HomeMy WebLinkAbout3220 MAIN ST./RTE 6A(BARN.) - Health 3220 Main Street
Barnstable
A= 300- 010
I
i
s' Massachusetts Department of Environmental Protection
Bureau of Resource Protection
" Well Completion Reports
dA
--- ------ -------- -----
Well Driller 2n
t�
Please specify work performed: Address at well location: 0
New Well Street Number: Street Name:
3220 MAIN STREETy
Please specify well type: Building Lot#: Assessor's Map#:
onitoring
Assessor's Lot#: ZIP Code:
Number Of Wells:
1
City/Town:
Well Location BARNSTABLE
In public right-of-way: GPS (GPS for the deepest well)
G"Yes Gs^No North: West:
41.70183 70.30346
Subdivision/Property/Description:
Mailing Address:
ri click here if same as well location address
Property Owner: Street Number: Street Name:
11 BEARCOURT DRIVE
City/Town: State:
Engineering Firm: ATTLEBORO MASSACHUSETTS
COMPLIANCE ENVIRONMENTAL ZIP Code:
02.730
Board of health permit obtained:
C.Yes G Not Required
Permit Number: Date Issued:
vV
-- tv
Massachusetts Department of Environmental Protection
iBureau of Resource Protection—Well Driller Program
` 45- Well Completion Reports(Monitoring)
Well Driller - Monitoring Form
DRILLING METHOD
Overburden uger edrock Choose Bedrock—
WELL LOG OVERBURDEN LITHOLOGY
TOM Code Color Comment Drop in drill Extra fast or Loss or addition
From(ft)
stem slow drill rate of fluld
0 r,
15 Medium Sand + Yellowish Brown
YES NO Fast Slow Loss Addition
PERMIT INFORMATION
DEP 21 E RTN# DEP Groundwater Discharge#
ADDITIONAL WELL INFORMATION
Developed <Yes f�No Are these wells nested? f"Yes C"i No
Surface Seal Type lCernent rea of group(sq.ft)
Total Well Depth 15 Depth to Bedrock
CASING ri is
From To Type Thickness Diameter Casing
above
0 0 IPolyvinyl Chloride ISchedule4O 2� ground?
SCREEN -No Screen
From"> To Type Slot Size Diameter
0 15 Slotted PVCzn 0.010
WATER-BEARING ZONES
From To Yield(gpm)
0 0
ANNULAR SEAL/FILTER PACK
From To Material 1'5 Weight Material 2 Weight Water
t)r Batches Method Of Placement
0 0.5 Concrete f4 —Choose Material— 0 Gravity
0.5 Native Material 1! -Choose Material— 0 0 0 Gravity J
0 0 Bentonite Chips/Pellets J 0 —Choose Material— 'F,— 0 0 0 Gravity J
15 Sand �J 0 =Choose Material— 0 0 Gravity
WATER LEVEL
Date Measured Static Depth BGS(ft) Flowing Rate(gpm):
06I06/2017 8. � �
COMMENTS
i
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
' Well Completion Reports(Monitoring)
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and
accurate to the best of my knowledge.
LEGER,
Monitoring.[M]. Supervising Driller Signature
DrillerDONALD LEGER Registration# 806 M DONALD,
SOIL EXPLORATION_
Date Job Complete
Firm CORPORATION Rig Permit# :270 06/06/2017
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
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JOB: BARNGEN
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DATE: 03/I3/I3
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TOWN OF BARN TAB E
7013 APR 24 AIM 9* 4
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TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date q L;5 1 ,2-o 12 Time: in Out
Owner (LJ�S l�ll�l V �LU4�a� --C-' Tenant
Address u d :�LX �ZS Address 32Zo m A w 5-r
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities Ze i2-
� � .. ,..,.�.,�,�,
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 Z
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Z Number of Vehi we ax
Number of Persons Allowed (max) -`
Person(s) Interviewed L PAW Inspect
If Public Building such as Store or Hotel/Motel specify here
�
�
TOWN OF BARNSTABLE
BOARD OF HEALTH
2 ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date S 3 ) Time: In Out
Owner�g Fam K0 Tenant Pltv f
Address�' �I Vu� `(�-� K y Address -3;up MAW isl
Blip'L&S-Ivq Ma
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities
7. Lighting and Electrical Facilities
(Orr �Ipa 10A. )
8. Ventilation
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use -
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage'Disposal
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicle,;Al ed (m
Number of Persons Allowed (max)
Person(s) Interviewed `� � Inspecto
If Public Building such as Store or Hotel/Motel specify here
�
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION f
Date ( S Time: In J Out `
Owner 71A, Tenant
Address °L- Address
Compliance Remarks or
Regulation# Yes O Recommendations
2. Kitchen Facilities ..1 d
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 o
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal
16. Sewage Disposal
17.Temporary Housing
18. Driveway Width !
19. Number of Tenants Observed dL
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max) 31
Number of Persons Allowed (max)
Person(s) Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
I
I
FORM30 C�&W HOBBs&WARREN
TM THE COMMONWEALTH.OFMASSACHUSETTS
BOARD OF HEALTH CITY/TOWN
2-60' DEPARTMENT
a
ADDRESS C� �—
G1M SvOy`orr
,(( TELEPHONE
Address 32 zo KA) N �`r Occupan PAye A 6 AM ��
Floor Apartmen No.� 6R— No.of Occupants Y,
No.of Habitable Roomsping Rooms_
No.dwelling or rooming units_ No.Stories
Name and address of owner Jose m" 'R Nqu)
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress:and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation: 90C-A-1tay S
Dampness: 6 P.S. 4 V r 0 A-7 Tof As Tl.0-1
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pantry
Den
Living Room
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
St cks, Flues,Vents,Safeties.-
Kitchen Facilities Sink /O
ove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted /Aj 1 AJ eo 5-r 1p•
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR. (See Over)
"THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES PERJURY."
