HomeMy WebLinkAbout4380 MAIN ST./RTE 6A(BARN.) - Health •43$0 Main Street /'Route$6A
Barnstable
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Certified Mail#7006 2150 0002 1041 8849
� tEr4 Town of Barnstable
Regulatory Services
13A 15TABLE,
g MASS. Thomas F. Geiler, Director
t639.
rf°Ma' Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
April 23, 2008
Louise Vuilleumier
185 Stoney Point Road
Cummaquid, MA 02637
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 4380 Main Street, Cummaquid, MA was inspected
on April 18, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500— Owner's Responsibility to Maintain Structural Elements.
Observed both sliding glass doors into home that need handle replacements. Observed
holes in walls in kitchen and living room. Observed broken toilet seats in both bath
rooms. Observed holes in bathroom floors in both bathrooms along with toilets not
being properly secured
105 CMR 410.351 —Owner's Installation and Maintenance Responsibilities.
Observed li ht not working within bathroom near main entrance.
g g
You are directed to correct the violations listed above within fourteen (14) days
of your receipt of this notice by pulling any required building permits (if
applicable); by replacing both handles on sliding glass doors; by repairing holes in
walls as mentioned above; by repairing light with in bathroom near home entrance;
by repairing floors in both bathrooms.and securing toilets properly.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten(10) days after the date the order is served.
Q:\Order letters\Housing violations\Rental ordinance\4380 main st cummaquiad
i
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF HE BOARD OF HEALTH
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Desiree Thomas- Tenant
Q:\Order letters\Housing violations\Rental ordinance\4380 main st cummaquiad
i
FORM30 �xW HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA H
CITY/TOWN �[
W
DEPARTMENT
O ADDRESS
GSM SVOy`0�
�� TELEPHONE
Address _ Occupant_
Floor Apartment o. No. of Occupants_____
No.of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units___ o.St i
Name and address of owner
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:
Dampness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.: n
Hall, Floor,Wall,Ceilin : "' ^ ✓�
Hall Lighting: 4-
-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 Vents
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220 Fusing,Grnd.:
AMP: Gen. Cond. Distrib. Box: TIP
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom 51
Pantry
Den
—44
—Living Room /
Bedroom 1
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas,Oil, Elect.:
%arkks,.FluesVents,Safeties:
Kitchen Facilities in
Vet1aglE,
-
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF` THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION RE RT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
PENALTIES OF PERJU ''
r,
INSPECTOR—; TITLE
O A.M.
DATE 4— 1 /1^ TIME to-, P.M.
THE NEXT SCHEDULED REINSPECTION �ld P.M.
y
r
Certified Mail#7006 2150 0002 1041 8849
4y�I E r � Town of Barnstable
Regulatory Services
�+ t3Al2NbTAUM
°$ tb3MASS. 1$ Thomas.F. Geiler, Director
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
4 April 23, 2008
Louise Vuilleumier
185 Stoney Point Road
Cummaquid, MA 02637
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II —MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 4380 Main Street, Cummaquid, MA was inspected
on April 18, 2008 by Timothy O'Connell, Health Inspector for the Town of Barnstable.
This inspection was conducted on the basis of the rental registration in accordance with
Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements.
Observed both sliding glass doors into home that need handle replacements. Observed
holes in walls in kitchen and living room. Observed broken toilet seats in both bath
rooms. Observed holes in bathroom floors in both bathrooms along with toilets not
being properly secured
105 CMR 410.351 -Owner's Installation and Maintenance Responsibilities.
Observed light not working within bathroom near main entrance.
