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Home My WebLink About2103 MAIN ST./RTE 6A(BARN.) - Health 2103 Main Street/Rte 6A (Barn) Barnstable A - k A MRVP # 0/ Assessors Office (1st Floor) �—y Assessor, ap d Parcel. /. # 3 ' O !P/� Buildin D7tme1 •(4 h loo Zoning INSPECTION FEE $60.00 - RE-INSPECTION FEE $15.00 Request For A Housing Inspection For Certification Under the MA Rental Voucher Program Your Name Affiliation (Circle One) d<�;) Real Estate Agent Tenant Your Address f oZ> 7/ `t, W - '13 6/L� Ca-BSc Telephone Number (Day)o` 9t -2.21 --7-Z 1 1 (Night) Address of Property Where Inspection is Requested Unit/Apt.# l `fU -v`- G��3a Name of Owner C �fQ tl Address Poi I - ICJ .�Pr2N s�/► �r �'� 0 Z cP 4P Mailing Address (if different) Telephone Number (Day)Sa1,*-Z'L 1--j'7 I 1 (Night) Will there be any children under the age of six (6) who 11 be occupying the rental unit? (circle one) Yes No Was the dwelling constructed prior to 1979i Ye No ------------------------------------------------------------ FOR OFFICE USE ONLY: Certification The dwelling, dwelling unit, or roo Ong unit located at 6_2 4.,&1 was inspected on by Health Inspector for' the Town of Barnstable and was forund to be in compliance with the provisions contained within 105 CMR 410.00, State Sanitary Code II: Minimum Standards of Fitness for Human Habitation.. However, this certification does not include, a determination as to whether this unit contains any lead paint because under 760 CMR 49.02 Massachusetts Rental Voucher Program, a separate lead paint inspection must be conducted. Inspector's Signatur Date � � _ TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II:MINIMUM STANDARDS FOR HUMAN HABITATION Date ��f Owner f�>'�6�1�9s�P/�1/ �-� Tenant Vn � Address � � 6 � �?/ �'1dress � E Compliance Remarks or Regulation# Yes No Recommendations 2. Kitchen Facilities 91Z 3. Bathroom Facilities ` 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities �✓ (/ 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use j 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents s 15. Garbage and Rubbish Storage and Disposal. l� 16. Sewage Disposal �� 17. Temporary Housing PART II " 37. Plocarding of Condemned Dwelling; Removal of Occupants; Demolition �� - Person(s) Interviewed Inspec If Public Building such as Store or Hotel/Motel specify here HOBBS&WARREN.INC. 'F TOWN OF BARNSTABLE �. LOCATION a/Oj R SEWAGE # } VILLAGE 7 J34 AWS 2-e6 E' ASSESSOR'S MAP LOTS 17 ® 'l INSTALLER'S NAME PHONE-NO. A & B CANCO 775-6264 .SEPTIC TANK CAPACITY LEACHING FACILITY:(type) Qg,754/ad (size) /p01: GAL NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER/r9.s4 �i9t�itlG DATE PERMIT ISSUED: ��" j p_3 DATE' :COMPLIANCE ISSUED: 1 3 VARIANCE GRANTED: Yes No f `.. -� �� o�. �� e . � hr h L No.... � FIE$...._ `:....._ THE COMMONWEALTH OF MASSACHUSETTS AMOVED BOAR® OF HEALTH 6arnsta"hCO v8tmac""MorfOWN OF SARNSTABLE tripninl Wurk,i Tomitrnr#ion pruti# Application is hereby made for a Permit to Construct ( ) or Repair (—J�-an Individual Sewage Disposal System at: ...a o � .f .�.-....'� Loc it ion- \-dress r Lot No. .Y`..;w......... !°�lA_1�. '- ------------------------------------- y 8 ��''�eb,(!l. 9�c-----..� Y?.t.,�-------....::--- Orvncr Ad s CO-------------------------------------._..... �� = '� ' -----------------••_--•- Installer Address U Type of Building Size Lot............................Sq. feet g— ; __________________________E�pansion Attic ( ) Garbage Grinder (1#0) Dwelling '�10. of Bedrooms_______________ _ aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 9 Septic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter---------------- Depth.............. Disposal Trench--No_ ____________________ Width.................... Total Length................_--- Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by------- -------------------------------------------------••---•-•--•--••-• Date........................................ 14 Test Pit No. I________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ L% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------•------------------._....---.._..---••-•-•-•-•••••-•-•••••-_-••••......:................................................... 0 Description of Soil......................................................................................................................................................................... x ----•------------------------------------------------ .................................................................................................................. ------••---_ ........ U Nature of Rep - s gF Alteratippn A-s—Answer when applicable—ZOS� /1__ � ._ .•-•-••=-••••••• --••-• -- -_- -.-.Z®O.�._._�� .... � _� ------ ...--••---••----•-.... . •• •• U •. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has be n i ued by e bo of health. Signed .................... ...... .. .. ... ...� ...