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HomeMy WebLinkAbout1480 FALMOUTH ROAD/RTE 28 - Health 1480 Falmouth Road The Physica( _Therapy Ctr 209-018 Centerville No. 4210 1/3 ORA Pendaflex' r 10% o. Nam. m -gym , " . L> Et _. 117 �_. > aacsfiA m 77 CDm V1 G ED rmco _+ to CD vcl m tt� to til c �.ram £ C3 r .. 77 777 � �. _. - � �� - m. per ❑ � �: -ti =- -M m ED m vim: rr LA - .M ED 4M--2rrl m 7A "� CD ti M � R , o -� Tf th i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,.1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. ��t ,,, ( DATE: Fill in please: w „r6� a ' APPLICANT'S YOUR NAME/S: ✓ i_1JeA H r3 is: r2 BUSINESS YOUR HOME ADDRESS: I 1 1 pl W F Vttzt xf 0'V COT-4 I T OJOS— TELEPHONE # Home Telephone Number 0 — �` 0 6 NAME OF CORPORATION.. . a'r Cc- NAME OF.NEW BUSINESS, Tl(PE.OF BUSINESS Zo IS THIS A HOME OCCUPATION? YES . NO X .ADDRESS OF BUSINESS (.y b. . tom: rtvjZj4 IC hr'H Y L MAP PARCEL.NUMBER D Assessor C3ASq 10Cnr7"� 02 When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the;appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSI NER'S OF. ICE This individual h erfmfo Fnd ,fan p rmir equ'rements that pertain to this type of business. f A th rized Signatur * j COMMENTS: I 0 2. BOARD OF HEALTH This individual has be formed of the pamM rep it ments that pertain to this type of business. uthoried Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** : COMMENTS: 1c DATE 8131106 PROPERTY ADDRESS 1480 Ta emouth Road Ceat e2v.i e ee j Naas 02632 - On the above date, the septic system at the address above was Inspected. _ This system consists of the following.: 1.1 1-1000 gaieon ze/2t.ic tank-., Z.f. 1-Dizta-i&ut.ion Box., - 3., 1 0- eeach.in .e.e.ie s.1 � ya Based on inspection, I certify the following conditions: 4., 7h.is .is a 7.it.ee T.ive zept.ic zy�3tem 5o SgPt-ic Zy.6te .is .in RaoRe2 wo¢kzag o/tdea at the pAesent time SIGNATURE -� Name: Robert A. Paolini a Company: Joseph P. Macomber & Son Inc Address: P. O. Box 66 Centerville, Mass 02632 r Phone: 508-775-3338 or 508-775-6412 A CJSEPH P. �MACOMBER & SON,. INC. Tanks-Cesspools-Leachfields Pumped &,Installed Town Sewer Connections O. Box 66 Centerville, MA 026.32-0066 775-3338 775-6412 • COMMONWEALTH.OF MASSACHUSETTS ExECUTIVE OFFICY OF ENVIRONMENTAL AFFAIRS s DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PARTA CERTIFICATION Property Address: .14 8 0 Fa m o u t h Road Cent e2v.�-�.�e Owner's Name: John Biadaza)w Owner's Address: z a m n Date of Inspection: 8131106 Name of Inspector: (please print) Ro,aert A Pao.l"in Company Name: 1 a macomleZ I .S:o.n Inc. Mailing Address: Cen teitv7 e, N gT6. 026 32 Telephone Number: 5 0 8-7 7 5=3 3 3 8 CERTIFICATION STATEMENT . I certify that I have personally inspected the.sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section.13:340 of Title 5(310 CMR M000). The system: X XX Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F ' Inspector's*Signature: Date: 0. The system inspector shall submit a copy of this inspection report to the.Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system.is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ""This'report only describes conditions at the time of inspection and under the conditions of use at that ^. time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTI.FICATION(continued) Property Address: 14 80 � �u- h/2oad y Cent eay.�.�.�2 Owner: .7ohn Ba-2da,3aao Date of Inspection: 8/3 1/0 6 C. Further Evaluation is Required by the Board of Health: NO Conditions.exist which.require further evaluation by the Board--of Health:in order to determine if:the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: no Cesspool or privy is within 50 feet of a surface water no Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: n o The system has aseptic tank and soil absorption system(SAS).and the SAS is within 100 feet of a surface water supply or tributary to a.surface water supply. r� The system has aseptic tank and SAS and the SAS is Within a Zone 1 of a public water-supply. 2� The system has a septic tank and.SAS and the SAS is within 50 feet of a private water supply well. n o The system has a septic.tank and SAS and the SAS is less than 100 feet.but 50 feet or mare from a private water supply well**.Method used to determine distance u��sua�- **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5.ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: 3 f Page 4 pf 11 OFFICIAL,INSPECTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) . Property Address: 1480 T a im o a:t_h Ron d Cerz.te2v�..P.Po Owner: 701i2 Paidaza2o Date of Inspection: 8/31/0 6 D. System Failure Criteria applicable to all systems:. You must indicate"yes"or"no to.each of the.following.for all inspections: . Yes No _ X Backup of sewage into facility or.system component due to overloaded.or clogged SAS,or.cesspool X Discharge.or ponding of effluent to the surface of the.ground or surface waters due to an,overloaded or clogged SAS or cesspool _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2.day flow X Required pumping more than 4 times in the last year.NOT due to clogged or obstructed pipe(s).Number of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. _ X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion.of:a cesspool or privy is within a Zone:l of a public well. y Any portion of a cesspool or privy is within.50 feet of a private water supply well. �. x Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality.analysis..[This system,passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from..that.facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered..A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that,oneor moreof the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner.should contact the Board of Health to determine what will.be necessary to correct the failure. E. Large Systems: To be considered a large system the.system must serve a facility,with a design flow of 1%000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — y the system is within 400 feet of a surface drinking water supply _ X the system is within 200 feet of a tributary to a surface drinking water supply — X the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant.threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5'of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART B CHECKLIST. Property Address:1480 Fa.Pmou;�h Road ( onfonr)i PRo Owner: Sohn. /32 PrjnA(7/1 Date of Inspection: 8/31/0 6 Check if the following have been done.You must indicate"yes"or"no"`as to each.of the following: Yes No X Pumping information was provided by the owner, occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? X _. Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available:note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out X _ Were all system components,excluding the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? _ The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of.Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 f Page 6 pf 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS ;SUBSURFACE SEWAGE DISPOSAL:SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:1480 Faimoath Road Owner: John Baida sa zo Date of.Inspection: 8131106 FLOW CONDITIONS RESIDENTIAL NIA Number of bedrooms(design):- Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms)`. Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage.system.(yes or no):_. [if yes separate inspection required] Laundry system inspected(yes or no):_ Seasonal use:(yes or no):_ Water meter readings,if available(last 2.years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establ,;ishnient:o//-i c e.6 .& &e a u t y .6 a.e o n Design flow(lard on 310 CMR 15.203): d Basis ofdesign'flow(seats/persons/sgft,etc.): 7 4 EmI2 eo yeez 10 cha i2.6 Grease trap present(yes or no): no Industrial waste holding tank present(yes or no): a Non-sanitary waste discharged to the Title 5 system(yes or no):n o Water meter readings,if available: 2 0 0 4=13 8, 0 00 ga i Fo n.6 q10 D=3 7 8.10 8 Last date of occupancy/use:20 �1t9 6, 0 0 0 ga-e e o n-6 G B D=5 3 6.i 9 9 OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 6127101 pump 7 ma.int Was system pumped as part of the inspection(yes or no): n o If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool —Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank —Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 20t ea/tz Were sewage odors detected when arriving'at the site(yes or no): no 6 f Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM"INFORMATION(continued) Property Address.1 480 FaPmouth Road e nt eavi e ee Owner:,7ohn Ba2da,6aao Date of Inspection: 8131106 BUILDING SEWER(locate on site plan) Depth below grade: 24" Materials of construction:_cast ironX 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): aointa a/1/2eaa ;tight no .s.iynz /o .2eakye.ivented thaouyh stack on gu.i2d., SEPTIC TANK:_L(locate on site plan) 10 D 0 ya on Depth below grade: 4 q y?a d e Material of construction: X concrete_metal_fiberglass_polyethylene _other(explain) �- If tank is metal list age:_ Is age confirmed by a Certificate of Complianee(yes or no):-(attach a copy of certificate) Dimensions: 5' 8"XS'.6.X4 ' 10" Sludge