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1600 FALMOUTH ROAD/RTE 28 - Health
1t'5AW FALIWOU'rH RD. ELL, FOWER MALL , CENTER�VILLE A 209 014 l a �. IN UPC 12534 • No.2� 1 53LORar " NA8TIN98.YN Town of Barnstable Board of Health rKASS. 200 Main Street, Hyannis MA 02601 s639. & Office: 508-862-4644 John Norman,Chairrrnan FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt. March 8, 2022 Mr. Matthew Eddy Baxter Nye Engineering 78 North Street Hyannis, MA 02601 RE: Bell Tower Mall, 1600 Falmoutfl Road; Centerville A 2Q9 - 014 Dear Mr. Eddy, On March 16, 2021, you requested a hearing before the Board of Health to discuss a proposal to convert existing office space into residential apartments at Bell Tower, 1600 Falmouth Road, Centerville. A public meeting was scheduled and held by the Board of Health on March 30, 2021. During the public meeting, you testified that the change of use within the first phase of this project, will not result in an increase in sewage flow at this site; therefore the change would not trigger the Board of Health Regulation which would require the installation of an innovative-alternative system. You also testified public sewer will be available to this site in approximately three to five years. Our Health Agent Thomas McKean, commented the Health staff has no objections to this proposal because the estimated sewage flow will be reduced from 14,430 to 13,980 gallons per day. The Board of Health voted unanimously in favor, agreeing with your analysis and interpretation in regards to the reduction in sewage flow. The Board also voted not to require the installation of an innovative-alternative (I/A) system as part of the first phase of this proposed project. This property shall be connected to public sewer when it becomes available, within approximately five years. Sincerely, a - - tn Norman oe Chairman Q:\WPFILES\Eddy BeliTower 1600Fa[mouth Road March 2021.docx I DATE: $95.00 FEE*: BAPJWKASS ABM Town of Barnstable REC.BY: seg-0 Board of Health SCHED.DATE: 200 Main Street,Hyannis MA 02601 Office: 508-862-46a4 p John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D.. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION 1600 Falmouth Road 7 6� Property Address: 1 Assessor's Map and Parcel Number: M2 0 9 P 014 Size of Lot: 431, 680 s f (9 . 91 ac) Wetlands Within 300 Ft. No Business Name: Bell Tower Corporation Subdivision Name: APPLICANT'S NAME: Bell Tower Corporation Phone (617) 538-9326 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Bell Tower Corporation Name: Matthew Eddy Address:P..O. Box 1461, So . Dennis, MA Address:78 North Street, Hyannis, MA Phone: (617) 538-9326 Phone: (508) .771-7502 EMAIL: meddy@baxter-nye . com VARIANCE FROM REGULATION(leor.Reg.Code a) REASON FOR VARIANCE(May attach separate sheet if more space needed) 'his is not a variance request but a request for interpretation and confirmation that the project .s not an increase in and that Section 360-37 does not apply for the conversion of office :pace to residential apartments in a mixed use complex. Additionally, . pub is sewer wil e ailabe at the site within the next few ears which the applicant will tie into. NATURE OF WORK: House Addition House Renovation x Repair of Failed Septic System Checklist (to be completed by office staff-person receiving variance request application) Please submit first four on list as S collated packets: _ A. Five(5)copies of the completed variance request form — B. Five(5)copies of MA DEP approval letters for Innovative/Altemative septic system(when proposing an I/A system or secondary treatment unit(S.T.U.). _ C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: health0town.bamstable.ma.us *(Pool Plan-5 hard copies) D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or R.S. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only _ Full menu-Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*$95.00 for the following variances: 1)New construction, 2) Septic repairs with increase in flows, and 3)New owner/new lessee applying for food, pool or body art variances. Exemptions from Variance Fee: 1) Septic repair withou an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. Q:\Application Forms\VARIREQ Rev Jan 1-2020.docx TRANSMITTAL BAXTER NYE ENGINEERING & SURVEYING Registered Professional Engineers and Land Surveyors 78 North Street,3,d Floor,Hyannis,MA 02601 Tel`(508)771-7502 Fax:(508)771-7622 Date: March 16,2021 To: Barnstable Board of Health Total No.Pages: Attn: Sharon Crocker BN Job No.: 2020-053 200 Main Street Subject: 1600 Falmouth Road Hyannis,MA 02601 Bell Tower Mall Centerville,MA cc: File We are sending you ® Attached ❑Under Separate Cover ❑ Via Fax(No. of pages including Transmittal Sheet) ❑First Class Mail/Registered#: ; ❑ Overnight ❑Pick up ® Hand Delivery The following documents: ®Prints/Plans El Specifications ❑Estimates/Proposal [I Change Order❑ Shop Drawings ❑Reports/Calculations ® Other DATE COPIES NO. PAGES DESCRIPTION 5 1 Town of Barnstable BOH Variance Request Form 3-11-21 5 1 Site Analysis Plan 2-24-21 5 1 Septic Flow Calcs 08-25-20 5 1 Architectural Plans These items are transmitted as checked below: ® :For Your Use ❑As Requested ❑Returned For Corrections ❑ For Review And Comment ❑For Approval ❑For Distribution Remarks: /v Matthew Eddy, P.E. Managing Member 3 37 4e4 MEP/spk 0:\2020\2020-053\ADMIN\TRANSMITTALS\2020-053SC-BOH Submittal.docx /File Note: This transmittal contains privileged information..Please contact the sender immediately if this transmittal is illegible, incomplete or not intended for your use. Thank you. Crocker, Sharon From: Beaudoin, Griffin Sent: Monday, March 29, 2021 11:23 AM To: McKean, Thomas Cc: Crocker, Sharon; Collins, Nathan Subject: RE: Matthew Eddy Representing Bell Tower Corporation-.1600 Falmouth Road Centerville ' Tom, The property will not be able to connect to public sewer within the next two years. The property is located within the Route 28 Centerville Sewer Expansion project which is currently scheduled for construction from FY25 to FY27 according to the CWMP. The Route 28 East Sewer Expansion, that is scheduled to begin next year, does not expand past Phinneys Lane. Thank you, Griffin Griffin Beaudoin, P.E. Town Engineer Barnstable Department of Public Works 382 Falmouth Road - Hyannis; MA 02601 P: 508-790-6400—C: 774-487-9663 griffin.beaudoin@town.barnstable.ma.us From: McKean, Thomas Sent: Monday, March 29, 2021 9:47 AM To: Beaudoin, Griffin Cc: Crocker, Sharon Subject: Matthew Eddy Representing Bell Tower Corporation- 1600 Falmouth Road Centerville HI Griffin, The Chairman of the Board of Health asked me to reach out to you. Can you confirm in writing to the Board of Health that this property will be connected to public sewer within two years? The applicant wishes to convert office spaces into residential apartments in this mixed use complex. The estimated sewage flow will be reduced from 14,4309 gallons per day to 13, 980 gallons per day. The Board of Health meeting will be held tomorrow at 3 pm on Zoom . 1 i M. HERSHMAN CONSTRUCTION CO. 345 NORTH MAIN ST. WEST HARTFORD.CONN. 06117 OFFICE 203 232.5043. HOME 203 236.1975 203 233.6983 '1 Bell Tower Mall Septic Systems Analysis 1600 Falmouth Road,Centerville,MA By:MWE BN Project#2020-053. Date:2124/2021 ANALYSIS OF EXISTING SYSTEMS AND CURRENT FLOWS PROPOSED CHANGE IN USE AND PROPOSED SYSTEM CAPACITY CALCULATIONS xcess apace y Leaching Septic Permit Design Flow on Net increase for each system due to Total Design Flow with in Existing System Expansion Needed(Yes Existing Septic System Components SAS Dimensions Area(at) Capacity' Unil Permitted Design Flow Number Permit Plans Current Use 2021 Design Flow Calculation Flow retluctlon from office removal Flow increase for apartments cronversion to apartments Increase (GPD) or No) Area#1 System A 1.000 gallon pit with 4'stone Bottom Area: pi x 7'x T 153.9 153.9 GPO ,774;1; GPD 86-241 Y r" s:741.GPD. 1 9880 of office x 75 GPD/1 0 1 4940sfx.0751 370.5 GPD 6 bedrooms I 660 GPD 289.5 GPD 1,030.50 GPD 1 1216.83)1YES (depth=6 feet)Sidewall Area pi x 14'x 6' 263.9 659.7 GPD (on 2 floors) - System Capacity GPO Se tic Tank size: 1,500 allons System B u raded in 2000) 3 64'x 13'leachin chambers Bottom Area: 64x13 832.0 615.7 GPD 88-168 VOID 34 seats x 20 GPD/seat Great House _ 680 GPD de th=2 feet Sidewall Area 64+13 x 2 x 2 296.0 219.0 GPD ,"7482 GPD 2000488 ::::2482 GPD 9000 sf Retail 450 GPD Can bring flow to this Total Area 835 GPD (formerly 1995-1734), Total 130;.GPD - - 1,374 from System A System Capacity ' 50 with 3 rows chambers ,, Z4t GPD (1995 septic repair) Septic Tank size: 2,500 gallons 1 t Area#2 System C 2 1,000 gallon pits with 3'stone Bottom Area:12'diameter 113.1 113.1 GPD +-<;7062 GPD(66-243) �3 886 GPD 7077 sf office x 75 GPO/1000 sf _ 531 GPD 7077 sf x.075 530.8 GPD 8 bedrooms 880 GPD 349.2 GPD 1,233.85 GPD 123.32 NO (depu,li leaf)5idewall Area 12'dia x 6' 226.2 565.5 GPO 7077 sf retail x 50 GPD/1000 sf 354 GPD - Single Pit Capacity 678.6 GPD on 2 floors Total ,,,,;W5•t GPO System Ca ad with 2 Leach Pits 1357� Septic Tank size: 2.000gallons System 02 / (2)1,000 gallon pits with 2'stone Bottom Area: 10'diameter 78.5 78 5 GPD ;,%; 3,;%<<'L]!45 GPD 86-244 r ,+r.c.z 580 GPD 1660 sf retail X 50 GPD11000 sf (depth=6 feet)Sidewall Area 10'diem x 6' 188.5 471.2 GPD Single Pit Capacity 549.8 GPD System Capacity with 2 Leach Pits _-..:1','lbb'GPD _ Se tic Tank size: 2,050501.12llons k,, Grease Tre size: 1,5allons Grease trap seat capacity:1 100 seats r S stem D3 6 1,000 gallon pits with 3'stone Bottom Area:10'diameter 78.5 78.5 GPD 3-1501 GPD 88-170 ,:3295 GPD 1 150 seat restaurant x 35 GPD/sea "5,250 GPD [additional permit (depth=6 feet)Sidewall Area 1 O'dia x 6' 188.5 471.2 GPO for 516 gpd?] (26 temporary outside seating not in calculation) Single Pit Capacity 549.8 GPD ' System Ca act with 6 Leach Pits m ;3,28§GPD r Septic Tank size: 6,000 gallons - Grease Trap sizes: 2 1000gallons Grease trap seat capacity, 133 seats Area 3 System E + 2 1,000 gallon pits with 3'stone Bottom Area: 12'diameter 113.1 113.1 GPD >=a "A,062lb>GPD not visible =-736':0'. GPD 4177 sf retail x 50 GPD/1000 sf r 209 GPD 7077 sf x.075 530.8 GPD 8 bedrooms 880.00 GPD 349.23 GPD 1,088.85 GPD 268.32 NO (depth=6 feet Sidewall Area 12'dia x 6' 226.2 565.5 GPD 7077 st office x 75 GPD/1000 sf 531 GPD Single Pit Capacity 678.E GPD 853 gpd(86-245)?7 on 2 floors Total =-.740 GPD System Capacity with 2 Leach Pits 13$T GPD Septic Tank size: 2,00019allons Area 4 System F/G I H 9 1,000 gallon its with 2'stone Bottom Area: 10'diameter 78.5 78.5 GPD 3; ':�;4;803=0 GPD not visible >14,762 GPD 5383+4542 sf retail X 50 GPO/1000 sf 496 GPD 4542 sf x.075 340.7 GPD 6 bedrooms 660.0 GPD 319.4 GPD 4.173.75 GPD 774.25 NO (depth=6 feet)Sidewall Area 1 O'dia x 6' 188.5 471.2 GPD 4542+2900 sf office x 75 GPD/1000 si _ 558 GPD Sin le Pit Capacity 549.8 GPD 939 gpd(86-246)?? 80 seat restaurent(Papa Ginos x 35 GPDlsea 2,8'0 GPD System Capacity with 9 Leach Pits zti4,948',;GPD 810 gpd(86-247) Total >;f3;854;;GPD Se tic Tank size: 71500 allons Grease Trapsizes: 2 2000 allons Grease trap seat capacity: 133 seats Total on site for 7 septic systems: 15,378 GPO ;t4,446=GPD 13,461 GPD 12.682.65 GPD 13,989i d GPD under existing Net Flow is permitted 3 below existing 1,762.35 GPD flow 4S6b5`.GPD permitted Flow i M } I - -- -- I --I-------------------------- I - -___ -,---- -11.1�--�I'll-_______,_-1 ,� �I I � �__-,-,,, I I-- -I-11 I---------I-----. � `__,", ".11-1-1-1111---------i ___ ______ -- ------------____ ----.-- _.___,___._____,__-------______________ - -1 . I _- -- � I �__ � . I--,-- -� .1 - . . . . � I I . I . I . . . . . � � I . I . I . � � I . . I . I . . I I . I I I I � . . . I I � � . I I I � . . I I . � . . . � . I � � � I � I I . I . � I . . . I . I . I . . I I I I � I . . . . � . I . I . � I .. ,. I . , I. . . I I � � . . . I . I I I � I . . I I I . I . � . � I . I I I I � I I � . I. � I . . I I . I I . . . I . . I . I . . . . : I . . I . I � I . . . I I I 11" �, . ... � . . i 11 . .4 . - Y E . . . I . . I I .1 .I... . . i .- I SEPTIC DESIGN FLOW SUMMARY . . . . . I I . I 11 . . . . I � I . . . . . I I *B--A X TEN R. N�'-'!,, - � � I . . I . . . � ,� 11 . PARKING TABLE . , .. I I . I I I I . . � . . . . . I . I .I I . . I � � I � NITROGEN LOADING LIMITATION: 440 GPD/40,000 SF x 431,680 SF = 4,748 CPD I � �� I I I . NOTE . . . . . I I - � M. I I . I I � I � " - I I � I I R . PARKING REQUIREMNENT BY BUILDING USE .. . . PARKING REQUIRED I I I � . . I I I � / 1IN T RI'NO: & SU 'r VEYING I . I (LOT AREA = 9.91 ACRE LOT x 43,560 SF/ACRE = 431,680 SF) � � . I �N,j ,,',F,� , I . E C - . - ___ ____ . � I . I � EXISTING: I � � � I.. I � . . I 1. I . EXISTING GRANDFATHERED SEPTIC FLOWS PREDATED THE SALTWATER ESTUARY OVERLAY. � . . I I� I I I I I 1. THIS 'PLAN IS BASED `ON TOWN OF BARNSTABLE GIS INFORMATION ONLY. . . I I I I . . I . I � I . I I I � . , � I . I OFFICE = 23,636 SF x 1 PS/300 SO.= . I � � . . 79 SPACES I I . I � . I I . . 11 � � . � I THIS DOES NOT INCLUDE ANY D URVEYING. � I . I . . . I I . I . PLUS 1 PER SEPARATE SUITE x 3 SUITES= . 3 SPACES . . I PROPOSED CONVERSION OF 2ND FLOOR EXISTING OFFICE SPACE: � . � I . I I . � I I . I BAXTER NYE . I I .1 I I I . � I . � . I I . �.� . . EXISTING PARKING 'TOTAL: . � .. 4 940 SF +, 7,077 SF + .7, 077 SF + 4,542 SF = 23,636 SF . I � I I .1 I I . 2. S TEMS SHOWN BASED ON RECORD ASBUILT SKETCHES OBTAINED . . I . . � � I I . . . . I I - � � . . PROPOSED: . ..I . . I . . . . .I � 2S,636 SF x 75 GPD/1000 SF�1,773 GPD FLOW REDUCTION � � � . � . � FROM HEALTH DEPT AND TITLE 5 SEPTIC SYSTEM INSPECTIONS BY SEAN M. I ' I I I I . I MULTI FAMILY=1.5 PER UNIT x 26 UNITS = 39 SPACES. 1 39 SPACES I _ ... .� . . . I . . I . I � . � � . . . . I . JONES ON FEBRUARY -1.6, 2021-. . . ENGINEERING & . i . . . � I I I . . I . � .. PLUS 1 VISITOR PER 10 REQ'D SPACES = 3.9 SPACES � ' 4 SPACES � . . I PROPOSED APARTMENTS: 28 BEDROOMS x 110 GPD/BR = 3,080 GPD I I 1. . . - I . I . � I � � 11 � I I I � 11 . . . . � I I . � � .1 . .. 1. . � . � . �.. . �. � . I ,.. I � . . . . CHANGE IN FLOW: 3,080 GPD - 1,773 GPD = 1,307 GPD I I . I � .� . � . I . . I SURVEYING . . � � I PROPOSED PARKING TOTAL: . 1 I . 43 SPACES � . . I I . . I . � . . . . I I . . .. � I .1 . 1. . . I . I I .1 . I . . I . IIIIIIIIIIIIII � . I . I I I I . I . I I I . I . � � REQUIRED PARKING IS A REDUCTION WITH CHANCE IN USE: 1 1 � : OVERALL -SITE GRANDFATHERED SEPTIC FLOWS � . I . . � I . . I . . I .. I I � . I I . � . I . . . � � I . I . I . . � . I � . I . I - I I � I . � . . I I I . . I I . I I I - 82 PS - 43 PS = 39 PS . I . . 1 39 LESS SPACES I . PER EXISTING PERMITS . = 14,445 GPD � . I . 11 I � I . � I I . � . ; . I I . I . . . . I . I . I . . � . . . � � I . 1 . I I . � I � I I . . I . . . . I . .. � I � I I Registered Professional Engineers I � . � . . . I I . I , I . I . . I � � . . . I . . I � . . � . . � I . I . I . I I I I � I � I . I 11 .1 I � . . ... . 1 . I I I. .. I I I PROPOSED OVERALL SITE FLOW WITH CURRENT USES . I . 11, . 1 . . I . . � I . � I . 1. I � .. 1. � . 1 . . . I . . and Land Surveyors . . . I I . �� . . . I . � � . . I I � �. I I � I 11 . I I I I . AND CONVERSION OF 2ND .FLOOR SPACE TO RESIDENTIAL - 13,990 GPD ... . I . I � . . � . � I . . . . . I I . . I . . � � . . � . . I . I I I I . .I I . .111.1 I � I . . . I , � � . I . . �. � � . I I I I I I I I I I I . I . I I � � . � � . I . � . . I . . � . I � . � I . I � I .1 I . . . . . . . I . . . I . 1. 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G r,�`1 h 4 BUJLDING CODE: 2015 INTERNATIONAL EXISTING BUILDING CODE with MASSACI-IUSETTS AMENDMENTS-9TH EDITIONI�I� I�.I RI .I.I I.. V�I , °„n I ' I."...�II....e1.,,'n.I�I �.I.'I�I.,1'I;".O..'...t.I.�.*..-;.'.-�����-.Io..-.,--��.,�.I'I.I---."I.l-,-i�""1 I�,-r,1 I,..I,.-"��";',I-�'�.I;-�.��.:1I'.I:.I���.�.-.I.�.,�'I.�I:I-�.II.II.I PLUMBING CODE: 248 CMR 10.00:UNIFORM STATE PLUMBING CODE �;.���. .'- '''''-�.'�,�',�,��.;;;;I,w;;;�--!. .:,,].::��p..,!1-�:,-!,�:1��,:��,::!:-;�:i:.�e��. I.��l-.��f�������;-lI"..,�.'z�'r��f�:.�,��-.,-:e l�: ,�- I�,':-I�!-0'l':�--:-��-.-"-�,r�'.y'.�`,:�:�!:.',1���",.-...2�,�...�-�.. i.�';,.:'1.���-.-1�":1"'��-.1.,1l.-�,I',�..---'1�.�:�,-i-.�.�..�,�'. 1,l�;�.�":':��I"!.'*:l�;`-,-1v1:-Z-I:d ', Leh iLfhl�tibr ri!�ith a, tf-',1-.f-"-�.-;`l?-",."�,��,;1:- I.I".....,I'I.-�aI F.1.z.'��z.�-'F.:'.I . MECHANICAL CODE: 2015 INTERNATIONAL MECHANICAL CODE with MASSACHUSETTS AMENDMENTS-9TH EDITION ,4 : ';k Ii:: . . rip � --v?.i 6, '' k .I� �E�I I. . stet+ d'::. Y: .:+ r ELECTRICAL CODE: 2017 NATIONAL ELECTRICAL CODE with MASSACHUSETTS AMENDMENTS I I , n . s t s .�� .a ' ENERGY CODE: 2015 INTERNATIONAL ENERGY CONSERVATION CODE(IECC); ' LL O C U S MAP I A P . �I.����I�I..I���...,.I R.I.I I II I..I�.�..I.II-...II.�1.I 1 I.D..I,�I�...I..I.I�I.�I�.I I.�.I�-�I�.II I1,I.i..�I..��...�..I�., ��.�.....��.I�I�..I C.I I...��.�I...I..I..w...I I.�EI....��.1, �. NI...... �. � TI���.I I . I�� -. I ACCESSIBILITY CODE: 521 CMR-THE RULES AND REGULATIONS OF THE ARCI IITECTURAL ACCESS BOARD S T TO SCALE . .... 1I..I I. LI L. .I I E� CALE: NO .I . 1.-1 I .I I. I �. - I --. -� -----".� � � . I � C--1 I� . o .. I I '.. '�... 1 . . 1 . .I II . . I..II I AREA 20 8. . . I . ..N.1 EW AREA 3o EWI .. I.�...I �I..1 I.II.�1 I ..1 1.I� .I .. 1.I I...� �..I.I II... I II I.,.I ..� I .I .I. I -�-II�I.I......I �... I. -. I ' I �I I I II . . . I.... I �. a I-I .--�. I.. . . I...� . I... . 1.1...II� .,..� I. .. . . ..I .. . I I I� . �I..� . � 1 I 4I.:.. . � I I . 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'..�I..I. .:.'-'..I:l._":.11-.-1'I .I I�. �.-�.I I �.. . i o" .. � - - - \\ ----------- --- - -- // 1 \\ I I -�\-,'Z�-`.";;'` .'.�--/-�.'1. i _ 1 U SHEET A4 . i I I I 1 . - - - . - - . I - .. . ' � � 4 S . F *. . . �\ 9 . . . . . o I . . I. I I I�..I. .I . 1 .1 1. . I I . II . ,��� I 1 1 I . -� I � �.. I I � . . \ OVERALL BUILDING PLAN SECOND FLOI OR � \ "--,--. . Q .� . �� . 1 . . 1 I . I .1�.�.1 . . . � 1 I .I I 1. I I. . I I I . .� � �.� I ..I . .. �. . I I .I .I ..I I I.�.,..1 1 � .. . � SCALE: 1 /32'a_1,_0„ ` \ � � I I . \ �\ 0 > % \ A . PROJECT INFORMATION :1.. 1. \, � \. ��,�` \ PROJECT ADDRESS: 1600 FALMOUTH RD.CENTERVILLE,MA SECOND FLOOR i "�� PROJECT DESCRIPTION: CONVERTING 24,950 S.F.OF OFFICE SPACE INTO 26 UNITS OF MULTI FAMILY HOUSING . . \ \ . \ ' %I. '\ \ \ ` . . _ \ , . . - - . - \ . , TYPE OF CONSTRUCTION: TYPE III-B I ��� - - BUILDING OCCUPANCY:. BUSINESS FIRST FLOOR, (added R-3)OCCUPANCY ON SECOND FLOOR i . . I.PROJECT AREA: 24,950 SF EXIST AREA . BUILDING LIFE SAFETY INFO: SPRINKLERS,VISUAL.AND.AUDIBLE ALARMS EXIST,MODIFICATIONS WILL BE UNDER SUB - CONTRACTOR PERMIT . . r, i . . ADDITIONAL REQUIREMENTS: 1. THE CONTRACTOR SHALL REPLACE ALL MISSING FIREPROOFING AND FIRESTOPPING. . THE CONTRACTOR SHALL REPLACE ALL FIREPROOFING AFFECTED BY NEW CONSTRUCTION WITH . ARCHITECT: : FIREPROOFING TO MATCH BASE BUILDING STANDARDS,APPROVED EQUAL,OR AS REQUIRED,10 . MATCH THE EXISTING.. . .. 1 Mark S c h r yve r 370 Goss Lane 2. ALL CONSTRUCTION SHALL BE NON-COMBUSTIBLE: . Lancaster, MA 01523 .3. ALL WOOD AND WOOD BLOCKING SHALL BE FIRE RETARDANT TREATED. . . . . ph. (978) 844- 4708. .. 4. ALL INTERIOR FINISHES SHALL COMPLY WITH THE REFERENCED CODE REQUIREMENTS FOR FLAMMABILITY AND SMOKE DEVELOPED RATINGS AS WELL AS TOXICITY. 5.. ALL DOORS TO BE 3611 WIDE MIN.,341,MIN.CLR.IN OPEN POSITION(U.O.N.). , �r�g1 -' . 1,Tme ;„ S7� y'h tv rya idn 11 1a . 3� . . . , LAIm'r�' u1d . . E'u t.per . `>s' " , . '> 10 a . j i . DESIGN SET DATE OF DRAWINGS: 8- 25-- 20 0 i �, — _ --- -- -- - --- — _ P .�v� -� tit/ + I' ovEPA c - -— 1 K/TC _1/✓f=C �_ � R __._ __ r _ _ SG�' �" `j 20 T w 7 PIS;i-- 0�a �vQ►'� z 8 3 '�;7: � �' .� , 9 S-1 \ 3 D 78 p - / 1,� CD �Q � 7--p T�3 L r . ry i` ( / ; ` � Z�sE".S �G O vI/_ �5-6,8 C,P o - - -- -- 1 i d. /71 �* wj 3 pt It Q O - � / / a� � fir✓ ° � M `/ c, �, � O " /, � � . J. Lb , o K Ae \\ 4 D.cs o M''�' o .a 1 ' I A . / o s IR lye, t O _ k+ o oCi V !� T i �( t , y p,ID Al PLAN 0 F SEPTIC SYSTEM S WATER S E R V I CE S OF PROPOSED _ ' * BELL TOWER _-r10, IV HOPPING CE� NTER u � ly �9� IN BARNSTABLE C CENTERVILLE ) MASS. FF 0 R _ LEBEL- SOLLOWS OF SCALE : I' = 3 0' DATE : 3/18 /8 6 _ R E V. 3/2- 0/8 7 f410WE� BY: CRAIG R . SHORT, P. E. 4/ ?/ a7 131 OLD ROUTE 132 HYANN IS , MASS . 02661 -71138 6 z--,a . � -;W/X>. � �. ,. ,, DWN. 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DEL 7S ' h T'o ��' Mbar- -'G zNVERT' G I 0 _ 0 9 a 4 3. �l2/r r " T'o z3� v�ar��2Tr h � ,�, 7-c w.�r R 'ic COWS TRJCTiOn1 0)= SAN ITARY pI S P© sAL SysT�rt ; 4/,v w ,. r~ . , ,,, , r., 12 `d ' •EL o o� ,ax �.. , .,. � ... N /o=` � ~'i ©�i !t /2! p '(f r � r� I SHr''1L �.. '.,-01�{ !'=Q� M T'c7 MASS , F ao COL� / - 5 D.E V'A-NV� D E' !n 7-__ W N - >l-A RN S T,49 3 L F' H EA L T h► R F Q(jLA77C1NS _ a MZOO- s:o o — - -- - - ---- -r. . Q �GLD - 2! <o�_O" 2, --- __•�.�'►�E'.� SEPTIC 7'A N K) D i S T R 1 !.3 UTI �J !\I f3 DX AND C.1*'A C I-f 1 fv C7 P `l" TO F:�k OF RE. fy PO RCE D CONC R E7TE c o - MiN, F'i A !' S< o�� �/¢ I �Te. F-o 0 �7— 57RENG, T►� 300o Psi (2. 8 d0.ys) !Q • i MIN STEEL STRENG,TN = 20,000RS1 _J. �1. �9N/NStn �. '�5 T ___._SM ) �. ; 3t .�/VSPECTEj� - _ A�10 N T,hl L C L 1y .D WH i✓ L G V L O c� T'-7- c) n�1 O F' T.'E S T H O LE L. 3l.0 „ �. (l,e. /2 a 7-/f E' EFF.�C PROFILE : A / T, ► s c D i .P ._ s A L ys.T , N N' T 4 D "S /� I/ ,D T�? 3 i-D 6 -3 q©o s_ = 000�o = - s_ Pa _ ---f-�---- - ------ ----- ------ --- --f �.. -��H - �-_ L. -- 3 ...0 : v S Di: �`. ;y4P _ r^� � sNo� ,� �1 a v✓ _ 90 x 3vr9a�s o. � ���o� C RT/ ON A R N TA a �.. 4'� CE-N TIeR vILL�'� M/`7 . U 'REFERENCE - S 32 9Sx /Soho �{- 43' G,AL. �F4'D �o. �� _ _�'�Ti_c -T�.v�c , . . %�1• R��. vF DE � S DATg ssio � IZ"V(stD: 4116 84 P414N ��orc 3 93 Prn, 78 � G, �.F'•�7s.�' T r� = q a x iS9 P d L /3 5 0 �� Z'�'Q'p I-- FL a o S.E.D 2 - 2 4 y c7-G�,�}L= (� - -- -- - - \ 1 , ShC� f .. P ,/ e �,- . - - �3Z9S .�' f-� �' T 4oF 8� Qw�v ay; cRs Commonwealth of Massachusetts '09., d 9— 01 i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information I S(4 1 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return r' Company Name key. 74 Beldan Lane V Company Address Centerville Ma 02632 Citylrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After.conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Appro ' uthority 4. ❑ Fails 2/16/2021 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts r- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at Bell Tower Mall 1600 Falmouth Rd Centerville Building A is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and a 1000 gallon precast leach pit. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ElY ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,V 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. 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: ❑ The system has a septic 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Alk Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is Centerville Ma 02632 2/16/2021 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. CityfTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �n e 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Office Space Design flow(based on 310 CMR 15.203): 741 gpdGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Sq Ft= 1st floor 4940sq ft&2nd floor 4940sq ft Grease trap present? ❑ Yes ® No Water treatment unit present? ® Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 2020= 83,000 total gallons=227 gpd Last date of occupancy/use: Current Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc.rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts r= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 1600 Falmouth Road Building A u- Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: original system installed 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2° Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): H-20 Septic Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Access covers are on risers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(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 per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A V� Property Address Bell Tower Corporation Owner Owners Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1x1000 gals ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form f.- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1000 gallon H-20 precast leachpit with 4'stone was found with 3'standing water and no signs of past overloading. Access is steel ring &cover on riser to grade. 