294.5 Washington,DC 9/11 9/23 10/3 10 64 10/15 12 140.1 607.6 Worcester,MA 9/9 9/12 9/27 15 44 10/7 10 126.1 654.7 aDefned as 2 x baseline death rate. bDefined as days between 2 x baseline death rate and first nonpharmaceutical intervention. C Weekly excess death rate. dTotal excess death rate through 24 weeks. JAMA,August 8,2007-Vol 298,No.6 647 4 INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC Table 2.Nonpharmaceutical Interventions Implemented in 43 US Cities Between September and the most sustained and most days of 8, 1918,and February 22, 1919 nonpharmaceutical interventions had a No.(%)of Cities statistically significant reduction in excess Implementing Median(Range) pneumonia and influenza mortality rates Nonpharmaceutical Duration of compared with the 21 cities that had later Intervention Nonpharmaceutical Type of Nonpharmaceutical Intervention for>_1 wk(N=43)a Intervention,wk PHRT and fewer days of nonpharmaceu- Isolation or quarantine only 15(35) 1 (1-10) tical interventions(Table 4). School closure only 22(51) 1 (1-7) FIGURE 2 shows the aggregate city Public gathering ban only 6(14) 1.5(1-5) mortality curves by region(East,Mid- Isolation and quarantine and school closure 2(5) 5.5(4-7) west And South, and West). FIGURE 3 Isolation and quarantine and public gathering ban 4(9) 4(2-5) displays 4 city-specific mortality curves, School closure and public gathering ban 34(79) 4(1-10) including weekly EDR and the non- Isolation and quarantine,school closure, 15(35) 4(2-6) pharmaceutical interventions imple- and public gathering ban mented as well as their activation and aCities often implemented more than 1 nonpharmaceutical intervention combination during the outbreak period,so the total adds to more than 100%.The number of categories of nonpharmaceutical interventions implemented dur- deactivation dates for St Louis, Mls- ing some part of the outbreak was 1 in 1 city,2 in 23 cities,and 3 in 19 cities.The total number of weeks that at least souri, New York City, Denver, Colo- 1 nonpharmaceutical intervention was implemented was 4 in 6 cities,5 in 6 cities,6 in 8 cities,7 in 3 cities,8 in 6 cities,10 in 5 cities,11 in 4 cities,13 in 1 city,14 in 2 cities,15 in 1 city,and 16 in 1 city.No cities had at least 1 rado, and Pittsburgh, Pennsylvania. nonpharmaceutical intervention implemented for durations of 9 and 12 weeks. These 4 cities were chosen because they indicate the broad spectrum of out- source of the variation in the weekly pharmaceutical interventions earlier comes seen in the 43 cities studied as EDRs within and between the cities.The had greater delays in reaching peak well as for their geographical and so- ANOVA results are shown in TABLE 3. mortality (Spearman r=—0.7 4, cial diversity.(The mortality curves for The multivariate model demonstrates P<.001). Figure 113 shows the asso- all 43 cities are available at http://www that layered nonpharmaceutical inter- ciation between PHRT and the magni- cdc.gov/ncidod/dq/index.htm.)Over- ventions generally had a more signifi- tude of the first peak EDR; cities that all, cities that implemented nonphar- cant association with weekly EDR than implemented nonpharmaceutical in- maceutical interventions earlier individual nonpharmaceutical interven- terventions earlier had lower peak mor- experienced associated delays in the tions.Specifically,combinations of non- tality rates(Spearman r=0.31,P=.02). time to peak mortality,reductions in the pharmaceutical interventions includ- Figure 1C depicts the association be- magnitude of the peak mortality, and ing school closure and public gathering tween PHRT and total mortality bur- decreases in the total mortality burden. bans appeared to have the most signifi- den;cities that implemented nonphar- In exploring alternative and poten- cant associationwith weekly EDR(ie,the maceutical interventions earlier tially confounding explanations for varia- lowest P values,most were P<.001).The experienced a lower total mortality tion in city-specific EDR,we used a scat- large number of significant nonpharma- (Spearman r=0.37, P=.008). In sum- terplot to compare the cumulative EDR ceutical interventions X week interac- mary, when comparing the 21 cities of the 43 cities during pandemic waves tions in the model confirms that the tim- with earlier (less than the median) 1 (February-May 1918),2(September- ing of the implementation of a given PHRT with the 21 cities with the later December 1918),3(January-April 1919), combination of nonphannaceutical inter- (greater than the median)PHRT,there and 4(January-April1920).z,3We found ventions was a significant factor in reduc- are statistically significant differences no statistically significant association of ing mortality. One caveat is persistent for each of the outcome measures the EDR across the 43 