INSPECTOR TITLE
DATE TIME
A.M.
THE NEXT SCHEDULED REINSPECTION IL /��L P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions;when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness,for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and ther'efore is not included in this listing. Failure to include.shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 440`830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B) and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410�150(A)(2),and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony,roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
FORM30 &w HOBBSB WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOAOD OF HEALTH
imp
CITY/TOWN \
wOUIAS �rV
0
ARTMENT —
O ' I
RESS aknZ
GSM SVOy`ow ,
TELEPHONE
�
Address�w � ✓1J IQaC.� Occupant�►)P- /_VCJII'Q/b/l4"
Floor Apartment o.LrQrK No. of Occupants IfNo.of Habitable Rooms— No.Sleeping Rooms 2_
No.dwelling or rooming units No.Stories,
Name and address of owne d A? g .y A/15 Q�(p y6
Remarks Reg. Vio.
YARD Out Bld s.: Fences:
Garbage and Rubbish 'Y
Containers: '
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches:
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows:
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall,Ceiling:
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N E ui . Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS ❑ ST ❑ P Waste Line:
H.W.Tanks Safety and Vent(s)
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom
Pant
Den
—Living Room
Bedroom(1).
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Stacks, Flues,Vents,Safeties:
Kitchen Facilities Sink
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub.-
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS IN ECT REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTI 0 R "
INSPECTO TITLEay�i_L��
A.M.
DATE TIME , •M•
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
_
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions,when found to exist in residential premises,shall be deemed conditions which may endanger or
impair the health, or safety and well-being of a person or persons occupying the premises.This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that
other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local
health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to
include affect the legal obligation of the person to whom the order is issued to comply with such order.
(A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold,to meet the ordinary
needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer.
(B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as
prohibited by 105 CMR 410.200(B)and 410.202.
(C) Shutoff and/or failure to restore electricity or gas.
(D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com-
mon area required by 105 CMR 410.254.
(E) Failure to provide a safe supply of water.
(F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR
410.150(A)(1)and 410.300.
(G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object,
including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452.
(H) Failure to comply with the security requirements of 105 CMR 410.480(D).
(1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar-
bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests
or otherwise contribute to accidents or to the creation or spread of disease.
(J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public
Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.)
(K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or
other dangers or impairment to health or safety.
(L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating,
gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352,
so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety.
(M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release
of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105
CMR 410.353.
(N) Failure to provide a smoke detector required by 105 CMR 410.482.
(0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or
knowledge of the owner of said condition or conditions:
(1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven
or any defect that renders either inoperable.
(2) Failure to provide a washbasin and shower or bathtub as•required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any
defect which renders them inoperable.
(3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of
generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard.
(4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as
required by 105 CMR 410.503(A)and 410.503(B).
(5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.
(P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con-
dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner
to remedy said condition within the time so ordered by the Board of Health.
T
Project
1 3220 MAIN STREET
O BARNSTABLE
o VILLAGE
/ 1046
ASSUME"B"VENTS AND BATH ROON MA
BATH � VENT PIPES V.I.F.MAKE OPENING
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A1.0 Scale: 1/4"=1'-0" r A1.0 ��= r_ p max AL
Scale: 1/4 l Oil
F-'
2028
I I 201A OFFICE
III
201A OFFICEIssued For
OFFICE1 REV. ISSUE DATE
BATH i; a 2016 HALL
103A - �
112 BATH 2O3B
CLOSET - 205B 204B OFFICE
OFFICE OFFICE
104AX 1028
HALL O UP
/ OFFICE it -----� f'-- --� f-- --1 i-----
102A
MECH. 1U58 H 9
CLOSET
----- CLO. CLO. 1' Key Plan Second Floor
PERMIT
---
DRAWING KEY
AT THIS POINT 7 RISER
101A ®7.25"=50.75'MINUS "'%�-��"%« NEW WALL Drawing Title:
OFFICE"A" 12" STRINGER THICKNESS
"ENTRY +/- V-3" ? O EXISTING CONSTRUCTION Drawn By.CT Checked By. GSDG
CLEARANCE 1088 101B r TO REMAIN
\ OFFICE OFFICE W
ENTRY . C= DEMOLISH REMOVE
UP
ZOFFICE
( CX - COMBO EMERGENCY LIGHT/EXIT
JL LIGHT W/ BATTERY BACK—UP
AlmO
i Drawing Number.
3 First Floor Plan Existing j Flle Name: Scale: AS NOTED
A1..0 Scale: 1/4"=1'-0" Date: 1/26/18
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