You are directed to correct the violations listed above within fourteen (14) days
of your receipt of this notice by pulling any required building permits (if
applicable); by replacing both handles on sliding glass doors; by repairing holes in
walls as mentioned above; by repairing light with in bathroom near home entrance;
by repairing floors in both_bathrooms and securing toilets properly.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Q:\Order letters\Housing violations\Rental ordinance\4380 main st cummaquiad
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF HE BOARD OF HEALTH
Thomas A. McKean, R.S., CHO
Director of Public Health
Town of Barnstable
Cc: Desiree Thomas- Tenant
s i
Q:\Order letters\Housing violations\Rental ordinance\4380 main.st cummaquiad
r• '
FORM30 CAW HOBBS&WARREN rM THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA H
CITY/TOWN 0[ �
n DEPARTMENT
ADDRESS
GSM s0y`0
TELEPHONE
r Address Occupant_
Floor Apartment o. No.of Occupants____
No. of Habitable Rooms No.Sleeping Rooms
No.dwelling or rooming units o.St
Name and address of owner
Remarks fZegg�Vh.
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:
Dampness:
Stairs:
Lighting:
STRUCTURE INT. Hall,Stairway:
__--- - - - Obst'n.: , tj Id
Hall, Floor;Wall,Ceiling: .�.
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central ❑ Y ❑ N Equip. Repair
TYPE: Stacks, Flues,Vents:
PLUMBING: Supply Line:
❑ MS LIST ❑ P Waste Line.-
H.W.Tanks Safety and Vents
ELECTRICAL Panels, Meters,Cir.:
❑ 110 ❑ 220, Fusing,Grnd.: V
AMP: Gen.Cond. Distrib. Box:
Gen. Basement Wiring:
DWELLING UNIT
Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks
Kitchen
Bathroom c>I
Pantry Tru-
Den
Living Room /
Bedroom(1).
Bedroom 2
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
ks, Flues ents,Safeties.:, .
Kitchen Facilities 4inp
'-96ve
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin,Shower or Tub: --
-` Infestation Rats, Mice, Roaches or Other.-
Egress Dual and Obst'n.-
General Buildin Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED BY 105CMR 410.750 OF" THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
. "THIS INSPECTION RE, RT IS SIGNED AND CERTIFIED UNDER THE PAINS AND
as
�.. PENALTIES OF PERJU
r•
TITLE
INSPECTOR
DATE f TIME ,®, r o A.M.
^® P.M.
(� A.M.
THE NEXT SCHEDULED REINSP.ECTION `d P.M.
410.750: Conditions Deemed to Endanger or Impair Health or Safety
The following conditions, when found to exist in residential premises,shali'be deemed conditions which may endanger or
impair the 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 II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for
human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so
in every case and therefore is not included tin 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 410.482.1
(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.
1� ,t , n f✓ca 17
COMPLETE • . • . DELIVERY'
■ Complete items 1,2,and 3.Also complete A. Sign to
item 4 if Restricted Delivery is desired. ❑Agent
s Print your name and address on the reverse X ❑Addressee
so that we can return the card to you. 4A R v y(Printed Name) Date of D iv ry
® Attach this card to the back of the mailpiece, WU�s �ntf_�
1119.
or on the front if space permits.
41� . D. Is delivery address different from it
I 1. ArticleAddressed to: if YES,enter delivery address below: No
I LOUT-;C t
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I C43Yn tMOSA U CA, AAA 62(Q3-1
3. Service Type
❑Certified Mail ❑Express Mail
❑Registered ❑Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2Article u service lai eq ' ' 7J'0 215 Oj!0 0 0`2{U641` 8 64 9 11 i It{#
j PS Form 3811,'Februa y.2004 Domestic Return Receipt 102595-024M-1540
C UNITED STATES,P .S Kt,
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• Sender: Please print your name, address, and ZIP+4 in this box •
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Town of Barnstable
Health Division
200 Main Street
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Hyannis,MA 02601
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��- li°*, r k."r v .�e ...,.ti i.Ti.k� e,.ka ..x"sc=P■ -� ■ ��`r "�`"k�^�'.v�rr,�nM.:.
. Froi�txt. e�'d�es , �o4 � .:�� �zou�ist�tvuille S} mien
5/6/08
Dear Mr. O'Connell,
I just,want to let you know that I am in the process of evicting Desiree
Thomas from my barn apartment located at 4380 Main Street,
Cummaquid, MA 02637. I have a court date at the end of the month
as she owes me more than $10,000 as well as having damaged the
apartment.