cities when com- nonpharmaceutical interventions X city (P<_.001;TABLE 4). paring successive waves.Specifically,the interactions,meaning that the success of Figures 1 C and 1D show the associa- severity or occurrence of wave 1 is not a strategy of nonpharmaceutical inter- tionbetween early,sustained,andlayered associated, either positively or nega- ventions in a particular city does not uni- application of nonpharmaceutical inter- tively, with the severity of wave 2; the formly translate to all other cities.The 2 ventions and total excess pneumonia and severity of wave 2 is not associated with outlier cities in our study, Grand Rap- influenza mortality burden in 43 cities. the severity of wave 3;and the seventy ids, Michigan,and St Paul,Minnesota, Figure 1 C shows the statistically signifi- of wave 3 is not associated with the sever- exemplify this point. cant association between PHRT and total ity of wave 4(figures appear in the online The scatterplots in. FIGURE 1A, mortality burden.Figure ID shows asta- supplement at http://www.cdc.gov Figure 113, and Figure 1C display the tistically significant association between /ncidod/dq/index.htm).'," associations between the PHRT and increased duration of nonpharmaceuti- Pubhshedvirologicalevidenceforstrain each of the 3 dependent variables. cal interventions and a reduced total variation during wave 2 is limited to a Figure IA displays the association be- mortality burden (Spearman r=-0.39, single genotypic variantwithout evidence tween PHRT in days and time to first P=.005).In summary,the 21 cities that for significant phenotypic change in peak EDR;cities that implemented non- had earlier PHRT(ie,less than the median) virulence.30-33 While plausible,no virologi- 648 JAMA,August 8,2007—Vol 298,No.6 �I INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC I cal evidence yet exists to explain the per- Similarly,scatterplots comparing the in 1918 demonstrated no association. plexing mortality difference between the cumulative EDR to the city-specific popu- Among the 43 cities we investigated,nei- spring 1918 wave,which was reportedly lation size and density;sex distribution; ther the cit}�s population size,density,sex milder,and the subsequent fall and win- and proportion of ages of younger than distribution, nor age distribution ac- ter waves.Additional studies may clarify 1 month to 5 years, 15 to 40 years,and counted for the differences in mortality the understanding of the 1918 pandem- older than 65 years,which corresponded (figures appear in supplement at http: ic's wave phenomena. to high reported specific mortality rates //www.cdc.gov/ncidod/dq/index.htm). Table 3.Multivariate Model Showing Effect of Combinations of Nonpharmaceutical Interventions on Weekly Excess Death Rates for 43 US Cities Between September 8,1918,and February 22, 19191 Sum of Mean Source of Variation of Squares Square F Score P Value Type of confounders Week 29 75677.0 2609.6 16.24 <.001 City 42 65557.9 1560.9 9.72 <.001 1 Nonpharmaceutical intervention School closure 1 1288.7 1288.7 8.02 .005 x Week 8 4551.8 569.0 3.54 <.001 Banning public gatherings 1 1342.0 1342.0 8.35 .004 Isolation and quarantine 1 911.1 911.1 5.67 .02 x City 10 3976.5 397.7 2.48 .006 Ancillary nonpharmaceutical interventions 1 897.3 897.3 5.59 .02 x Week 13 6122.4 471.0 2.93 <.001 x City 12 10257.6 854.8 5.32 <.001 2 Nonpharmaceutical interventions School closure and banning public gatherings 1 681.3 681.3 4.24 .04 x Week 9 6497.0 721.9 4.49 <.001 x City 13 6229.9 479.2 2.98 <.001 School closure and isolation and quarantine 1 -2335.3 2335.3 14.54 <.001 x Week 4 2434.2 608.6 3.79 .005 Banning public gatherings and isolation and quarantine 1 292.3 292.3 1.82 .18 x Week 1 563.9 563.9 3.51 .06 Banning public gatherings and ancillary nonpharmaceutical interventions 1 272.6 272.6 1.70 .19 x Week 4 7444.6 1861.1 11.59 <.001 x City 4 5547.6 1386.9 8.63 <.001 Isolation and quarantine and ancillary nonpharmaceutical interventions 1 48.1 48.1 0.30 .58 x Week 2 1507.6 753.8 4.69 .009 x City 2 824.7 412.4 2.57 .08 3 Nonpharmaceutical interventions School closure,banning public gatherings,and isolation and quarantine 1 762.4 762.4 4.75 .03 x Week 2 2239.3 1119.7 6.97 .001 School closure,banning public gatherings,and ancillary 1 691.6 691.6 4.41 .04 nonpharmaceutical interventions x Week 10 12260.5 1226.0 7.63 <.001 x City 26 51423.8 1977.8 12.31 <.001 School closure,isolation and quarantine,and ancillary 1 3451.1 3451.1 21.48 <.001 nonpharmaceutical interventions x Week 4 2493.5 623.4 3.88 .004 Banning public gatherings,isolation and quarantine,and ancillary 1 51.9 51.9 0.32 .57 nonpharmaceutical interventions x Week 8 4535.2 566.9 3.53 <.001 4 Nonpharmaceutical interventions School closure,banning public gatherings,isolation and quarantine, 1 503.7 503.7 