12. Cesspools (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 ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/201 B Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately AS= BUILT ATTACHED SEPARATELY - t5hW.doc•rev.7262018 Tdle 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 16 1 r t i Ln 1 V3 vj --j Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments b� 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building A Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 f - Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � I 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name / information is Centerville V Ma 02632 2/16/2021 required for every page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information Lf a— on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Company A Lane Co � Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approvin ot�i rity 4. ❑ Fails 2/16/2021 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Itl Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at Bell Tower Mall 1600 Falmouth Rd Centerville Building C is served by a Title V septic system consisting of a 2000 gallon septic tank, distribution box and 2 1000 gallon precast leach pits. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '0 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ 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. a. 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, isafety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I� iSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. 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: ❑ The system has a septic 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool r\jf t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts r , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commerciallindustrial Flow Conditions: Type of Establishment: Retail &Office Space Design flow(based on 310 CMR 15.203): 885 gpd Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Sq Ft= 1st floor 7077sq ft&2nd floor 7077sq ft Grease trap present? ❑ Yes ® No Water treatment unit present? ® Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 2020 =40,000 total gallons= 110 gpd Last date of occupancy/use: Current Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: original system installed 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage. T" Official t5insp.doc-rev.7/26/2018 Title 5 Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1-' a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): H-20 Septic Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Access covers are on risers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts r6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(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 per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts !a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2x1000 gals ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2x1000 gallon H-20 precast leachpits with 3' stone were found with 3'standing water and no signs of past overloading. Access is steel ring &cover on riser to grade. 12. Cesspools (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 ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts 1n Title 5 Official Inspection Form L i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (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.): t5insp.doc•rev.726/2018 Tdle 5 official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form IWO Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owners Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately ASmBUILT ATTACHED SEPARATELY t5insp.doc.rev.7f26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 18 LT-. wt C^ 1 f —�] JN10 � I 1 o Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form fin' a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building C Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked C. Inspection Summary: P �Y 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 c Commonwealth of Massachusetts o�09.DI Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .� � 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name / information is Centerville V Ma 02632 2/16/2021 required for every page. City[Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information St or /51H3 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane rQ Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 2/16/2021 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 1 of 18 Commonwealth of Massachusetts I� p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . � 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at Bell Tower Mall 1600 Falmouth Rd Centerville Building E is served by a Title V septic system consisting of a 2000 gallon septic tank, distribution box and 2 1000 gallon precast leach pits. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form I." Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � .� 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 1- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. 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: ❑ The system has a septic 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5ins .doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 P P 9 P Y 9 Commonwealth of Massachusetts - p Title 5 Official Inspection Form �- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,u 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Retail &Office Space Design flow(based on 310 CMR 15.203): 736 gpdGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Sq Ft= 1 st floor 4177sq ft&2nd floor 7077sq ft Grease trap present? ❑ Yes ® No Water treatment unit present? ® Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 2020= 180,000 total gallons=493 gpd Last date of occupancy/use: Current Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: original system installed 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts 1d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �n 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): H-20 Septic Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Access covers are on risers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene El 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(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 per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 'M 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2x1000 gals ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 2x1000 gallon H-20 precast leach pits with 3' stone, one pit was found with 2' standing water and the other dry with no signs of past overloading. Access is steel ring &cover on riser to grade. 12. Cesspools (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 ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately ASmBUILT ATTACHED SEPARATELY t5insp.doc•rev.U 2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 18 4 A a , I I ( A rT-1 I vim• v w J Commonwealth of Massachusetts �n Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �Q 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts r- p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building E Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts 4 0q_ 011 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name / information is required for every Centerville ✓ Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane C Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 2/16/2021 Inspector's Signatur Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at Bell Tower Mail 1600 Falmouth Rd Centerville Building G is served by a Title V septic system consisting of a 7500 gallon septic tank, 2 x 2000 gallon grease traps, distribution box and 9x1000 gallon precast leach pits. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G V Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y .� 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. 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: ❑ The system has a septic 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. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow El N Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® 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 fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ 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(5)] t5insp.doc•rev.7/2612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ❑ No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. City town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Retail, Office Space& Restaurant Design flow(based on 310 CMR 15.203): 4762 gpdGallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): See below Grease trap present? ❑ Yes ® No Water treatment unit present? ® Yes ® No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: 2020 =693,000 total gallons= 1899 gpd Last date of occupancy/use: Current Date Other(describe below): Design flow= Restaurant 108 seat @ 35 gal per seat, Retail @ 8283 sq ft,Office @ 9084 sq ft. 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form l.- Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® 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)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval.. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: original system installed 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments � 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. C4rrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 7500 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): H-20 Septic Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Access covers are on risers. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �Q 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: 3.5 &3.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 2 x 2000 gal each Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 5 Date of last pumping: unknown Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(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 per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(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.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System.Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 9x1000 gals ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts +� Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System SAS cont. Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 9x1000 gallon H-20 precast leach pits with 2' stone. Access is steel ring &cover on riser to grade. Pit#reference is represented on attached as-built 4= 6"standing water, 5=6" standing water, 6=6" standing water, 7 =4'standing water, 8=6" standing water, 9= 1'standing water, 10=6"standing water, 11 = empty, 12=4' standing water. 12. Cesspools (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 ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (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.): t5insp.doc.rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately AS= BUILT ATTACHED SEPARATELY t5insp_doc-rev.7/262018 Title 5 Official Inspection Form:Subsurhace Sewage Disposal System-Page 16 of 18 IA- b d ' 3 77 - -- Z . _ ? ; ` 3 z 75- ':. i V w IN, lVe :. a � ' . �yf s Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1600 Falmouth Road Building G Property Address Bell Tower Corporation Owner Owner's Name information is required for every Centerville Ma 02632 2/16/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 A/6 � / 5 t ( V0 R "it, U 2 McKenzie, Marybeth From: MacNeely, Martin <mmacneely@commfiredistrict.com> Sent:, Wednesday, October 17, 2018 11:58 AM To: McKenzie, Marybeth Subject: RE: Bell tower Mall, Centerville Marybeth, Here are my contacts for that property Joe Souza 508-367-3067 property manager John Callihan 617-538-9326 owner Let me know if I can help any further. Martin From: McKenzie, Marybeth [mailto:Marybeth.McKenzie @town.barnstable.ma.us] Sent:Tuesday, October 16, 2018 4:28 PM To: MacNeely, Martin <mmacneely@commfi redistrict.com> Subject: Bell tower Mall, Centerville Hello Martin, I am hoping you can help me. I am looking for the property management name and contact info for the Bell Tower Mall. I have spoken with a few of the tenants, but no one seems to know who it is. I don't have the contact info available to me either.There is a huge rat problem between the two complexes, on the left side, which needs to be addressed especially before the cold when they will want to head inside. I appreciate your time and help. Thanks, Marybeth McKenzie R.S. Town of Barnstable Health Inspector 508-862-4644 1 t 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. DATE: 1 19 14 Fill in please: 3� 13�"►�rF°5 +�r� P-b �� APPLICANT'S YOUR NAME/S: (A n 1l t D"Pci`I LISA 1LKf E5m1 i Q PGty&kS Ok. (_EN''r v BUSINESS YOUR HOME ADDRESS: i_r o PQv3LRS 1�� �';_3(<,L',umPS Kivr TELEPHONE # Home Telephone Number . ) Z b 2--2-H I no 6 31 q -602-z NAME OF CORPORATION: 5^PLy y,'N f A"E OF ( A Pry.. CC D NAME OF NEW BUSINESS SAMC TYPE OF BUSINESS IS THIS A HOME OCCUPATION? *2 YES NO ADDRESS OF BUSINESS iC;cv 1 r. Zf� ; n�} Zc, CG me_vi,L-E r M/k. MAP/PARCEL NUMBER 90q J Ig (Assessing) When starting a new 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 COM ISSIO ER'S )7�� This individual e n iFlf rmr it req rements that pertain to this type of business. A horized Signat MENTS: S 2. BOARD O EALTH This individual has been i rme of the permit requirements that pertain to this type of business. Authorized 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: i YOU WISH TO.OPEN.A BUSINESS 9- For Your Informairon: Business certificates [cost$4O;OO for-4 years): A business•certificate ONLI�REGISTERS YOUR NAME,in town [which ou roust do by IM:G L it does:na*give'you permission to operate.] You mu$t first obt n5 tke ne�essai y s.i. natures .ri.t.i --- -. Tahe the canj�letrr� forn�..1.0 the Town Clerk's.Office; 1st Fi.,.�E,.7 h1ain St., H zannis. MA OTC ,T � o h.s form at 2d0 Main:St,; Hyannis. required hk Ia�ti.; � % 0 fTawri H':a11).and bet the 60sine'ss Certificate that is: DATE' ` 7113 Fill m APPLI' ANT'S please, YOUR NAME/S Ch��sf��h�r Rem le cor�ori � ' BUSINESS YOUR HOME ADDRESS ! �i lF c TELEPHONE # Home Telephone iVumber, 7b�->� /�1U NAME OF COPPORATION ' - NAME TYPE OF"BU. ES IS D.RE A HQIVIE OCCUPATION?-�--Y_ES O L� L�OOOES., OF BUSINESS` �Q[ y rf �/. I - IVIAP/PARCEL N0MBERJbJ�¢r' Assessing.] When starting a new.business there are several things you must,d.o in order to.b;e�n.ogrnphaice:vvth the rules and rec�ulations:of the Town of Barnstable This form is tnterjdetl to ass styou in o.bWa...g the information you n ay need. You MUST CEO TO 200 Matn'St; -j�orner of Yarmouth Rd:S&1Via�n Street] to make sure y`bu have.the appropriate permits,and.licenses required to legally-operate your business in this town. 1. BUILDING CO M(SSIO.: R S QF E This In.divtd al his Jill el an perm' re uir in'to this.type of-business,MUST COMPLY WITH HOME OCCUPATION �Au Qrized Bignatur RULES AND REGULATIONS, FAILURE TO coMnnEnnrS:. COMPLY MAY RESULT IN FINES. 2. BOARD.OF HEALTH This individual has:be eii of the:permit requirements that pertain to this typE,of business. AuthQi,-ized Sigr;attire** COMMtNTS: 3. CONSUIVIERAFFAIRS tUCENSiNGAUTHORITY) This individual has:been Informed of the licensing requirements that pertain to this type.:of business; CO Authorized Signature.* t1lIME111TSt i 4 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you e must do by M.G:L.'-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. r DATE: 16 - I Fill in please: APPLICANT'S YOUR NAME/S: 5,r w ,A-o f r 1 L BUSINESS YOUR HOME ADDRESS: S' v VYAve t. AR TELEPHONE # Home Telephone Number NAME OF CORPORATION NAME OF NEW BUSINESS_ (jrc�( I-Kcc f`�17 Cy. ►� TYPE OF BUSINESS IS THIS A HOME OCCUPATION? - YES' ADDRESS OF BUSINESS16,. r Lc_ f MAP/PAR.CEL NUMBER �::U�'I t3 1 (Ass.essing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM O R'S OFFICE This individu ha ' f y p rmi requirements that pertain to this type of business. �X!! Author¢ . Signatur COMMENTS: 2. BOARD OF HEALTH This individual has be n inf ed f the ermit equirements that pertain to this type of business. Authorize ignature** MUST%:,0MPLY WITH ALL COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. �--� Authorized Signature* "AMENTS: 1 YOU WISH TO OPEN A BUSINESS? For Your Informations Business certificates (cost$.. 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. DATE: CV �� << Fill in please: APPLICANT'S YOUR NAME/S: " r +{31 BUSINESS YOUR HOME ADDRESS: c7.� G l( C.l wc!-�-1 TELEPHONE # Home Telephone Number .NAME OF CORPORATION: ti`��-�ti NAME OF NEW BUSINESS yt&A lA.)12u p'�s TYPE OF BUSINESS c) N -� l .IS THIS A HOME OCCUPATION? YES ADDRESS OF BUSINESS MAP/PARCEL NUMBER 1� (Assessing) When starting a new 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2.. BOARD OF HEALTH This individual h b en i rrp��l of per it requirements that pertain to this type of business. Authoriz d Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of he licensing requirements that pertain to this type of business. ;_0:!tg LAI Authorized Signature** COMMENTS: YOU WISH.TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the 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" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. t Z7 DATE: 1 a �� s � ara, f L Fill in please: x APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: �Zu( Nil ci i?� k ,� ., i�: _ �OF, '`z'iZ?- l7`I`( _ �' u• r: l('e O�lo�Z- TELEPHONE # Home Telephone Number: - 13 NAME OF NEW BUSINESS Itcr� �o�� £, nY; I� Lt"-- TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO tck kCkb Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS %6d6 �,. �1r U rl- ' t U Ltja o — MAP/PARCEL NUMBER Zo tyt�( When starting a new 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 COMMISSIONER'S OFFICE This individual has b informed of any rmit requirements that pertain to this type of business. Authorized Signature** r COMMENTS: 2. BOARD OF HEALTH _ This individual has been in rmed of the per quirem nts that pertain to this type of business. orize 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: 4. YOU WISH TO OPEN A BUSINESS? For Your Information; Business certificates (cost$30;.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, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. i DATE: 1 2- 3 b�' Fill in please: APPLICANT'S YOUR NAME/S: KCC / -C. BUSINESS YOUR HOME ADDRESS: 1 5 / O TELEPHONE # Home Telephone Number to'2-31a0 -� a-4 <� V p r NAME OF CORPORATION: .N)1+ 1U Q 1 - r S L L C NAME OF NEW BUSINESS Ke I le r vl 5 TYPE OF BUSINESS L IS THIS A HOME)OCCUPATION? YES NO o Ce-n 4-er'vj l j.e ADDRESS OF BUSINESS' 4✓LU icy 4-h Rd S-tcq � , MA oZ,(.,3-L MAP/PARCEL NUMBER O / .(Assessing)- When starting a new 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 COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual h been in med of th permi requirements that pertain to this type of business. Authorize ignature** 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: r i °FINE roy Town of Barnstable Main-Streets Hyannis Massachusetts--02601 �QHAERYSPABI.F + . 9-ppr 1659. A10� Growth Management Department Thomas A. Broadrick, AICP 367 Main Street,Hyannis,Massachusetts 02601 Director of Regulatory Review Phone(508)862-4785 Fax(508)862-4725 www.town.barnstable.ma us January 25, 2007 Sanctuary of Cape Cod, Yoga&Wellness Center c/o Charles Cannon, Jr. 7 Joseph Road Framingham,MA 01701 Reference: Site P1an.Review#002-07—Sanctuary of Cape Cod,Yoga&Wellness Center C.16.00_Falmouth Road,Umt 28, Centerville,MA Map 209, Parcel 014 + Proposal: Convert an existing retail space to a yoga and wellness center. Change of interior layout. Construction of one ADA bathroom, ADA shower and a steam room. electrical, lighting, HVAC and sprinkler will be reworked as needed. Dear Sir/Madam: Please be advised that the Building Commissioner,Tom Perry,has approved the above- referenced proposal subject to the following: • The installation of a second ADA compliant bathroom, is necessary. • Applicant must obtain all other applicable permits, licenses and approvals required including, but not limited to, Health Department approval and signage. If you have any questions, or require further assistance,my direct telephone number is 508-862- 4679. Sincerely, �, Ellen M. Swiniarski Site Plan Review Coordinator CC tSP e: Tom Perry,Building Commissioner Health Department E CRAIG `R. SHORT, P. E. 235 Great Western Road P.O.Box 1044 Telephone(508)398-8311 South Dennis, MA 02660 Fax(508)398-3063 PROFESSIONAL CIVIL ENGINEER-SOIL EVALUATOR SEPTIC SYSTEM DESIGNS—HOUSE DESIGN PLANS—WATERFRONT DESIGN&PERMITTING Tom McKean,Health Director January 22,2007 Barnstable Health Department 200 Main Street Hyannis,MA 02601 RE: Bell Tower Mall,Route 28,Centerville,MA The original design flow for the referenced septic system for units 32 thru 41 (see attached)was for 4,762 GPD. The system was comprised of two(2)2,000 gal. grease traps for the restaurant with a 7,500 gallon septic tank and nine(9) 1,000 gal. leach pits with 2 foot of stone all around. The current use is for the existing Papa Gino's Restaurant(92 seats)and retail and office space. This will produce the following design flow: EXISTING USE: Restaurant @ 92 seats x 35 gpd= 3,220 gpd Retail: Unit 34=2,640 SF Unit 35= 1,670 SF Unit 36= 1,607 SF Unit 37= 1,650 SF . Unit 38= 1,230 SF 8,797 SF @ 50 gpd/1,000 SF= 440 gpd 2na floor office space Unit 40= 1,181 SF Unit 41 =2,525 SF 3,696 SF @ 75 gpd/1 000 SF— 27�pd (existing use) (3,938 gpd) Proposed additional use: The proposed wellness center with sauna and showers is for up to 10 people per day. For Title 5 (section 15.203:5)treat as a school with cafeteria,gymnasium and showers. Then the design flow will be: 10 people x 20 gpd=200 gpd. To provide for future expansion,you can use twice that for the design= 200 gpd x 2= 400 gpd TOTAL NEW DESIGN FLOW= 4,338 gpd This is 424 apd less than the original design flow of 4,762 ffpd Therefore, based on the calculations above,the addition of the proposed Wellness Center will not exceed the original design flow for the referenced septic system. y' If you have any questions,please give me a call. Sincerely, 110 ^ NCRAiG IORT Craig 7ort,P.E. a VIL c .27483 r . TOWN OF BARNSTABLE LOCATION�Q _Gi-l'O,( �\av` SEWAGE # VILLAGE 1��� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. VAL coo LEACHING FACILITY:(type) (size) NO. OF BEDROOMS —"� PRIVATE WELL, PUBLIC WATER _ ---- BUILDER OR OWNER -' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes _-No h `f ' r i 44r- i j----_-----._ -------------- --------------- t ' i r . � t 1 I { � Y a ' Jy Y "r i t { i I� h1 iti 0 J /• S • � i _ Y ��. ,, i full LV I i .::.--....-,,:r ♦q,.�•4,...- ^-.+/�rr.ak.h-RN"r..-..^-,.-�.;`�,+rr :.� u:r,.,,- ;a�m,. .. i ,.;,.:u '^'tyrt r.,+•-^+r--T�.'sz...--M_,TH-,.w...-r':rr..rr» ..�,.�,..a.++unk.+,t...�.,.-..•�""^`-C--'.^..r:..� p. TOWN OF BARNSTABLE BAR-W . Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender )(t)CO �c,.\ �x- M,,, qzN MV/MB Reg.# Village/State/Zip �, �f t i KJ t Business Name �', � ;,, > _ ' -11 ,`� am/pm; on 7J"0 20 02 Business Address _.: ' -1 '+� �. . \4 Signature of Enforcing Officer Village/State/Zip _Q Location of Offense �� k `[��,�� � u -~� Enforcing Dept/Division Offense. Facts 1k i...t rl l'`� "t 1�.�. -T Y\.t. `, t Uyei� AK--) OwW This will serve only as a warning. At this time no legal action has been taken. It is the goal of . Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. OF�ER(Xfi ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD ENFORCING DEPT. TOWN OF. BARNSTABLE' BAR-W Ordinance or Regulation WARNING NOTICE Name of Of fender/Manager ' � (,` ,. , t.a " .3i r. if : Address of Offender t.r+:t ►C,.i ��,�t w�� ., ��11� MV/MB Reg.# Village/State/Zip i i V (, - 1411 ,`" � ., Business Name _� t1 ` t _i,. ...t � ti. � am/pm; on " /,( Q26 0 f ` Business Addresst .' - . 'w t >_ Signature of Enforcing Officer; Village : '. „1 NO i �..` t Location of Offense s, _ it ' .. it ` , " ? ' :Xs ,11i � .� � � u L3 Enforcing Dept/Division 0f^f ense ti a t S i Vim- N Facts ti, l. ��' i .__.lax ' - ,, This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. , Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFOR CING OFFICER GOLD-ENFORCING DEPT. ''**..-a- i...,.,^✓.,,,' -.✓w.as.,•;r7'"' n:r,."""_"t..,�� ^a sr.� r5 a�n;-•Y ..�.,,�^,S;y"os-, -ss�,.�'`t^ +"�F...!,f•`h.+;,�...�7"Sr7-,rx-...r-.;.'.W..^r TOWN OF BARNSTABLE BAR-W 2. 3937 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager(. 52.(, I-.k x 1( r C � .r1'-k � �� t� 12 1 14 , MV/MB Reg. Address of Offender Jj9Q (k� (gip p p�� GC S. # Village/State/Zip % lj�(_�,t��, :� + � � Business Name �� r'if1. v� C tc,.mil . am/pm, on 1 20j�Z Business Address C v 1 \ d ��k' � # c', Signature of Enforcifi'i� Officer Village/State/Zip '-t ` ,+.�_*, �� 1•..i, l+.d . �7 ' Location of Offense l\ \( Enforcing Dept/Division Offense. P 4\61 C,)O-Al 0-1 lii `) Facts..1»; Lk A� k2N.1 -1 CZ ti i ``s lr 1 Cm (7- This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. *tnzs. ,,:'�" e...r ..j+'z .-.++..r+.,�: -r,•e�.*^r�aa-..- --'"". TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE 7 Name of Offender/Manager ' :1 { sty 4 L - 1 ' _. Address of Offender jitic# ( A,), O i, „ i E ,A MV/MB Reg.