I ask that you give me,time for the eviction process after which I will
update the existing violations. As you are well aware, I do not want to
fix anything as it maybe destroyed before the eviction process has
taken place.
I will let you know when updated have been made. Please let me
know if this is possible by-returned mail or by calling me on my home
phone (308.362.6269) and leaving a message.
Thank you for your attention,
Si cere�,
Louis Vuilleumier
. �axv�ra,m+.�r:`;�"� 'w:, s .�- e �+1ry r e w,n+px•se+w.w y .f.sr�.fe...»w taa� t«„.sra¢ . . ,�f
�.+£I�stoned Pornt Roan°/POABox'z2 cumvnaqu,a,
MA-02637 -
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CO OFFICIAL USE
CO . ,
0 Postage $ I&
Certified Fee
ru 7r, Pot .
p Return Receipt Fee r^�
(Endorsement Required)
Restricted Delivery Fee
O (Endorsement Required)
Ul
rrq Total Postage&Fees $ a 1 s S
PU
Sent
Sfre•et,Apt. o:: _
Nor PO Box No. ( --- �O 1L�!
City State,ZIP+44 }
CR.��CYI�fY\
Certified Mail Provides:
o A mailing receipt
o A unique identifier for your mailpiece
o A record of delivery kept by the Postal Service for two years
Important Reminders:
e Certified Mail may ONLY be combined with First-Class Maile or Priority Maile.
o Certified Mail is not available for any class of international mail.
a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For
valuables,please consider Insured or Registered Mail.
e For an additional fee,a Return Receipt may be requested to provide proof of
delivery.To obtain Return Receipt service,please complete and attach a Return
Receipt(PS Form 3811)to the article and add applicable postage to cover the _�
fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver foil
a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is
required.
a For an additional fee, delivery may be restricted to the addressee or
addressee's authorized agent.Advise the clerk or mark the mailpiece with the
endorsement"Restricted Delivery".
a If a postmark on the Certified Mail receipt is desired,please present the arti-
cle at the post office for postmarking. If a postmark on the Certified Mail
receipt is not needed,detach and affix label with postage and mail ,
IMPORTANT.Save this receipt and present it when making an inquiry.
PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047
' r
� FZHI r � Certificate# 06 - 796
"` °" Town of Barnstable Fee Paid: $35.00
a' BARNSTABLE,
NIA1639.. ,0� Regulatory Services Department
ArFD MAC a.
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
2007 CERTIFICATE of REGISTRATION
Property Location:4380 Main Street/Route 6A Apt. 2 Barnstable MA 02637-
Owner's Name: Vuilleumier,Louis
Owner's Address P.O. Box 12 Cummauuid MA 02637-
Owner's Representative's Name (If Applicable)
Address:
Telephone Number:
Number of Rental Units On This Property 4 Number of Bedrooms Authorized: 3
Maximum Number of Motor Vehicles Authorized outside of Buildings Overnight: 4
Maximum Number of Occupants Authorized (occupants under 22 years of age are exempt) 4
11/14/2007 1 12/31/2007
Date Issued: Expiration Date Thomas A. McKean,R.S.Director of Public Health
*This certificate must be conspicuously posted within such dwelling or portion of dwelling*
COMPLETE •N COMPLETE THIS SECTIONON DELIVERY
■ Complete items 1,2,and 3.Also complete A. Sig ture .�
item 4 if Restricted Delivery is desired. ❑Agent
0 Print your name and address on the reverse k3 Mdressee
I so that we can return the card to you. B. iv b (Printed Name) I C to f elivery
I! ■ Attacti jhis card to the back of the mailpiece, � 'r
or on the front if space permits.