3.14 .08 and ancillary nonpharmaceutical interventions x Week 9 6068.3 674.3 4.20 <.001 x City 13 23509.7 1808.4 11.26 <001 Error 770 123 691.2 160.6 arz=86.7% JAMA,August 8,2007-Vol 298,No.6 649 INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC COMMENT been key factors in their success or failure. pandemic virus in a community was dif- During the 1918-1919 influenza pan- In 1918,decisions to activate nonphar- ficult,we chose to measure public health demic, all 43 cities eventually imple- maceutical interventions were typically response time in reference to excess mented nonphannaceutical interventions triggered by excess morbidity,mortality, pneumonia and influenza mortalityOe, but the time of activation,duration,and or both,as well as situational awareness whenweekly EDR first crossed the thresh- ' choice or combination of these nonphar- ofother communities nearand far.Because old of 2 X the baseline and the mortality maceutical interventions appear to have discerning precisely.the first arrival of rates entered an acceleration phase). Figure 1.Scatterplot of Public Health Response Time for 43 US Cities From September 8, 1918,Through February 22, 1919 �A Time to first mortality peak by public ©Magnitude of first-mortality peak by public health response time health response time New York City,NY 35 • r=-0.74 0 250 O r=0.31 0 30 •Pittsburgh,PA P<001 a P=.02 ro 25 e 0 a 200 O O o m St Louis, • 0 0 00 0 0 20 O cco L � 00 0 150 Pitts urgh,PA• O CO o 0 15 O ODenver,CO y New York City,NY O 0 O E W 10 00 0 0 50 • O O O 0 0 O 0 St Paul,MIN O *Denver,CO St Paul,MNO 5 Grand Rapids,MI w St Louis,M • 0 0 O Grand Rapids,MI -15 -10 -5 0 5 10 15 20 25 30 35 -15 -10 -5 0 5 10 15 20 25 30 35 Public Health Response Time,d Public Health Response Time,d ©Total excess pneumonia and influenza mortality ❑D Total excess pneumonia and influenza mortality by by public health response time total No.of days of nonpharmaceutical interventions .0 800 •Pittsburgh,PA r=0.37 o Pittsburgh,PA r=-0.39 5 P=.008 j 800 0 P=.005 d 700 0 0 700 O 0 o Denver,CO O 0 ao 0 O Denver,CO• 0 600 O �� 0 0 0 600 O.,O O00 O O 500 New York O 0 %0 O O 0 O Ca 0 0 O w *City,NY 0 00 00 500 • 0 0 O is 400 0 GO St Paul,MN O 6 400` O St Paul,MN New York City,NY 0 O O p O •O O 0 St Louis,MO• St Louis,M N 300 O SOO N 300 O O O 0 200 Grand Rapids,MI 200 Grand Rapids,MI 0 -15 -10 -5 0 5 10 15 20 25 30 35 20 40 60 80 100 120 140 160 Public Health Response Time,d Total No.of Days of Nonpharmaceutical Interventions The 4 cities represented by black circles are discussed further in the text.The 2 cities represented by blue circles are outliers chosen to demonstrate that the associations shown are not perfect.The Spearman rank correlation coefficient was used. Table 4.Implementation Strategy of Nonpharmaceutical Interventions for 21 Cities Between September 8, 1918,and February 22, 1919 Public Health Response Time,d Early(<7 d) Late(>7 d) 25th 50th 75th 25th 50th 75th P Outcome Variable Percentile Percentile Percentile Percentile Percentile Percentile Value Time to peak,d 13 18 22 9 11 13 <.001 Magnitude of first peak(weekly EDR) 54.7 67.6 84.8 101.5 125.8 145.4 .001 Excess pneumonia and influenza 359.1 451.2 505.2 529.5 580.3 654.7 <,001 mortality rate(total EDR) Total Days of Nonpharmaceutical Interventions Most(>_65 d) Least(<65 d) Excess pneumonia and influenza 358.0 451.2 505.2 529.5 559.3 610.4 <.001 mortality rate(total EDR) Abbreviation:EDR,excess death rate. 650 JAMA,August 8,2007—Vol 298,No.6 Q 'M INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC Hence,the difference in time between the Figure 2.Aggregate Weekly Excess Death Rates for 43 US Cities by Region From September firstnonpharmaceuticalinterventionsand 8,1918,Through February 22,1919 this excess mortality threshold may be a positive or negative value.For example, 120 in Philadelphia,Pennsylvania,whichwas •west ♦Midwest and South ■East affected early and was unprepared to re- spond,the PHRT was 8 and the EDR was 100 approximately 37/100 000 population at o o the point of implementing nonpharma- �5 8o ! ceutical interventions;in contrast,New 0 CL York City's PHRT was-11 days and the m o EDR was 0/100 000 population at the o g 60 point of implementing nonpharmaceu- x tical interventions. New York City re- 40 sponded to its first influenza cases and the o perceived severity of the epidemic in nearby cities without waiting for excess 20 deaths to accumulate. The US Centers for Disease Control and ° e Prevention's newly released interim com- Sep 15 22 29 Oct 13 20 27 Nov 10 17 24 Dec 8 15 22 29 Jan 12 19 26 Feb 9 16 23 munity mitigation guidance recommends 8, 6 3 1 s, 2 activating nonpharmaceutical interven- 1918 1919 tions when outbreaks due to a pandemic The total excess death rate is 555 for the East region;413 for the Midwest and South region;and 529 for the virus strain first are confirmed in a state West region. or metropolitan service region.16 Several theoretical models suggest that the effect with an enforced staggered business hour pharmaceutical interventions late and in- of targeted,layered strategies for nonphar- ordinance from October 5 through No- dividually rather than combined. Pitts- maceutical interventions may be opti- vember 3, 1918.34 During this era,New burgh's cumulative excess mortality mized when community influenza attack York City's health department was re- burden(EDR=807/100 000)ranked 43 rates are 1%or lower."