# Village/State/Zip r Business Name i , VI( am/pm, on ' 20 1,Z` a n Business Address Signature of Enforcing Officeii Village/State/Zip Location of Offense 1 � tt , :� f .a a" `• �i�'=.. C. 1x ;,a+ 0, Enforcing Dept/Division ` Offense I( ". t f t� . : > � � " # 4� a` c;� t�t t 1-1, Facts ""This will serve only as a warning. At this time no legal action .has been taken. ' It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are ' attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. RECEIVED JUL 302002 TOWN OF BART TOWN OF BARNSTABLE 3930 HEALTH DEPEPT.. BAR-W ��9 Ordinance or Regulation WARNING NOTICE t Name of off ender/Manager T(�� � �C)�pt�(C,�IL Address of Offender I(DW) "LL"% vj�l MV/MB Reg.# Village/State/Zip QUA\e-,-Vi KA A Business Name am/pm, on d 20 Business Address Signature of Enforcing Officer Village/State/Zip CQ� C V k\\ l\ n Location of Offense . �� �Gl,�,�`1Q �, �5 �=� ✓61dAlY Enforcing Deep-{t�/Division Offense C � �� 1, — c ��`` ( l�j \��' \ t � Facts ��V �� Z�C��_�� J� [ 1� � ( �Q CS� ��U�� AIN, L This will serve only as a warning. At this time no legal action has been taken. It. is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. E , 3 P M o � 'Tovr� r LL _ 1600 Falmouth Road Centerville, MA 02632 MALLI (5O11) 771-2446 RECEIVED JUL 3 p 2002 aoo C� � 'e�A- ,il-�.'f;7fJlJI,a�If,�.,�},ffitf•�ftjaf 1,�717�1,:,,,.)� �.,rlt,,,„1,},f �-- t <- � �.". ... ::'..' .:::.. .... C 1 °• ' f ::: .. ... � .... ._... :�.:" II i� /' T6%VA�'�' 1600 Falmouth Road Centerville, MA 02632 M�►LL (508) 771-2446 TO: ALL TENANTS CC: JOHN T. CALLAHAN III / TOWN OF BARNSTABLEd FROM: MALL OFFICE DATE: JULY 27, 2002 RE: WARNING NOTICE FROM BOARD OF HEALTH This office has received both a phone call and a written Warning Notice from the Town of Barnstable Health and Environmental Division. A copy of the Warning Notice is attached. As stated in the Warning Notice, the Town has received complaints from abutting owners of residential property that delivery trucks serving the Bell Tower Mall have been left running for excessive periods of time. The Town advises that air quality regulations limit the time that a delivery truck can be left running to five (5) minutes. EFFECTIVE IMMEDIATELY, it is incumbent upon each and every tenant to insure that any vendor making a delivery to its business adheres to the five (5) minute limit. Any fine levied against, or legal expense incurred by, the Bell Tower Mall as a result of a tenant failing to comply with the foregoing regulations will be the responsibility of the offending tenant. If you have any questions, please contact the mall office. G o LIJ N WiT- y,J W U J CW OC � cT f Health Complaints 26-Apr-02 Time: 1:20:00 AM . Date: 4/22/1902 Complaint Number: 3380 Referred To: Lee McConnell Taken By: BARBARA SULLIVAN Complaint Type: Article X Detail: UNSANITARY CONDITIONS r Business Name: PRO-CUTS Number: GOD Street: RTE.28 Village: CENTERVILLE Assessors Map-Parcel: Complainant's Name: NA Address: Telephone Number: Complaint Description: Coombs and brushes are not sterilized. Employees eating their lunch on top of the dryers. r Actions Taken/Results: LM investigated complaint 4/23/2002. LM - spoke with manager of Procuts about complaint and did a full inspection of the shop. As observed, the combs and brushes are placed in a small container of bleach and water solution before and after each hair cut. The employees were eating in the front of the shop but only if it was slow and not next to anyone getting there hair cut/permed/colored! Did request that the employees eat in the back break room. The only violations observed was the lack of MSDS sheets and the break room. Investigation Date: 4/23/02 Investigation Time: 3:00:00 PM 1 _ 1 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2. Printers 3.Auto Body Shops �j unsatisfactory- 4.Manufacturers COMPANY 1 �-Y,k,TS (see"Orders") 5. Retail Stores 6. Fuel Suppliers ADDRESS AoM R1?% lass: 7.Miscellaneous �\,_X QUANTITIES AND STORAGE (IN- indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Undergroundw 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 LL Miscellaneous: cis �s�S �S� ► � , �Ihi c� 1� L GAT - DISPOSALMECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply 0__Oto5 Town Sewer ��P-ublic O On-site OPrivate 3. Indoor Floor Drains YES N0�K R�(7 -by &q�, + /n L O Holding tank:MDC O Catch basin/Dry well `� fA r&_ I c O On-site system 4. Outdoor Surface drains:YES NO ;tAJ,_Q_rl O Holding tank:MDC O Catch basin/Dry well -Y Liti O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 1. YES NO 2. 4 Q . da Person s me d Inspector Date 40% CGfx14 Gr�� TOWN OF BARNSTABLE ' LOCATION ALMe►cfl''17" iRA SEWAGE # a Q00 e4 ff8 t 10_11 r +(Ylo�t l ASSESSOR'S MAP & LOT o'209 INSTALLER'S NAME&PHONE NO.�I.ii m di-UY C4-11 6-d 50-6 6q-2 i)d-o SEPTIC TANK CAPACITY SV;c tXrs LEACHING FACII.ITY: (type) COAP—_ Cl" her'S (size)lut'Y 1-3))e 9 NO. OF BEDROOMS .100 644, BUILDER OR OWNER J014 n TGR tLk0 ERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 1. 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 aleai�g facility) _ _ _ - Feet Furnished by ° �/� 0 i PT 22 04 01 --=--� a ` -9 _ v 4' qll�i5sGTOWN OF BARNSTABLETION RlltybyLA RA SEWAGE# 9QQQ '4 M I (' +rl� ASSESSOR'S MAP&LOT aoj , ,'l INSTALLER'S NAME&PHONE NO_:Um o&4Y CO-1 IA Nr rJ SEPTIC TANK CAPACITY S ZR0 OXrs LEACHING FACILITY: (type) Poly C"barS (size) NO.OF BEDROOMS — G#L ex- BUILDER OR OWNER_ . A n 'I Co tiood n PERMTTDATE: - '7-OU COMPLIANCE DATE: SS 2S--00 Separation Distance Between the: Maximum Adjust ed ted Groundwater Table to the Bottom of Leaching Facility I. 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 1 g faci ' Feet Furnished by ;r o — F S = MAW 14ol — -:N- Cover- C_ TJ� m i N C A- �e f i � r— 44 �._._._.._—. r7 r— - ' I A - x 5 �r J io7 ` �/ d]W�), •v- Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: 6014A4Q�UdA,-4*9 , R,)bl C �40al,--3, z BUSINESS LOCATION:fO1�4 2!�: t. �- � �� '�La <=', MAILINGADDRESS: '5A-/fit E�_ Mail To: TELEPHONE NUMBER: (�`/� ` 7 72 4 7 06 Board of Health s Town of Barnstable CONTACTPERSON: 'V P.O. Box 534 ' EMERGENCY CONTACT TELEPHONE NUMBER: v""�`�'S� iS" �`QZ� Hyannis, MA 02601 TYPEOFBUSINESS: G- Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you 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 j you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid 'y' Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners I Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers Metal polishes hydrochloric acid, other acids) Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazarRd s (please list): Spot removers & cleaning fluids (dry cleaners) < Other cleaning solvents Bug and tar removers i WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS i 15 -� 520 P� i' ORA MCkO Pro- v' _ Sj 1 t SP 339 578 -99?' US Postal Service Rece:.,Qt for Certified Mail No Insuran;.e Coverage Provided. Do no usei International Mail See reverse San 0 Wet&Number Pot ,State,&Z Code ' Postage $ ,72 Certified Fee Special Delivery Fee Restricted Delivery Fee N Return Receipt Showing to Whom&Date Delivered za o Return Receipt Showing to Whom, Q Date,&Addressee's Address 0 TOTAL Postage&Fees $ � VI Postmark or Date 4 1 0 LL 17t Stick postage stamps to article to cover First-Class postage,certified mail fee,and N, charges for any selected optional services(See front). If you want this receipt postmarked,stick the gummed stub to the right of the return + dress leaving the receipt attached, and present the article at a post office service y endow or hand it to your rural carrier(no extra charge). If you do not want this receipt postmarked,stick the gummed stub to the right of the M eturn address of the article,date,detach,and retain the receipt,and mail the article. If you want a return receipt,write the certified mail number and your name and address o°1s on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authodze4ogent of the addressee,endorse RESTRICTED DELIVERY on the front of the article. 10 M 5. Enter fees for the services requested in the appropriate spaces on the front of this 9 receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 10 6. Save this receipt and present it if you make an inquiry. a T d SENDER: o ■Complete items 1 and/or 2 for additional services. aISO WISh t0 receive the H ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. d ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 4) permit. y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery U) ■The Return Receipt will show to whom the article was delivered and the date a c delivered. Consult postmaster for fee. O 3. rticle ddressed 4a.Article Number•' / di/��� 4b.Service Type J GL ❑ Registered 4E Certified W �l jJjjy, ❑ Express Mail ❑ Insured N c 'l� ❑ Return Receipt for Merchandise [1 COD 7.Da livery z 0lZ , 5.Received By: (Print Name) B.Addressee I Address(Only if requested W and fee is paid)cc t g 6.Signature: Addressee or Agent) 0• X N Ps Form 3 December 1994 J Domestic Return Receipt r� I UNITED STATES POSTAL SERVICE First-Class Mail I Postage&Fees Paid USPS Permit No.G-10 • Print your name, address, and ZIP Code in this box• Public Health Division ~ Town of Bamstable P.O.Box 534 Hyannis,Massadtu s OW I. 1 Town of Barnstable Department of Health, Safety, and Environmental Services Public Health Division Eo 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health April 29, 1997 John Callahan Bell Tower Corp. 80 First Street Bridgewater, MA 02324 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE RENTAL ORDINANCE, ARTICLE 51 The property owned by you located at 1660 Rt.28, Centerville was inspected on April 17, 1997 by Edward Barry, Health Inspector for the Town of Barnstable because of a complaint. The following violations of the Town of Barnstable Rental Ordinance Article 51 and the Sanitary Code H were observed: 410.602: Along the northeast boundary and the northwest boundary of the vacant lot behind the Bell Tower Mall are scattered pieces of cardboard, paper and plastic. On the lot behind the Bell Tower Mall is an old mattress, broken toilet, old broken signs, etc. 410.602B: On the lot behind the Bell Tower Mall are two unregistered vehicles, a gray truck and a school bus both used for storage. 105.CMR 590.020B: All the dumpsters were stored on a pervious surface. You are also directed to correct the remaining above listed violations of 41.602 and 410.602(B) within five (5) days of receipt of this notice by removing all the rubbish debris from the ground and disposing of it properly. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, this violation must be corrected regardless of any request for a hearing. You are further directed to correct the violation of 105 CMR 590.020B within 30 days by placing the dumpsters on impervious surfaces. �v Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. You are also subject to non criminal citations of$40.00 for the first violation and $15.00 for each additional violation. Tickets will be issued daily until the violations are corrected. PER ORDER OF T E BOARD OF HEALTH omas A. McKean Director of Public Health S The Town of Barnstable • 1Iealth'Department t """Ln 367 Main Street, Hyannis, MA 02601 I"" e Office 508-790-6265 �w� ��'�,�`� Thomas A. McKean FAX 50b-j7PP344 Director of Public Health NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY CODE II, MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at f d'�a�9 was inspected on Health Inspector for the Town of Barnstable, because of a complaint. The following violations of 105 CMR 410.00, State Sanitary Code II, Minimum Standards of Fitness for Human Habitation were observed: You are dir ed to come ese violati0 w�ivre fou hours of re ipt of this no e. You are also directed to correct within �y �� � days/hours of receipt of this notice. You may request a hearing if written petition requesting same is received by the Board of Health within seven (7) days after the date order is received. However, these violations must be corrected regardless of any request for a hearing. Please be advised that failure to comply with an order could result in a fine of not more than $500. Each separate day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health �� �� ������ ��z� �e ' ' i ., t v . ~ � � '"r ` � � ` � TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH �Sr satisfactory 2.3nters .Auto Body Shops satisfactory- 4.Manufacturers COMPANY O un(see"Orders") 5.Retail Stores �7 6.Fuel Suppliers ADDRESS 16 C18SS: ( 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground 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: /DU U 6 U DISPO AL/RE LAMATI i S C ON REMARKS: 1. Sanitary Sewage 2.Water Supply _ oil O Town Sewer Public C 10-On-site OPrivate 3. Indoor Floor Drains YES NO-,k' O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC (xCatch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO - 1. 2. Person (s) Interviewed Inspector Date s } LAY Date: q �� TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: T/?0 C'1) f-S BUSINESS LOCATION: &zi Power pald MAILINGADDRESS: CQr� 1"1! Ile �I�Y1�1 Mail To: TELEPHONE NUMBER: 77 Y' f a oo Board of Health / �� Town of Barnstable CONTACT PERSON: �'"'! /VI Qih Q`f® P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: �©,? Hyannis, MA 02601 TYPEOFBUSINESS: S'a /0 n Does your firm store any of the toxic or hazardous materials listed below, either for.sale or for you 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. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid 164104-.0k Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers �es� Any other products with " o' o ' labels Paint brush cleaners ® (including chloroform, ormaldehyde Floor & furniture strippers hydrochloric acid, other acids) Metal polishes j6jjj�_ Laundry so' stain removers X Other products not listed which you feel (includin bleach) may be toxic or hazardous (please list): Spot removers cleaning fluids �2ty�rM Cameo (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Southeast�4fA's Lurg�st Chiun of Salons andetatl Super Centers WAREHAM 295-3400 x? HOURS: FALMOUTH 540-8288s:-9 Mon-Sat 9 to 8•Sun 10 to 6 CENTERVILLE 778.-0206- i.w 6 WE USE AND RECOMMEND , HYANNIS t778-13i 3 • DENNIS tAll �99a-7180 $89.5 UUMMatrD( PLYMOUTH s747 3432all cuts MARSHFIELD 8200 all styles ESSENTIALS 834- t TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS X90 D HE -�uxC185S' 7.Miscellaneous Iffe' QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots1Underground 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 L*.4jKd�-7 J X is ellaneous: j .1 S-�•02, Uw. DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply /40 44k O Town Sewer Public 6-A41 S On-site O Private .n j '�t 3. Indoor Floor Drains YES NO_�,/ O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES—LNO ORDERS: O Holding tank:MDC S -✓ Catch basin/Dry well O On-site system 5.Waste Transporter DestinationName of Hauler YES NO 1. 2. at/p; Ilk 4�"�4 '4 e Person( .Interviewed fnsptretor Date 'I S s COMMONWEALTH OF MASSACHUSETTS N EXECUTIVE OFFICE OF ENVIRONMENTAL AFF FEB 4,�* o DEPARTMENT OF ENviRoNmmTAL ftomcTI_o 1 ONE WINTER STREET,BOSTON MA 02108 (617)292-5500 *4r 8 � 199? WILLIAM F.WELD . �f TRUDY Governor 6 ARGEO PAUL CELLUCCI DAVID . STRUHS Lt. Governor Commissioner February 10, 1997 Patrick Corcoran Resource Controls 474 Broadway Pawtucket, RI 02860 re: SURRENDER OF GROUNDWATER DISCHARGE PERMIT #0-593 for: Bell Tower Mall 1600 Falmouth Road, Centerville Dear Mr. Corcoran: The Division of Water Pollution Control is in receipt of your letter dated January 28, 1997 submitted on behalf of Bell Tower Mall Corporation. The Division hereby acknowledges that Bell Tower Mall, pursuant to 310 CMR 40 . 0041 (13) , has surrendered Groundwater Discharge Permit #0-593 and will manage the remediation site located at 1600 Falmouth Road in Centerville in accordance with the requirements and procedures of M.G.L. c. 21E and the Massachusetts Contingency Plan (MCP) . --� Please be advised, in this acknowledgement of receipt the Division is not taking a position as to whether the permittee in fact qualifies under the applicable regulations to surrender its permit, but assumes that in surrendering the permit, the permittee, along with its LSP and attorney, has made this determination. . i t �e Printed on Recycled Paper Please contact Marybeth Costello at (617) 556-1029 should you have-- any questions. Sincerely, C Michael V. Rapacz, Deputy Director Wastewater Management cc: Frank Mezzacappa, DEP/DWPC/SERO Laura Stanley, DEP/BWSC/SERO John T. Callahan, Bell Tower Corporation, 80 First Street, Bridgewater, MA 02324 j Board of Health, Town Hall, Barnstable, MA 02364 Cape Cod Commission, 3225 Main Street./P.O. Box 226, Barnstable, MA 02630 Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of �4�w q � Environmental Protection ; Southeast Regional Office �G --Pee, Weld MAlllam F.We ���`� _'} Gowwr« s l Trudy Coxe f 9�� David B.sautes commbalon.r June 26, 1996 7 Mr. John T. Callahan, President RE: BARNSTABLE--WSC/SMP-4-0826 Bell Tower Corporation Bell Tower Mail 1600 Falmouth Road 1600 Falmouth Road Centerville, Massachusetts 02632 RELEASE ABATEMENT MEASURE M.G.L. c.21E and MCP, 310 CMR 40.0000 Dear Mr. Callahan: On May 26, 1994, the Department of Environmental Protection, Bureau of Waste Site Cleanup (the Department) , received a letter report titled "Barnstable--WSC/SA 4-0826, Bell Tower Mall, 1600 Falmouth Road, Barnstable, Massachusetts, Release Abatement Measure (RAM) Plan" (the RAM Plan) dated May 25, 1994, prepared by Resource Control Associates, Incorporated (RCA) . The RAM Plan proposed the installation of groundwater recovery and treatment system to prevent the potential migration of contaminated groundwater. Treated groundwater was to be discharged to the on-site septic system and a groundwater discharge permit obtained. On June 12, 1996, Patrick Corcoran, a representative of RCA, informed Laura Stanley of the Department in a telephone conversation that additional assessment activities were conducted at the site subsequent to the submission of the RAM Plan. Mr. Corcoran also informed Ms. Stanley that based on the results of the assessment activities, RCA determined that the RAM Plan was no longer necessary. Please be advised that RAM Plans not initiated within one (1) year of the approval date are no longer valid or approved pursuant to 310 CMR 40. 0443 (7) . Please be further advised that until this site is Tier Classified, a RAM can not be conducted until a complete RAM Plan, as described in 310 CMR 40. 0444, is submitted and either approved in writing by the Department or presumptively approved within twenty-one (21) days of receiving a complete submittal. 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(S08)947-6557 • Telephone (508) 946-2700 Y -2- Should you have questions regarding this letter, please contact Laura Stanley at the letterhead address or at (508) 946- 2880. Sincerely, Gerard M.�. Martin, Acting Chief Slite Management and Permit Section M\LAS\ka CERTIFIED MAIL NO. Z 276 549 845 RETURN RECEIPT REQUESTED cc: Barnstable Board of Health Post Office Box 534 Hyannis, Massachusetts 02601 ATTN: Tom McKearn, Hazardous Waste Coordinator Town of Barnstable 367 Main Street Hyannis, Massachusetts 02601 ATTN: Warren Rutherford, Town Manager Resource Control Associates, Incorporated 474 Broadway Pawtucket, Rhode Island 02860 ATTN: Ralph Tella, LSP DEP - SERO ATTN: Andrea Papadopoulos, Deputy Regional Director Jonathan Hobill, Acting Regional Engineer Frank Mezzacappa, Water Pollution Control Laura Patriarca, FMF Program Coordinator Data Entry No. � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Migool *p5tem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder( ) Other Type of Building (LSM$ucjvX No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date '1—1 S^9 Number of sheets / Revision Date Title ". 4 Description of Soil k wIt -45 Nature of Repairs or Alterations(Answer when applicable) �, P PP Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signe Date / S Application Approved by A Application Disapproved for the following r s s J Permit No. IJI Date Issued 1t �� ♦ e �'.� l r �•Y i I l/ Fee No. - ' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pplication for MiOogar *pgtem Congtruction Permit - 6. .� Application is hereby made for a Permit to Construct( )or Repair( an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. i31-L%-_ UOLJF-W- OA Ll WL (24L Installer's Name,Address,and Tel.No. D s*gner's Name,Address and Tel.No. We.tue4 (bwS*r e O • vK-t-- VW O ONJ O7 �a '�'��'� t^*'''�S- 1`l4hn�IVlti�. �fLoatL. 6A �L*►w�.S - I _Type of Building: _ -- Dwelling No.of_Bedrooms Garba e Grinder Other Type of Building No.,1 f Persons Showers( ) Cafeteria( ) j Other Fixtures 11 Design Flow g gallons per day' Calculated daily flow gallons. Plan Date -� S-9 S- Number of sheets ? / Revision Date { Title I . I Description of Soil <0 - 'n Nature of Repairs or Alterations(Answer when applicable))l ` T _ Date last inspected: `.Agreement: The undersigned agrees to ensure the construction and�!maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. Signe 170 Date Application Approved by _ t! !, d Application Disapproved for the following r6sns / f Permit No. ' Date IssuedtF THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH,DIVISION - BARNSTABLE, MASSACHUSETTS r Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed Apr repaired/replaced on by W\e-K-Ek 4.mv1,V, for a� �L b.,.s�. (`^k�-� ts�C�►�Z IGNG, has been constructed in accordance_ with the provisions of Title 5 and the for Dis osal System Construction Permit No. IJ dated01 IF Use of this system is conditioned on compliance with the provisions set forth below: 'A Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office William F.Weld Governor Trudy Coxe Secretary,EOEA Thomas B. Powers Acting Commissioner O December 14 , 1994 John T. Callahan RE: BARNSTABLE--Groundwater Bell Tower Corporation Discharge Permit 1600 Falmouth Road SE #0-593 Barnstable, Massachusetts 02632 Dear Mr. Callahan: In response to your application for a permit to discharge into the ground a treated effluent from a groundwater treatment system located at Bell Tower Mall, 1600. Falmouth Road, Barnstable and after due. public notice, I hereby issue the attached final permit. No comments objecting to the issuance or terms of the permit were received by the Division of Water Pollution Control during the public comment period. Therefore, in accordance with 314 CMR 2 . 08, the permit becomes effective tl rty (3.0) days from the date of issuance. Parties aggrieved by the issuance of this permit are hereby advised of their right to request an Adjudicatory Hearing under the provisions of Chapter 30A of the Massachusetts General Laws. and 314 CMR 1. 00, Rules for the conduct of Adjudicatory Proceeding. Unless the person requesting the adjudicatory hearing requests and is granted a stay of the terms and conditions of the permit, the permit shall remain fully effective. Very duly yours, Ro ert Fagan, Regional Engineer for Resource Protection F/FM/ljr Enclosure cc: Cape Cod Commission' 3225 Main Street P.O. Box. 226 Barnstable, MA 02630 (enclosure) 20 Riverside Drive • Lakeville, Massachusetts 02347 • FAX(508,947-6557 • Telephone (508) 946-2700 -2-' cc: Board of Health Town Hall Barnstable, MA 02364 (enclosure) Resource Control Associates, Inc. 474 Broadway Pawtucket, RI 02860 ATTN: Patrick D. Corcoran (enclosure) , DISCHARGE PERMIT Name and Address of Applicant: Bell Tower Corporation, 1600 Falmouth Road, Barnstable, Massachusetts 02632 Date of Application: February 24 , 1994 Permit No. SE #0-593 Date of Issuance: December 14 , 1994 Date of Expiration: December 14 , 1999 AUTHORITY FOR ISSUANCE Pursuant to authority granted by Chapter 21, Sections 26-53 of the Massachusetts General Laws, as amended, the following permit hereby issued to: Bell Tower Corporation (hereinafter called "the permittee) , authorizing discharges from an on-site groundwater treatment system located at Bell Tower Mall, 1600 Falmouth Road, Barnstable, Massachusetts such . authorization being expressly conditional on compliance by the permittee with all terms and conditions of the permit hereinafter set forth. Robert P. Fagan, Re Tonal / Date Engineer for Resource Protection -2- I. SPECIAL CONDITIONS A. Effluent Limits' The permittee is authorized to discharge into the ground from the wastewater treatment facilities for which this permit is issued a treated effluent whose characteristics shall not exceed the following values: Effluent Characteristic Discharge Limitations Flow 65, 000 Gallons per Day Tetrachloroethene 5 ppb Trichloroethene 5 ppb 1, 2-Dichloroethene(cis) 70 ppb Acetone 3000 ppb 1, 2-Dichloroethane 5 ppb (a) The pH of the effluent shall not be less than 6. 5 nor greater than 8 . 