depth:_. to a c e Distance from top of sludge to bottom of outlet tee or baffle: t a a c e Scum thickness: t a a c e Distance from top of scum to top of outlet tee or baffle: t as ce Distance from bottom of scum to bottom of outlet tee or baffle: ` How were dimensions determined: m e a z u a e d Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,,evidence of leakage,etc.): _ Pump tank eveay 2 yeaaz o Zniet 9 outiet tees aae .gin- puce tank .ins .stauctultai-eu 3oun GREASE TRAP:N0(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): gaeaze taa/2 i,3 not /2ae,3eat 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: 1480 7a.2mou.th road centp2y i P Pv Owner:2nhn PaLlaAe7an Date of Inspection: 8/31/0 6 TIGHT or HOLDING TANK: N0 (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): , Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes.or no): Date of last pumping: Im is(cond)tion larm Ind float switches,etc.): .cm o agn C zag zankz aae not /2aeZent DISTRIBUTION BOX:Y e-3 (if present must be opened)(locate on site plan) �. Depth of liquid level above outlet invert: 0 Comments(note if box is level and distribution to.outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): Box .iz eeve—o 11a.6 2 eate2a,&3.40 3o-eid caa/z ove2.i No ieakagp .cn o2 ou o ox.! PUMP CHAMBER: NO (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pu 8 Page 9.of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1480 tTa ffzouth Road Cent eay.i.e.ee Owner:aohn Baidaza2o Date of Inspection: 8137106 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Located see page 10.1 Type X leaching pits,number: 1 leaching chambers,number: X leaching galleries,number: 1.0 leaching trenches,number,length: leaching fields,.number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of.hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Loamy to m�d.ium , 6ando . No �s cc�n� o Pa.iia-,ze So.iez ate d2y., e e ¢ .ion In 12a2 tng zozo CESSPOOLS: NO (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: - Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yesf yr no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Cezapooiz ate not p/tezent PRIVY: NO (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): pa ivy .ins not paezent 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUI$SUR!'ACE_SEWAGE:DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 14 8 0 Fa; o u t h /R o a d Centeavi. ie Owner: John Baidaaazo Date of Inspection: 8131106 SKETCH OF SEWAGE DISPOSAL SYSTEM Prbuide a sketch of the sewage disposal-system including ties to at least two permanent referdnce landmarks or bench arks.Locate all wells within 100 feet.Locate where public water supply enters the boil$ng. I p,I `5 10 Page I l,of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACESEWAGE DISPOSAL SYSTEM INSPEC PART C SYSTEM INFORMATION.(continued) Property Address: 1480 F a e o u t h Road , Cente2vi Le Owner: John Ba eda j06 Date of Inspection: SITE EXAM Slope _ .. Surface water Check cellar Shallow wells Estimated depth to ground water � feet Please indicate(check)all methods used to determine the high ground water elevation: N 0 Obtained from system design plans on record-If checked,date of design plan reviewed: u e Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: n o Checked with local excavators,installers-(attach documentation) e Accessed USGS database-explain. �—. You must describe how you established the high ground water elevation: I red. : Ca e Cod Comm.izion Nataz 7aa-ee CoAt°u2b 4nd pugeic llate2 SuPP-gy 1 (�eQQ head 20tection _.a/tea ma Sel2i 1995 lJate2 ae�ou2ce� o ice ca e cod commition. � ru Leaching Pit feet Groundwat Feet Below Bottom of Pit High Groundwater Adjustment 1.8 ft per Frimpter Method Therefore,the vertical separation distance between the bottom,, of the leaching pit and the adjusted groundwater table is G feet: 32 11 News."Wrww Now •FK",'• TOWN OF = I30AZ D QF 11$A1,T�� RFACR BRINAGE DISPOSA4 BYST>;M T SPECTI.ON FORM - PART D.•- CERTIFICATION .eunau ....,,�. «'+„ '*•ti�^"'""`s"""""�'°'~�..r. *�A� •tYPL OR PRIH?,CLLARLY— PR .PERTY XNSPLF07*H 1 STREET ADD055 .1480 Fa--emou.th Road A-SSESSORS MAP BLWK ANV 'PARCE'Ll iI 209-018 . OWNER's NAME John DaX.d—a ai0 . NW PART"D C$RTIPXCAI' ON _ NAME 'OF INSPECTOR Rob.rt: A -Paoliri COMPANY NAHE COMPANY AgDR.RSS ,! 0:2��3.2-0066 " Str• Torn-or City. BtaLP L p COMPANY TELEPHONE t. 508. 1 �7.5 3338 FAX �' 508',.;190 � f 578 . C13R m-riCATION. STATEMENT I certify that I have pergoriallY .ins-peoted .•the 06wage 'digpopil. system at this address and that.-t1id� information reported .1s true,. aoviirate, and omplete a� of the tithe .a�P'�inspeatiion., The in0pevtio:n was per-formed and any recommendations regard.it►g�ienceain th@ main properefunct�,•onparid •maintenanoeent of on— .site my training and exp.q site sewage disposal. systems. Check one., XXXX SysteM P-AS99D = The inspection which J. have .•cond�a��s rosaae�•uatelY., proteat�publi•on • = which indicates that :the system health or the envl.ropment as defined io- .310 CMR. if 30.3's Any fAiItt•re criteria riot evaluated' are as stated in the FAILURE' CRI•'PMA .section o:f this. form. System FAIL- DD The inspection which I -have 'found that 'the system fails to protect the public Health Rnd the enY4roomen•t ' in ac(;o'rd•anee with Title 61 310 CMR 15 . 3Q3, and as - specifically noted -on .PA T: C - . FAILURE CRITERIA of this i spection,.form, Date Insecto>' Signature' ne' copy of this cert�,fJ�oaU4.*n 'fnu•st -he �rovi'ded 'to :the •QWN9R.i �h* BU`fER-• where appll.oable ) and thV, DQARD OF HEA ilt ; L * if the inspection FAiL'E-D., 'thb .cwne�' .osr"operator s;hall . upgsade'.the syetetn. within o'ne year of the date of the inspection► unless. al-lowed Qr' requ�.,red nt.harw{se. as provided iT qA,0 CMR 36306 . TOWN OF BARNSTABLE ° LOCATION J 44 C60- R-� S�b `���o ��\SEWAGE# VILLAGE Q 'l�jlQ, ASSESSOR'S MAP&PARCEL of-O f— OIX INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY j400 LEACHING FACILITY:(type) 1 WIL (size) NO. OF BEDROO OWNER b ,.� c✓ sew/ PERMIT DATE: COMPLIANCE DATE: 3 dG Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist , on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist , within 300 feet of leaching facility) Feet FURNISHED BY Rook &T cQnp:rt'Itk- i I i ai to vie -2'yD - / 76 6 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH tk satisfactory 2.Printers 3.Auto Body Shops _ V.. O unsatisfactory- 4.Manufacturers COMPANY_Gy4/rl��' 61 Air (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS `V d '`vjClass: 27 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic S hJIAe 'cVrgaics: ]= &Y //�� e//ss a ) v I i'�Z� 11Q '1 led G beam 7)- l °• e'.I- Ll- 7h � �. Miscellaneous: 10 ��--g-a rt as we, �vSf' �lil o s 7' l b2 DIS O AL/RECLAMATION REMARKS: ' 1. Sanitary Sewage 2. Water Supply vnaAkf O Town Sewer t�Tublic -7,On-site OPrivate 3. Indoor Floor Drains YES-No O Holding tank:MDC ' O Catch basin/Dry well �tf O On-site system 4. Outdoor Surface drains:YES x NO ORDERS: O Holding tank:MDC ACatch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. I� 2. 014 i _o- Person (s) Interviewed Inspector Date / L , MAY lqq� TOWN "OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTHY 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY ° (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESSlass• 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: S R_ � DISPOSAURECLAMATION REALAM S: d 1. Sanitary Sewage 2. ater Supply G oIE A O Town Sewer Public On-site OPrivate 3. Indoor Floor Drains YES NO X7 O Holding tank: MDC ! O Catch basin/Dry well O On-site system setV Q 0 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. Person (s nterviewed -nsp o ,Da TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: WAf Mail To: BUSINESS LOCATION: &Ant &WAoard of Health MAILING ADDRESS: � � -/� own of Barnstable O. Box 534 TELEPHONE NUMBER: u�Ca19L1191 yannis, MA 02601 CONTACT PERSON: L. Al WIAIIV EMERGENCY CONTACT TELEPHONE NUMBER: _ Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, ' YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners L. Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids bet xic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business J MO THLY INVENTORY - MONTH % _- zi��,r- / � OFFICE: FFI E PRODUCT � PRODUCT CODE QUANTITY BG B&G PARTS BG -50 hose 246180 BG koroseal tank gasket P-268 001284 BG valve cable 9 inch 246130 BG valve extension 8 inch 246134 BG multi jet c/c tip complete 5850-cc 246290 BG valve packing teflon 001342 BG nesh monel screen each 001272 BG up, leather 6/set NP-271 001277 BG rack and crevis tip only 246276 BG crack and crevis tip extension 246106 BG check valve 12/set PV-266 (each) 001307 BG b&g 124-cc 272250 'BG pump cylinder brass 1 gal. 001300 EQUIPMENT(SERVICE MATERIAL ACCT) E actisol compact unit 243500 E bee gloves n-22 246030 E bee hat-ventilated n-16a 246035 i E ee pole complete 246025 E ee pole-head only 246026 E bee suit w/veil n-19 s/m/I/ 246040 E ee suit w/veil n-19 A 246041 E ee veil n-11 246051 i E ee veil n-20 w/zipper 246052 E corks #3 248300 E dowels 1" 1m/lot 249241 ,E uracell batteries pr 249881 IE ever ready batteries pr 249885 E flashlight bulb- kpr-103 249932 E flashlight#1626 black 249950 E loves- neoprene- large 251802 E loves- neoprene- medium 251805 E loves- neoprene- x large 251810 E loves-rubber- elbow 251850 E iypro pump 6500-cr 254310 E -7 mouse traps 72/cs 259550 E -9 rat trap 12/case 264250 E evr-rust service kit 260300 E olasti plugs 500/lot 260795 E service record labels 100/roll 266640 E siege cartridge one grm 196600 E tech dusters (10 or more) 249400 E rays- open bait 1000/case 260350 E rays- open bait 250/sleeve 260349 E victor rat bait stations/50case 263850 SUB TOTAL RETAIL(OTHER) R contrac pellet throw pk 049100 R dual odor elim. 12x5/ca 80976 R ficam granular 16# bag 092800 R ficam plus r/s 12 cans case 092676 R ficam wasp & hornet 12x14/cs 092821 R flytec 12 x 1 # 098001 R or the birds 12x10.5/cs 033651 R gold stick - large 24/case 102906 R gold stick-mini-#912 24/case 102901 R ug sprayers each 256250 - R etch all traps 12/cs 257681 R ouse masters 12/ca 259801 jR Detcor 12x16/cs 139501 �R ro control foggers 12x6oz 152501 R rotecta b/s 6/cs 261651 R orotecta Ip 6/case 261562 R Drotecta rtu 12/cs 261601 R oach kil 12 x 10 oz. 182001 ZI c R ockland home 6xl/cs 185011 R ockland to odor 6xl/cs 185026 oo/ IR ropel 12 x1 qt. 194706 R strike insect strips 24/case 217501 R vector glue trays 24/case 283615 R vector light bulbs 24/case 283621 R Vector system 283610 R victor flying insect traps 12/ca 250101 R hit pt-4..allure 4/kit 241845 R whit pt-4 allure 6x4/kit 241846 R whit#20-1015 wand 285010 SUB TOTAL SERVICE CHEMICALS C avitrol mixed per lb. C avitrol w.c. 5# 027233 C Daygon bait 2% 4x5# C :)orid 4x5#/cs 033731 1 C p 100 4x 1gal 027454 C p 300 12x24/cs 027351 C Dp 300 12x34/cs 027403 C p-300 4x1 gal/cs 027361 C ommodore wsp 12x12x2x5.6 046011 C ontrac blox 4x4#/cs 049011 C contrac meal throw pk 049050 C dirtac 4# 075710 C dirtac rat and mouse 120 x 1.5 075730 �o�( C ditrac 18# 075715 C ditrac 4 x4 # 075711 C drax 080611 02 C drione 8x1#/cs 080951 C dursban to 48/cs 081451 SC .d.v.p. 2x2.5/cs 055456 C empire 16x1pt. 084991 C ficam dust 6x5#/cs 092782 - C ficam plus 12 x 8 x 1oz./case 092661 C lee 10 x 1.6/case 093130 C gencore plus foggers 010131 C gentrol 10x1.25 101060 C gentrol10x10x1.25 101061 C plouee louee 251863 C old fast mouse 72/cs 251870 C kI master II 1 gal 114930 C nox out 5x1/cs 115001 C iquid tox 50 x1.7oz./case 122750 C -nag roach paste 12x1.25# 124266 C axforce 288/cs 128601 C maxforce gel 8x3x60/cs 128621 3��(S . , 1 C maxforce.Ig 96/cs 128606 a 1L5 C mouse masters 12/cs 259801 C precor 10x10x1.25/cs 148502 C ro control ant bait 8box/case 152526 C -400 + 1 gal/cs 159841 C ozol tracking powder 6# pail 195540 02 ,-'/ C safrotin 31.25oz 195700 SC safrotin 6x31.25/cs 195701 C safrotin 10 x 10x1.25 195592 C siege cartridge 24x100/grm/case 196601 C talon 4x10/cs 209321 C talon 4x200x25/cs 209401 C talon weather blox 4x12.5/ca 209246 C timbor 24 x 1# 210201 C Lorus box 211200 r '� SC trapper Itd 72/bx 251985 C trapper mouse pro glue bds. 72/ca 251935 C trapper rat glue boards 48/cs 251982 a C uld : by-15 2x2.5/cs 283610 C waltharn glue board 910700 C waltham insect monitor 100/cs 910800 C altham plastic bait sta. 910725 CSC whit 310 avert 12 x 30 gram 241376 C whit 3-6-10 12x23/cs 241021 C whit 3-6-10 15#cyl 241025 C whit 565 15#cyl 241577 C whit 565 2x8#cyl 241581 C whit 565 8#cyl 241580 C whit #170 x-clude 4x1gt/cs 241203 C hit #240 12x16/cs 241221 C hit#270 15 Ib. cyl. 241362 C whit #279 engage 12x20/cs 241368 C whit #515 12x12/cs 241461 C whit#565 12x6 oz./cs 241551 C' (!S C whit #565 plus xlo 12x20/cs 241596 SC zp tracking powder 4 x1 # 243121 SUB TOTAL ERMITICIDE TOTALS ARE TO BE # OF CASES OR CONTAIN ORS ON HA I dragnet 5 gal u turn 080575 I dragnet 4x1 gal/cs 080586 I dursban tc 4 gal/case 081651 I bora care 4x1 gal/cs 033671 I equity 2 x 2gal/case 085011 SUB TOTAL TOTAL COST OF ORDER NOTE -SHADED LINES NOT INCLUDED IN TOTAL � o � � TOWN OF B NSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH � satisfactory1 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY l^ (see"Orders") 5.Retail Stores � 6.Fuel Suppliers ADDRESS 1 V y ,-�N-0� . Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons 777 Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: '/© Y' P01W S'v`olt-6"1 l� ,a j?L,Iblwdo v�Ce� x S� l3Ce��i C�Ldv �- x fob IYA v" X DISPOSAIJRECLAMATION REMARKS: _ 1. Sanitary Sewage 2.Water Supply 0 S -- O Town Sewer )Wublic *gOn-site OPrivate . 3. Indoor Floor Drains YES NO>� O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES /\r NO ORDERS: O olding tank:MDC tch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. � .-/g-1' Person(s) Interviewed Inspector Date McKean Thomas From: McKean Thomas To: Maloney Kathy Subject: RE: 10/06/94 AGENDA THE PHYSICAL THERAPHY Date: Wednesday, October 05, 1994 5:02PM The following are the comments of the Barnstable Health Division regarding the proposed project SP#41-94: The septic system was upgraded in 1993 with the addition of ten galleys. I can only assume that the proposed use will not exceed the design of the septic system. Does the applicant have any records of the septic system components? From: Maloney Kathy To: McKean Thomas Subject: 10/06/94 AGENDA THE PHYSICAL THERAPHY Date: Wednesday, October 05, 1994 2:59PM NEED YOUR COMMENTS ON ABOVE CAPTION SUBJECT FOR TOMORROW'S MEETING. JANET Page 1 McKean Thomas From: McKean Thomas To: Maloney Kathy Subject: RE: 10/06/94 AGENDA THE PHYSICAL THERAPHY Date: Wednesday, October 05, 1994 5:02PM The following are the comments of the Barnstable Health Division regarding the proposed project SO#41-94: The septic system was upgraded in 1993 with the addition of ten galleys. I can only assume that the proposed use will not exceed the design of the septic system. Does the applicant have any records of the septic system components? From: Maloney Kathy To: McKean Thomas Subject: 10/06/94 AGENDA THE PHYSICAL THERAPHY Date: Wednesday, October 05, 1994 2:59PM NEED YOUR COMMENTS ON ABOVE CAPTION SUBJECT FOR TOMORROW'S MEETING. JANET Page 1 TOWN OF BARNSTABLE SITE PLAN REVIEW A) 645 DATE: September 27, 1994 TO: Thomas McKean FROM: Janet Locke, Site Plan Review Coordinator RE: Site Plan Review 41-94 The Physical Therapy Center, 1480 Falmouth Road, Centerville Map 209-18 Proposal: to occupy office space in the building with a dentist an a hairdresser Please submit this form, with any comments or additional requirements you may have regarding the above referenced application, to the Building Commissioner's office by October 6, 1994 I have the following/attached comments/requirements regarding this application for Site Plan Review . I do not have any comments/requirements regarding this application for Site Plan Review at this time. (Signature) -8/25/94 Location: 1480 Falmouth Road, Centerville, MA Map 209, Parcel 18 across the street from Cape Cod Package Store and beside the gas station at the intersection of Phinney' s Lane and Rte 28 Owner : J & E Realty, 1480 Falmouth Rd, Centerville, 775-8343 Applicant : Jean Egan, The Physical Therapy Center P.O. Box 604, Osterville, MA 02655 428-0300 Site: Existing 2 ,000 structure Zoning District ilB Flood Hazard C Groundwater Overlay AP Two tenants presently - !lair Lab, Dr . Auger Requested Use: Physical therapy medical office 800 sq. ft . ,5,'de o 6vI%1,.70 /1pQm Qoom -- ---- ---- v� To .Den+i5+ of iof a- Nee-h4m(ca/ RCOM re-cVf�on close+ e xerc1ze s''PFIY room Cr�c�5f�nq� <Q..aSca'Oe .�aha'Sca ,egMpe.d er,�-.-o,�cP ra ai The Physical Therapy Center , Inc. is interested in renting space at 1480 Falmouth Road, Centerville for the purpose of establishing a satellite office. The Physical Therapy Center , Inc. ' s main office has been located in Osterville for 10 years . Our business employs three registered physical therapists , an assistant physical therapist , and an office administrator . We specialize in personalized rehabilitation of orthopedic injuries , but treat the full range of musculoskeletal deficiencies and maladies . The majority of our business is generated from physician referals , and a small percentage comes from walk in traffic. An increasing number of our patients live in the Centerville and West Barnstable areas . We would like to be available for these people in a satellite office which is closer and more convenient than Osterville. We are a registered Medicare and Medicaid provider, and handle several HMO' s including Pilgrim, and most health insurance companies . The property under consideration is a 29000 square foot building owned by J & E Realty Trust . It is located across the street from Cape Cod Package Store and beside the gas station at the intersection of Rte 28 and Phinney' s Lane. Upon best knowledge there are two tenants presently in the building: The Hair Lab (a hair salon) , and a dentist , Dr . Auger. We are interested in renting 800 sq. ft . of space downstairs in the building. It is accessed from behind the front of the building. The space is finished, but upon best knowledge has never been occupied. The space would be divided into two 12 ' x 10 ' treatment rooms , with the balance occupied by an exercize and reception area. There is a large existing bathroom and closet space. The landlord would modify the existing entrance to .incorporate a downward sloping handicap . entrance. An existing permitted sign at the front of the building has blank space available to include the company' s name. The company would also like to attach a small sign at the back of the building to identify the entrance. We anticipate initially employing one full time therapist on the site, with administration handled through our main office. Our normal business hours are from 8:00 am to 6:00 pm, during the week days . It is our hope that eventually the business will expand to include two full time therapist on site, and so we could occupy up to six parking spaces at one time in the course of an hour . The existing site plan indicates that there are presently sufficient excess parking space to accomodate the anticipated future expansion. f 4PPLICA7.1 uN I UR SITE FLAN REVJCW FOR 00•10E USE Olyi DATE RECEIVED t ' ACTION DUE BY &OCATION Legal Description: /490 �a�inoy�h �Pd �L C�n-/e.ev��l� Planning Board Subdivision Numbers Assessor's Map and Parcel Numbers &hAPa 2091, Aar/ Property Address* OWNER OF PROPERTY APPLICANT !name: 9- oeeaA/1 Name$ -;,le %'/r✓s.ca/ Te!2$f, �pH P 4ddress• Address s Ro. 60�e 604 Phone s Phones- yo*S— 0 3 0 0 ENGINEER AGENT(interest owner or applicant) names Names Address Address Phones Phones STOi.AGE TAFRISt UTILITIES 'ZONING CLASSIFICATION(S) :115710.