D. Is delivery ddress different from item ? ❑Ye
1. Article Addressed to: If YES,enter delivery address below: ❑No
I '
? � \), i\ (,-
k Service Type
C v M PA `, `i G�f 3. 10 Certified Mail ❑Express Mail
❑Registered JD Return Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?Pft Fee) ❑Yes
2. Article Number
(Transfer from service fabeq i iti i7 0 0 71 0 710 10 0 0 5 5 82
1;�2 j4 6 9 i i
PS Form 3811,February 2004 Domestic Return Receipt _ 102595-02-M-1540
UNITED STATES-PO AL SEF E s 9 e taid
rY
• Sender: Please print your name, address, and ZlP+41n".'t6is box •
Town of Barnstable
Health Division
200 Main Street
—HYMnis—MA.02601
It It I III It I all
i i.d
Certified Mail#7007 0710 0605 5.821 2469
P�OpIHE ro Town of Barnstable
� Regulatory Services
- IIAfiNS'CAIILE,
�o "AS'. m Thomas F. Geiler, Director
O 3.639. �m
ArFd Mai a' Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
November 7, 2007
Louis Vuilleumier /
P.O. Box 12
Cummaquid, MA 02637 f/✓1 L J
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170..
• s ,
The property owned by you located at 4380 Route 6A unit#2,was inspected
on October 16, 2007 by Timothy O'Connell, Health Inspector.for the Town of
Barnstable. This inspection was conducted on the basis of the rental'registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the Town of Barnstable Code were observed:
070-10- Smoke Detectors and Carbon Monoxide Alarms. No CO alarm.
You are directed to correct the violations listed above within twenty-four(24) hours
of your receipt of this notice by installing CO alarms in accordance with Mass State
Fire Codes.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after-the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
QAOrder letters\Housing violations\Rental ordinance\4380 Route 6A 42.doc
Should you have any questions regarding the above violations, please contact the Town
Health Division and a to speak with the inspector. who performed the inspection.
PER ORD OF TH BOARD OF HEALTH
Tho as A. Me e , R.S.; CHO
Director of Public Health
Town of Barnstable
Cc: Timothy O'Connell, Health Inspector
Q:\Order letters\Housing violations\Rental ordinance\4380 Route 6A#2.doc
FORM30 ,C&w HOBBSSWARREN'" THE COMMONWEALTH OF MASSACHUSETTS
` BOARD OF1d&y5rH
CITYpN
J W ^.\
D RTMENT / _"
� /✓��
ADDRESS
G�y 5 8•e
TELEPHONE
Address — Occupant_
Floor . Apartment No. o.of Occupa
No.of Habitable Rooms__ o.Sleeping Rooms
No.dwelling or rooming units_ No.Eories
Name and address of owner r
5 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:
Dampness:
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 L
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
S ks, Flues,Vents,Safeties:
Kitchen Facilities fink2
e _.
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 VIOLLATIO S 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.(S e Over)
"THIS INSPECTION REPO T IS ED AND CERTIFIED UNDWTEINS AND
PENALTIES�b•PEF�aIJ
INSPECTOR //�� TITLE
DATE V TIME ` P
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
if
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.
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COMPLETE .N COMPLETE THIS SECTIONON DELIVERY
• Completi items 1,2,and 3.Aiso complete A. Signature
Item 4 if Resfncted Delivery is desired. X �V1iy 1 ❑Agent
® Print your name and address on t!1e reverse ❑Addressee
so that we can return the cans to you. B. R ei b ( rl ted Name) C. Qf
■ Attach this card to the back of the mailpiece, 3 lJ
or on the front if space permits.
D. Is elivery address different from Item 17 Ye
1. Article Addressed to:
If YES,enter delivery address below: ❑No
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®Certified Mail ❑Express Mail
❑Registered ®Return Receipt for Merchandise i
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4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Numberz r8 i_5,s s i
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UNITED STATES PT r 1 1 "-',';
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• Sender: Please print your name, address, and ZIP+4 In ffiis box •
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I /,r Town of Barnstab
Health llivisio
200 Main Stre CO2601 )
Hyannis,MA
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°FjTati Town of Barnstable
nA °� Regulatory Services Department
` BARNS'CABLE, `
.1MASS. Public Health Division
i639• �0
200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
Au
gust 28, 2007
Louis Vuilleumier
P.O. Box 12
Cummaquid, MA 02637
RE: 4380 Route 6A, Cummaquid
Dear Louis,
I am writing in regards to the rental ordinance for the Town of Barnstable. I am
curious if you still own the above-referenced property as rental units? If so, please
provide an updated list of tenant info (name &phone number) so that I can contact them
to schedule the rental inspection. If you no longer own these as rentals,please contact me
so that I can update our files. Correspondence may be sent to:
Town of Barnstable
Health Dept. —Attn. Caitie
200 Main Street
Hyannis, MA 02601
You may also call me directly at 508-862-4072.