5 at' any time. (b) o The discharge of the effluent shall not result in any demonstrable adverse effect on the ground water or violate any water quality standard that has been promulgated. B. Monitoring and Reporting (1) The permittee shall monitor and record the quality of the influent to the treatment system according to the following schedule and other provisions: Minimum Frequency Parameter of Analysis Sample. Type PH Quarterly Grab Volatile Organic Compounds* Quarterly Grab * (USEPA Method #524) -3 (2) The permittee shall monitor and record the quality and quantity of effluent from the. treatment system prior discharging to the leaching area according to the following schedule and other provisions: Minimum Frequency Parameter of Analysis Sample Type Flow Daily Continuous Reading PH Daily Grab Volatile Organic Compounds* Ouarterly Grab * (USEPA Method #8010) (3) The permittee shall monitor, record and report the quality of water in eleven (11) monitoring wells, MW- 14 , 15, 16, 17, 1M, 2 , 7S, 8S, 10, 12 , and 13 according to the following schedule and other provisions: Parameter Frequency of Analysis Static Water Level Quarterly Specific Conductance Ouarterly PH Ouarterly Volatile Organic Compounds* Quarterly * (USEPA Method #8010) (4) Any grab sample or composite sample required to be taken less frequently than daily shall be taken during the period of Monday through Friday inclusive. Grab samples shall be taker. between 8 : 00 a.m. and 6: 00 p.m.. All samples shall be taken over the operating day. The permittee shall submit all reports on an acceptable form, properly filed and signed, on the last day of every month, beginning thirty days after the issuance of this permit, to the Regional Environmental Engineer, Department of Environmental Protection, SERO, 20 Riverside Drive, Lakeville, MA 02347 , and to the Director, Department , of Environmental Protection, Division of Water Pollution Control, One Winter Street, Boston, MA 02108 , and to the Board of Health, Town Hall, Barnstable, MA 02632 . f -4- C. Supplemental Conditions (1) The permittee shall notify the Regional Director at least thirty days (30) days in advance of. the proposed transfer of ownership of the facility for which this permit is written. Said notification shall include a written agreement between the existing and new permittees containing a specific date for transfer of permit, responsibility, coverage and liability between them. (2) The permittee shall operate and maintain the approved treatment system until such time that the permittee. can demonstrate that the influent water quality compiles with the limits for discharge specified in Section 1.A of this permit by providing three (3) consecutive months of sampling data to the DEP. When such a. level of mitigation has been achieved the permittee shall sample all the monitoring wells (stated in B. (3) ) for analysis of all parameters in section I.B(3) . The permittee shall provide the DEP with written documentation verifying that the performance standards has been attained and request DEP approval to terminate the operation of the subject treatment system. When the system has complied with the performance standards and received DEP approval to conclude operation, the permittee shall be submit to the DEP a schedule by which the treatment system shall be taken out of service, dismantled, and/or removed from the, site. Plans shall also be submitted detailing the measures to be taken to remove . and/or properly secure the recovery, and monitoring wells at the site. (3) The permittee. shall receive access and control of the operation and maintenance of the ground-water recovery systems, treatment system, injection well (s) and all monitoring wells in the event of a sale of the subject. property during the period of this permit. (4) Approval. by the Division of Water Pollution Control to terminate the Operation of the groundwater recovery/treatment system for which this permit is written does not relieve the permittee from any further actions that may be required by the Department. -5- This permit is an action of the Department. Any person aggrieved by this action may request an adjudicatory hearing. A request for a hearing must be made in writing and postmarked within thirty (30) days of the date you received this permit. Under 310 CMR 1.01(6) (b) , the request must state clearly and concisely the facts which are the grounds for the request, and the relief sought. The hearing request along with a valid check payable to Commonwealth of Massachusetts in the amount of one hundred dollars ($100. 00) must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P.O. Box 4062 Boston, MA 02211 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town (or municipal agency) , county, or district of the Commonwealth of Massachusetts; or a municipal housing authority. The Department may waive the adjudicatory hearing filing fee . for a person who shows that paying the fee will create an undue financial hardship. A person seeking a . waiver must file, together with. the hearing request as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. Commonwealth of Massachusetts Executive Office of Environmental Affairs. Department of Environmental Protection ' Southeast Regional Office William F.Weld Governor Trudy Coxe Secretary,EOEA Thomas B. Powers Acting Commissioner October 31, 1994 John T. Callahan RE: BARNSTABLE--Draft Bell. Tower Corporation Groundwater Discharge 1600 Falmouth Road No. SE #0-593 Barnstable, Massachusetts 02632 Public Notice Dear Mr. Callahan: Enclosed herewith is a public notice for the referenced groundwater discharge permit application, which you recently submitted to the Division of Water Pollution Control. The Division has reviewed your application and has made a tentative determination to issue, subject to the public notice process. Please have this notice published in a' newspaper of general circulation in the municipality where the project is located. This notice shall be published at the applicant' s or permittee' s expense in accordance with the requirements of 314 CMR 2 . 06 as amended (copy enclosed) . It is the applicant/permittee' s responsibility to forward proof of publication to the Department at the above noted address. The mandatory thirty (30) day public comment period will commence with the date of publication of the public notice. It is in the permittee' s best interest to 'publish this notice upon receipt and forward the proof of publication to the Division as soon as possible to avoid delays in proceeding with your request. If you have any questions please contact, Mr. Frank Mezzacappa at (508) 946-2723 . ver t ul yours, Jeffrey oul Chief Water Pollution Control Section G/FM/ljr - cc: Board of Health Town Hall Barnstable, MA 02630 20 Riverside Drive • Lakeville,Massachusetts 02347 • FAX(508)947-6557 • Telephone (508) 946-2700 -2- cc: Resource Control Associates, Inc. 474 Broadway Pawtucket, RI 02860 ATTN: Patrick D. Corcoran MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION DIVISION OF WATER POLLUTION CONTROL SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE LAKEVILLE, MASSACHUSETTS 02347 TELEPHONE (508) 946-2700 PUBLIC NOTICE GROUND WATER PERMIT APPLICATION Notice is hereby given that the following applicationjor a ground water discharge permit is being processed and that the following actions being proposed thereon pursuant to Section 43 of Chapter 21 of the General Laws, and 314 CMR 5. 00 and 2 . 06: APPLICANT: Bell Tower Mall PERMIT NO. SE #0-593 FACILITY LOCATION: 1600 Falmouth Road TYPE OF DISCHARGE: pump and treat QUANTITY OF DISCHARGE 45 gallons per minute PROPOSED ACTION: Tentative Determination to issue permit A copy of the application, . draft permit, and statement of basis or fact sheet relative to the draft permit may be obtained from the Division' s Permit Section at the above address and telephone number. Comments on the proposed action or requests for a public hearing thereon pursuant to 314 CMR 2 . 07 must be filed with the Division ,at the above address within. thirty (30) days of this notice. • Robert Fagan, Regional Engineer ` 9 1p Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of A RECEIVED Environmental Protection SEP 13 1994 Southeast Regional Office 1 OF ABLF William F.Weld, TOM HEALTH DEFT. Governor _A t V' Trudy Coxe Secretary. Po Thomas B. Powers OEA C(a Acting Commissioner .Fly September 6, 1994 John T. Callahan RE: BARNSTABLE--Water Pollution Bell Tower Corporation Control, Bell Tower Mall, 1600 Falmouth Road Draft Groundwater Discharge Barnstable, Massachusetts 02632 Permit No. SE #0-593 Dear, Mr. Callahan: The Massachusetts Clean Water Act (M.G.L. , C. 21; S. 26-53) was amended by Chapter 246 of the Acts of 1973 to authorize the Division of Water Pollution Control to regulate discharges into all water of the Commonwealth, including groundwaters. IThe Division regulates discharge through the issuance of discharge permits which impose limitations on the amount of pollutants which may be discharged in the effluent, together with monitoring and reporting requirements and other conditions to insure adequate treatment of all liquid wastes prior to discharge. The Division has reviewed your application submitted for a permit to discharge treated wastewater to the ground located at Bell Tower Mall, 16.00 Falmouth Road, Barnstable, Ma and has developed the conditions contained- in the enclosed draft permit. Within fourteen (14) days of receipt of the draft permit, you should indicate to this agency in writing either the acceptability of the permit conditions or any problem areas. Any discharge not authorized by or in violation of the terms of the permit is in violation of State Law and subject to civil or criminal penalties. The proposed permit can only be considered in draft form because of provisions in the Law regulating public notice of the proposed issuance of the permit and opportunity for public comments and public hearing. Following receipt of comments on the public notice, and public hearing, if necessary a final determination to issue or deny the permit will be made. If you should have any question or require additional information please contact Mr. Frank Mezzacappa at (508) 946-2723 . Very truly yo Jeff { G ul , ief - Watert'q ,lut on Control G/FM/bh �,�` 26 Riverside Drive • Lakeville, Massachusetts 02347 9 FAX (508)947-6557 • Telephone (508) 946-2700 -2- cc: Board of Health Town Hall Barnstable, MA 02364 Resource Control Associates, Inc. 474 Broadway Pawtucket, RI 02860, ATTN: . Patrick D. Corcoran Cape Cod Commission , 3225 Main Street P.O. Box 226 Barnstable, MA 02630 DISCHARGE PERMIT Name and Address of Applicant: Bell Tower Corporation, 1600 Falmouth Road, Barnstable, Massachusetts 02632 Date of Application: February 24 , 1994 Permit No. : SE #0-593 Date of Issuance: DKi-kr i Date of Expiration: AUTHORITY FOR ISSUANCE Pursuant to authority granted by Chapter 21, Sections 26-53 of the Massachusetts General Laws, as amended, the following permit hereby issued to: Bell Tower Corporation .(hereinafter called "the permittee) , . , authorizing discharges from anon-site air-striper located at Bell Tower Mall , 1600 Falmouth Road, Barnstable, Massachusetts such authorization being expressly conditional on compliance by the . permittee with all terms and conditions of the permit hereinafter set forth. DRAFT Robert P. Fagan, Regional Date Engineer for Resource Protection -2- I. SPECIAL CONDITIONS A. Effluent Limits The permittee is ,authorized to discharge into the ground from the wastewater treatment facilities for which this permit is issued a treated effluent whose characteristics shall not exceed the following values: Effluent Characteristic Discharge Limitations Flow 65 , 000 Gallons per Day Tetrachloroethene 5 p-ob Trichloroethene 5 ppb 1, 2-Dichloroethene (cis) 70 ppb Acetone 3000 PPb 1, 2-Dichloroethane 5 ppb (a) The pH of the effluent shall.. not be . less than 6. 5 nor greater than 8 . 5 at any time. . (b) The discharge of the effluent shall not result in any demonstrable adverse effect on the ground water or violate any water quality standard that has been promulgated. B. Monitoring and Reporting (1) The permittee 'shall monitor and record the quality of the influent to the treatment system according to the following schedule and other provisions: Minimum Frequency Parameter of Analysis Sample Type pH Ouarterly Grab Volatile Organic Compounds* Quarterly Grab * (USEPA Method #524) -3- (2) The permittee shall monitor and record the quality and quantity of effluent from the treatment system prior discharging to the leaching area according to the following schedule and other provisions: Minimum Frequency Parameter of Analysis Sample Type Flow Daily Continuous Reading PH Daily Grab Volatile Organic Compounds* Quarterly Grab (USEPA 'Method #524) (3) The permittee shall monitor, record and report the quality of water in eleven (11) monitoring wells, MW- 14 , 15, 16, 17 , 1M, 2 , 7S, 8S, 10, 12 , and 13 according to the following schedule and other provisions: Parameter. Frequency of Analysis Static Water Level Ouarterly Specific Conductance Ouarterly pH Quarterly Volatile Organic Compounds* Ouarterly * (USEPA Method #524) ' (4) Any grab sample or composite sample required to be taken less frequently than ,daily shall be taken during the period of Monday through Friday inclusive. Grab samples shall be taken between 8 : 00 a..m. and 6: 00 p.m. All samples shall be taken over the operating day. The permittee ,shall submit all reports on an acceptable form, properly filed and signed, on the last day of every month, beginning thirty days after the issuance of this permit, to the Regional Environmental Engineer, . . Department of Environmental Protection, SERO, 20 Riverside Drive, Lakeville, MA 02347 , and to the Director, Department of Environmental Protection, Division of Water Pollution Control, One Winter Street, Boston, MA 02108, and to the Board of Health, Town Hall, Barnstable, MA 02632 . -4- C. Supplemental Conditions (1) The permittee shall notify the Regional Director at least thirty days (30) days in advance of the proposed transfer of ownership of the facility for which. this permit is written. Said notification shall include a written agreement between the existing and new permittees containing a specific date for transfer of permit, responsibility, coverage and liability between them. (2) The permittee shall operate and maintain the approved treatment system until such time that the permittee can demonstrate that the influent water quality complies with the limits for discharge specified in Section 1.A of this permit by providing three (3) consecutive months of sampling data to the DEP. When such a level of mitigation has been achieved the permittee shall sample all the monitoring wells. for analysis of all parameters in section I,.B (3) . The permittee shall provide the DEP with written documentation verifying that the performance standards has been attained and request DEP approval to terminate the operation of the subject treatment system. -When the system- has complied with the performance , standards and received DEP approval to conclude operation, the permittee shall be submit to the DEP a schedule by :which the treatment system shall be taken out of service, dismantled', and/or removed from the site. Plans shall also be submitted detailing the measures to be taken to remove and/or properly secure the recovery, and monitoring wells at the site. (3) The permittee shall receive . access and control of the operation and maintenance of the ground-water recovery systems, treatment system, injection well (s) and all monitoring wells in the event of a sale of the subject property during the period of this permit. (4) Approval by the Division of Water Pollution Control to terminate -the Operation of the groundwater recovery/treatment system for which this permit is written does not relieve the permittee from any further actions that may be required by the Department. -5- This permit is an action of the Department. Any person aggrieved by this action may request an adjudicatory hearing. A request for a hearing must be made in writing and postmarked within thirty (30) days of the date you received this permit. Under 310 CMR 1. 01 (6) (b) , the request must state clearly and concisely the facts which are the grounds for the request, and the relief sought. The hearing request along with a valid check payable to Commonwealth of Massachusetts in the amount of one hundred dollars ($100. 00) must be mailed to: Commonwealth of Massachusetts Department of Environmental Protection P..O. Box 4062 Boston, MA 02211 The request will be dismissed if the filing fee is not paid, unless the appellant is exempt or granted a waiver as described below. The filing fee is not required if the appellant is a city or town (or municipal agency) , county, or district of the Commonwealth of Massachusetts, or .a municipal housing authority. The Department may waive the adjudicatory hearing filing fee for a person who shows that paying the fee will create an undue financial hardship. A person seeking a waiver must file, together with the hearing request., as provided above, an affidavit setting forth the facts believed to support the claim of undue financial hardship. V J� • Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Protection Southeast Regional Office William F. Weld Governor Daniel S.Greenbaum ,q camm�asioner June 4, 1993 Bell Tower Corporation RE: BARNSTABLE--WSC/SA 4-0826 1600 Falmouth Road Bell Tower Mall Barnstable, Massachusetts 02632 1600 Falmouth Road NOTICE OF RESPONSIBILITY/ ATTENTION: John T. Callahan III NON-PRIORITY DISPOSAL SITE M.G.L. c. 21E and MCP, 310 CMR 40.000 Gentlemen: The Department of Environmental Protection, Bureau of Waste Site Cleanup (the "Department") , has determined that the Bell Tower Mall located at 1600 Falmouth Road, Barnstable, Massachusetts (the "site") , is a disposal site as defined in the Massachusetts Oil and Hazardous Materials Release Prevention and Response Act (M.G.L. c. 21E) . The cleanup of disposal sites is governed by M.G.L. c. 21E and the Massachusetts Contingency Plan (310 CMR 40.000 et sea; the "MCP") . Because this location has been confirmed as a disposal site, it will appear on the next "List of Confirmed Disposal Sites and Locations To Be Investigated" published by the Department. The Department confirmed this location as a disposal site on May 26, 1993. BACKGROUND The Department is in receipt of a report/Interim Measure Proposal dated March 18, 1993 prepared by Resource Control Associates. Inc. of Pawtucket, Rhode Island. According to the report, tetrachloroethene has been detected n the groundwater at concentrations of up-to-450-parts-per-billion-- � (ppb) . Results indicate that the M ssachusetts Maximum Contaminant Level (MMCL) for drinking water has been exceeded since the MMCL for this compound has been established at a concentration of 5.0 ppb. This contamination constitutes a release of hazardous material at the site. In order to prevent the continued off-site migration of a plume of tetrachloroethene Resource Control Associates, Inc. has also submitted an interim measure proposal for a groundwater recovery well and treatment system. 20 Riverside Drive a Lakeville,Massachusetts 02347 • FAX(508)947-6557 a Telephone (508) 946-2700 ,f` i -2- STATUTORY LIABILITIES The Department has reason to believe that you ("you" as used in this letter refers to Bell Tower Corporation) are a potentially responsible party (PRP) with liability under M.G.L. c. 21E, section 5, for response action costs. Section 5 makes the following parties liable to the Commonwealth: current owners or operators of a site where oil or hazardous materials are located; any person who owned or operated a site at the time hazardous materials was stored or disposed of; any person who arranged for transport, disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport, disposal, storage or treatment site from which there is or has been a release or threat of release of such material; and any person who otherwise caused or is legally responsible for a release or threat of release of oil or hazardous materials at a site. This liability is strict, meaning it is not based on fault but solely on your status as an owner, operator, generator, transporter or disposer. It is also joint and several, meaning that you may be liable for all response action costs incurred at the site, regardless of the existence of any other liable parties. You may be liable for up to three (3) times all response action costs incurred by the Department. Response action costs include the cost of direct hours spent by Department employees arranging for response actions or overseeing work performed by PRPs or their contractors, expenses incurred by the Department in support of those direct hours, and payments to the Department's contractors. For more details on cost liability, see the cost recovery regulations at 310 CMR 40.600 et sect. The Department may also assess interest on costs incurred at the rate of twelve percent (12%) , compounded annually. To secure payment of this debt, the Commonwealth may place liens on all of your property within the Commonwealth. To recover the debt, the Commonwealth may foreclose on these liens or the Attorney General may bring legal action against you. In addition to your liability for up to three (3) times all response action costs incurred by the Department, you may also be liable to the Commonwealth for damages to natural resources caused by the release. Additional penalties may be imposed under M.G.L. c. 21E, Section 11 and other laws for each violation of M.G.L. c. 21E or other laws, or under M.G.L. c. 21A, Section 16, for violations of c. 21E, and other statutes, regulations, orders or approvals. The Department encourages PRPs to take response actions at sites. By taking the necessary response actions, you can avoid liability for costs incurred by the Department's contractors in performing these actions. If you do not take the necessary response actions, or fail to perform them in an appropriate or timely manner, the Department is authorized by M.G.L. c. 21E Sections 3A(j) and 4 to have the work performed by its contractor. -3- DETERMINATIONS The Department has classified this site as a non-priority disposal site. Notice of such classification will be published in a newspaper that circulates in the potentially affected community(ies) . Because this site is a non-priority disposal site, you are advised to apply for a waiver of Department approvals. If a waiver application is approved by the Department, most response actions including interim measures such as the one outlined in the March 18, 1993 report by Resource Control Associates, Inc. , may be completed at the site without further Department approvals. Waiver applications can be obtained by writing to the Waiver Unit, Department of Environmental Protection, Bureau of Waste Site Cleanup, One Winter Street, 5th Floor, Boston, Massachusetts 02108. NECESSARY SITE ACTIONS You and your agent(s) must continue to evaluate the need for a Short Term Measure (STM) as defined in 310 CMR 40.542, and notify the Department immediately if an "imminent hazard" exists at the site. You must submit a proposal to perform the STM if one is deemed necessary. No STM may be commenced without prior Department approval. This evaluation must continue throughout the remedial response action for this site. Please notify the Department in writing of your intent relative to submittal of a waiver application or the pursuit of approval of the interim measure proposal within (14) days of receipt of this letter. Your cooperation in this matter will be appreciated. If you have any questions, please contact Ray McCarthy at (508) 946-2882. In any correspondence to this office, please refer to case number WSC/SA 4-0826. Very truly yours, �� JWeph F. Kowal, Chief Site Support Section JFK/RFM/rr CERTIFIED MAIL #P808 785 214 RETURN RECEIPT REQUESTED cc: Boston - BWSC Division of Response and Remediation r -4- cc: Board of Health Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Susan G. Rask, Chairman Board of Selectmen Town Hall 367 Main Street Hyannis, MA 02601 ATTN: Theodore Panitz, Chairman DEP-SERO ATTN: Data Entry TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 2•Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY , r r (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Class: 7.Miscellaneous C 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) J transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: , " k r ; ` F P DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply a O Town Sewer OPublic O On-site OPrivate t -� 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: f� O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter { �� Name of Hauler Destination Waste Product 1 YES NO 2. Ll Person (s) Interviewed Inspector Date 1 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY 04k 1`� (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS ? Class: 7.Miscellaneous ' TIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERoveUnderground 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 �Ju �l�cellaneous: 4 DISPOSAL/RECLAMATION /REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer Vublic On-site QPrivateo � 3. Indoor Floor Drains YES N0' O Holding tank:MDC Q Catch basin/Dry well VL O On-site system 4. Outdoor Surface drains:YES NO ORDERS: Q Holding tank:MDC Ue. &N "Catch basin/Dry well O On-site system 5. Waste Transporter Destination Waste Product 1. Nelt s - U'a- Cv E NO 2. Perso W erviewed lifspector Date V \ �• *41 .y 4 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH O satisfactory 3.Auto Body Sliops unsatisfactory- 4.Manufacturers f�' !'r O (see"Orders") 5.Retail Stores COMPANY J:k 't_ lit._' L �':" - 6.Fuel Suppliers ADDRESS 1.