+ PROPOSED Seazr Districts Numbers N er:_ Public— -- •Flood Na2ardr G ;i:es iZes Private Groundwater Overlay#_ Above Grounds Above Ground:_ Fire Districts Urderor•oundr dergrounds Water: LOT AREA# oW.4113A sq. Contents contents: PublioJL--, Private:_ NUMBER OF BUILDINGS Fire Protection:_ Existing# EAR}.INC+ FAACES CUTS Proposed# �•y,P �egaireds_1Q_ Existing; S Electrical: Demolitions %rov:deds^3 Froposed: Arial:_J In Sites 35 To Closes Undergrounds_ TOTAL FLOOR AREA (in sq. If f Site: _.. - Totals 54 P Gass Residential# llatur•al:_ Offices 1H_A1S70F:ICAL ISIhIC (yes)_ ( FroDane:_ medical Offices_ I,6Sy Commercials /,200 1N AgA •GF_CR1?1CAL ENVIRONMENTAL (specify use) G%r SG/0-7) CONCEPH r_E.O.E.A.Is (yes)_ ( )_ Kholesale [poitc? WITHIN 100' OF UETLAHD RESOURCE AREA: (yet)_ (n • _ Institutional$ Industrials TOWN OF;BARNSTABLE SITE PLAN REVIEW �4, 1 9 4 S EP 2 7 1994 ECEIVE CG:•itr,ia G. S1il PLAa The Site Plan shall Include One or more approp►iately scaled• MPS or drawings Of the / property, drawn to an engineer's scene. clearly and accurately Indlcating such elements of y, the following Information as are pertinent to the development activity p►opostOs rj 1) Legal descrlptlon, planning board applicable) the pe applicable). Assessors' Map and Parcel number and address (if applicable) of Rl+t property. address and phone number of the property owner, and applicant if different ❑ 2) Name, than the property owner. O ❑ 3) Name address, and Phone number of the developer, contractor, engineer, other t�l design professional and agent or legal represcntltivt. 10. r ❑ 4) Complete property dimensions, area and toning classification Of property. QJ ❑ S) Existing and proposed topographical contours of the property taken at two-foot 12'1 o-� contour Intervals by a registered engineer or registered land surveyor. J 6) The nature, location and site of •ii significant existing natural land features, ,\`0 ❑ including, but not limited to, tree, shrub, or brush sh rfacesraall 1I excess of rte$ Over six feet real la • , g ten inches 110 ) In caliper, grassed (6') In diameter and toll features. ❑ 7) Location of all wetlands or watertxodles on the property and witAtn one hundred feet `�. (1001) of the perimeter of the development activity. Qj o- ❑ 8) The location, grade and dimensions of all present and/or proposed streets. ways and V easements and any other paved surfaces. ` � v � ❑ e� 9) Engineering cross-sections of proposed new curbs and pavements. and vision triangles measured to feet from any proposed curb tut along the street on which access is proposed. ❑ 10) Location, height, elevation, interior and exterior dimensions and uses of all buildings or structures, both proposed and exlstingt location* number and area of floorsl number and type of dwelling unitst location of emergency exits, retaining . walls, existing and proposed signs. ❑ 11) Location of ali existing and proposed utilities and storage facilities including sewer connections, septic systmS and any storage tanks, noting applicable approvals if received. ❑ 12) Proposed surface treatment of paved areas and the location and design of drainage systems with drainage calculations prepared by a registered civil engineer. [] 13) Complete perking and traffiC circulation plan, if &MI lcable, showing location and dimensions of parking stalls, dividers, bumper stops, required buffer areas and planting beds. 0 14) Lighting Plan showing the location' direction and intensity of existtng and -proposed seta fixtures. met light!ih ❑ IS) A IW$C&ping plan stowing the location, name. number and site of plant types, and the locations and elevation and/or height of planting beds* fences#.walls. steps and paths. ❑ 16) A location map or other drawing at appropriate state showing the general location latl of the property to surrounding areas including. where relevant, e and re Ctltt pt�Ftftielle Lh0 txlating street 6Y$t&1 ue turno rada n i 6n0 Wand a P3 zo ng area and location of nearby public faclllttes. ❑ 17) Location within an Historical 01striet and any other designation as an Historically Significant property, a"d the age and type of each existing building and structure on the site which Is more than fifty (50) years old. _3JeAT214F;nci 10 VjWar V131 3S Q rIN-L'ocatIon of site with regard to tones of Contribution for public supply wells as det ermined lin a report entitled "Groundwater and Water Resource Protection Plan, sY �tier.nstable, Massachusetts' prepared by SEA Inc., Boston. KA. dated September. 1985, which Islon file with the Town Clerk. fj (❑,. 119)tLoca�ti n of site with regard to flood Areas regulated by Section 3-5.1 herein. s of Concern as ❑ de Location of site with regard designated by the Co�r+� e lth of I:assachv etts. critical Exec'vtiveEnv off cesofaEnvt orvnental des Affairs. Lv_aS,I N 'Jr r1l Zoning Ulstrlct Old -King' s Hiqhway District Ny or Listed in National and/or State Register of Historic Places uo _ Perimeter set backs+ Front Side 3- !6 /� Rear a`a• : Lot Coverage Type of Use ( z o n i n 9> --- Flood Plain Zone G Elevation Number Of Floors oZ Floor Area+ 1st - 2nd — Other (specify) Requirements+ Required i9 Parking � Provided Handicapped Spaces 3 Are there accessory buildings' AJ� . Accessory Buildings Floor Area PLEASE PROVIDE A BRIEF, NARRATIVE DESCRIPTION OF YOUR PROPOSED PROJECT. at I have completed (or caused to beonompleted)the back this of page t Site Plan Review Application and the checklist a lication and that. to the best of my knowledge, the information PP submitted here is true. 9 (signatur (date) 6 i 1 .__—----------- ----- - YI- NO Division of Land is this a division of fifty(50) acres or more of land which was in common ownership ns or 1/1/88? is this a division of fifteen (15) acres or more of innd which was in common ownership as of l/1/s8 and which was the result of an earlier ( ( subdivision within the last seven (7) years? is this a dewelo ament which proposes to divide laud in common ownership Into thirty (30) or more residenUnl dwelling units? is (his n development which proposes to divide tnaxl III conuraon ( ( ownership Into lean (10) or morc business, office or Industrial premiscs? CreaUon of more than 30 dweMng units Is this a devclopment. Including the expansion or existing developments, that Is planned to create or accommodate more than 30 dwelling units? Commercial Construction Will the development create retail or wholesale business; office or industrial development; private, health, recrcallonal. or educational devciopinerit with a floor area as follows: 1) New construction greater than 10.000 square feel? 2) Addition or auxlliaary bulidingw greater than /atesquare fuel? O (� 3) Outdoor conanurcial space greater than 40.000 square feet? 41 Use;chaange.4 which luive a Auor arcat greater than 10.OW bwluurc feel? FacllltIcs for Transportation to or from Barnstable County Will the development construct or ex1imid rae.001cs for lransp>ortutlun to or frau Vanistable Comity? e , Acem To The Cout Or A Great Pond is lhls development a bridge. maid or driveway providing dime! 1 f vehicular access to the waist or as great pond? Illstorie Structures Will the deveiopincnl demolish or subslanttailly taller :na I lislorle i ) structure listed with the National or Mnssaachuselis Register of I11storic Places, outside n nnuaicipaal historic district or rnatslde the Old Kings (Ilghway Ilisioric District? (Note: Repairs, upp;rndes. changes• alterations or extensions to a single faamliy taonic are exempt from Commission review unless the proposed rcpnir. upgrntte. chnnge. ol(cnUlou. or extension Is greater than 25%of tlac flour area, of the uxlslirIg dwclihag.) 17 I -8/25/94 Location: 1480 Falmouth Road, Centerville, MA Map 209, Parcel 18 across the street from Cape Cod Package Store and beside the gas station at the intersection of Phinney' s Lane and Rte 28 Owner: J & E Realty, 1480 Falmouth Rd, Centerville, 775-8343 r Applicant : Jean Egan, The Physical Therapy Center P.O. Box 604, Osterville, MA 02655 428-0300 Site: Existing 2,000 structure Zoning District HB Flood Hazard C Groundwater Overlay AP Two tenants presently - Hair Lab, Dr . Auger Requested Use: Physical therapy medical office 800 sq. ft . ate aS .5,de o� 6v,%G?