Your assistance with this matter is greatly appreciated.
Respectfully,
Caitie Barrett
Health Division
Rental Program Coordinator
#508-862-4072 Direct Line
CERTIFIED MAIL# 7003 1680 0004 5458
„JE Town of Barnstable
BA Regulatory Services Department
■ RNSTABLE,
9$ '�: � Public Health Division
A'FD"AAA A 200 Main Street, Hyannis MA 02601
Office: 508-862-4644
FAX: 508-790-6304 Thomas A.McKean,CHO
August 1, 2007
Louis Vuilleumier
P.O. Box 12
Cummaquid, MA 02637
RE: 4380 Route 6A, Cummaquid
Dear Louis,
I am writing in regards to the rental ordinance for the Town of Barnstable. I am
curious if you still own these units as rental properties? If so,please furnish an updated
list of tenant information (name and phone number) so that I can contact them to
schedule this inspection. If you no longer own these as rentals,please do give me a call
so that I can update our files.
Your assistance with this matter is greatly appreciated. Please do not hesitate to
contact me directly with any questions.
Respectfully,
Caitie Barrett
Health Division
Rental Program Coordinator
#508-862-4072 Direct Line
f
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so that we Ca.. ?the card to you. B. R ed b ( Name) C. Date f e ery
■ Attach this card to ._':. k of the mailpiece, ���5 4.1 I i�, ��� 0
or on the front if space permits.
D. Is delivery address di ferent from item f? ❑Yes
1. Article Addressed to: If YES,enter delivery address below: ❑No
3. Service Type
V MGM A V� i�p1 bZ(p 3�1 Gil Certified Mail ❑Express Mail
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4. Restricted Delivery?Pft Fee) ❑Yds
2..Article Number 7:006z 0810. 000:0 ;352418318
(Transfer from seMce {
PS Form 3811;February 2004 Domestic Return Receipt 102595-02-M-1540
UNITED STATEsryry P6sTAyyL SERVICE
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• Sender: Please print.your name, address, and ZIP.. ;in this box•
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Town of Barnstable
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200 Main Street
Hyannis,MA 02601
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Certified Mail#7006 0810 0000 3524 8318
pFSHE rpw� Town of Barnstable
Regulatory Services
r BARNSFABLE,
90 MASS. Thomas F. Geiler,Director
p i639.
ArE0 MAta Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
I
February 9, 2007
Louis Vuilleumier ^ nsc�
P.O. Box 12 /•��CX�
Cummaquid, MA 02637 S I�
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 4380 Route 6A Apt. 1, Cummaquid was inspected
on January 26, 2007 by Timothy O'Connell, Health Inspector for the Town
of Barnstable. This inspection was conducted on the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500 - Owner's Responsibility to Maintain Structural Elements —
Window above door was broken; ceiling panel in bathroom needs replacing; master
bedroom ceiling needs repair.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by fixing window above entrance door; by fixing or
replacing ceiling panel in bathroom; by repairing ceiling in master bathroom.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Q:\Order letters\Housing violations\Rental ordinance\4380 Route 6A Apt. Ldoc
7
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF TH BOARD OF HEALTH
omas A. McKean, R.S., C
Director of Public Health
Town of Barnstable
Cc: Talia Arone, Tenant
Cc: Timothy O'Connell, Health Inspector
QAOrder letters\Housing violations\Rental ordinance\4380 Route 6A Apt.L.doe
105 CMR 410.
The following violation(s) of the Town of Barnstable Code were observed:
(Town code violation number-violation description)
170-
170- -
You are directed to correct the violations listed above within (3O ) days,_
Pritten#) (#)
of your receipt of this notice by
a o c
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served.