`,^'!� ��� ;'!1 /i .�-` -;f) l `� 7.Miscellaneous Class a 1,ra_'_v'l Ltl�— QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Drums Above Tanks Underground Tanks 0 IN OUT IN OUTI IN OUT I#&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: DISPOSALIRECLAMATION REMARKS: Nu-, /1. Sanitary Sewage 2. Water Supply rul urto ow, O Town ewer °9, uc K S Pbli 7 V �rl'r ! 11,'/1/ 9 I� `(D On-site OPrivate - 3. Indoor Floor Drains YES NO O Holding tank: MDC O Catch basin/Dry well O On-site system F-ft",I 4. Outdoor Surface drains:YES NO ORD:ERS'. 3 O Holding tank: MDC OO Catch basin/Dry well j �` f' ��C: � � � � 7Pr O On-site system 5. Waste Transporter r �"7 Name of Hauler Destination Product� YES NO 2. AIVI Person (s) Interviewed Inspector 1 Date TOXIC AND HAZARDOUS mTrEPIALS REGISTRATION FORM ////� /�� Mail To: NAME OF BUSINESS: CL014 CARe 14L ��A, C �+� rC �e V;�� ��at�Board of Health MAILING ADDRESS: 1600 Rimw Cep. ije Town of Barnstable TELEPHONE NUMBER: 5'0g -02W P.O. Box 534 CONTACT PERSON: T,&4 VALj-kS Hyannis, MA 02601 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? 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: 1600 r-At RoJ-n+ Pw C 14eryi fle S TELEPHONE: �� $� —0 2-Tr LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous characteristics and must be registered t. Please put a check beside each product that you store: Antifreeze (for gasoline or coolant systems) Drain cleaners 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 be toxic or hazardous (please list): (dry cleaners) Pc�c��dre}l�eE�Per� Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY-. (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS •&60 Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN I OUTI IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) t Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers r, N t Miscellaneous: LL� i DISPOSAIJRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply - i- O Town Sewer �OPublic On-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 NO ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product 1. YES INO 2. Person (s) I terview Inspector Date % 0 t, OF BARNSTABLE ` 1�0 O LOCATION SEWAGE # 9 VILLAGE Akt�- ASSESSOR'S MAP & LOT 7a INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER \ BUILDER C4k OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: A IVZ VARIANCE GRANTED: Yes No 6 1 � A Rio AAA l o r v OF BARNSTABLE L *' ON SEWAGE VILLAGE (:CIJ 1� t ASSESSOR'S MAP 6t LdTITO D/ INSTALLER'S NAME & PHONE NO. 1�-kCXLO '7 11M SEPTIC TANK CAPACITY LEACHING FACILITY:(type) >' ' NO. OF BEDROOMS PRIVATE WELL PUBLIC WATER BUILDER OWNE DATE PERMIT ISSUED: e- DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 �1 `o i > may. i i ASSESSORS MAP NO: W PARCEL NO: (OttI✓ l- No.. �31) Fxs...... .............._ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH AMOV0 TOWN OF BARNSTABLE Appliration for Dispuiial Works Toni '. Application is hereby made for a Permit to Construct ( ) or Repair (9 an Individual Sewage Disposal System at: �nn -. c2Q..n-Address ^ ...Lot No. Owner Address a .......................... --� w�...... Q . ..-='-�=� �-------------------------------- ............................................. A...........kA!jNAr . Installer Address d 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 ( ) dOther 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........................................ a Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_--____-___-_•__--_-_--. rX, Test Pit No. 2................minutes per inch Depth of.Test Pit...:................ Depth to ground water........................ ---------------•------------------------------------------••-•------ -•...•---•••••....•-----.......-••----•...............••-••--•-••--•--.....---•.---•- 0 Description of Soil------.... �_--------S v�' z" M� 5lv_'Nj x ---•---••---•-•---•--•••-----•............... U ------------------••--------------------------------------------------------------------------------------------------------------------------.------------------ W U Nature of Repairs or Alterations—Answer when applicable_____�!�?S�a�L-L---_.._____.t_1� °a........g_.. .....__. \""I\` --- 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 Com liance has been ' d b the board of health. Signed ----- ------ --- ........... Dale Application Approved By --- - ---------------------- -------------- ®----- ------------------------ Da[e Application Disapproved for the following reasons- ------------ ------ -------------------------------------- ----------------------------------------- ----------------- - -- ------------------------------------------------------------------------------------------------------- ---------------------------------------- PermitNo. ....1. ��30 A...-.- Issued ........................ ..........................------------ ------ Da[e f / J oil- v THE COMMONWEALTH OF MASSACHUSETTS d BOARD OF HEALTH TOWN OF BARNSTABLE A Iiration for Ui� uiial nrk Cann rnr n'n rent >� - 9� Application is hereby made for a.Permit to Construct ( ) or Repair (/9 an Individual Sewage Disposal System at: �— _ ................................-•---........*............. .............. • ��--LpcaRfon-Address or Lot ofNo. •• - ---->. ........ --•-_.-Z __....---••-•-•--•------------•---.........•..............•--- Owner Address a --••..��e� (�r»sr'c)uc'-�o,J ..--•--------------•------------ 3...----Rose` .........A.......-•-•-. ................... Installer Address Q Type of Building Size Lot............................Sq. feet U DwellingNo. of Bedrooms.............................. ...Ex Expansion Attic — ----------- p ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) P 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................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ps Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ 04 .•--•-••••-••------------------•---•---••-••...... .. ............................ .... - O Description of Soil........t -L-----------c' �� L T P'- 5� S..tr�� �. U ••••••••••••---•---•--••••••••••...•--•--••••-•-••••-••••-•••••••._.....•---••••••••••--•-••...•••--•••-•--•••--•--••••••••••-•--••••••-••••-•-•••••---••-•-••-........•••••--••-•-•..................•- W x Nature of Repairs or Alterations—Answer when applicable �.SL-t-- \ boo S �c Zrw�� PP �.. 4 -------- = U rZ�---P---•------••- .............................................t ��.......... -` � ,�<, � ....h_'� Agreement: f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with r 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 b the board of health. D ate Application Approved'By ... `' ---1 ._ -...- -.� ..... :.. .................Date- ............ -- Application Disapproved for the following reasons- ---------------- ---------------------------------............................. -------------------------------------------------- -------------------------- ' -` ......-----------.......--------------------..-...........-.......-------------------------- -----------....Date----------- Permit No. 1.-... Issued Date... r -..' �.........--- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE C rdiftrate, of Q-Teraptianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.......�� `c)cE ...... ("ot�g� - --------------------------------------------------------------------.................................----------------------------------- 1, Installer at ....---- - \'�' q E,� ......... ML4 e C `��R*1• l� ;� z has been installed in accordance with the provisions of TITLE 5Lo iThe State r nmental Code as described in the application for Disposal Works Construction Permit No- ------------- dated -------------------------------------........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �' DATE.. 177- ..I. -- - ---------------------------------- Inspector ............ ..................---- -------- ..........----------...------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH R TOWN OF BARNSTABLE -1-._� .- FEE........................ %Vvsal Workiiinn r Ilan rrnti Permission is hereby granted.....t�IZAQ�._.__._ ?`►...........................S� ••-••••-•-•----••-•••-••••........•-•••••••........................•.-•-•- to Construct ( ) or Repair ( ► an Individual Seaa{ge Disposal System at No....... �� t_._ C1 r.) r "% Street i as shown on the application for Disposal Works Construction P rrm_i4.No.____._ .._t/!D�jate ....................... ______........._.. lthDATE.. = Board of-He FORM 36508 H0138S Q WARREN INC.,PUBLISHERS _ DANIEL S. GREENBAUM Commissioner GILBERT T.JOLY Regional'Director C { February 21, 1991 Centerville Cleaners h� RE: BARNSTABLE--WSC/SA 4-0826 1600 Falmouth Road Centerville Cleaners Centerville, Massachusetts 02632 1600, Falmouth.Road LOCATION TO BE INVESTIGATED ATTENTION: Mr. John Dallas NOTICE, M.G.L. c.21_E and 310 CMR 40.000 Gentlemen: The Department of Environmental Protection (the "Department") has determined that Centerville Cleaners at 1600 Falmouth Road in Centerville, Massachusetts (the "Location") is a Location To Be Investigated ("LTBI") for oil and hazardous materials within the meaning of M.G.L. c.21E and the Massachusetts Contingency Plan, (the "MCP") 310 CMR 40.000. On March 14, 1989, the Department received a copy of a letter from the Barnstable Board of Health documenting the release of hazardous material at the Location. According to the letter, a sample collected from the effluent generated from the dry cleaning machinery which dicharged to a septic system at the Location . contained 150 parts per milliom of tetrachloroethene (PCE) . Moreover, on December 19, 1990, during a visit to Centerville Cleaners, a Department representative witnessed a PCE spill resulting from a leaking valve connected to the PCE pump of the dry cleaning machinery. Efforts to contain the spill with numerous cloths were inadequate resulting in further spread of PCE over the concrete floor. Based upon available information, the Department considers this Location reasonably likely to be a Disposal Site. Therefore, this Location has been identified as an LTBI and published on the Department's list of "Locations and Disposal Sites" since January 15, 1990. The information currently available is insufficient to allow the Department to fully .evaluate the Location. M.G.L. c. 21E and the MCP require that the following be completed and submitted to this office within ninety (90) days of receipt of this letter: 1. Preliminary Assessment ("PA") , as designated in 310. CMR 40.535, 40.541. Recycled Paper 2 - 2. Phase I - Limited Site Investigation, as designated in 310 CMR 40.535, 40.543. 3. Interim Site Classification Form with sufficient supporting evidence, referenced by document and page, in accordance with 40.544 of the MCP. These documents will provide the information needed to determine if the Location is a disposal site and to decide if further remedial response actions are necessary. The tasks that should be completed for a Phase I report are outlined in 310 CMR 40.543. An Interim Site Classification Form may be obtained by writing to Henry Cui of this office. If you perform the activities noted above, the Department will not seek to recover the costs it incurs in reviewing the Phase I - Limited Site Investigation report and the Interim Site Classification Form that you submit to the Department. You should be aware that if the Department performs these assessment activities, you may be held liable for costs incurred by the Department in doing SO. If the Phase I - Limited Site Investigation indicates that the Location is a non-priority disposal site, you may apply for a waiver of Department approvals. If a waiver application is approved by the Department, most response actions may be completed at the site without further Department approval. Waiver applications can be obtained by writing to the Waiver Unit, Department of Environmental Protection, Bureau of Waste Site Cleanup, One Winter Street, 5th Floor, Boston, MA 02108. If at any time an "imminent hazard", as defined in 310 CMR 40.542, is discovered at the Location, you must immediately notify the Department, and submit a proposal for a Short Term Measure (STM) . No STM may be commenced without prior Department approval. If the STM is not performed in a timely manner, the Department is authorized to perform the STM and recover the costs for performing this work. If the LTBI is confirmed as a disposal site, you may be named as a potentially responsible party ("PRP") , with liability for up to three (3) times all response action costs incurred by the Department. Response action costs include the cost of direct hours spent by Department employees arranging for response actions or overseeing work performed by PRPs or their contractors, expenses incurred by the Department in support of those direct hours, and payments to the Department's contractors. For more details on cost liability, see 310 CMR 40.600: Cost Recovery. The Department may assess interest on costs incurred at the rate of twelve percent (12%) , compounded annually. You may be liable for - 3 - damages to natural resources and liable under M.G.L. c.21E, section 11 and other laws for each violation of c. 21E or other laws, or ' under M.G.L. c.21A, section 16, for violations of c.21E and other statutes, regulations, orders, or approvals. Your cooperation in this matter is appreciated. If you have any questions regarding this Notice, please contact;Henry Cui of this office at (508)946-2882 and refer to case number CS =0826. Very truly yours, Jo. ph F. Kowal, Chief Site.Support Section K/HC/lm CERTIFIED MAIL #P253 152 839 RETURN RECEIPT REQUESTED cc: Boston - BWSC Division of Response and Remediation Board of Health 3.67 ..Main Street Hyannis, Massachusetts 02601 ATTN: Thomas A. McKean Board of Selectmen 367 Main Street Hyannis, Massachusetts 02601 SERO - WSC - Data Entry �� n I VCR ��b �� 9 r ,.� F -• � • No. ..lL'.�'J6 FE$.............................. 4 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH w..............................._OF...., f�-7 s F....,I.................................................... Appliration for Disposal Works Tonstrnrtion rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: C :?L� / Lir':✓t't< T cl/ 9 2 ..........---......_.... ........................ ...................•................. ............................................................... on-Address ,*;`Location-Add ,*;` or Lot No. < ,. r r.-, • r- t Owner ,!/- Address Installer Address ;T -.'..�; Type of Building ���! cGf, =y r -� Size Lot_. _:�_`__ -'-:....Sq. feet U Dwelling No. of Bedrooms......................... .....Expansion Attic ( ) Garbage Grinder ( ) a Other—T ype of Building .� ��_...___..... No. of persons............................ Showers ( ) — Cafeteria ( ) _ Otherfixtures .......................••-•----•-•••••-----...-- ••--•---•-•••-••....._..--••-•--.......-•-•-•••--••----•---•--•----------•---•--•-•---------------- W Design Flow..•..........:=........................•.._gallons per pertsian per day. Total daily flow__._.__... ............................gallons. WSeptic Tank—Liquid capacity!,=0:0...gallons Length L..�-'....... Width-la--- ..... Diameter________________ Depth.4___1..._.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 1 3 Seepage Pit No.....f.............. Diameter.....in......... Depth below inlet...!............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by.... �_ ./'_"°_'_f.....:"� .'%. '' °`,.__'_:`r�r_`4: Date_._..__`"`._._•' C W --------•----•••••---- Test Pit No. 1___. .........minutes per inch Depth of Test Pit_..� _.f..______ Depth to ground water____ !.....".`.. . 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water._______--__--_----._-_. W .........•.......................................... ..............Y...............................................:..:....._•.......--___...---------•-•-. D Description of Soil__? 5p_. ......__�.......f_`:-- � t� �a fa/�rt[. V ............................... ••-------•..............•-•--••-•--------------••-•-•----•-------•••------------------------•••---------•---•-----•••••---•--•----•--------•--•----•------•--•--•-••--- 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 TITS, 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. Signed...................................................................................... ................... � � /0 -- 1 late (J ApplicationApproved By......=---- .......................... ---••---- ---------•----•--••--•-••-•-- Date Application Disapproved for the following reasons:---•---------------------•-------------•-•-•--......----•-----•---------------•---------------•-•-••-----....... •.............................. ................•--......---•---------•--•--------•----.....--------•---...----•---••-•-••------•••. --•-----•-•-•-----••---------•-•-----•----•...-------•-------- n� s Date Permit No....... c.... /_ -- Issued U -... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD r�OF HEALTH � ......... .............OF.......... ::`""'S 27to /...................................... %Trrtif irate of Tompfianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired ( ) by---------------------- ---------------------------------------------------------•--•- j ,.._../.j.............� -------------------------------------- at...._......lr -!'!_ ....... '.. .•-�N.... �.............. I S al.er. _._.._.... ...._____..____.________...__._____._._______.__.._________._._._________._ has been installed in accordance with the provisions of T[m 7 6 �5_obT 5 atate Sanitary Code as described in the application for Disposal Works Construction Permit No_________________________________________ dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILLFUNCTION SATISFACTORY. DATE............V . ...�..4F....................... Inspector-•-•---• j -• -- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH) (f ---� ..........11, ................/?" , �:. OF........................................................................... No......................... FEE........................ Disposal Works 'up ontrortion rrmit Permission is hereby granted -----..........._ �^��-�-------------------- " 1� .. r /, to Construct ( & �,� "� t/' �C�'�z•<<Aws' e^t......-t C .....� nor,repair ( C)-an I d idu 1 el k;� &1i os�>I Sys em atNo.•------•----•---••-----•••------•---••.....--•-••--....--•-P r fi ----.._-U-`-----�-------------------------------------•--------•------ Street �p as shown on the application for Disposal Works Constructi rmit Noo l.___ ��ated_._ �_•r` ::...1 . X.�o� --- DATE •----------------------------•-••-•....---- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS �.�.......--�__......mow_..-•�..-- TOWN ' OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,RFpatr O satisfactory 2• Printers LKR D:.; OF HEALTH 3. Auto P.ody Shops v ' �/7 `` O unsatisfactory- 4. fanufacturers COMPANY // � (_,L � 4 (see"Orders") S. Retail Stores WMMONNO6. Fuel SupFliers ADDRESS�j/ MY2iV- ' Class: 7. Miscellaneous QUANTITIES AND STORAGE (IN=indoors; OUT=outdoor. MAJOR FIATHRIALS • Case . lots Drums AbclveTanks Undetgrotind Tanks I� it OUT a l lsns_ 9M [AAA Fuels: • Gasoline, Jet Fuel (A) Diesel, Kerosene, 02 (0) Heavy Oils: waste motor oil . (C) new motor oil (C) transmission/hydraulic "Synthetic Organics: degreasers •Miscellaneous: •- u 1 .j L L - L DISPOSAL/RECLAMATION RUV.RKS: 1. Sanitary Sewage 2. Water Supply Town Sewer O Public ,r On-site 4 Private �_ !'!� 3. Indoor Floor Drains: YES NO _0 ------- , Q Holding tank: MDC OCatch basin/Dry well .._,__.__�.._.._..___._......._....__.._ _ O On-site system �Am f l f q. Outdoor Surface drains:YES NO HolditiL tank: MDC Catch basin/.Dr well O On-site system ST ay L,.1�J S. Waste Transporter aF S71AID ICH Licensed? lj�mg��Jayjgy nestinatinn Waste Produr.L_ YES 1 NO 2. v�I�LY 12 2J 81 •Person(s) Int.ervi'ewe - i • Inspector Date j 1 ,a ENVIROTECH LABORATORIES 449 Rte. 130 • Sandwich, MA 02563 • (508) 888-6460 3/3/89 Centerville Cleaners 1600 Falmouth Rd Centerville,MA 02632 Att: Bev SAMPLE: Effluent from cleaning machine LOCATION: Centerville Cleaners Centerville,MA DATE: 2/16/89 TIME: 9:45 AM COLLECTED BY: Ron Saari RESULTS OF ANALYSIS Parameter Units Results EPA Method 601/602 ug/L Tetrachloroethene 150,000 ug/L n (Volatile organics) (see attached) , U " /50,110 u 1 R'Khald J. Saari Director GR13UNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Sample Designation: CC-16 Project Name/Number: Centerville Cleaners Laboratory Number: 904810 Date Analyzed: 02-22-89 Sample Matrix: Water PARAMETER CONCENTRATION DETECTION LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BDL 5, 000 Chloromethane BDL 1, 000 Vinyl Chloride BDL 1, 000 Bromomethane BDL 5, 000 Chloroethane BDL 1, 000 Trichlorofluoromethane BDL 1, 000 1, 1-Dichloroethene BDL 1, 000 Methylene Chloride BDL 1, 000 trans-1, 2-Dichloroethene BDL 1, 000 Methyl tertiary Butyl Ether * BDL- 10, 000 1, 1-Dichloroethane BDL 1, 000 cis-1, 2-Dichloroethene * BDL 1, 000 Chloroform BDL 1, 000 1, 1, 1-Trichloroethane BDL 1, 000 Carbon Tetrachloride BDL 1, 000 Benzene BDL 1, 000 1, 2-Dichloroethane BDL 1, 000 Trichloroethene BDL 1, 000 1, 2-Dichloropropane BDL 1, 000 Bromodichloromethane BDL 1, 000 2-Chloroethylvinyl Ether BDL 1, 000 trans-1,3-Dichloropropene BDL 1, 000 Toluene BDL 1, 000 cis-1, 3-Dichloropropene BDL 1 , 000 1, 1, 2-Trichloroethane BDL 1, 000 Tetrachloroethene 150, 000 1 , 000 Dibromochloromethane BDL 1 , 000 Chlorobenzene BDL 1 , 000 Ethylbenzene BDL 1, 000 m+p Xylene * BDL 1, 000 o-Xylene * BDL 1, 000 Bromoform BDL 1, 000 1, 1, 2 , 2-Tetrachloroethane BDL 1 , 000 1, 3-Dichlorobenzene BDL 1 , 000 1, 4-Dichlorobenzene BDL 1, 000 1, 2-Dichlorobenzene BDL 1, 000 Sample dilution required to keep parameters within calibration. BDL = Below Detection Limit. "Trace" indicates probable presence below listed detection limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). ENVIROTECH LABORATORIES 449 Rte. 130 • Sandwich, MA 02563 • (508) 888-6460 3/3/89 Centerville Cleaners 1600 Falmouth Rd Centerville,MA 02632 Att: Bev SAMPLE: Effluent from cleaning machine LOCATION: Centerville Cleaners Centerville,MA DATE: 2/16/89 TIME: 9:45 AM COLLECTED BY: Ron Saari RESULTS OF ANALYSIS Parameter Units Results EPA Method 601/602 ug/L Tetrachloroethene 150,000 -ug/L l (Volatile organics) (see attached) fq 0 0 15 (f)P Ronabd J. Saari Director L GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Sample Designation: CC-16 Project Name/Number: Centerville Cleaners Laboratory Number: 904S10 Date Analyzed: 02-22-89 Sample Matrix: Water PARAMETER CONCENTRATION DETECTION LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BDL 5, 000 Chloromethane BDL 1, 000 Vinyl Chloride BDL 1, 000 Bromomethane BDL 5 , 000 Chloroethane BDL 1, 000 Trichlorofluoromethane BDL 1, 000 1, 1-Dichloroethene BDL 1, 000 Methylene Chloride BDL 1, 000 trans-1, 2-Dichloroethene BDL 1, 000 Methyl tertiary Butyl Ether * BDL 10, 000 1, 1-Dichloroethane BDL 1, 000 cis-1, 2-Dichloroethene * BDL 1, 000 Chloroform BDL 1, 000 1, 1, 1-Trichloroethane BDL 1, 000 Carbon Tetrachloride BDL 1, 000 Benzene BDL 1, 000 1, 2-Dichloroethane BDL 1, 000 Trichloroethene BDL 1, )00 1, 2-Dichloropropane BDL 1, 000 Bromodichloromethane BDL 1, 000 2-Chloroethylvinyl Ether BDL 1, 300 trans-1, 3-Dichloropropene BDL 1, 000 Toluene BDL 1, 000 cis-1, 3-Dichloropropene BDL 1, 000 1, 1, 2-Trichloroethane BDL 1, 000 Tetrachloroethene 150, 000 1 , 000 Dibromochloromethane BDL 1 , 000 Chlorobenzene BDL 1, 000 Ethylbenzene BDL 1, 000 m+p Xylene * BDL 1, 000 o-Xylene * BDL 1, 000 Bromoform BDL 1, 000 1, 1, 2 , 2-Tetrachloroethane BDL 1, 000 1, 3-Dichlorobenzene BDL 1, 000 1, 4-Dichlorobenzene BDL 1, 000 1, 2-Dichlorobenzene - BDL 1, 000 Sample dilution required to keep parameters within calibration. BDL = Below Detection Limit. "Trace" indicates probable presence below listed detection limit. * Non-target compound. Method References: Method 601 -'Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). c NoFS ADD Fps...:.......: ` ._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 77.p.y✓y!...