�,•�f9 Re4r- �S hz 1`5> T�e��inerr� Treo�Me r� Roo," 20o rrI — To Den a- Nec han ica R ooM rec �/'01? CIoSe+ e xerc�ze �'PP�y �firoon, `'•� rGY.� CrX+S�rnq� L �aNidSra o�Ad sc a PF e ,2a, pecd en��u�c� Pa �K, �� OorA6n5 The Physical Therapy Center, Inc. is interested in renting space at 1480 Falmouth Road, Centerville for the purpose of establishing a satellite office. The Physical Therapy Center, Inc. ' s main office has been located in Osterville for 10 years. Our business employs three registered physical therapists, an assistant physical therapist , and an office administrator. We specialize in personalized rehabilitation of orthopedic injuries, but treat the full range of musculoskeletal deficiencies and maladies. The majority of our business is generated from physician referals, and a small percentage comes from walk in traffic. An increasing number of our patients live in the Centerville and West Barnstable areas. We would like to be available for these people in a satellite office which is closer and more convenient than Osterville. We are a registered Medicare and Medicaid provider, and handle several HMO's including Pilgrim, and most health insurance companies. The property under consideration is a 2,000 square foot building owned by J & E Realty Trust. It is located across the street from Cape Cod Package Store and beside the gas station at the intersection of Rte 28 and Phinney's Lane. Upon best knowledge there are two tenants presently in the building: The Hair Lab (a hair salon) , and a dentist , Dr. Auger. We are interested in renting 800 sq. ft . of space downstairs in the building. It is accessed from behind the front of the building. The space is finished, but upon best knowledge has never been occupied. The space would be divided into two- 12 'x 10' treatment rooms, with the balance occupied by an exercize and reception area. There is a large existing bathroom and closet space. The landlord would modify the existing entrance to incorporate a downward sloping handicap entrance. An existing permitted sign at the front of the- building has blank space available to include the company's name. The company would also like to attach a small sign at the back of the building to identify the entrance. We anticipate initially employing one full time therapist on the site, with administration handled through our main office. Our normal business hours are from 8:00 am to 6:00 pm, during the week days. It is our hope that eventually the business will expand to include two full time therapist on site, and so we could occupy up to six parking spaces at one time in the course of an hour. The- existing site plan indicates that there are presently sufficient excess parking space to accomodate the anticipated future expansion. D N T 3 r r rn Al 00 y a 3 0 . o C 2 a �► a . G N, b fib h� II u � 4k 0 dw 1 HERRICK & SMITH 16 SCHOOL STREET HYANNIS�MASSACHUSETTS 02601 WASHINGTON OFFICE BOSTON OFFICE 1800 MASSACHUSETTS AVENUE,N.W. TELEPHONE 617/771-2994 100 FEDERAL STREET WASHINGTON,D.C.20036 BOSTON,MASSACHUSETTS 02110 202/659-2700 TELECOPIER 617/771-6079 617/357-9000 May 8, 1984 Mr. Edward. J. Machado Mr. John A. Baldazaro 140 Captain Carleton Road Cotuit, MA 02635 Re: Richardson:. Road Associates - Land Encroachment Gentlemen: Please be advised that this firm. represents Richardson Road Associates, holder. of. record title to the. property upon which the Centerville Nursing and Convalescent Home is situated. Mr. Edmund Lundberg has referred to us your correspondence dated January 30, 1984. A recent inspection and survey of the property owned by. Richardson Road Associates .abutting your prop- erty confirms the information contained on the certified plot plan accompanying your January 30, . 1984, corre- spondence. Specifically, our. survey. reveals that the paved portions of the parking lot area on the northwest portion of the property, known as Lot 2, Route 28, Centerville, Barnstable County, Massachusetts, as recorded. in Plan Book 196, Page 33 at the Barnstable County Registry of .Deeds, have encroached. upon property owned by Richardson Road Associates. Said encroachments have occurred. without the knowledge or consent of Richardson Road Associates. In light of the long- standing relationship between Richardson Road Associates and you as neighbors., our client has authorized us to HERRICK & SMITH Mr. Edward. J. Machado Mr. . John A.. Baldazaro Page Two May .8, 1984 inform you. that Richardson Road Associates has. no objec- . tion to your continued use of the area in the limited manner now being utilized. This limited use does. not, at the present time, interfere with the use that our client is presently making of his land. Mr. Edmund .. Lundberg has indicated his desire to grant to you a license to allow you to continue: to use the encroaching portions of the parking lot, and this letter is intended to grant such a license. This license will be revocable at will upon. written notice to you. Should you or your counsel have any questions concerning: this letter, please feel free to contact me at your convenience. inc 41urs, ric er PMB:csd cc: Mr. Edmund Lundberg David W. Pyne, Esq. TOWN OF BARNSTABLE F R OCATION �ja; jtaR i �a SEWAGE # L_�-" / ;S " VILLAGE �Jey� n�L�rn ASSESSOR'S MAP LOT INSTALLER'S NAME PHONE NO. ` 44,-r SEPTIC TANK CAPACITY „. c'ev 0 LEACHING FACILITY:(type) TvCgLgp (size) NO. OF BEDROOMS /0 PRIVATE WELL OR PUBLIC WATER u r BUILDER OR OWNER §y. DATE PERMIT ISSUED: // q DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ��� I r� be- � A 99 li THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di:,pwial Wurk.6 C owdrurtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at -- - -•-------------------------------------------------------------------------------••-....---••-••• .......�� .........:��I� .... ��•--••---_: lit Location-Address Jbl-1� or Lot No. ?�.A)..--._......j?'�1�1-S.c�1_ ----- --•------•------•---------------------•---------------.------................----------- oo-ncr Address 5---•••...... .C.0 -�.A��-^4-i -------------------•-•- 5 3------- t�D.--•--------.....--------.....-•---...------ Installer Address Type of Building Size Lot.................... Sq. feet U Dwelling No. of Bedrooms.-.- •----.-____ _ _ -Expansion Attic Garbage Grinder aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' 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. 3 Seepage Pit No--------------_--.- Diameter.-.--.----.-.-.-.--. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 6.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ----------------------------------------------------------------------------------------------------......................................................... 0 Description of Soil........................................................................................................................................................................ W U --•••--•-•-••---•---•-•-•-•--••••••••-•--•-------•-•-•--•--•---••••---•---••-•---•-•••-•••••-•------•-•-••••...-••-••-•••••••----••-------------••------•----•------•--•--..._...................-••-_.. W x •-•------•--------------------------------••----------------...•--........-•---....•-•--•--------------•---s;:......--- - ----........ V Nature o� epairs or. Alterations—Answer when applicable.--.-f'�=�' .��_......�0--___-/_ �J1�C....�_�f�l�'f_.. 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 board of health. Signed ........ .. .......................... ..... Date Application Approved By ----------� V� 1-----l.l..'... Date Application Disapproved for the following reasons: .............................. . ... . ............................................................................ .......... ........................ ............. ..................... . ......................--............. ............................... .............................I---------- Da Permit No. .......�`�....�...---....�..� Issued ......................... ..................................................... to Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of Graplianre THIS 1 IT CERTI Y, That th In 'eidual Se3wage Disposal System constructed ( ) or Repaired ( ) C. 1 at .------�.�1".-.�a......- .1..!.4 dV f ... e._.. ..l:_ Il: has been installed in accordance with the provisions of TfLE v he S�tate_Fnvironmental Code as described in the application for Disposal Works Construction Permit No. 1��� ..-../ ..._..._.. dated .---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUEA AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................. .................... ........._(. .,,7...__.-...f�......._. Inspector ..._.... \..., '..:.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No............. FEE........................ Permission is hereby grant d. .-PbAl...`5.... /V.--- -----. .---....... to Constru to ( or air an Inc' i heal Se�=ag�Dispos System ��� ,�,�� y��/ at No. �"l?.. !'/l r �J_,[..-!.Y_ e��f° i `� ... . ----/L/ .