Non-compliance will result in a fine of $100.00 per violation. Each day's failure to
comply with an order shall constitute a separate violation.
Should you have any questions regarding the above violations, please contact the Town
Health Division and ask to speak with the inspector who performed the inspection.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean,R.S., CHO
Director of Public Health
Town of Barnstable
Cc:
(Name,tenant,owner,Fire Dept.,Building Dept....)
1
Cc: f d
(Health inspector's name)
(Generic codes located at QAOrder letters\Housing violations\Rental Ordinance\GENERIC CODES.DO,C)
Q:\Orderletters\Housingviolations\Rentalordinance\template.doc
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i:
Certified Mail#0000 0000 0000 0000 0000
t Town of Barnstable
Regulatory Services
�.YARLTb'a'r1St;E. �r
A Thomas F. Geiler, Director
Public Health Division .
Thomas McKean,Director
200 Main Street,Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
date
cl.d dress
ci ,state zi d '�' 6
ty p
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at Was inspected
(Address)
on by 70 , Health Inspector for the Town
(date) (Inspector's n e�
of Barnstable,
(Reason for inspection)
The following violation(s) of the State Sanitary Code were observed:
State code violation number- iolation dcscriptionjp � � n
105 CMR 410. 5'&3 - rr -
- - 0 D- 0 r�
G�' l u ✓ice
105 CMR 410.
105 CMR 410.
Q:\Order letters\Housing violations\Rental ordinance\teinplate.doc
FORM30 HkW HOBBS&WARREN " THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF TH
CITY To
W
DEP� TMENT
ADDRES /
(..,soa g61
GSM sv 0 ye `� f
TELEPHONE
Address �3 O `Vt ------Occupant -ajA�', An'�a.��
Floor Apartment No._ __No. of Occupants �I
No.of Habitable Rooms No.Sleeping Rooms_,_
No. dwelling or rooming units No.Storie
Name and address of ow er
1 marks Reg. Vio.
YARD Out Bld s.: nces
Garbage and Rubbish
Containers:
Drainage
Infestation Rats or other:
STRUCTURE EXT. Steps,Stairs, Porches: 1110 coo
Dual Egress: and Obst'n.:
❑ B ❑ F ❑ M Doors,Windows: �1C
Roof
Gutters, Drains:
Walls:
Foundation:
Chimney:
BASEMENT Gen.Sanitation:
Dam ness:
Stairs:
Li htin :
STRUCTURE INT. Hall,Stairway:
Obst'n.:
Hall, Floor,Wall, Ceiling: _
Hall Lighting:
Hall Windows:
HEATING Chimneys:
Central O 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 r
Bedroom 1 .110 j
Bedroom 2 0 13, qX 11 , IWO,
Bedroom 3
Bedroom 4
Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.:
Wks, Flues,Vents, feties: c
Kitchen Facilities_._.. _130 _ -
Stove
Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.:
Wash Basin, Shower or Tub:
Infestation Rats, Mice, Roaches or Other:
Egress Dual and Obst'n:
General Building Posted
Locks on Doors:
ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH
MAY MATERIALLY IMPAIR THE,HEALTH OR SAFETY AND WELL-BEING OF THE
OCCUPANT AS DETERMINED 'BY�105CMR 410.750 OF THE CODE OR THE
AUTHORIZED INSPECTOR.(See Over)
"THIS INSPECTION REPO SIGNE AND CERTIFIED UNDER E PAINS AND
PENALTIES OF PERJURY
INSPECTOR < TITLE
i A.M.
DATE I TIME _ .
A.M.
THE NEXT SCHEDULED REINSPECTION P.M.
. T
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 heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those
items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the
occupants or the public. Because Chapter 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.