-"Given the ex- nowned internationally for its innovative out of 43 cities during the study period. ponential growth of an unmitigated in- policies of mandatory case reporting and However,thebenefits of these interven- fluenza pandemic,it is reasonable to ex- rigidly enforced isolation and quarantine tions were not equally distributed.Those pect that the timing of interventions will procedures 35 Typically,individuals diag- cities acting in a timely and comprehen- be among the most critical factors.Such nosed with influenza were isolated inhos- sive manner appear to have benefited most expectations and biological realities are pitals or makeshift facilities,while those in terms of reductions in total EDR.For consistent with our observations of the suspected to have contact with an ill per- example,St Louis,which implemented 1918 pandemic,when rapid public health son(but who were not yet ill themselves) a relatively early,layered strategy(school response time was a critical factor in the were quarantined in their homes with an closure and cancellation of public gath- successful application of nonpharmaceu- official placard declaring that location to erings),and sustained these nonpharma- tical interventions. be under quarantine. New York City ceutical interventions for about 10 weeks Late interventions,regardless of their mounted an early and sustained response each,did not experience nearly as delete- duration or permutation of use, al- to the epidemic and experienced the low- rious an outbreak as 36 other communi- most always were associated with worse est death rate on the Eastern seaboard but ties in the study(cumulative EDR=358/ outcomes.However,timing alone was it did not layer its response. New York 100 000 population). not consistently associated with suc- City's cumulative mortality burden,452/ The 1918 experience suggests that sus- cess. The combination and choice of 100000,ranked 15 out of the 43 cities' tained nonpharmaceutical'interven- nonpharmaceutical interventions also studied. tions are beneficial and need to be"on" appeared to be critical as confirmed by In contrast,Pittsburgh,under orders throughout the particular peak of a lo- the multivariate model.. from the Pennsylvania health depart- cal experience.Many of the 43 cities in For example,New York City reacted ment, executed a public gathering ban the study,particularly in the Midwest and earliest to the gathering influenza crisis, on October 4,1918,but city officials de- South and West,experienced 2 peaks of primarilywith the sustained(>10 weeks layed until October 24 before imple- excess pneumonia and influenza mor- beginning September 19,1918)and rig- menting school closure.A week later,on tality (eg,Birmingham, Alabama, Cin- idly enforced application of compulsory November 2,the state rescinded public cinnati, Ohio, Columbus, Ohio, Den- isolation and quarantineprocedures,along gathering bans.The city applied its non- ver,Indianapolis,Indiana,Kansas City, I JAMA,August 8,2007—Vol 298,No.6 651 -w . INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC Louisville,Kentucky,Milwaukee,Wis- land,Oregon,Rochester,New York,St ton,Toledo,Ohio;see figures in online consin, Minneapolis, Minnesota, Oak- Louis, San Francisco, California, Se- supplement at http://www.cdc.gov land,California,Omaha,Nebraska,Port- attle,Washington, Spokane,Washing- /ncidod/dq/index.htm). These second Figure 3.Weekly Excess Death Rates From September 8,1918,Through February 22, 1919 �A St Louis,MO Total excess death rate:3M/100000 population ©New York City,NY Total excess death rate:452/100000 population 140 Public health response time:+1 d Public health response time:-11 d Total No.of days of nonpharmaceutical Total No.of days of nonpharmaceutical 130 interventions:143 interventions:73 120 o 110 Z m too- Weekly excess death rate mo 90 o 2 x baseline mortality m a First pneumonia and influenza case r O 80 CO)p 70 N 60 U 50 �L 0 40 30 20 � 10 Sep Oct Nov Dec Jan Feb 23 Sep Oct Nov Dec Jan Feb 23 8, 6 3 1 5, 2 8, 6 3 1 5, 2 1918 1919 1918 1919 School closure Isolation,quarantine Public gathering ban Other° Others Denver,CO Total excess death rate:631/100000 population �D Pittsburgh,PA Total excess death rate:807/100000 population 140 Public health response time:+9 d Public health response time:+7 d Total No.of days of nonpharmaceutical Total No.of days of nonpharmaceutical 130 interventions:151 interventions:53 120 o 110 Z 100 0 90 r o 80 O o 70 60 V C 50 + a :R t6 40 30 20 �.