-------------------•-•--. -.- ated as shown shown on the application for Disposal Works Constructio P imi No- e..--.-_-.- Street < - y-- Board of-He\lth DATE--••- // ,-.... s-------------------------------------------- FORM 36508 HOB &WARREN.INC..PUBLISHERS C) I NO.. .... ....... THE COMMONWEALTH OF MASSACHUSETTS f'k r BOARD OF HEALTH---'j TOWN OF BARNSTABLE Apphration for Uiripwml Workri Towitrurtion "rrmit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: I .....................................................................! . .................................................................................................. Location-Address — or Lot No. ......eh.............n...9)q .................................................................................................. 0-ner Address F t, _Z, ...........__.X.........(). . ....... ....................... ...7.2�....... ...........)............................................ Installer Address Type of Building Size Lot............................Sq. feet U Dwelling— No. of Bedrooms....(__________________________________Expansion Attic Garbage Grinder ( ) Other—Type of Building ............................ No. of persons......_...._._...___.__.___ Showers Cafeteria ( ) Otherfixtures ............................... . . ------------------------------------------ .................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. IY4 Septic Tank—Liquid capacity------------gallons Length................ Width-.___--_-_-._... Diameter............._._ Depth................ Disposal Trench—No. ..................... Width-___-.__---_-____-_ Total.Length......__.___......_. Total leaching area....................sq. f t. 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................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......_.._.........._... ........... ----------------------------*-------*"*------------**------------------------- --------------- ----------- 0 ...Description of Soil.......................I............................................................................................................................................... U ......................................................................................................................................................................................................... ........................................................................................................................................................................................................ U Nature oQZepairs or Alterations—Answer when applicable_� X. r A k2_Ln..........a........... ................................................................................................................................................. Agreement: The undersigned agrees, to install the'a'foredescribed 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 Certifi6ate of Compliance has been issued by the board of health. Signed -------- ..---------------------------------- ..... Date Application Approved By ...........�4e--I' ----------------------------------------------------........... .../........ �;......... U --- ---- re Application Disapproved for the following reasons: ........................................................................................................................................ ........................................................................................ ................................................................................................................ ........................................ PermitNo. ...... --- Issued ........................................................ Dare y t .....::r-:........1_._ ..............s.__ ............... ..... ........ _......... • ... .. .. ....:ia. .._ ..:.ice:.... ....... ...... _.... 99 CRESCENT STREET WORCESTER. MASSACHUSETTS 01605 617 753-1475 . TWX 920-315 COMPANY&3 INCORPORATE1111tf1D al I.:iJ` June 22, 1984 WE PLAN REVIEW Steven J. Pizzuti, Esq. P. O. Box 941 149 Main. Street Hyannis, MA 02601 RE: C. K. Smith and Company, Inc. Land Encroachment Dear Mr. Pizzuti: I am in receipt of your letter dated June 18, 1984 regarding the encroachment by Hair Labs, Inc. upon our property referred to as Lot 1, Route 28, Centerville, Barnstable County, Massachusetts, as recorded in Plan Book 196, Page 133 at Barnstable County Registry of Deeds. C. K. Smith and Company, Inc. has no objection to the continued use of the encroached ar a in the limited manner now being utilized. As the-certified plan dated January 26, 1984 reveals, that use is .for parking only. C. K. Smith and Company Inc. hereby grants Hair Labs Inc a -licenseo use tbg encroach* portions of the parking-1ot and this letter is intended to grant such a license. This license will, however, be revocable at any time upon written notice to you. Should you have any questions or comments, please feel free to contact me. Very truly yours, David J. Ada s Vice President r3 c TOWN OF BARNvOTABLE BUILDING DEP T f kc! y99 no b7 H' LOC&TIONJ ^� 5EW&CxE PERMIT UO. of VILLAGE IMSTQLLER°5 q&ME 6, ADDRESS - 13UILDER 5 tJ l�t./lE J ADDRESS �7XL _ _ _ DINTE PERMIT DATE COMPLI &MCE ISSUFO :- I � � s �� r3; �� y 310 CMR: DEPARThIENT UI' I:NVIRONNIENTAL QUALITY ENGINEERING 15.02: c, !inued ke, pond, stream, tidal water, watercourse, or open or covered drain tributary iereto, unless approved by the Massachusetts Department of Environmental C .Jality Engineering. ¢• (12) Connection to Common Sanitary Sewer.' Individual sewage disposal systems or other means of sewage disposal shall not be approved where a common sanitary sewer is accessible adjoining the property and where permission. to enter such a sewer can be.obtained from the authority having jurisdiction over it. The Board of Health may require the owner or occupant of an existing building or buildings, wherever a common sanitary sewer is accessible in an abutting way, to cause such building or buildings to be connected with the common sanitary sewer in a manner and within a period of time satisfactory to the Board of Health. (13) Volume of Sanitary Sewage. Each unit of the disposal system shall be designed to treat adequately the estimated volume of sanitary sewage to be l discharged from the premises to be served. The volume of such flow should be based on the estimated maximum contributory population and the resultant maximum expected daily quantities of sewage as determined from the table below. No cooling water, ground water, discharge of roof drains, or other uncontaminated water shall be discharged to the sanitary sewage disposal 0 a ( system. 1 SEWAGE FLOW ESTIMATES *" Pee, r Gallons per Person 7uType of Establishment Per Day s Boarding Schools, Colleges 65 j Nursing Home and Rest Home 100 t . School, without cafeteria, gymnasium or showers 10 r r' School , with cafeteria, but not gymnasium or showers 15 School , with cafeteria, gymnasium and showers 20 Swimming Pool 10 s r Camp, resident washroom and toilets 25 kv Camp, resident mess hall 10 Camp, day washroom and toilets 10 Camp, day mess hall 3 Camp Ground showers and toilets per site 75 Gymnasium per spectator 3 } Gymnasium per participant 25 Theater, Auditorium 3 0 Public Park toilet wastes only 5 Public Park bathhouse, showers, and flush toilets. . 10 Factory or Industrial Plant, without cafeteria 15 h' Factory or Industrial Plant, with cafeteria 20 Work or Construction Camp 50 i j. ( Y . r 'The applicant should be aware of his obligation to comply with the t L requirements established by the Division of Water Pollution Control pursuant to M.C.L. c. 21. s. 43. "Estimated sewage flows other than those listed should be considered in relation to actual meter readings of established flows from known or similar installations. Generally, estimated sewage flows will be based on 200 percent Q of average water meter readings in order to assimilate maximum daily flows. iUD 17 12/31/86 �—'�`� 310 CMR - 292 Z -7 ---- 7F� la�� � � 310 CMR: DEPARTMENT OF ENVIRUNt.If:NTAL QUALITY ENGINEERING 15.02: continued . SEWAGE FLOW ESTIMATES (continued) Gallons per day Single and multiple dwelling units Per Bedroom motels, hotels, boarding houses 110 Tennis Club per court 250 -. Bowling Alley per alley 100 Country Club dining room per seat 10 Country Club snack bar or lunch room per seat 10 Country Club locker and showers per locker 20 Church per seat 3 Church vestry/kitchen per person at capacity 5 Trailer, dump station per site or per trailer 50 Mobile Home Park per site 200 Office Building per 1,000 sq. ft 75 '3 Dry Goods Stores per 100 sq. ft 5 Drive In per stall 5 Nonsingle family, Automatic clothes washer per washing machine 400 Hospital per bed 200 Service station, excluding thruway per island 300 Skating Rink 3.000 gallons pei'•,day plus 5 gallons per seat Gallons per Seat or Chair per Day Restaurant, food service establishment, lounge; tavern 35 Restaurant, thruway service area 150 kitch 1 Barber Shop/Beauty Salon inn NOTE: Laundromat wastes are considered industrial wastes and must be approved by the Department of Environmental Quality Engineering. t (14) Type of System. Except as provided in 310 CMR 15.18, an individual sewage disposal system shall consist of a septic tank discharging its effluent to a suitable subsurface sewage disposal area as hereinafter described. Where buildings are served by more than one system, each system shall consist of a septic tank discharging its effluent to a suitable subsurface sewage disposal area. Separate systems for laundry waste disposal are not recommended. (15) Drainage. An individual disposal system shall be located in an area where no surface water will accumulate. Provision shall be made to minimize the l flow of surface water over the area. (16) Cover Material. Earth materials used to cover subsurface sewage disposal 's facilities shall be free from large stones, frozen clumps of earth, masonry, stumps, or waste construction material. Machinery which may crush qr disturb the alignment of pipe in'the disposal system shall not be allowed on any part of the disposal area. (17) Construction in Fill. Where an individual sewage disposal system is to be constructed wholly or partially in fill, the fill shall be properly placed and compacted to minimize settlement or it shall be allowed to settle for a minimum of 12 months whichever occurs first. The fill material shall be clean `? coarse washed sand or other clean granular material essentially free from clay, fines, dust, organic matter, large stones, masonry, stumps, frozen clumps of earth, wood, tree branches, and waste construction material, and shall have a percolation rate of less than 2 minutes per inch before and after placement. Before the fill is put in place, all trees, brush, and stumps shall be removed from the area to be filled. Topsoil. peat. and other impervious materials shall be removed from all areas beneath the leaching facility and for a distance of 35 Y s feet in all directions therefrom when the leaching facility is above natural ground elevation: or impervious materials shall be removed for 10 feet in all directions therefrom when the leaching facility is below natural ground elevation. No sewage disposal system shall be constructed in fill placed upon x 12/31/86 310 CMR — 293 1 sR THE COMMONWEALTH OF MASSACHUSETTS BOAR® . HEALTH .......... -------------OF..... .... .-........... ..................................... Appiiration for llhip sal Works Tomitrnrfivit thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an I di idual Sewage Disposal System at: ....._.. ��_ . : .. -----------------••-•............••--•-• ............ -• ......------.................---•-.----- Coca ion Address or Lot No. - .... .11.. Y� ., �.:�.. . /� Address Installer Address VType of Building Size Lot............................Sq. feet �-� Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) a14 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( )..— Cafeteria ( ) d 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. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •---•---------------------------•••----••------......-----•---••-•-•--------._........----.._....-•......................................................... 0 Description of Soil........................................................................................................................................................................ x V ..............................................-------------------•--------........------•----------------••-----------------------•---•--•----•----...•--•••---------------------•-•-••----------------- ---------------------------------------------------------•----------•--............................................. -----------------.............-----•------ - ------ - r U Nature of Repairs or Alterations—Answer when ap 'cable...__ }-_c�__e� -CI.C-I.14-1.i-c —L- :::......... ... . -A--- ' Agreement: 100 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI..I 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has4beis.,u bhe b and of health. LSigned ... ---- (.2 ---- . ..... Date ApplicationApproved By................................................................................................... Date Application Disapproved for the following reasons:--•-----------------------•---•---------•-•-----••------------•-••----•-------------•--••-•-•---------........_ -•--•-••-••-----------------•----•--•-----...._.....-••------.........-•---------•-----••-------•------------------------------------••---------••----------•---••-----•----•----•--••--------••--.-•-.. Date Permit No.................. Issued _.1:.:;1`N/ ' ,.,. -------------•----•-----------•-•- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH . ........... ... ... : ...............OF......... A. Iadw'................................................... Appliration for Disposal Works Tonntratrtion jhrmit Application is hereby made for a Permit to Construct ( ) or Repair an I di 'dual Sewage Disposal System at°• ................ •. ............................................... .. Loc ion-Address or Lot No. ..... "a._ . ... .. .. . . r -------------------- .................................................................................................. -.----•............_...........____........_ caner Address ______:...--•-----•--•-••- yy,., ... .........•--••-•-••---•-•-•--•.. ....................---•--. ............................................ W __•-•-•---•---•-•••� � C � In�aller � � `, Address dType of Building w Size Lot............................Sq. feet U Dwelling.—No. of Bedrooms________________________________ _Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons-__-•______-_-____--___-___- Showers ( ) — Cafeteria ( ) a ` 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........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G%, Test Pit No. 2................minutes per inch Depth of Test Pit................... ;Depth to ground water........................ {y+ ••-••••-•--•••---••.....-•--••••••••-•-----••-•••.........................•---•-•--•_•-•---•---•---......................................................... Description of Soil_________________________________ '.' x U ---------------------------••----___•___---•---•-•------------•-•------------•------•--_..-------- ----....-- ----........__...........-------•••--. -------------------------------------------------- 'e. 0-C U Nature of Repairs or Alterations—Answer when ap cable.__ .c .��A ( �_�. -• ---------P1 A.............. S_ - ------------------------------------------ /G` .. 4t--- ----------.------------------..__.._......---- Agreement: i% 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 ,he b and of,health. t, f Signed•..-------• ...... r • Date Application Approved BY = ------------••.._..._..__..__ --------------------Date........................................ Date Application Disapproved for the following reasons__________________ :." ._._..__..__._ --------------------------------------------------- ---•-•--___---•----•-------•------- :..__ Date ------'- -------•---------•---•----•---••-•-----•---------•--•-•-•.............•---•-•-•--- e Permit No......................................................... Issued.:.......................... ........................... Date 1 THE COMMONWEALTH OF MASSACHUSETTS , BOARD O HI ALTH ................ ... ....OF............ :":..........: (Errtifiratr of Tamp ta- r �--- THIS TO E Y, That the Individual Sewage Disposal System constructed ( ) r Repaired by.. ••---• --•-.. i-- ----=----------• _•-- .•-•-= . --- ------ ----------------------- i _ l -, Insta f has bee installed in accordance with the visions of TIT 5 of h tate Sanitary Co e as d'e crib the IY application for"Disposal Works Construction Permit No. - . __ ___ - .__... dated.t ��. � • F THE ISSUANCE OF THIS CERTIFICATE'SHALL ®.T BE CONSTRUE®:AS A GUARANTEE-•THAT THE', SYSTEM 1 id:FUNCTION SATISFACTORY. DATE... .. Inspector ,s.R s r"T•Y+�'RY ""dq �t 'r+' w Y es• + v.��. i�e�r acr v'..,W§�.M 'sS -M^�"��`3.7'' .A� '�t"*;•�� m'�"''s(� 1�; r4' i,ti..w.+«.�..r+. tus •"`:s?�•k�r..n..u?.tax.4..._ = ..�Y..._ -{�x �::.?S�'Tti.�.'a�.;�asliwr'�`s�' _ .._ .�.�G..t�;;,,�}t.:� THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ............ ......... ........O F.---•-- ...................---- No.. .... ...... �'�tl'r! FEE... ............... Disposal f rks onsknution Upantit Permission is hereby granted----"------- - -r - = ---•-•.------------------- ------------------------ ------------- ------ --to Constr t ( 4or pai ( ) an Individu e ispos Sysat No..-_- '0 ._._ greet as shown on the application for Disposal Worksction Per No._ __-r .___ _ Dated..____.�.'_z_ ................... ?!� ------------------••-_- Board of Health DATE......... k FORM 1255 HOBBS & WARREN, INC., PUBLISHERS ' l \ � l �L O.0 A T IONS J�]b SEWAGE PERMIT NO. L o f t U� ti► �A hd cts'air a O - 6 VILLAGE 71 4 Y i-I I N S T A LLER'S AME i ADDR SS a 3UILDER OR OWNER DATE- PERMIT ISSUED DATE COMPLIANCE " ISSUED r Ct,y �` t � l � 2� c 13 ' ,c ��. ..J � � . , (, -�. .� 5� 9 .s No......................... Fss.......... ............... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9F HEALT - --....O F ...... : .. i ......... ----- Appliratiun -fur UWVautt1 Worko Cnunitrurtiun Permit Application is hereby made for a Permit to Construct (k�or Repair ( ) an Individual Sewage Disposal Syst at ------------ cation-Address or of N . ............................ .... ..................................... w ` Owner i Address Installer Address d Type of Building Size Lot_---_--42).o.d..Sq. feet U Dwelling—No. of Bedrooms----------- _. p ( ) g ()s�'___-______Ex Expansion �ttic Garbage Grinder per,, Other—Type of Building 42 0 -- No. of persons............................ Showers Cafeteria (-�— a d Other fixtures ..................................................... - -------•---•--------------._.._:...__...- w Design Flow—-----------------/-.aZ__-.---------------gallons per person per day. Total daily flow....... . .............gallons. W Septic Tank—Liquid capacittllv.4__gallons Length----tal en�i idth............_..Total leachin area.• Depth-------- f-- x Disposal Trench—No....................... �tylth------ -- � g q• Seepage Pit No.._r..-1.° t. tl_c' Diamet /depth el.w inlet................... Total leaching area------------------sq. ft. Z Other Distribution box Dosing tank aPercolation Test Results Performed by._---------_- . _ _____ __� ---— ---------------------- Date_-_--___-_----_.----_----_._--_--._._... Test Pit No. 1----------------minutes per inch Depth of ! est Pit.................... Depth to ground water_..-__-..__--.-----.___. �14 Test Pit No. 2................minutes per inch Depth.of Test Pit-------------------- Depth to ground water...................... n+ -----------•----------------------•-------------- --------------- ....{ Description of Soil----------------�..+_"r_ j?.-..- .----- --------�„ -•ds' .1�r-------------------------------------- x ---- - ----- w ------------------------- ------------------ ----------------------------------------------------------------------------------------------------- ----------------------------------------------------- UNature 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 e undersigned further agrees not to place the system operation until a Certificate of Compliance has been issued b the board of health. Signe _ _- ---- �!i./ Lei eG�, CI V - ..-... ---- •----` --DF/ G Application Approved By---.---•-14� .. Date Application Disapproved for the following reasons------------------------------ ------------....-•----•--•---•-•----•-- -•-----••-••-•--•---••-••-•••-------•-------•----------------••-••-•••-...:--••--••••--•••-----••••--•••.•-----•-•-••-•••--•------•-••-------------------------•------------------------•-------••------ Date Permit1Vo........................-................................. Issued.... --------------- Date low- No. l FEa...... .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALT _. ..C.. .Q"� 1... .._..OF........ . Appliratiun -for Di,quiial Eorkii Towitrnrtinn Prrmit Application is hereby made for'a Permit to Construct ( 41"'or Repair ( ) an Individual Sewage Disposal System-at: Z..t1C .�:.. �!!r<�t r ......='"9L t rK: ?_ i(a: U Yr' C �1' _---_-------•---- (�' Location-Address //' or Lot Dio. _. _�!!?Id._. !_�� �._.t ........_.. l_�_..r _. !_!J/GrJ._/_r i________________________________________ r< ll/1:/�1� • O w ne r / j �• ddress .................... //Lf�- �I 1..lLL ?�`ls =c^w�................ ................... .D lt_!.................................................-------------- Installer Address G "�'� Ca U Type of Building / Size Lot.............`------.--.-.Sq. feet Dwelling—No. of Bedrooms._._-__-.-__1.__��__'l� _.-......Expansion Attic ( ') Garbage Grinder ( ) Other—Type of Building a g 1=:,4-,,F 't�7��__ No. of persons---•--�.`J._•.---...... Showers (� ) — Cafeteria Other fixtures ---_------------ ------ 2 ----. U<,71:, k;F -?nra '.._.. ...._..._... d ---- W Design Flow---------------------- .............gallons per person per day. Total daily flow.........Z. ......._....`.. /.A ..__.--------gallons. - WSeptic Tank—Liquid capacity_/,_r:!�_gallons Length................ Width................ Diameter---------------- Depth---.----_-.-_. x Disposal Trench=No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No---r__`_l_:_ •_ 'Diameter____________________ Depth below inlet.................... Total leaching area------_..........sq. ft. Z Other Distribution box ( ) Dosing tank ( ) „ a Percolation Test Results Performed by..............�/a-�i !._�a �_--� ...................... Date............................___.__._. - ,� Test Pit No. 1----------------minutes per inch Depth of -Ast Pit-------------------- Depth to ground water.----------------------- f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water_---_-_..__.---..--_---- O Description of Soil--------------------- ---=== y......---- C - j^ � w ---------------t -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 been issued by the board of health. /f Date Application Approved BY . -- D�- G3 --/-------- ate Application Disapproved for the following reasons:---•----------•-•-•----------- •...................••••---......_•---•- --•-•-••----•----•--------.--•------------------------------•------------•--•------------------------._.-.. -------•-•-------- Date PermitNo........................................................ Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH ............OF......... .. ....GL/l/1/1 .........-.....-:........................ Trrtifiratr of f omplinnrr - THIS, Taj_ RTI That the Individual Sewage Disposal System constructed (1 or Repaired ( ) by-- : ------ ---- ------- ------- ;•• , Install r J at...'. - lU / (��.t• v "t l ------ ----�...../.�... A. has b n installed in accordance with the provisions of Ar cl I of The State Sanitary Code as'flesc ib d in the application for Disposal Works Construction Permit No... _ �..__2_,3,�---------- dated........ `_�,`. . .............. THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRU. ® A GUARANTEE THAT THE ; SYSTEM WILL FUNCTION SATISFACTORY. DATE........................................-------------------------•••--•-- Inspector...... .. d i THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH C� O F.......... ................. . ............ FEE N o. ..... /.V---........ Bi-rivotitti nit tinat it Permission s ereby granted------------- to Constr ct ) or parr an Individual S/��`ag Dis oral y` s/te'm at No. ................ Street �.� as shown on the application for Disposal Works Construction Perm' :_. .�__ D ed.... ^� �l......................... oard of Health �I DATE --.-•-------------------1-------------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS a M1 Ya ram• .'b S ,. � .,5{ j ,.!� A',R�. t"r 4 \ a ce / CC o tP at I lip `1 �} J �poC3 7,QG. i T 7'°"As ApG'om�/ A.t/ 7 IWE "i BO�t+�i�✓(��s' � 'SP/,d�®• WA,of f"&�fOOgA.1 .�A/� /T 710WP / 0-0' 45 7l �� o AP.N E LA 4 348 6 N �� s : ENCROACHMENTS RTE. 28 The State has no objection to owners present I LOCUS use.use. "Pending any future change by Town or State, owners agree to modify I 4i its use accordingly. (Landscapin, will be (; upgraded after State completes its planned re-surfacing of Rt. 28) p p �t� 4 O TF R tJ NORTH At present, owners hold license to use the i encroached areas. (copies on file with j R OUTS U Building Inspector) At suggestion of .the I to 0$ Planning Dept. owners will seek to secure p update of these licenses' . a 1Y DRAINAGE PIPE AS SHOWN EXISTING 1 'p v ON PLAN ENTITLED 'PLAN OP D LIGHTS i �d PROPOSED DRAINAGE SYSTtAf AND OUTLET', DATED NOV. 9, 1930. /'' OBTATE SAID P1118 CARRIES RUNOFF f;ROAf - ROUTAt 28 AND ILOWS ACROSS LOT , 18 AND DISCIWCES ONTO LOT 16 LOCATI01'?' MAP (NOT TO SCALE) THRGUCH A CONCRETE HEA WALL 1 I DUNPSTER 12" WHITE ' �B BUILDING Z6.: E: IIB AREA Pt vE SE I"BA CKS: FRONT = (100' ALONG RT. 28) .SIDE REAR = 20 20' ASSESSORS MAP 209 PARCEL f8 GALLSYACIrtNc FLOOD ZONE C, / PANEL 250001 0005 C ® �60•0g �� GROUNDWATL'R OVERLAY DISTRICT (AP) 14' WHITE PINE 4.3 9 ACRES \ Za,b' '� r� 1*' WHITE PINE .86 ACRES S.T. LZA CH PIT ff'J1 I PARKING CALCULATIONS: 10. / IIUII, HAIR SALON: 1200 S.F. (1 SP./200S.F. ) = 6 SPACES DING -� DENTIST: 900 S.F. (1 SP./300 S.F. ) = 3 SPACES OFFICESr (784 S.F. + 584 S.F. ) ( 1 SP./200 S.F.) = 7 SPACES 0 S.F. = 3 SPACES 7200 �- ,..` PHYSICAL THERAPIST: 784 S.F. (1 SP./30 ) ✓i / R.f. i:!%/ r�f!Tll/y ":T TrTnr, F 1; r - 11Ft_D.�D:_ 1 A_ES • ��'� � ��"��" f� � TOTAL PROVIDED: 35. SPACES ;/II LJII, HANDICAP: 19 SPACES (5%) _ .95 SPACES NEEDED DI NG '/ HANDICAP: 2 SPACES PROVIDED /M NOTE: APPROVAL OFF SPECIAL PERMIT FOR PHYSICAL �,% _� 12 T THERAPIST WILL BRING BUILDING TO FULL �84 8f OCCUPANCY. f'�_ SIGNAGE: EACH OF THE FOUR RENTAL UNITS HAVE A �.'. _ 20" X 38" PANEL ON EACH SIDE OF A TOWN O "1 if-� APPROVED MASTER SIGN PANEL. _ U11 _ F .es ACRES . © Apr � 9 20.412 S.I. .....► 1 ' f' .47 ACRT 33.6 10 0--6 � ©. o ► 0 to artrr 14 cis YlS- A3 -, , SITE PLAN REVIEW 3 BOI�DING DEFT ABLE `v LU EXISTING D AUG i f "1993� W � SICNS ROUTE 28 STi�.TE IIIGIIIYAY d ro wn cap e engine erin,�, inc. Kh Y I:x TREE,Z' cAl,. .................. {, EXISTING CONDITIONS PLAN CIVIL ENGINEERS > LAND S rrR v ;YO Jz s FOR WO FALMO UTH ROAD IN THE TOM OF: � F�t ST. 4ftRfJR .................. � : R to �a, YA1��10UT11, MA U NIIsIlVILL D.,ARNS I' IDLE, MA �- EXIST. CONTOUR- l4 . - •J t �� " s�{ ,,,,•:,, t: EXIST. LIGHT .............. PREPARED FOR: .10 TIC+ Ic YLOw �IOJJN DAJ,J)ASfl ICE, OJA 'L : SCALE: 1"=20' DATE: AUGUST 9, 1993