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Parcel ID 351-042 Developer I,�....__...___. ! Lot
Location 4380 MAIN ST./RTE 6A(BARN.) I Pri Frontage 235
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Sec Road Sec
Frontage
Village BARNSTABLE Fire District BARNSTABLE
Sewer Acct I Road Index0949 _
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Map refs
Owner Info
owner VUILLEUMIER, MARION R & LOUIS E Co-owner
Streets 1.579 BUCK ISLAND RD#147 I Street2 -_.._.:.._�_.�_.., .._..�..._._....___. � ��
City IWEST YARMOUTH state l' zip;02673 Country
Land Info
Acres 1.00 Use€APT 4-UNIT MDL-01 I Zoning'RF2 Nghbd ;0109
Topography I Road
- --- -,---- - — -- ------ -------- -- - --- ---__...
Utilities I Location
Construction Info
Building 1 of 3
Year Roof _ __— Ext
1900 Gable/Hip -Wood Shingle
Built Struct Wall'v....____
Effect Roof ..._ ___..._.-._ AC
I ._ __....
Area 2595 Cover Asph/F GIs/Cmp I Type'None I
Be
style,Colonial Wa1l ITypical Rooms'5 Bedrooms
Model €Residential Floor I Int
_. '�___.. _ - Batn2 Full + 1 HT~ I
,
Rooms
Heat"_._.._ _.___ Total
Grade iCustom ITypical 9 Rooms I Type Rooms
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Parcel Detail Page 2 of 3
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Found-
Stories 2 Sty w/UAT , Heat(Gas Found- Typical _ __ $
Fuel[ ation i ' WF
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Building 2 of 3
Year Roof Ext `--
Built 1936 I Struct Gable/Hip Wall Wood Shingle
Effect 1343 Roof(AS h/F GIs/Cm Ac None
ver Area Co I p p TYPe __�_
Style Cottage WBe
nt all Typical Rooms 2 Bedrooms
Bath
Model Residentialz O Floor Ir it .__...,_._ _ Rooms 1 FullW
Heat Tota 1
Grade Below Average Type None Rooms
Rooms
Stories 1 Stogy Heat None Found- ical
1 ry Fuel - ation sT yp
Building 3 of 3
Year _ __.... . Roof I ..__...., .. __.__.._. Ext ._._.... �___....
Built 1950^ ,_.... Struct l WallWOOD FRAME
Effect1475 — -__.._--_- Roof[ Ac NONE
Area Cover 77�
Int erBe(
'-� B
Style Service Shop
Wall Rooms ;
Model Ind/Comm Int Hardwood Bath
1 Full
_ ,� Floor ��
Grade B@IOW A Heat Total „
_ verage � i
Type Roomsd�a�,x�
Stories Heat iElectrlc Found Typical
Fuel[__— ation
Permit History
Issue Date Purpose Permit# Amount Insp Date Comments
Visit History
__...._._ _- _.. ... - .......... _
Date Who Purpose
Sales History
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LOCATION SEWAGE PERMIT NO.
VIA,' LAGS
' I N S T A LLER'S NAME A ADDRESS
® UILoDE R OR ARAM
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DATE PERMIT ISSUED -�9-y(7)
DATE COMPLIANCE ISSUED Cp_� ��
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THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEAL"
.. . 0-n.--....OF..... .-d... . .. .....................
ApplirFation for Dhipvii al Iforko Tonstrnr#iun ramit
Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal
System at ..�
................ . ................. •---•---•-.............. ----------................................
Lo on•Address or Lot - o.
.._ - ..... �11 -------------------------- )` �flI-Q L .(, ld----------------------------------------------
er _ ddress
aj ............... _ .....---•------•--•---_...--
Installer Address
Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons............................ Showers — Cafeteria
Q' Other fixtures
--------------------•---------
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity......_.....gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
►-' Percolation Test Results Performed by...........................---------•------••-•---•---------------------- Date........................................
Test Pit No. I................mmutes per inch Depth of Test Pit.................... Depth to ground water........................
fT Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
--- f Q
O Description of Soil :. _. :... �. .-. -
f _.....................................................................
• •_•_•_•___•___•__-i__•___`:...................................................................................................................
..................... .....•_•_•___•--------------•---
x .................. cam -•-----------------------•-------- ........................ .
U Nature of Repairs or Alt4rations—Answer when applicable._______= � � _-___-��_-_ ' ...........................................
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iITI.L 5 of the State Sanitary Code= The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has ee issued by the boar o health.