- . ............................. Date Application Approved By ......... . ... Dare Application Disapproved for the following reasonr: ........................... .................. . . .............................. ... ... .. ............. ...... ....... ..........................................qq........ . ........... . ...................-................. . ...... .........................--..-.............-................. -....-.................................. Permit No. ........ .. ...- y e� Issued ....-....-...........-..................... ...... e ... -............... Dare lw'�r+�i•e�:..«;��.::�"`^-r�•..-��,i�..,.w�--;�--�-:�..:-'4'-�-•.--^.r-;...:.++��ir..:=�%..'s,�'r.�-.-.......�.y.,-...�.;::' a�1.--+''."'^•3-�'^rt�Y4....�,�.�f�.�,..-�tR.rt�-'�....+sm,aw.�-'...3,e.r':.i..re��..��.:u�..ctL. par — THE COMMONWEALTH OF MASSACHUSETTS 11A 11 OF HEALTH TOWN OF BARNSTABLE 13 .� �ltrttttan fur Diripi ial Work,i Towitrnsthin runfit Application is hereby made for a Permit to Construct ( ) or Repair ( -ran Individual Sewage Disposal System at: ..�1...� f �..............•--r�.a�.......( -------- ............................-----•--•-----.....-•----•--..........---------------............---• ...................... Location-Address or Lot No. ....................................... --L------�, � 1- �! nr?.�:s...... ........ O-ner Address Installer Address UType of Building Size Lot............................Sq. feet a , Dwelling— No, of Bedrooms_______________ ___ ___________________Expansion Attic ( ) Garbage Grinder (N0) p, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures --------------------------------- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity------------gallons Length................ Width---------------- Diameter................ Depth................ Disposal Trench--No. ..................1. Width.................... Total Length--___---..-_-__-___- Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) 0-4 Percolation Test Results Performed by-------------------------------------------------------------------------- Date....................................... aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water....................,... L% Test Pit No. 2................minutes per inch Depth of Test Pit_................. Depth to ground water........................ 9 -•------•-------------------•-------•--•----------•••------•---...----------•---•----•.......--••--..........---.........---............._.............••---- ODescription of Soil........................................................................................................................................................................ W ----- -------------•--------------.....------------•----------..............._......--------•----••------------•--------------------------------•---•-------...-••--•----•-••--•-•..........------•.---- UNature of Repuirrs or Alterations—Answer when applicable_ a_C....... !I :a......../. Agreement. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the boa d of health. j Signed ...........................- /c .. .:.:.--C$ •;,.a.� ..�. Date Application Approved By .................... , -J...cL�... bate Application Disapproved for the following reasons: ................ ........ ........................................................... ........................................ ... ........................................................................... .............................:........ . . ....................... --. . . ............................. ........................................ PermitNo. ----- 1C�Z...-..-J .y ----------------- Issued .................................................................... Dare ---------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH `r TOWN OF BARNSTABLE (( Certiftrate of V amplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired`( -L.--f by............ f .C?}......../�4i�11. ........... ....... .. . .. . ........... .. ....... ., tnst:d�et at cW6.3......... -......�r�. .... ., !E.t�t 1., .� ......... ..... has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ..._..7__: ,..tj---L-ei .. dated .......... .._..------ -..__. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ...................-..,..1,.....)...?--...1..-.._ ......--- -- ---- -- Inspector ................... ....I --------._--------------- --------------- --------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE �� FEE....3o....... Binpnnal nrkn Tunotrurtion "pantit Permission is hereby granted--------�-f-=�....---�%/( r6------------ ------------------------------------------•--------------.-----.--.---.--- to Construct or Repair fa n Individual Sewage Disposal System -,� ? /� ! I',r)_� .�?., _ -----------------------------------•-----------.. ------------- ....................... at No...-_---.�-----•--....-_R � �'! Street q as shown on the application for Disposal Works Construction Permit No.l-3_-<_j�Z.- Dated........................................... - ��---------------------------------------------------•-••--••- _ / q "Board of Health DATE.............•1-•n_ --..-.a --•/3-................................ FORM 36508 HOBBS r&WARREN.INC.,PUBLISHERS