� 0 Sep Oct Nov Dec Jan Feb 23 Sep, Oct Nov Dec Jan Feb 23 8, 6 3 1 5, 2 8, 6 3 1 5, 2 1918 1919 1918 1919 School closure School closure — Public gathering ban Public gathering ban — Isolation,quarantine Otherd. Other° Type and duration of nonpharmaceutical interventions are indicated under each plot.For the specific nonpharmaceutical interventions,black bars indicate activation. 1 a Business hours restricted,streetcars'capacity limited. bStaggered business hours,signs with"cover coughs." cStaggered business hours,warning signs posted in theaters. d Schoolchildren given information to take home,warned not to gather in groups. 652 JAMA,August 8,2007—Vol 298,No.6 INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC peaks frequently followed the sequen- automobiles; rapid means of commu- tion of early, sustained, and layered tial activation,deactivation,and reacti-' nication in the form of the telegraph and nonpharmaceutical interventions to vation of nonpharmaceutical interven- telephone;large,heterogeneous popu- EDR in 43 US cities demonstrate sat- tions, highlighting the transient lations with substantial urban concen- isfaction of the criteria of strength(the protective nature of nonpharmaceuti- trations(although a much higher per- magnitude and statistical significance cal interventions and the need for a sus- centage of the US population lived in of our findings,which also argue against tained response. For example, Denver rural areas compared with the"pres- an association by chance alone), con- (cumulative EDR=631/100 000 popu- ent);a news system that was able to cir- 'sistency(early and combined nonphar- lation)responded twice with an exten- culate information widely during the maceutical interventions were consis- sive menu of nonpharmaceutical inter- epidemic,including many daily news- tently associated with reductions in ventions that included public gathering papers and broadsheets distributed in mortality, and our analysis is consis- bans,school closure,isolation and quar- communities;and a wide spectrum of tent with 2 recent smaller, prelimi- antine, and several ancillary nonphar- public.health agencies at various lev- nary historical epidemiological re- maceutical interventions and these ac- els of government. ' ports, although these studies look at tions are reflected temporally in its When examining the 1918 pan- only 16 US urban centers, do not in- 2-peak mortality curve. demic,however,it is important to rec- clude actual activation and deactiva- Such dual-peaked cities are of particu- ognize the numerous social,cultural,and tion time points,duration,or layering lar interest because of the specificity and scientific differences that do exist be- of nonpharmaceutical interventions, temporal associations between excess tween that period and the present. For and rely extensively on secondary his- mortality and the triggers of activation example,the legal understanding of pri- torical sources.3"' and deactivation of nonpharmaceutical vacy, civil, and constitutional rights as Further, our retrospective study is interventions and the implications for a they relate to public health and govern- consistent with the results from recent causal relationship. Among the 43 cit- mentally directed measures(such as mass theoretical models of the spread of a con- ies,we found no example of a city that vaccination programs) has changed temporary pandemic,which highlight had a second peak of influenza while the markedly over the past 9 decades.In ad- the value of early, combined, and sus- first set of nonpharmaceutical interven- dition, public support of and trust in tained nonpharmaceutical interven- tions were still in effect,suggesting that these measures,along with trust in the tions to mitigate a pandemicti-ts) speci- each city with a bimodal pattern served medical profession as a whole,has shifted ficity (best demonstrated in cities with as its own control. In dual-peaked cit- over time.Finally,other features of the bimodal mortality peaks when the trig- ies,activation of nonpharmaceutical in- modern era that need to be considered gers were activated,deactivated,and re- terventions was followed by a diminu- when applying lessons from history to activated),temporality(interventions al- tion of deaths and, typically, when the present era include the increased ways preceded the reduction of EDR), '1 nonpharmaceutical interventions were speed and mode of travel,above all high- dose response(layering and increased du- deactivated,death rates increased. volume commercial aviation; instanta- ration of the nonpharmaceutical inter- History is not a predictive science. neous access to information via the In- ventions were associated with better out- There exist numerous well-documented temet and personal computers;a baseline comes), biological plausibility (these and vast differences between US society understanding among the general popu- interventions reduce person-to-person and public health during the 1918 pan- lation that the etiologic agents of infec- interactions and biologically would be demic compared with the present.We ac- tious diseases are microbial; and ad- expected to reduce the spread of a com- knowledge the inherent difficulties of in- vances in medical technology and municable agent such as influenza),co- terpreting data recorded nearly 90 years therapeutics that have expanded con- herence (our data align with the estab- ago and contending with the gaps,omis- siderably the options available for deal- lished body of knowledge on the sions,and errors that may be included in ing with a pandemic. epidemiology of influenza), and anal- the extant historical record.The associa- Historical contextual issues and sta- ogy(isolation and social distancing have tions observed are not perfect; for ex- tistical limitations aside,the US urban been demonstrated as effective means of ample,2 outlier cities(Grand Rapids and experience with nonpharmaceutical in- preventing person-to-person spread of StPaul)experiencedbetteroutcomeswith terventions during the 1918-1919 pan- other respiratory tract diseases,such as less than perfect public health responses. demic constitutes one of the largest data rhinovirus,severe acute respiratory syn- ' Future work by our research team will sets of its kind ever assembled in the drome,respiratory syncytial virus,vari- explore social,political,and ecological modern,postgerm theory era. cella,and seasonal influenza). determinants,which may further help to Our findings conform to 8 of A.Brad- The ninth tenet, experiment, could explain some of this variation. ford Hill's 9 tenets on causal associa- not be demonstrated directly because The United States of 1918 had many tions in the consideration of disease and of the paucity of influenza pandemics similar features to the present era:rapid the environment.36 Specifically, dur- in the past century,the trend away from transportation in the form of trains and ing the 1918-1919 pandemic,the rela- such traditional public health mea- JAMA,August 8,2007—Vol 298,No.6 653 INTERVENTIONS DURING 1918-1919 INFLUENZA PANDEMIC Sures for disease control during the past lin, MD,Richard Goodman,MD,JD, Daniel Jerni- Influenza, 1918-19.London,England:His Majesty's 50 ears,and ethical limitations of using gan,MD,MPH, Lisa Koonin,MN,MPH,Anthony Stationery Office;1920. i y g Martin,MD,Martin Meltzer,PhD,William Thomp- 20. McLaughlin AJ.The Shattuck lecture:epidemi- population-wide nonpharmaceutical in- son,PhD,David Shay,MD,and Mary Wilson,MD, ology and etiology of influenza.Boston Med Surg J. terventlonS in the absence Of a serious provided constructive review of this manuscript.No 1920;183:1-23. one metioned in this section was compensated for 21. Sydenstricker E.Variations-in case fatality during threat. contributing. the influenza epidemic of 1918.Public Health Rep. These findings contrast with the con- 1921;36:2201-2211. ventional wisdom that the 1918 an- REFERENCES 22. Sydenstricker E. Preliminary statistics of the in- fluenza epidemic.Public Health Rep.1918;33:2305- demic rapidly spread through each 1. Murray CJL,Lopez AD,Chin B,Feehan D,Hill KH. 2321. community Killing everyone in its path. Estimation of potential global pandemic influenza mor- 23. Frost WH.The epidemiology of influenza.Pub- tality on the basis of vital registry data from the 1918-20 lic Health Rep.1919;34:1823-1837. 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Taubenberger JK,Reid AH,Lourens RM,Wang Author Contributions:Drs Markel and Cetron had full Washington,DC:RAND Health Center for Domestic R,Jin G, Fanning TG.Characterization of the 1918 access to all of the data in the study and take respon- and International Health Security;2006. influenza virus polymerase genes. Nature.2005; sibility for the integrity of the data and the accuracy 11. Ferguson NM,Cummings DAT,Fraser C,Cajka 437(7060):889-893. ' of the data analysis. 1C,Cooley PC,Burke DS.Strategies for mitigating an 34. Department of Health of the City of New York. Study concept and design:Markel,Lipman,Navarro, influenza pandemic.Nature.2006;442(7.101):448-452. Minutes of the Department of Health meetings from Stern,Cetron. 12. Ferguson NM,Cummings DAT,Cauchemez S, August 10 thru December 31,1918.1918;Book No. Acquisition of data:Markel,Navarro,Sloan,Michalsen, et al.Strategies for containing an emerging influenza 31.Located at:Municipal Archives of New York,New Stern. pandemic in Southeast Asia. Nature. 