Si ie
....... �
�o Date
Application Approved BY l ... ..---. i��� •-••--•-•....... fr' �j. _ ,�.
- Date
Application Disapproved for the following reasons---------------••------------•--------•-•------•------...--------------------•--•--------------................
...............................•-•-•--------•------...........-------------••---•--------.......-•---------••----------........--•--------------••-----......------------•-----•------------•--•-..-•---
Date
PermitNo.................. ._.... Issued._-.. 'z. .^_.....------•--------------------- .........................
Date
No................
--_....... FEs.....: ... .....�.� ..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD_OF• HEALTH
4�.. J.. .J._.....OF......�fr .l�<.,�.�:-:?..1. ................................................
App iraation for Dispnsal Works Tonstrnrtiun Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair (y) an Individual Sewage Disposal
System at:
.:�.�.: . ...-----••-•...................... ... ..................................................
.Locatison_. ddress
- - .►`` .....1_ t I$_+ !. ?� ....---- ....... �-t?a�r r� or Lot No./__i Cj....... ..................................
S Owner _ "` ! t Address
... : -` —'f 1 i '__�•... �`............. -
Installer l Address
d Type of Building Size Lot............................Sq. feet
U Dwelling No. of Bedrooms......................... ... .Expansion Attic Garbage Grinder
aOther—Type of Building ............................ No. ofpersons............................ Showers ( ) — Cafeteria ( )
dOther fixtures ...............................................=-----.....--------------•----------------------------------------------------:....._.._..._......----
W Design Flow..".......................................gallons per person per day. Total daily flow............................................gallons.
f� Septic Tank—Liquid ca.pacity.........._.gallons Length................ Width................ Diameter................ Depth................
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 ( )
1 4 Percolation Test Results Performed by.......................................................................... Date........................................
aTest Pi No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
.....-••-•----•.....-•••...............•-•---•-•••-•-•-••....-----
D Descripti n of Soil `=='r...........`... .....................
x ----------------•--- ---------------------------.....
t., - -- - --------------•--------------•----•- ••--.._....•----------------•....-------------------•----------..._...-•------------
--------------------------------------------
U Nature of Repairs or Alt ations-Answer when applicable.............._'..: ..:''J_.__..;!............................................................
y I ,
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health. 1
Si ed__ A-.:r1 .r ---------------- ,•-f---A--=-I -------------••-- -•--------------------------
Date
Application Approved B _ -' ��.
PP PP Y �� 'l ,- ��
Date
Application Disapproved for the following reasons---------------------•• ................................................................................
lt-
-••---•••... t
f. t Date
r --
e
Permit No.............• .... Issued..... •-------
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD .OF HEALTH e
s^ Mir...
fit *tt
Q t'1"rrtifirtt a
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
/�/rt yf IJC i �.
by.......... •-•_...- ----- ••--• •. --------•--•-•.._...-•••--•-•-••----•••••--•----•--- ......: .........................
" Installer
i ivy �✓ � !'�� f'�
at .. ------- -------------------- --- ----•- - -----------------•--------............_...----------------•---••-•-•-
has been installed in accordance with the provisions of 5 /The State Sanitary C e as desc 'bed in the
application for Disposal Works Coiistruction7Permit No. __. ____.. Gt- _____.__.__ dated.__. _ .f_'. .._._.._.._
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY
r. t/ �ay • 4mr.'A'"r ' I- iG"
DATE y Alnspector �-�
», ^N THE COMMONWEALTH OF MASSACHUSETTS
A BOARD OF HEALTH
Iy F...........................c........ ... :...
No......... ............. FEE..-......_........:.
�i��ai��t1 nrk� �nn�trn_ r#inn, rrntit.. .•
Permission is hereby:-granted - ................................i...................................................
to Construct { ) or Repair O an ndividual Sewage Dis osal System '
at No ;c J 41 . ... 11l . P Y 1..�1 .
f Street
as shown on the application for Disposal Works Construction Permit .............. D .....1�. _".a...."-F.....................
DATE- a Board of Health
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS