HomeMy WebLinkAbout0578 OAK STREET (CENT./W.BARN) - Health 578 OAK ST
West Barnstable
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Crocker, Sharon
From: Crocker, Sharon
Sent: Friday, June 08, 2018 4:28 PM
To: 'claims@friedlineandcarter.com'
Subject: Records Request - Inspections at 578 Oak St,W.Barnstable
Attachments: Records Request - Inspections at 578 Oak St,W.Barnstable.pdf
Attached is your records request.
We have not had any inspections at this location (578 Oak Street, West Barnstable).
Regards,
Sharon Crocker
Office Manager
1
Friedline & Carter Adjustment, Inc.
436 Main Street,P.O.Box 338
Hyannis,Massachusetts 02601
` Tel. (508) 771-3232
FAX (508) 790-2344
` claims@filedlineandcater.com
DATE: June 4, 2018
Barnstable Board of Health
Attn: Records
200 Main Street
Hyannis, MA 02601
RECORDS REQUEST
RE: Our File Number: L3509
Insured:, _ ALCOCK, Arthur-& BASKIN, Jeanne
Date of Loss: 5/22/2018 -
Claimant: Desmond, Thomas
Loss Location: 578 Oak Street
West Barnstable Fire, MA
Please send information requested below in regards to the above referenced
caption and proceed accordingly:
Please forward complete medical and/or hospital records for the above claimant.
Please forward all hospital/physician bills for the above claimant.
X Please forward Board of Health records regarding all inspections at the loss
location.
Please forward Housing Assistance.
Please forward Police Report.
Please forward Fire Report.
Attached please find medical authorization forms. Please sign so that we may obtain
necessary medical records.
- —Please forward-Dog — —
Thanking you in advance for your anticipated cooperation.
Very truly yours,
Pauline A. Skiver
Liability Claims Manager
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�}+,�J�/S- a MMONWEALTH OF MASSACHUSETTS
Ir ✓�.(,W BOARD F H EA T
sJZI ..OF.
Apphration -fur Uhivviittl Works Tonstrurtion Prrutit
Application is hereby made foWft Permit to construct ( ) or Repair ( ) an Individual Sewage Disposal
Sy t ee� J6 0
.... ... .. ----------_----- -------_ .=- .....a.1ft.......
Location d ss or
Owne Address
Mob
Installer Address
Type of B uildii Size Lot_3_j __
Dwelling No. of Bedrooms........... .........................Expansion Attic ( ) Garbage Grinder
aOther—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( )
Other s ----- ------------
w Design Flow............ _--gallons per person per day. Total daily flow........3 .0...............gallons.
W Septic Tank T Liquid capacity
44""llons 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 ( ) "'(f,6- RG�j ,
aPercolation Test Results Performed by----------------------.................................................... Date------------------------------------....
Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water...._...................
f4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water.-------------------....
P4 ----•------------------ --! --- -• � --------•---7-- --
--------------
O Description of Soil.-------- �._.."..a----.-- a...-- ZA--------------
x ,
w
------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------x --- --- --- ------
U Nature of Repairs or Alterations—Answer when applicable................................................................................................
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has Abeen ' ed the boa d of healStgn _------- -- DateApplication Approved By-- • - --- - --- ----- ....Z'1---- -- -------- . ...f ----------C�
Date
Application Disapproved for the following reasons:........................ ....._.... ...........
i ..................... ------------- =------------------------------------------••----------- � �'' ------(dam_...�_' " ....
t1 Date
-Permit No........................................................ Issued....... =` Z.7_............
Date
N9 ..................
THE COMMONWEALTH OF MASSACHUSETTS
Application is hereby made foVva Pe t C nstruct or Repair an Individual Sewage Disposal
S ysteZm
.. .. .... .............................. ---------- ......................... ................. ......(T.Or...K4............
Lo
Installer Address
ize
ildi
` ' ~ -- - - '-'-'-'(tl� --',- -- -- 7DwoU�g� No. of Bedrooms.. ---� Attic �r� l�- �
Other--Type of Building ............................ No ofycrsou---.----_- Showers ( ) -- Cafeteria ( )
(}t6cr
Design FI
uisposa Trench--Nu -------------------- Width-------------------- Total Length-------------------- Total leaching area--'-_-..sq. ft.
Seepage Pit Nu'_----- Diameter.................... Depth below inlcL.___-._. Totalarea----._.sq. �. �
�� Other Divt,i,o600box ( ) Doa��� tank ( ) --^ �- ��� '�l- � �� -��, �
~~ = , ' ' V - - ' =
Percolation TestDeso�y Pe�ozozc6 by---------------- uut�-'------------
� Ics Pit No. l................minutes per inch Depth of Test Pit.................... Depth to -round water--------
^ r14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wuter--.------
�� _----_---��. --
D�o��o � �� �� �1*� = �l � ~��� '
------�~--' '--�= '`'~"°^�'~7- -' --~'' '--~��w^�°'`�^"*^�'�����=a�Y`�
---`-----------------'--'--`-------'----'----'---'-'-----------'--------
�� '----'''''''---'--''------'_--..---_--_----_-----.-----'----------.---_-_�
L) Nature of Repairs or Alterations—Answerwhen applicable.------------'__-.-_------------'
---'--''''-----'-'-'-''-'----------------------------'------------------
Ag,ccoeot:
The undersigned agrees to install the uforcdcocribed Individual Sewage Disposal System in accordance with
| the! ' ovisi of Article XI of the State SanitaryCode � system in
operation until a Certificate of Compliance has been uWedb Ithe boar o�f�heall
�
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Application Approved D
' �~~ -- _ . - n"� . ~~
Application Disapproved for the following roozons:-----' ---_-------.------------.-._-----'-
_-.-_-._-.---.-_-_----_'_.-''_-_--_'-._-------_. - -''---- ---
Issued
� Permit No' o,m '
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THE COMMONWEALTH orwAssAoHussrTs
BOARD 0
HEALTF+�,,
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Tafffirate of am urr
has been install d in accordance with the provision f r i� XI of 10 State Znitary Code as described in the
_,,______ _ Disposal` _ Works Construction_ - -.'-- --~=�.....'-n,''v' --------------- ----'`'--'~-'--'—'-- ......... �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOTBE CONSTRUED
SYSTEM Vi FUNCTION SATISFACTORY.
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! THE oommomvvEAcr* OF wAssxc*ussrTs
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BOARD OF, HEALTH
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