2005; York,NY. Analysis and interpretation of data:Markel,Lipman, 437(7056):209-214. 35. Markel H.Quarantine!East European Jewish Im- Navarro,Sloan,Michalsen,Stern,Cetron. 13. Longini IM Jr,Nizam A,Xu S,et al.Containing migrants and the New York City Epidemics of 1892. Drafting of the manuscript:Markel,Lipman,Navarro, pandemic influenza at the source.Science.2005; Baltimore, MD:Johns Hopkins University Press; Sloan,Michalsen,Stern,Cetron. 309(5737):1083-1087. 1999. Critical revision of the manuscript for important in- 14. Germann TC,Kadau C,Longini IM Jr,Macken 36. 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Interim Pre-Pandemic Planning Guidance:Commu- in US cities. Proc Natl Acad Sci U S A. 2007;104 Funding/Support:This study was funded by a con- nity Strategy for Pandemic Influenza Mitigation in the (18):7588-7593. tract from the US Centers for Disease Control and Pre- United States:Early,Targeted,Layered Use of Non- 39. Berman Institute of Bioethics;Johns Hopkins vention(Sol No.2006-N-08562,Non-Pharmaceuti- pharmaceutical Interventions.Atlanta,GA:Centers for University. Bellagio meeting on social justice cal Interventions Study/contract 200-2006-16894). Disease Control and Prevention;2007. and influenza. http://www.johnshopkinsmedicine Role of the Sponsor:The US Centers for Disease Con- 17. US Bureau of the Census.Weekly Health Index org/bioethics/bellagio.Accessibility verified July 9, 4 trol and Prevention provided funding as part of pan- [October 6,1917 to June 26,1920].Located at:New 2007. demic preparedness research. Drs Cetron and Lip- York Public Library,New York,NY. 40. Gostin L.Public health strategies for pandemic i man.from the Division of Global Migration and 18. Collins SD,Frost WH,Gover M,Sydenstricker E. influenza.JAMA.2006;295(14):1700-1704. Quarantine at the Centers for Disease Control and Pre- Mortality from influenza and pneumonia in 50 large 41. Institute of Medicine;Board on Global Health,Fo- vention participated as full scientific collaborators in cities in the United States,1910-1929.Public Health rum on Microbial Threats.Ethical and Legal Consid- the investigation. Rep.1930;45:2277-2329. erations in Mitigating a Pandemic Disease Event: Acknowledgment: Matthew Cartter, MD, MPH, 19. Ministry of Health.Reports on Public Health and Workshop Summary.Washington,DC:National Acad- Cleto DiGiovanni Jr,Jeffrey Duchin,MD,Bruce Gel- Medical Subjects No.4:Report on the Pandemic of emies Press;2007. 654 JAMA,August 8,2007-Vol 298,No.6 1 /1.1,'2,08 TUE 9: 24 FAX 508 362 3683 west Barnstable Fire U002/002 w 1� WEST BARNSTABLL FIRE DEPARTMENT 2160 Meetinghouse Way West Barnstable Ma. 02668 twestbarnsta blefiredept(a�veriron.net Chief Joseph V. Maruea Emergency: 911 Business 508-362-3241 Fax: 508-362-3683 13 February 08 Marlene Weir, Chairwoman E ARNSTABLE PLANNING BOARD 200 Main Street Hyannis, MA 02601 R1l : SUBDIVISION#817 (JENKINS) OFF PARKER ROAD,WEST BARNSTABL[+ Dear Ms. Weir: The West Barnstable Fire Department has reviewed the revised subdivision plan received by Stephen Seymour on February 10. 2008- The department is satisfied with the design of the turnaround-tee located at the end of the proposed private road- 'The department does, however, still have concerns about emergency access to Lot ]of the proposed, subdivision. Our concerns are as follows: A Fire trucks would have to make a sharp turn within the narrow neck of property that connects the bulk of the lot to the end of the private road. The driveway to any house built upon Lot 1 would be long and narrow. It will be in excess of 600'. It will be more susceptible to blockage by snow, trees and other vehicles than a typical driveway. ® Any driveway of this length is more Iike a road because fire apparatus can't park on the street to access the residence therefore the driveway must be constructed to support fire apparatus- This department would like the Planning Board to note that there are no fire hydrants available to fight fires in this subdivision. This means that water for firefighting must be shuttled in large tanker trucks frorn hydrants in neighboring communities. This combined with long narrow driveways, with minimum size streets and with the large to massive size of the homes typically being built all make effective firefighting extremely difficult. The only cost effective solution to this problem is to require automatic sprinkler systems in the houses built like this. Therefore. the West Barnstable Fire Department redo amends that residential automatic sprinkler systems be required for the houses in this subdivision Glad all similar future subdivisions). Thank you for your consideration. If you have any questions or need any additional information, please fcrel free to call me. Very truly yours, Joseph V.Maruca, Chic f it / 3:1/2008 TCfE 9 23 FAx 508 362 3663 W®et sarntiLabl® Fir® f�j00i/002 WEST &LR STABLE FIRE DEPARTMENT 2160 Meefan,,zhouse'Way P.O, ]Box 456 'Nest Baruw-ikable.IA 02668 -winww.westbar nsfablefire.eom Joseph V. Marinea Fire Chief E4 mergency: 911 Business :y08-362-3241 Fax. 508-362-3683 FAX TRANSMITTAL COVER SHEET THERE ARE PAGES INCLUDING TIIIS COVER SHLLT DATE: 3 i i ✓� TO: )m e /n ray FAX NO: FROM: COMMENTS: n �C G� � it U J�7 CONFEDENTIAEIT7� NOTICE: The facsimile transmission may contain confidential information 'belonging to the sender which is legally privileged and which is intended only for the use of the individual or entity named above. Any copying, disclosure, distribution or dissemination of this information or the taking of any action bayed upon the contents of this communication is strictly prohibited. if you have received this transmission in error, please notify us immediately by telephone and return the original transmission to us by mail or by delivery to our address as listed above. k#�>k*fFka�k�k�K�k��k�k�k�k�k�k=F##=k*#��*#�:�k9,c9F�k:k�F�ka'�'>k�k�k�dc�Jc�lcz�c�lcxc�k�k�k�k�kN�N�skax�N�KskwsN�kohsk�k�,t'�ku�x�xc�K�k 4 . i j y , � 1 , a � J a FST � A7ZOF�OH [ Ngs`0yz1 q�RI A� w I�r1.oe.AC' �R 3u 3 G 1M1� e � f? LOT 2.28 AC. � .". • O = 99,365 SF. ZONING DISTRICT RF[RESOURCE PROTECTION OVERLAY DISTRICT) WP WELL PROTECTION,GROUNDWATER PROTECTION OVERLAY DISTRICT � ~ SN = 18.3 sz `?ry, BULK REGULATIONS: w z�, AREA:87,120 SF. 8 FRONTAGE:150' 3.0 4 sst•p.�r SIDE YARD:15' znrA EDGE REAR YARD:15' = 8F' OF BOG FRONT YARD:30' a .� 0 h $ 4J0.6S Q ` a LOT 3 J9A7ESq Jp� RVS.TRUS", yy 8 3 ? y s4 2.01 AC rKOt LOT 4JyE 3 2.13 AC. 87,595 SF. 92,790 SF. 13 a SI'„' = 16.2 LOT 2 SIN = 17.7 --__ 2.22 AC 3 96,703 SE o �S J'38• E W r9 v S3b."/ 1 A 65.74 SIN - 21.9 tiNo Isza.,soa^E Ri bx_ Vie° y W 2,800SF.WE'1'LAND av 2 c�PG A��!, }3 Fi.vtIDti o- 4 N zyBS, BOG 5 v pgOYO " O'v F 303s• — ` s la w 1 ISJIT 'I 1 N 65.17'S5"W .01.95 O f430^4931^µ. 4J.19' �.00 r4E 30°JirJrW lln.4J' �� `'' 'r yz� •f d;4 s•1r s HS WIDE PRIVATL7 R0 N30"3b'J7 ai1.pA4�0 4, R sr I _ID LAYOLrp UTH E. r t o- gp JENICINS 4,,�Rcr zzz.nv eA�a y9e '7�S IJJO �� 561"190YE 114%b I N 4s'ari4•q, .aT1'°fs A.JENICpVS zsR.sv 'D 6 .TRUSTPE SW5902•E 3 PROPERTY OWNER APPROVAL REQUIRED UNDER - PETER JENKINS,JR.,EDW IN JENKINS& SUBDIVISION CONTROL LAW JOHN P.JENKINS BARNSTABLE PLANNING BOARD / FIICF 453 CHURCH ST. H W.BARNSTALE,MA 02668 DATE SIGNED:---------- ApG g --------------- > 8 DEFINITIVE SUBDIVISIONPLAN LOCATED IN • • --------------- ? w�o WEST BARNSTABLE,MASS. LOT 1 mg -----------—--- PREPARED FOR PETER JEIV%IlNS,JR.,EDWINJEN%DNS& --------------- 2.52 AC JOHNP„IElVR711>•S � .. --------------- 109,557 SF. o°� DATE.•JULY25,2007. SCALE:NOT TO SCALE �2�T FILE:419BA p-k-d 3 SIN = 20.9 o w� NOTE:LINEAR FEET OF ROADWAY=750 FT. - Av ROADWAY AREA=39,624 SF.=0.91 ACRES _ — 16.750 SF.WETLAND GO CAPE&ISLANDS ENGINEERING 800 FALMOUTH R OAD,SUITE 30/C MASBPEF,MASS.02649 [5 0 814 7 7--72 72 6-5W5 Ny, pNFO 56'S9'S0"E S� J I TOWN OF BARNSTABLE - ».. ¢ y 44?.r„ �7� 1 1 � .�• �l ti' 1 �.. 11 • r � t P $�• • •d R YT . ' ` I ` l ' is A�l ,� �,'�'' -..�'`�•` ZONING DISTRICT RF [RESOURCE PROTECTION OVERLAY DISTRICT] ,�� `✓ `, WP WELL PROTECTION,GROUNDWATER PROTECTION OVERLAY DISTRICT <r ` t V \\ • ` sorpca�a•mw•°nay.d vm,.uc oaww�<nr.usrs 4 � L 11"\r ` BULK REGULATIONS: t AREA 87120 SF. ZONING CLASSIFICATION,, �® Q\, �`'' `FRONTAGE:150' ` ` \, \\ rp '`• SIDE YARD:15' TOWN MAP 176 PARCEL 21 07c, •� IB�AR YARD:15361 PARKER RD. SF ' ''� ,FINT YARD:30 ,,..,®—-.�..,��. W.$ARNSTALE,MA 02668 16 \�''•,• r'� `°''\ _ WEST BARNSTABLE FIRE DISTRICT' t \ \ \ \ \ '�• �(J /�i 30SS3'`-, S�6°290„ ---- �•�". ` ! ' - ------- ,/ _ _ - _ T ,\ 70rg ___l_ --- -_ `\- a. ti•1• 38- 000, ��• �jrj+Yi) n� TA, __ _♦ , 1 , `!` 11 ,\ -44- ` ; ` , ,TRUSTEE LOT/� i dop /i� ! � ', \I �, , , ; ®fir ' ` \\ /( // LA ♦♦ ~\� �i"� ``� 3 \ •` ( /! 1 / DRAINAGE/ _ � �7 Y _-- - _ _ ` \I EASEMENT' , ! 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[FRMR.BOG] �''yy, IIVS S OSQFFll i ir•_ `♦ ' `��' r/ // � �66 - ' ____48-- \\ ,\ \\ ,\ ®, '�•.;�`+ ---- P�// "52- 16`750 SF.WE LA ' Q; Alloc olop 14 EXISTING CART PATHSHALL REMAINAS A RIGHT OFWAY RE PD.JAN..14,2008 40 FT.WIDE ROAD . . - '1 r II � _ 1 � , TOPOGRAPHW PLAN — , LOCATED IN fA y�EST B�iRNSTABLE,IIVIASS. J l ' 1 PREP��ED FOR A f �� 1 o� 567 BE PETER JE SJR. EDTV"JE S t13of �1 r t ,/ ��`_-- o �s ' .�°•°°° ' °�� PROPERTY OWNER: / c )AVID In " 1 PETER ENKINS JR. EDWIN JENKINS & ( � ` - J(JHIV P.JEIVK S e ��., z� ti J JOHN P. JENKINS �• �r 1 453 CHURCH ST. D.A TE:DE�'.6 2DD� SCALE: " 501NOTE:L 0 T 5A IS NOT A SEPARATE BUILDABLE LOT. 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