--.....0F....... Appliration for Diopooal Works Tonstrar#ion Famit Application is hereby made for a Permit to Construct (.�r Repair ( ) an Individual Sewage Disposal Systempat: // S f� Loc t- n Address r Lot N . .......................1-•--------._......------......-----------------/.._.._.......------.._ . .......----------------------..__.._...._.....--------.... ..._�........----.........----- //!� Own Address Installer Address Type of Building �e L~�j / / S� 4 �7 5 s Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria a Other fixtu es .............. . d •--------- W Design Flow._3�,a1-/ allons per person per da`y. Total daily flow_._.._...__��______________________gallons. WSeptic Tank—Liqui capacity,/_OeP.gallons Length_13........._ Width.4'_r'V� Diameter________________ Depth_ !_8_n x Disposal Trench—No_ ____________________ Width.................... Total Length__._-_____..____.__. Total leaching area....................sq. ft. 3 Seepage Pit No........./.......... Diameter..../_O. ._... Depth below inlet....(.............. Total leaching area...Z.�7...sq. ft. Z Other Distribution box Dosin&tank ( ) Y1 r a h n i �..•r e ZSG '�� �3 — Percolation Test Results Performed b ___i_._._-____ _____ _______________________________ Date ALS Test Pit No. 1.... ___minutes per inch Depth of Test Pit....... Depth to ground water... Test Pit No. 2..__.!;�Z__minutes per inch Depth of Test Pit......Z_7____ Depth to ground water-----el ....... ........... _D Description of Soil...... ....... " .�� S ..... ` A.-,Q 5........... J W ---•-•---•-•---- ----------------•------••----•-•-•----•-----------•---------•------•--••----••---•-----------------•-------------•--•------------------•-•--•-----•••-•---••--••-•--•-•••••-••-•-'-•-- VNature 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 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. c�q -- ......... ...................................... Application Approved .............- -- --•----........ ...................- --,__ ...._...Z��?�` . Date Application Disapproved for the following re ns_......................... ___ ..................................................q Date Permit No..� ..1 Issued._.. L/ -j W . •D -- ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........777 ........OF...�-- .a,r ?�5, �.. fr......................... Trrtifiratr of Tomplittnrr THIS IS TO CAR,TIFY, T�jthe Individual Sewage Disposal System constructed (�r Repaired ( ) .�.--�-- Installer �l at �� `' �20 C .tom Za.� �R Z13 e-t�7 has been installed in accordance with the provisions of TITLE. 5 of The State Sanitary Code des ribed in the application for Disposal Works Construction Permit No.__._._��__. Z-------J `7 dated_._..____e7j_ _ ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ - Inspector.................................................................................... FICZ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f T - .' .....O F...., 1Zy1 �.5 T AP 'C....... .......... v A;jV irtttinn for Uhiv aal Works Tnnitrnr#inn Prrntit Application is hereby made for a Permit to Construct ( A<or Repair ( ) an Individual Sewage Disposal System at: ......................,.. .. -. Locati n-Address pp or Lot No. / mac...�. 3 ♦ �1 Owner Ad ress eL ri l ie / �f G h:.. ....... 3 ........ - Installer Address r✓ Type of Building 9 O S e q * )Z e,_S Size Lot........_... / ..Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ............ No. of persons................. Showers Cafeteria a Other fixtures ...................................................... Design Flow...............34�..................gallons per person per day. Total daily flow____.__...3--v-----�---..........gallons. P " Length___/_.4_r_. Width------- Diameter-----------=--- Depth.._IV..... Septic Tank—Liquid capacity....._..idth.... . Total Length.................... Total leaching area....................sq. ft. Disposal Trench—No. .................... Width._.. Seepage Pit No..................... Diameter.._... . �._.. Depth below inlet.......`.-........ Total leaching area./G.?..?-sq. ft. Other Distribution box ( f ) Dosing tanlf„{-�j'' z Percolation Test Results Performed a by M ^' c Z 434C Date---•s,• f g.S...-•-'----- - •-- •-- -- -� Test Pit No. 1 -._..minutes per inch Depth of Test Pit__ ..._ Depth to ground water......1.z. ' �- (i, Test Pit No. 2.A.Z...minutes per inch Depth of Test Pit----- Depth to ground water...... .. pi ............................-----•••-•-•................................................. ----•---- ---•----•--•---------••---...-- D Description of Soil...... ?! c7_Cz.r'4 5-----•.�jr ^ S 's r' `�..e.r-•----------•--. U •--•--•-------------------•-------------------------------------- •-•--------------------------------- ----------------------- --------------- ---------------------------------------------------------------------------------------------------------------- ---- ..............................................:........... U Nature of Repairs or Alterations—Answer whe applicabl ........ -----------..................................:..:.................................. ----------------------------•---•--...-•--•-----•---••••--••-••-----•-----. .•••---. .....-----------------------------------------------------------------•----•---••---•------•-- Agreement: The undersigned agr ins a or scribed ,Individual Sewage Disposal System in accordance with the provisions of TITLi: 5 of th Sa ry Code—.The undersigned further agrees not to place the system in operation until a Certificate of C pli a has been issued by he board of ealth. ..Signed.. .. --• -- - -----. . .... ......:........•------------•--.. •--�n- Application Approved y... ' -- •- --- ------------------ Date Application Disapproved for the following reasons----------..................................................................................................... - ------•------•---•••--•••-•...--•-•.................••----•-•-----•-•---••-•--••------:....._.........•---•------••-.....-•----------•------•--•-••--•--•---•---•-••••-••-•--•••----------•.._.......--- I. � Issued ..Date Permit No... � ...... .............. �YDate y > •..................-................... 't��....................................................................................N THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........................... .......... . Cnrrtifiratr 6f Timplialtrr THIS IS TO CERTI7Y, That the Individual Sewage Disposal System constructed (�r Repaired ( } by. 4..�']._.�4.--a......... -•-------------------•----._...--•----------------•-------------•---------------•----•-•------•--------------. Installer at ...........!/_.� v•..ILJ.....�._.,. l�P�' f C- !�--�-`--'.-•---........- -!?...Z✓-e_ !v.�/ ....... ; has been installAd in accordance with the provisions of of The State Sanitary Code as escribed in the application for Disposal Works Construction Permit No.-�s __.......` 0.... dated........ $,`_ .................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE'THAT THE SYSTEM WILL FUNCTION SATISPACTORY. DATE................................................................................ - Inspector.................................................................................... . 7C� le-FRs7.�¢. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........-.......................•---....oF...•............................................-- .............................. c Appliratinn for Disposal Works Tonstrur#ion Prrmit � Application is hereby made for a Permit to Construct ( 401'�r Repair ( ) an Individual Sewage Disposal System at I,3P// Taw c . .��► o��.:...� �. Locatipn-Address o'r t,ot No. G.0 . . / S o / w s .3 .. Q/ .� t 4Z Z 7 _v n 7 - — ......................_ _............. - .---------••-........ ....... . ................................ ...... •- owner ... O� .3 A dress Installer Address Type of Building ® , Z` l e R3 L Size Lot........ .... .... ...Sq. feet U Dwelling—No. of Bedrooms...................................... .....Expansion Attic ( ) Garbage Grinder ( )U '4 Other—T e of Building No. of persons............................ Showers QI Other—Type g --------•----•-•------------ P ( ) Cafeteria ( ) a Other fixtures ••----••••••---•••--••••••••••••..........•-•-•-._...... W Design Flow.............. r` .........._..........gallons per person per day. Total daily flow..............__ .....................gallops. WSeptic Tank—Liquid capacity.!�.O9.Wlons Length...e.A_ Width......i�._..... Diameter................ Depth-_/:R...... x Disposal Trench—No..................... Width.................... Total Length............I------ Total leaching area...................sq. ft. Seepage Pit No....... ........... Diameter.....!_p....... Depth below inlet...... Total leaching areal . ..�'sq. ft. Z Other Distribution box (1 ) Dosing tank..(—'J' 0.4 • M h n , n w ,c LSC •��-.3� ..�� a Percolation Test Results Performed by.__.l .r.._-.-------c•..............•-•------------ Depth to ground water.........._ Test Pit No. 2.- ':........minutes per inch Depth of Test Pit.....�._z..�-.. Depth to ground water................. . •---------------------------------------�.. -•--•------•......----.........------ /..z r---------.--------- ..s y W, e D Description of Soil--------------- - ---r'.-g ` _ .�" ' `� . V ...............•---•••••-•-••-•-•-•--•-•...---•......-------••••....••-•-••---..........._.......•••---••••-•-••....-••••-....•-••-••---•-----••••-•-••.....••--•-•--•......_......--------••----•-•---•- UNature of Repairs or Alterations—Answer when�—Vkicabl ..._.__. r......................................:.................................. ---....---•-•........................•---........_•--•-.... Agreement: The undersigned agr ins or scribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of th t a ry Code—.The undersigned further agrees not to place the system in operation until a Certificate of C plia has been issued by a oard "ealth. - Signed..1.. f............ Application Approved a...s. . C+ �i _-_-�� �f .................. PPY _._, _ Date Application Disapproved for the following reasons:............................................................................................................ ------•---------------••-•-----•••........-•-•-••-••--•-•••---••--•-•-.._....-••--------•.....----------•------•--................................•••-•-............--••-•••----...-•••-•••-------•--. Permit No._.__t5Eii;..�. �. _._____ Issued............. --��4 ----- ------•- I ate -...-•.......Date........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.....�-"...a..�.. 5 Z Gi `J f If Trrtifutttle of Tomplittnrie THIS IS TO CER IFY, That the Individual Sewage Disposal System constructed or Repaired '� P �' ( ) ( ) by....... .- ' -_..�.. ..•-�- '--�-' 4 1 ....................... Installer has been installed in accordance with the provisions of TITLE of The State Sanitary Cod �s d scribed in the application for Disposal Works Construction Permit No... �_.......� ... dated-------- i,.�.yf���................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE............................................................................. Inspector.................................................................................... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No� .....1M ................................... Fzz........................ Disposal Works Tonu#rnr#inn rgrmit Permission is hereby granted...G�t.G ---'-..�..-..--Z.............�.':�•..................................-•----......................--- to Construct ( or Repair ( ) an Individual Sewage Disposal System , at No........ _.� /..f..._. —.Q..------.(' .S�-, 4 � ? � - _. �e. , T e, ,:...../t `� -------------------- :�..o-------------------------------- - treet � as shown on the application for Disposal Works Construction Perm' ................ ate .._..-.../. `.� .rS ....... ........ �.J_.. •---�-ram Health ................................... DATE. �/e Board of••. ...............•----•-•------•--•--............. FORM 1255 A. M. SULKIN. INC.. BOSTON �..- .- . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �i ------. .To...✓V.�....OF....... -iZ�✓S i f"f-.13 Lam' .................................................... Appliration for Dispoii al Works Tomitrur#ion Vamit q 'Application is hereby made for a Permit to Construct ( L-Y'08r Repair ( ) an Individual Sewage Disposal 1 System at: - .•Location-Addres or Lot No. ------------ ---- ------------- Own Address Installer Address Type of Building S eq ir- !Z�s/�.�/ ��. Size Lot........ Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ...............•-•-------------------------•--------...----•-------•--._...------------------....---•-------•------...--------...-••-•............•••• +� G o W Design Flow................ _____.___..__gallons per person per day. Total daily flow_.._._.____-.__._________._______.___gallons. W Septic Tank—Liquid capacity/,-Otallons Length/ �_G_. Width___ !_"._��__.rDiameter________________ Depth... �.... Disposal Trench—No. ______.............. Width.................... Total Length.................... Total leaching area____._.________. sq. ft. Seepage Pit No........ Diameter...... I._.___ Depth below inlet....... Total leaching area.,.sd_A._sq. ft. Z Other Distribution box (✓f Dosing tank ( ) J aPercolation Test Result Performed by..__. .�._^!.._! _�_!?!.e_.'`.!!...Z__.�SS Date____._ /_ . Test Pit No. 1____ '._minutes per inch Depth of Test Pit---/__z2_.____ Depth to ground water----- _.z....... ` fs, Test Pit No. 2..... z._minutesper inch Depth of Test Pit---l_2_...... Depth to ground water...... __3r._.�. D Description of Soil.......4_=_!-T_ r . `3.1.._..3....... c----s.. `'------------ - � `� e ... =- U -••-•••-•-•••-••-----•••••••••••••-•••.....••-•-•--__•-- ----•--------------------------------------------•.------------------------------------•-----------•-------------------------------------------------...-----------------------------------------_-•1- U Nature of Repairs or Alterations—Answe w n applicable_______________________________________________________________................................ • i Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITALE 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 t board health. Application Approved BY -?...�—S .::- ...................... / ......... Application Disapproved for the following ons._ _____. _ .................. ___••-••••••••••--•-•-••-•--••••- Date----•-......_ ..._..--•-•...•-•••••• - ---------- --------------•--•------...--•----•-----•----••------•----••••-•••-••••--•- -----••-----•- Date t �/_ ?Permit No.... �----.._ 1 . F --.. Issued. .......... ......................................................................... .................... . ............-..-w......►.o�. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �0..!^/ ........OF....�.' .............. Trdifiratr of Tompliaurr ; THIS IS TO CERTjIFrY, That the Individual Sewage Disposal System constructed (� Repaired. ( ) by....... .... �!fQ` s�[ %e-�----�..... Q` L--------------------•--T----.........-.-f-•.---------•-------•---------•-----y-..-•----------....-..------....._ at _ .1.C- v e ....._..-J�--'--•---.-. InstC e—.. _.! - 28 /� (i�/` ✓e/J'Z — has been installed in accordance with the provisio"ns of TITLE r 5 of The State Sanitary C de s de ribed in the application for Disposal Works Construction Permit No--- �.../�.ER-••• dated--------- ... _�__ .............. y - THE ISSUANCE OF THIS CERTIFIC®TE SHALL NOT BE CONSTRUED AS A GUI ANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ATE... -•-•-••----•--......- ---...-•-........ Inspector.................................................................................... No....... F$ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... -7_v -►/�J....OF..........rr %.. �71 Appliration for Disposal Works Tonstrnr#ion Permit Application is hereby made for a Permit to Construct ( teor Repair ( ) an Individual Sewage Disposal System at: Location-Addresses` or Lot No. .•........--... .. `. -J_ ten/ ............. / - -- f . ....................................... O Address c:� I7 4..' ......... ..................... Installer Address UType of Building / to eQ I n n 5 V- 0- /��� Size Lot...........................Sq. feet ., Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .............. No. of ersons........_...._.............. Showers a YP g .............. P ( ) — Cafeteria ( ) dOther fixtures ..---------------------------------•-------------•••-..---......-----------.....------------.............-•••-------•... W Design Flow....................b:..:_..............gallons per person per day. Total daily flow....................�...._..............gallons. R: Septic Tank—Liquid capacityi.`R-`gallons Length�.p_-._"_-. Width...L....�... Diameter................ Depth-.`�.-.. Disposal Trench—No.......... ......... Width.................... Total Length........._..�...... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter....6..p__...... Depth below inlet....... !......... Total leaching area.,,� .sq. ft. Z Other Distribution box (60< Dosing tank ( ) _ '-" Percolation Test Results Performed by....P......r,-)...'. S- �' "'!.`'-`^!'5- -_.L�Sc Date...... ,.a Test Pit No. I.... ." ...minutes per inch Depth of Test Pit... ..?.......... Depth to ground water...... Z..�._. ` (il Test Pit No. 2.... .. _---minutes per inch Depth of Test Pit---!..Z......... Depth to ground water...... _ ......_ , .... ----- ---•-.------ O Description of Soil ... ? P , � .. r�. ✓ j -- - x ......._••--• •...•-- ---•---....... ---•-----•--------------------------- . ......................................... V •-----•-••-----•-----------•-------•------•-----•-•••.....................•---•---•..._..---•--•--••-•••••-----••-•-•---•-•----•---•----•--••---•---.........•-•-•---••--•-••-••---•---•-•----••--•--••. W UNature of Repairs or Alterations—Answ * w n applicable............................................___....___.:.... •-------------------------�-_J*........1 - a' .......��..4 ..e,-- G = •- �.+/- - ---..-v_-- ................... 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 thy boar health. Si ned _ -- --------------- -�'..... 1� a Application Approved By................... .....::.......•-•---�.��fG ----•--.....-----------•- y-�-J-y--�- - ------------ Date Application Disapproved for the following ons._ .-��. ---....... ____________________________•_-.......____.__..._.._.__.._--...........__ ...............................................•----................ Date ....._ Permit No �...�.�._....__.. .... Issued...................................................... .. Date THE COMMONWEALTH OF MASSACHUSETTS � + BOARD OF HEALTH ..............................O F... •-�........................................ '-,. .......................... Trrtif irate of Tomplianrr T4, S IS TO CERTIFY, That the Individual Sewage Disposal System constructed (4-1"o�r Repaired ( ) •� by- � -- �- ... -----..p- ..p- -- . ...........................�...`..--------•---------......._....7-------.-......._.-------___. at....... .. .' � / 1-.t?•�--••--------- _ j t Q�^�` Inst ' ------- ----•- ---•....-----------•-••---•----•--••--•-•-•••••-•--••-......._.._..•••--•-•--••--••---•--------•-...._. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as de cribed in the application for Disposal Works Construction Permit No.._S-.E....I-��.ram- ...... dated__...a /.5: . a• �-- v- '--------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUA ANT E THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..........................................................................-_._.. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � I j.. . ..OF.. / � Disposal Wort' Tonstrnr#ion Permit Permission is,hereby granted_:.............................. •'..._.. ....`......_.. ...:.............................................................__.. to Construes (I") or Repair ( ) an Individual Sewage Pisposal System - Tv ,.� � k ;, a a 'a --, z P T P ✓ r Street G as shown on the application for Disposal Works Construction Permit NcF. r..1(15_- Dated..........!/ zY „-,,,,, J -••••--•..... �' � -------------•-.....--•-. DATE. S — Board of Health FORM 1255 A. M. SULKIN, INC., BOSTON THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A F M L DATA 1 N&Z? ..1(..1 Fims .............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliratinn for Biupuuttl Marks Tunuirur#iun rami# Application is hereby made for a Permit to Construct �) or Repair ( } an Individual Sewage Disposal System at: .. ....._ -='v J`pt'�.-�es; �,� � Q/ -•---------------------_....._......... ow... -..... _ ......---•-------------.....•....---•--•--•--•.. -, --...._..---•------------------- Address 4.- s. ............... ........... ........---- Installer Address �— UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) �4 Other—Type of Building ....... No. of persons a YP g ...............•--•-• P sons.----------•--------•--•---- Showers ( ) — Cafeteria ( ) P4Other fixtures ...........r-----------------------------------------....---....--------......--••-• r W Design Flow. `- ' !p Q:p.-Su Q...gallons per person�pe�day. Totalda y�flow.......................................... IWns. WSeptic Tank—Liquid capacit�....•..--...gallons Lengthy.............. Width................ Diameter................ Deptl`'............ x Disposal Trench—No. .................... Wig �............... Total Length....-,---------- Total leaching area_. ------sq. ft. Seepage Pit No.......I............ Diameter.................... Depth below inlet.................... Total leaching area.---..............sq. ft. Z Other Distribution box Dosin tank �^ ) Percolation Test Results Performed by -............... . ................. .... Date............................�/ Test Pit No. l..t..?.....minutes per inch Depth of Test Pit..... .Z..�f... Depth to ground water•.�_ .... .. Lt, Test Pit No. 2---!-_.?._...minutes per inch Depth of Test Pit.................... Depth to ground water........................... a `.... r- ,-, Q Description of Soil c1..a '�as - ------- -----•-........................ . •-••--•--�-a v •----------- -------------------------•--•-------•-----------•-----••-•----•---•-••----------------•----.........----•----------•-----•-----•-----...---------------•-•............••--•- ..---••-----•---...•-•••-----•-•---••---------•----••---••---••-•--•-•-•-•-••--••-•----•-•-----••••-------------••-••••-•-•----••---••--•-•--------..._.....•----------••------•••---•----............•. 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 iITU 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 o health. .� .. ................................................ �f�? G . -•of-•--•-------•-••----•:............................•••-. 4/APPlication Approve 7 Application Disapproved for the following r s;....................... ---- - -Date----------- Ll r ,f Date Permit No. ''S �.4! 1. ....._ Issued............. -/ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -� .�...... :'...... ......OF.. -"''.`�.!'..�'..�.�c`...�................................ (In ifirate of (Ijimpfiaurt THIS IS TO CERTIFY, Tht the Individual Sewage Disposal System constructed ('�r Repaired ( ) �'.f.........................."�......----•-------•--•-----......-------•--.:..............---•-------.....-•----••----•----••---•---•--•--.._...._ at.... �� C a/V /........ O Installes "7 Z `Z Z— 7 -3 �4 s-7 / •P� - --••-••-••--------•-•••.................••••.......-•••• •.....-•••-•-•---••- has been installed in accordance with the provisions of TI t5t_TVS.t Sanitary Co s de cr' in the application for Disposal Works Construction Permit No.... .. . dated--------���. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................. �,sp TH n a� F=.....t... ........ .............................................. h' ♦ �J Ben Twe-,(- 1 �1Vm�a., 1\ Septic T es, BlAq A 1a129)87 o —37' o 64` 34.5� a.6.5 JW -- BLDQo A F Pell Tower r iai) Sepfii'c Ties, Bldg. C ,alagls7 7D� -- -- - o _ 4a' r3L DC, o C i Bell Towey- Mall S pti'c T e.s, 1318g. p /z z l87 Leas — o — — o 17. 5 ° 610 a,8 69, QLDG_ D 3LDGo E � i c B el1 ToL,-)e- ma�� 1ala� � L2aGh Pets - 47 o - --- -- -- - — 0 BLDCn. D BLDG. F ee- I Tower Mot t S5,-p is I its , Bldg e t=, C, H �a.lagls� 0 II3` 0 i-7l 5� )40� 0 1071 c? 83' �• 37 175 47.5' fr-XA 3 3, 1.,l a QLb t- UP 7L ' 0 I Or O ' I U x� J 3o,g,► u � 4Z r.J 7� � v �0 Xp 1� No.......................-- Fss..........................._ THE COMMONWEALTH OF MASSACHUSETTS G� -�--• BOARD OF HEALTH f� .17_(10 vvN......OF..... ............................................... L Appliration for Biu oti al Works Tomlrnr#ion permit Application is hereby made for a Permit to Construct (,pill'or Repair ( ) an Individual Sewage Disposal System at: 3.4F4.L- To ✓✓E/'Z .S � .. A '....2.0 9 Pc I. /4 %ZT� 2 a 6-,o�%E1z✓i C_LE' i►-?� Loc Location .... ....................t .............................................. Location-Address O� or Lot No. Pj, ......................................1/�/S TZ Jig L/.. _..__l .�../.z T'� t 3 .2 /7� 1✓!✓ S ..._......•........_ •-•--- _ Owner Address �° 0 N r5 / S7-�Z✓••!L- Installer Address dType of Building Size Lot............................4_.a G Sq--feet- Dwelling—No. of Bedrooms......... ___________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building o. f persons. ___.__- .-___.-...__ Showers ( ) — Cafeteria ( ) Other fixtures ........ ¢� 6 ¢-'S�•--�2-- "� --75�Q 1.v o:o_s.�................... W Design Flow............................................gallons per person per day. Total daily flow------ z......._.....__......gallons. WSeptic Tank—Liquid capacity.904kallons Length.l.L1._��_ Width__L_�__G_.. Diameter________________ Depth....L__..._.. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------.'L_....... Diameter.....1__2....... �Dep�th below inlet......L..-........ Total leaching area....(?.7.19.-sq. ft. Z Other Distribution box ( Yr Dosin tan C Z '" Percolation Test Results Performed by S__._.._I._,.M e etfN/E,nye-� Date....... .'...... ....................... aTest Pit No. 4r _�_�minutes per inch Depth of Test Pit. !......... Depth to ground water___w,�' -------- (i, Test Pit No.6.....Lt_minutes per inch Depth of Test Pit...... Depth to ground water....N,rleq......... .P p g.s9 C O Description of Soil........C.m Se ......t... 'r�v V4e..7_;,VP,.S.----F� G!� '� L----•-•---------------------- x U -•-•••••--------••-•-•-•-••----•••.............••--••••----•-•--•--••.........••--••-••...•••--•••----••---•----•-----•-----••......--•------•---------•----•---------•-•-•-------••-------•-•------•-- x ------------------------------------------------------------------------------------------------•-------•••-•-•----------...--••--••-••••••-•-••--•-------••-----••--•---•---•-•-•-•--•-------......... U Nature of Repairs or Alterations—Answer when applicable............................................................................._..._.._........__. ..-- --•-•••••-------------••••------•••-•-•----••-•--•----••--•---••-•••-•-•-•---•-••-•-••-•••••-••-•......••••-••••-------••--•----•-------••----•••••••--•-•-••-•-- ................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned f ther rees not&ace the system in operation until a Certificate of Compliance has been issued by the board of he h. Signe e r ��� ------------------------ --..................... Date ApplicationApproved By....................................................................................... .......... Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ --......-•-•---•-----------------------------•----•--------------------•----•-----------........_......--••---•-••-----.._..---•----•••--•--••-•-•--••--••-•-•••••-••••-••••......--•--•--•---•......_.. Date PermitNo......................................................... Issued-....................................................... Date e- .............................ee........-..•.....e....ee.ee-e.e..e.ee.............._._............0..........•...........e.e.....1 THE COMMONWEALTH OF MASSACHUSETTS L� C, G�. BOARD OF HEALTH ��vt/i..... F......?. ✓........................................... M&rr#ifiraU of Tompliana THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1/l'or Repaired ( ) by------ .C E-, ------.4:: ---�I1/ST..e----------------------------------------------------------------------------------------•-•-----••-•--•--------- at.-••t3� 6 L 7_' v✓. rloP IC' alnlT -. e $ �` 'n/T,�2vt t� ..... •-••-•--•--••-•--•. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•---••-•----•----•-•---•--•--•--•-••••......--••-•----•-._.._._. Inspector.................................................................................... S � No................»....... Fims............._............ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �J 77—'0 V_-V.. •.OF.....`, �� /\/ , .. .. ............................................................................ ApplirFa#ion for Disposal Works Tonstrnrtinn rranit Application is hereby made for a Permit to Construct (!,for Repair ( ) an Individual Sewage Disposal System at: ``. 7 c vv" ;t _�s,'o<a/__1 2 o e 1�G s /�f 2 f�= .,i :r�i1 V- r r_ .r✓sr-a ..✓??�� ............... .. .---._._._...-------....._...--------- --....----------........_..-------•---•-•-- ----••---•-•-----------------.._.......--- Location-Address ,•r - _,or Lot No, Owner _ Address Installer Address Type of Building Size Lot.... '._ _..`'.' Dwelling—No. of Bedrooms...........' __._._____________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building Vic' ! `'� • o. of persons____._._-~_______________ Showers — Cafeteria PLIOther fixtures ...............................................................' .. ---`�. I G. . v t� f - =-------•-------------------------•---•--•-----_---- W Design Flow___________________________________________gallons per person per day. Total daily flow________ _______.__._____.______________gallons. WSeptic Tank—Liquid capacity`�`�.2`_?`�gallons Length_lL.... Width__(____"_._ Diameter________________ Depth_._.L_-___.__. x Disposal Trench—No_ ____________________ Width-------------------- Total Length............t....... Total leaching area--------------------sq. ft. Seepage Pit No.________�-________ Diameter__._ _.!?_..____._ Depth below inlet___._�'______.____ Total leaching area___ �.�__...__.sq. ft. Z Other Distribution box ( )' Dosing tank4 ")" _ '~ Percolation Test Results Performed by:__ ."=___!'___.`'=".'c :`_'...£'_:__''` ....____ Date........................................ Test Pit No.-I....... .4-._minutes per inch Depth of Test Pit.E_ ____________ Depth to ground water------------------------ Test Pit No.6:____� ._minutes per inch Depth of Test Pit....... Depth to ground water____ ......... .................................r.................................................................................... ..... ----•-•-••------•_...-- Description of Soil x -----------------••--..........................8............................................................... x U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ---------------------•------------••---------------------------------------••---------•--------------•--•----•--•------------------•••-----•-----------------•---------•----------------•-•--........... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State Sanitary Code—The undersigned f ther rees not 'lace t=systemn operation until a Certificate of Compliance has been issued by the board of he h. Date ApplicationApproved BY----•-------------------------------------•----------•-----...._....-••----•--------I----------•. ........................................ Date Application Disapproved for the following reasons----------------------------------------•----------------------•---------------------------------------•••_•---- .....----••-------------------------•----------•---•---------•--••---•----._..._.._..._...----------•--•---••-••••--•-...•-•-------------------•-•--•----------••-•-----••------••-•-•••--••-._...._.._. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH t' v+i<�v �`3 N ......:........................oF............................................._....................... ................ Tntifiratt of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 1-lor Repaired ( ) by---•-j.�----'---`=--J` `= .Y �"'_ ��t/S i --------------•----------------------.....---------------.._......._........__..__..._ _ Installer at t L G. T .i c> '� ✓%�=`f2 v'................................................................ -----------------------------------------•------------ ---------------------..----------------------------- - -----•-•--•••.........•.............................. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-------------------------_...................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....................................................•- •---------------------- Inspector...................................................................................... - r _ THE COMMONWEALTH OF MASSACHUSETTS 2, �/ /BOARD OF HEALTH ................... _....._..---------._.....................---....... No.....-_•......................... FEE........................ Disposal Works Tnnstrnction rrmit Permission is hereby granted------ '-y = �'� to Construct � o Repair ( ) an Individual Sewage Disposal System at No. �-`--•--s c r �=-/ •---- ---------------- � c =--- --• ---- == ? C l"/`- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ------------------------•----....-------------------------------•------------...•---•---•-•--•••--•_•-_•- Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON No......................... FE$............................. THE COMMONWEALTH OF MASSACHUSETTS k� BOARD OF HEALTH plir,ation f-ar 15ispos al Works Tunstrurtinn Prrutit Application is hereby made for a Permit to Construct ( vor Repair ( ) an Individual Sewage Disposal System at: k3.E7 G L. T' ® w'�=7'Z .S A/- 07. C E�✓i�'�Z ................�? 2 a..4......P..c L.. 14- 2 C Q 2 8 c c.v�,=.Z sic A � � .r _......... ........................................................... -••--.._.....-•----•--••----------...-••-•--•---•------••• --...........-- Location-Address or Lot No. -S 0v 4-Lip w.s 13 / o L..a iZ.Tom' �� 2. &... Address '.---------•--•-••-•-- ---o ..s'?"��.. ✓ tr ' ---••---- Installer C Address ��i9 as d Type of Building ` Size Lot............... Dwelling—No. of Bedrooms............... /�-�-_.:._______Expansion Attic-�— Garbage Grindep--�--)— p`4 Other—Type of Building 1z 4 t_� of persons_._. ................. Showers-C—�' �afeteria-f--} Other fixtures g e 8 *---s .F..r � p 7S !� v es-- S---------------••-••---•---• WDesign Flow...........................=..........gallons per person per day. .-+�.. Total daily flow.........�_! _�__..._.............._gallons. WSeptic Tank—Liquid capacityt'Sna.gallons Length 1A"__G.-�Width-_ -.......... Diameter________________ Depth...5�..8.�� x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..........I---------- Diameter.._..�.`f._.._.. Depth below inlet.....L............ Total leaching area.'°F 1.8...sq. ft. Z Other Distribution box ( V" Dosing tank-{' '-' Percolation Test Results Performed by _t5.C R•- M t C N Ni v�lC Z Date.-_s /3,j 8 T- � -_... Test Pit No.?...............minutesperinch Depth of Test Pit-A_2........... Depth to ground water.... (i Test Pit No..T..............minutes per inch Depth of Test Pit----!_9....._.. Depth to ground water._.19 ___!✓°}..___. ------------------------------------------------------------------------- ..... .. a_ ........ .... o O Description of Soil............... -'--V. Q � '%/.— ''�A-N .r2gv�.ET x W ------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------•------------------.--•-- V 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 TITLL 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. Signed--x ----------------------------- ---4/- -- --------- ate ApplicationApproved By.................................................................................................. Date Application Disapproved for the following reasons-------------------------------••----•------------------------•-----------------• .......................... .............................................._.......................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date ........................................................................................................................... �THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tv.. � �z N (9rdifiratr of Tomplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (+/lor Repaired ( ) .--------••-•--•--...------••---...---•-----•................................................. Installer at. T ------ --_..--•------•------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-------...........-------•----....._......••-------•-•-•--.._.. Inspector................................................................................... ...................:......._......................................................... q _ it THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ©.�!✓ ✓.oF. .1��....r N.............................................. No......................... FEE........................ Disposal Works Tonstrudian Vanfit C ><c Ey C c� N-5. '..................•._....-- Permission >.s h eby granted...... -----•----. _..........._...-----._................ to Construct ( Vj or Repair ( ) an Individual Sewage Disposal System at No....... - -c..t ....T---?- .G .....-�E... ....... c•✓- /' t............................................, Street as shown on the application for Disposal Works Construction Permit No..................... Dated......................................... •--------------------------------------------------•----------•--•----•---------------•-•------•-----._ Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON 7 No....................... Fins.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7— 0 vN,,,,� _:�"2,;Z— /V-- ........... ..............................OF.....L........ Appliration for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct � or Repair an Individual Sewage Disposal System at: 4- '7— CD FZ __G Pci- ) 4- R' t -e '26 ............................ .................................................................................................. Location-Address or Lot No. 7 Owner -------.............../. ..... Addr_es s .. .................................................................................... ............................................. .................... 0.4 ................................ M Installer Address !4 Type of Building Size Lot..._ ...0 U Dwelling—No. of Bedrooms.............. -- --------------Expansion Attic-C— ' Garbage Grinder-()- 04 Other—Type of Building ....... o. of persons.--.................... Showerg-(--T-- Cafeteria--(—) Other fixtures ......... ....( 2 A::/e-� ) <D- 7,5-(i a / � z)Q e; __->/:' ...................I---------- ...................../?�............................................... Design Flow............................"`...._...._.gallons per person per day. Total daily flow......... ......................jg��llons. WSe tic Tank—Liquid capacit/.��9_gallons Length/_9_'...�.'. Width..-t;---' Diameter________________ � a 1, p ....... Diameter----------..... Depth...I---I------- x Disposal Trench—No. .................... Width.................... Total Length.._........_........ Total leaching area............ ----sq. f t. Seepage Pit No.........I----------- Diameter.._...- ....... Depth below inlet_... ............. Total leaching area 4./ Z Other Distribution box Vj' Dosing tan ....sq. ft. Percolation Test Results Performed by....43 14 VV'/C ----------*................**----------------------------------------- .... Date... ............ Y/ Test Pit No.2 ...............minutes per inch Depth of Test PitJ_'L#......... Depth to ground water.... .............. 44 Test Pit No.g...............minutes per inch Depth of Test Pit__- .......... Depth to ground water._,_A/J""�....... 04 -3 '�3 1�a.............................................................................................................. ........................... I 0 Description of Soil...............C.. ....... .........f- Z' __S...... t��4 W ............................................... ......I............................ U ..................................................................................................................................................................................................... W Z ........................................................................................................................................................................................................ 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 TI T 1Z- 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. Signed.. 71e . .. .. .................................. ate ApplicationApproved By.................................................................................................. ......................................... Date Application Disapproved for the following reasons:............................................................................................................... ........................................................................................................................................................................................................ Date PermitNo................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS it ? BOARD OF HEALTH &7 ..........................................OF..7-77 4 ... ................................................................... (Intifiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by----------=---------------`---:_----------------`----_ ,_5__i----------------------------------------------•--------------------------------------------------•--•----------------- Installer at-----_Z>' 1F/—_4...... .........S, C , ?e-' 6 c, eF- ..............................I............................................................................................... has been instilled in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated_..._.__._._._.-__....._.._.._..._.........._._. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... o THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...... .....v.v. .111..OF...... .../X/.......................................... ..... . .......... . No......................... VEE.................... Disposal Works Tonstrudion Vvrrutit Permission is hereby granted...... - S (' E,"'- 51' C /v,/ c,) ..................................................................... ----------------------------*------------------------- to Construct ( V�'®r Repair an Individual Sewage Disposal System at No. a.r=—e-..c.....71.0..vv..,'�EZ?......__1=�' .................52..................................................................................................... Street as shown on the application for Disposal Works Construction Permit No..................... Dated....__.___...._..__.._.............I..... I..... ................................................................................................... Board of Health DATE_ FORM 1255 A. M. SULKIN. INC.. BOSTON . No......................... FIz$............................_ THE COMMONWEALTH OF MASSACHUSETTS •�� BOAR® OF HEALTH T -- ...OF..... 3�9GZn7. Appliration for Disposal Works Tonstrnrtinn rumit Application is hereby made for a Permit to Construct ( -<r Repair ( ) an Individual Sewage Disposal System at: 73 -EF L_,L 7-7.-o ---—10 .iZ -S H�c9?. 0 EN7--4�,Z ....--•-------•••-_.... .---•-------•---•-------------•-------..._..-------.......--•-•----- Location-Address or Lot No. ...........................................3 o e..L.. w:s .............................'a i2 i. 13 2 /f�`'`. .^/�t//s ._. --------- ------•--- Owner Address .................................' /. T,................ ......� .TEi2_Y'�.L L.�....---......---...........-----•--. Installer Address P4 9 9 a c � Type of Building Size Lot___._.!...................Str-fleet .a Dwelling—No. of Bedrooms............................................" Expansion Attic 4- Garbage Grinder p`L,, Other—Type of Building No. of persons..........--_............... Showers-(—j— Cafeteria �- Other fixtures -----G-lg B C'S 7 r �`�f `+4 ---------------------------------------•-----------•----...------ w Design Flow________________________ _______________gallons per person per ( y. Total daily flow........'�_ _..............__.__.gallons. WSeptic Tank—Liquid capacityl��'�4.gallons Length_��.�_ __ Width..-��___.._ Diameter................ Depth_-��" 6_~ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............__..____sq. ft. Seepage Pit No-----------I........ Diameter...--/__-2-...... Depth below inlet-_--__-�!_._.._._.. Total leaching area.._.32.9--sq. ft. Z Other Distribution box (✓)" Dosing tank Percolation Test Results Performed by.__3 S._L). ._...j._.,__r./_«_'��jrW1Cz Date-----2 �3avv..5'__.. Test Pit No.4..<....�_-minutes per inch Depth of Test Pit....L.2--...... Depth to ground water.... � .._-- GLI Test Pit No.6__'�t.Z....minutes per inch Depth of Test Pit----- De th to round water-___.^� .___. P1 ----------------------------------,---...------••----•---- ¢- _..._........ D Description of Soil..------.C-a .......F-...F'-�' s °I ---� ------. Q '� ........................... W c., w -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 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 o health. ,� , Signed- �E / ce ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons---------------------------------------------------------------•----------------------------....-----...----•-- ....---•-----------------------------•-•--•---•------•-•-••-----------.......----......--•-----......--•-I--••••-•....-•------•••----•--•••------...------•--------•--•-•---•------------••--••--•------- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS G� BOARD OF HEALTH �V9 ...........7.. ©............!.-OF........30-9...2N Tntafiratr of Toutpli anrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( ) by---. .......!� - !VAS.. Installer fe-/ L� .................. at.----B,ELrL---•-T o w --Z 'r`t 4 o�: �X '0T' �.✓T�2�<c,c.�E M ..r has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-----•-••----------------._......._•---•-•••--•-----•--•--_.... Inspector............................................................. .............. THE COMMONWEALTH OF MASSACHUSETTS 19> BOARD OF HEALTH ......7-V...Vn.0 ^l........OF......3. 7 -✓..... No......................... FEE........................ Disposal Works UTnn#ra i.on rrmit Permission is hereby granted_...._/f/G/.Ar y___ e, --------------------- ------ •----------- ----................. •-•........ ._...... ........ to Construct e5-or Repair ( ) an Individual Sewage Disposal System- at No....A--•_---Z'.c.--••. __--`ivl 2 S P--t:o? (..AST- '-�� �8 G' r,^. Nr'2=2 Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated.......................................... ........................•------•-------------•--------------------------------...-----------•--•---....._ Board of Health DATE.-----------------------•---•--------...------------...........-•---•----•-... FORM 1255 A. M. SULKIN, INC., BOSTON No........................ FEB............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Disposal Works Tontitrurtion "pamit Application is hereby made for a Permit to Construct +__�or Repair an Individual Sewage Disposal System at: 7�3 ........... .J.................. .......................................................................................... Location-Address or Lot No. 7 4"� .... ..................................................................... .........................7__ Owner Address C)fV Z'77 L 4 Installer Address Type of Building Size Lot_.`Z/'......---.._9 0S_.__ S,,r.-feet U .... .. _ Dwelling—No. of Bedrooms_._.......':." .... .....................Expansion Attic-(—) Garbage Grinder 04 Other—Type of Building No. of persons......................... Showers — Cafeteria C-) P4 Other fixtures ...... .../ ��k.... .................................................................. Design Flow..................... .....................gallons per person per day. Total daily flow.......at- z...(4.___.................gallons. 1:4 Septic Tank—Liquid capacityL �.gallons Length.�.S�......... Width__:�g......... Diameter--.--______.._. Depth--.!) .....§C W - Disposal Trench—No. .................... Width....._.............. Total Length.._................. Total.leaching area....................sq. f t. Seepage Pit No----------1--------- Diameter....I...�....... Depth below inlet......!;?...........Total leaching area... ...sq. f t. Z Other Distribution box (4-� Dosing tank_. Percolation Test Results Performed by..a-,5 C 11 - to I S C'Z Date.... ----------------------*------------------------------- Test Pit No.4.K...Z---minutesperinch Depth of Test Pit--- ------- Depth to ground water__'n"` '-��................ 0z Test Pit _'-_....minutes per inch Depth of Test 'Pit..... ..... Depth to ground water..--^ ....... M .............................................I..................................P..... ................. 0 Description of Soil......... ...... =.-..... ...... ........... ?............................... U ........................................................................................................................................................................................................ ........................................................................................................................................................................................................ 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 T I T11 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. Signed-`5 ............................. ApplicationApproved By.................................................................................................. ........................................ Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS _P BOARD OF HEALTH .........................................OF....... ......:�.............................................................. Trrtffiratr of Toutpliattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed e-J--o-r Repaired by.. A / / C f-, ......... ....................................................................................................................... ------------------------ .... .. Install, A"7 at.................................................... ............................................ ........./' ........................................................... wv ............ has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction,Permit No......................................... dated......-_..........__._...._.._...........__..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Q.!::7..Vlk :�.........OF.....Z / ....................................................................... No......................... FEE---..................... Disposal Vorkv Tomitrurtion "Punfit Permission is hereby granted....... ............C_ Q /� .S -I- .............................................................................................. to Construct (L__1 or Repair an Individual Sewage Disposal System at No..-. ......-,775A.' e- .......... ....... -----------------`�------------------------------------------------------- Street as shown on the application for Disposal Works Construction Permit No..................... Dated.._.__._._.........._..................... ......................................................................................................... Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN, INC., BOSTON No................_....... FRic.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for Uhipoul Works Tonotrnrtion ramit Application is hereby made for a Permit to Construct (V) or Repair ( ) an Individual Sewage Disposal System at: Z3 EL L 7"0✓v S H-C;> , c A-F ve7 7. jAIP-- -- ... ....... -----------•-------••----------------- ---------------------------------------••------------------A-----------•---_-_--..---.--------- Location-Address m4P or Lot No -_ ...L V ems. c.o s---�- .. L .J�...l.. AW2T Owner _ Address a � / /�� �.r �_O/�/Sw�.�. �.S.......%�/Z Vo., L-.L._ .......................•.................. Installer Address Q Type of Building Size Lot.... 4 R c Sq.-feet- Dwelling—No. of Bedrooms .......... .....Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building N , of persons_ ..-- Showers ( ) — Cafeteria ( ) Other fixtures . i 4' / S` s= L lam.. . .C� 7 S�4_o��� ®'° -5 --------------------------- Design Flow.................... -_-...........gallons per person per day. Total daily flow____O_.. 2 gallons. lons. WSeptic Tank—Liquid capacity.ZR!agallons Length_e/__"__`f__'. Width...G_'__G" Diameter._._____-__-_- Depth...,.(,......... x Disposal Trench—No. .................... Width............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter..._L!? Depth below inlet.....4!............ Total leaching area---te.7.A....sq. ft. Z Other Distribution box (1/_ Dosin t '-' Percolation Test Results Performed b S C, %�' M acet/�✓t L•��+/�e Z Date..... ,aa Test Pit No.4----�_7..minutes per inch Depth of Test Pit.... .Z...._... Depth to ground water-__ _..._. fi Test Pit No. G I._minutes per inch Depth of Test Pit----1............... Depth to ground water-------_.�_... a -�s s9 ?g3 90 •• . --....... .--- O Description of Soil-----------.� `� TZ5�---� -vim-- S i✓.a.S j !s�Z x .............................................. U .....•--••---•-•--•-•---••••.....-•-•-••--•-----•-•--••••-•-••••••-•-•••--•-•••••-••-.......•••••-•--•-•••••-•-----•••---••-•------•••---•-••-•-••--••-----•••......-••-••-•••-••-•---•••-•............. w ------------------------------- ---------------------------------------------------------------•---.--------------------------...----------------•------------------------------•-•••---••••-•-•-•---- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System4aance with the provisions of TITL1 5 of the State Sanitary Code—The undersigned fu r agr not toys em in operation until a Certificate of Compliance has been issued by the board of health. Signed.A°, . .. • •• --......... •....•. � ... e ApplicationApproved By...........................................................................................•••• ........................................ Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ ....................••----...----------•-•-------•------•------•-•------------•------------•---.._.........----------------------------------------------------------------------------------------.•-•-- Date PermitNo......................................................... Issued....................................................... Date ..................+.......................................................................................................... THE COMMONWEALTH OF MASSACHUSETTS Cn BOARD OF HEALTH (Irrtifiratr of Tourplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (14 or Repaired ( ) byer j'..........- .......................................----•-------------............•-••••-- �. Install .� ........................ at...x�� G v vv'4V —'� `�l� l�,�n/T� G7 tee►/T�2v c c ---------------- ---------------------•-------•.......-- has been installAd in accordance with the provisions of TITLE > of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated-----------.------------.--..................... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... i ,.� t No................_....... Fss............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T � . Appliration for Disposal Works Tonotrnrtion Pumit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 4� z. /. �_v � rt; �. � ) ,�:-=�v°7 •... __......_----.i........._ ........................................ ................ •---......_......--------•••---•...------................--______........ Location-Address c r Lot No ._.-:.'' �� �=G. 5 3/r ........................................... =� �I------ ----_- .........�� 1 ^r!. c✓s �. 7..... ... ) Owner _ - _ Address f:...... t; .......................���`''T'`----------------------------------- ----..........`..__... .......y../.........._. '-........._......_...__......................... Installer Address d Type of Building Size Lot.................u.c.....Meet V Dwelling .._..... ............................., g—No of Bedrooms _"" Expansion Attic ( ) Garbage Grinder ( ) A4 Other—Type of Building's f f ' f No. of persons.... Showers ( ) - Cafeteria ( ) Other fixtures ---- 1.�- --E -�� �� � � ��' �<� �"' c l d :r c� ra �s 7- . .................. ----/ -- ----• W Design Flow........................................gallons per person per day. Total daily flow__I....`a... .. ......_..........__......gallons. WSeptic Tank—Liquid*capacity�?C??.gallons Length l'..±.... Width..°:!_.____... Diameter________________ Depth... _..__....-- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____ ___________ Diameter....__.......... Depth below inlet....v.............. Total leaching area-(t.f_�.....sq. ft. Z Other Distribution box (vj Dosing tank-(--) '-' Percolation Test Results Performed by,...............................................................'`Z.... Date-----4?__Z_2 Test Pit No -_ `____minutes per inch Depth of Test Pit...?.' .__....... Depth to ground water....... f= Test Pit No. ...............minutes per inch Depth of Test Pit... .. _r____ Depth to ground water-----f`z -___. ............................................................. 4Z �9 7�: 7o -----........................................................ 0 Description of Soil........�_1+.1-2..z...... .:.:"i..c...........c� �✓.� .5....... ........ ,.. ✓- ... V -------------------•-••----------------.....----------------------------------••------ W -----------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------------------•--•--_...-- V Nature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------•--.....--•--------------------------------...---------•--..........---••--------------------------•-----------------------------------------------------•------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned f� er agr not top c "the sy tem in operation until a Certificate of Compliance has been issued by the board of health. .^...--`-. �. ... ... . /Date ApplicationApproved By..•-----------------------•---•-------------•---•---------------•-----------------------•---- Date Application Disapproved for the following reasons---------------••-•--------------•-----------------------------------------------•--------------•----•-•-•----- -------------------------------------------------------------------------------------------••--------•-......------------------------•-----------•-----•-•-----------------------...- •------------- Date PermitNo................................................... . Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ley r .......... �.:. �./ .......................... ............................................................... dw wrtif iratr of Tontpliattre THIS IS,TO CERTIFY, That the Individual Sewage Disposal System constructed (1-115 or Repaired ( ) by---f�.....�..'`. - y----.....`-` -...=.................................................. n Installer J.... ! U .Jt�s ....%.�'�",y- r J G..-i t�..'7✓i G./i%`r ,1.+ �7 v� i r. �— at --•---------•----------------- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated------------------------------------------- yam-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT:,`I'Al ,' �. SYSTEM WILL FUNCTION SATISFACTORY. DATE..............•-•-•-•-••-•-------------------•--•--.........--•....._..---••-•-- Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................. -�.. ?_ No......................... ........................_....._.................. FEE........................ Disposal Works Tonstrudion Upautit Permission is hereby granted.....Zt.C �- � c C--) ``� S to Construct (1__i__0'r,Repair ( ) an Individual Sewage Disposal System No. l-�!= '-_ _ .�...v.✓fie-_`1�'..._.� !`/d ��ni%_ i?�:s= y-.....................................� at �,�� � Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... ..............................•------------------------•----•••--•--------.....--------....------....... DATE. Board of Health -------------------------------------------------------------•--•......•••... FORM 1255 A. M. SULKIN• INC., BOSTON No......................... F:c$............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ^� ✓1/'v..........OF... ��l�Z�Vr.... f' Appliration for Dispaii it Viarkii C> omitrttrfivit Prruat Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: ZN04 G- T 0 E- --s A;0-vi? C.,J--iff' ..MA . --• --•-------- ----------••-------...--------------------------------------...---._.......------.....----------•- Location-Address or Lot No. ......................1!3�L - .S CLLC v►� S JZ �/ ! -----•- .... ..-----•-------------------•---•---_._. _ ...................................................... Owner ^' Address L..-Q t`!4!-•l•-•'..............•------- .. _1=_ z,.✓'<_..Lr_ .,E ......................................... Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building of persons....................... ... Showers ( ) — Cafeteria P4 Other fixtures ..... _.% e��_ _/ 7 3(.7 s f@ 7S o�v o o t �oo•5e a . W Design Flow..................... :_•_--gallons per person per day. Total daily flow.:....'_q.0.3........_..._-..gallons.�� WSeptic Tank—Liquid capacity 7SW.gallons Length.__<t_.. _..._.. Width.X..��' Diameter---------------- Depth..�.2__...G x Disposal Trench—No. .................... Width_._.........._._.... Total Length.................... Total leaching area-_-_-___--_-.___._.. . . sq. ft. • • Seepage Pit No........ ......... Diameter.._...1..©...... Depth below inlet.__._4!___________ Total leaching area._z` �3•_sq. ft. Z Other Distribution box ( ✓S Dosin tank '-' � Percolation Test Results Performed by.. S /✓� a hl�/E'UI/'J C Z- _ ---------- -- -----••--•---•-••------------..._......----•••-• Date---- -•�` ......-5•---..... Test Pit No.f..e Z_--minutes per inch Depth of Test Pit.....1.�_ ...... Depth to ground water----'~�'`�'........ 4s Test Pit No. 6.... _ ___minutes per inch Depth of Test Pit---- .z._---._.. Depth to ground water..-_"VV........ O Description of Soil------. Q A 'S ---�F- -1 w 1m -S i9 wD $ T G_2/A) ✓L"L x w -•----....-•---------------------------------------------------------------•-....-•---------------------•-------------------------------------------------------------------•--•---•-••••••--•--•------- 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 TITLE 5 of the State Sanitary Code—The undersigned f ther rees no place the system in operation until a Certificate of Compliance has been issued by the board of hea Signed_�__a =-� ........... .............. �..-------- �e7 ApplicationApproved By--•-••-----•---•-•-----•--••-••--••-•••-----------••-•••••------•--------------••-•---_-• --•-- ................................. Date Application Disapproved for the following reasons----------------•-----------•------------------------------------------------------------...-•••-•-•-•------•---- ----------------•---•---------------------•------------••••-- -•--•--•••-----•-------•---•-•------....--............................................................................................... Date PermitNo......................................................... Issued....................................................... Date ......................................................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 01 BOARD OF HEALTH L ¢ 7-c...-A. .......O F.... -'.'`�2 �✓ ........... .... 67 %rdifiratr of Tompliattrr THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (1,1ror Repaired ( ) by--- cC` JN.s. --------------------------------------------------------------------------------------------•----....--------••------ �- Installer at... ...�.L'L•••-•�--••�-' -- ...... �'.!........F' I- _t- Z`8 V'i has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... - --- -- _---_-------_=. _��.--------------- ----------------------------------- No......................... Fms............................_ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �`.......... ...... .......................................... Appliration for Uhipasal Works Tontrnrtion Famit Application is hereby made for a Permit to Construct (�) or Repair ( ) an Individual Sewage Disposal System at: %mod' e- ,-%-';� r - r _..y"i o J> �s psi . .....--•---....----....._....-----••-----------------............. .....- ------- Location-Address _ or Lot No. ......................L=r _ ......................~L L_wr _S_.. .F �.— �� G— `� � f..................................7� 11 _Zz: ,{',r .r s__3�_ Owner ddress a �� t•— � P i`O ` d C' -----{2 -------- -- -------- -•-----.- ......- ------ C4 Installer Address UType of Building _ Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) pa., Other—Type of Building tv °_!.'_° f No. of persons____________________________ Showers (_ ) — Cafeteria ( ) dOther fixtures .-- a� A 3<' S k i " c� - `� - G:_ .,c '3 . Design Flow....................:- `.` gallons per person per day. Total daily flow....`. ..' _~'_� ___.__...........gallons W � , WSeptic Tank—Liquid capacity._._ gallons Length. . .-_....__ Width_ ..... .._ Diameter________________ Depth_l_ --_---'- x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area............_.......sq. ft. Seepage Pit No........9.......... Diameter.._..(..P....... Depth below inlet....._ ......... Total leaching area. °.'o-3..sq. ft. Z Other Distribution box (VI Dosing Percolation Test Results Performed by..� _ .__... ....'?'......................................, � r'� -�,0 �� �..........Date a Test Pit No.4l___ __ _.....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---_'_-----:---.__.. a ------•... ...------•.............................................f�-p ` _-3 � '/ !�<� r�V D Description of Soil......-- _ _..: _.� .._�� e=, �-- r j ��':71 ,'-_'= /-:. W :,........•----.-- ---------•----------------- U ---------------•--••-------••-------------•----••--•------•--•---••-----------------..........._. 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 TITIE 5 of the State Sanitary Code— The undersigned urther grees n to place the system in operation until a Certificate of Compliance has been issued by the board of li th Signed?!.. = _. r• ' Date ApplicationApproved By.................................................................................... ........... -•----=--•••-•----•-----•......--•----- Date Application Disapproved for the following reasons:................................................................................................................ .......•-----------•.........................•----•---•------...---••-•--------------••-•-------.........-------•---••---•---•.....•------•••-----•-•------•--•-•-------•-••-••-•---•---•••---------•--- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS C BOARD OF HEALTH Pj .......................................... ....7............................................................................. (9rdif iratr of (bontpfiFatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed a,f or Repaired ( ) by............................ = ............. -_............................................................................................................................... Installer ......... ................... ....................<................. ............ -----•--•-------•••••••---------•--•-•----•----•-----•----• --------------------•-- -------------•-- has been installed in accordance,with the provisions of TITIEE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated------.------------------------_................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................•----....--------.......------..._...._-_.... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS (sj> BOARD OF HEALTH ....../7... .1��..OF.....%-� �2 %t,% ...........................•--.......................--••••..... No......................... FEE........................ Eliopos al orko 011no#ra ion Prrmit Permission is hereby granted--t/_.�. ._f±` _._.___��-_co--�--._ /� to Construct(�or,Repair ( ) an Individual Sewage Disposal System at -••-- . •-•--.......-•-•---•--....--•-- •-•--------.---------------------• --- Street as shown on the application for Disposal Works Construction Permit No---_--------------- Dated.......................................... .......................................•--------------------------------------------------....----_...._ Board of Health DATE................................................................................ FORM 1255 A. M. SULKIN• INC.. BOSTON No....�...... . Fps. -:5 _....._....._ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApplirFatiun for Uhipao al urkii Toustrnrtion Prrutit Application is hereby made'for aPermit to Construct ( Vror Repair ( ) an Individual Sewage Disposal System at: jl 1D c,7 H ` .��T 7 �._�`.e�t7e,- ,va_If e /lei _ �....... .. r-._._...•.. , � - ter? --- --- �.... -- --- L cation•Ad ress or Lot No. Owner Address M,09 d ad .......-......=---/....... .......... •-----......•..............----------•----•----......---•--•-••-•--•--...........---..... ......... Installer r17 ....................... A/, ,8 TYP.. of Building Size -1 ..Jq. feet Dwelling—No. of Bedrooms._....I ................................Ex ansion — Garbage Gnn re )— Other—TYPe of Building ... ....... Noof e - Sho ) — Caf fe �a Other fixtures ..... � --- -P-p -• 1 c�' ./ W Design Flow................... ......................... WSeptic Tank—Liquid capacityf5 eagallons Length_ �-..C. Width-6`._S j_e Diameter................ Depth.4�r.l. x Disposal Trench!No. -------------------- Width.................... Total Length.................... Total leaching area............g sq. ft. Seepage Pit No....... .......... Diameter.._ . i. Depth below inlet...�......_._.... Total leaching area.....:: .'...__....sq. ft. Z Other Distribution box ( V'�) Do Percolation Test Results Performed by.........n...10......................................i................... Date......_...�.�....�......... as Test Pit No.3,.....�.�.minutes per inch Depth of Test Pit...../._L..._.. Depth to ground water.... ._.. . f? Test Pit No. .... minutes per inch Depth of Test Pit..... ............ Depth to ground water..... �.. . -•••-•--------------------•••---------------------------......_._.._........ ...-- O Description of �� °�' x � -- -•-•------------------- -------------------------------•----------------------------------......-----------...------. ------------------------------------------------------.........--------••-...... W Repairs or Alterations—Answer when P a applicable...................................................................................._.......... U Nature of Re •-••----------------••------•---......-•--•---•----------•-•------------•-----------•-----•------•---•---•-•-••---------------------•---------••-------•-----------•-••••.--------------------•--------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1Z- 5 of the State Sanitary Code— Tjaq undersigned ther agrees not to place the system in operation until a Certificate of Compliance has b n iss ed y the board of lth. Signed........... ------. --• ....`--•- . ............ ... ........... Application Approved BY --- ----- --.----- -- Z Ali ae Date Application Disapproved for the f o wing reasons:-------•-----•-••--•••-•---•---••-•---------•--.............................................................. ..-•-•-••-•-••.........-•---------------------------------------------------------------••-•-----------•-............--•------------------...---...---------------------------------------........•-•--- Date PermitNo...................................................... Issued..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH v✓�✓ oF..... Z�✓..sT�1`�L r— ........ ............................ ....... ............................... Trr#ifirtt#r of Tontplianrr THIS IS TO CERTIFY, T t the I dividual Sewa e Disposal System constructed ( Repaired ( ) by-------------------------------------------------------fit/>_ --- 1 I alley - tY �` -e�'= .tea � � fie,# /2 e 2� �' at ` has been installed in accordance with the provisions of TITLE The tate Sanitary Code as described in the application for Disposal Works Construction Permit No........... dated-----__ ._-__o`Z_ _.-_ ..... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................. Inspector..........................................................................=......... No.....�6�..t?.' 7 FEs .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � g3 g �9� cc0 �/i/, O F... -. s�G1J•-S r "2-3 L ---------------------•---.................. ApplirFation for. BiupuuFal Iforks Tonstrurtion rantit Application is hereby made for a Permit to Construct ( V111"Or Repair ( ) an Individual Sewage Disposal System at: 13 D G-, ..V, _ - p--- •- ........._.. ••. _ ........................ ----••--•--•--------••-----•---•------•---•-Ad - ---......... _ c L av =eC7�v s t:���/ cJ �� i 3/ °r c �i✓iV�s Owner Address s� W ...-•-•••-••-•-.. •� � ._.. •••-•--•-•-- ..-•--- •••--•-•..............••--•••---•--•................................_.._. ...................... Z Installer Address�4 3 .068 C7 Type of Building Q��-/� /2� / L Size Lot .........................Sq. feet Dwelling—No. of Bedrooms........... ...................Expansion Attic-(`) Garbage Grinder( -)` p, Other—Type of Building ............................ No, of persons.. _.._..__.._..... Show rs ( ) — Cafeteria ( ) Other fixtures .•-- g®C7 Q O � .. •. ---------- .............................. W Design Flow......................................_...gallons per person pe> day. Total daily flow............................................gallo1�s. WSeptic Tank—Liquid"capacity> 5:! ?Qgallons Length.1_Q...G_. Width!-`; '...�.-- Diameter________________ Depth.'�.__._..7__- x Disposal Trench—No,..................... Width_...................... Total Length.................... Total leaching area................._sq. ft. Seepage Pit No._-.!..�...?... Diameter.._,t_d_f ... Depth below inlet....G............. Total leaching area...�__&.ysq. ft. Z Other Distribution box ( ✓) DosingGt' __("�) '-' Percolation Test Results Performed by._.......'...�. ' c t'` ice/�W. C Z 3�/ •-----------•--•----------------=------------------ Date..... ---•--.....-----------•--.. r aaa Test Pit No. ................minutes per inch Depth of Test Pit.....�_z...... Depth to ground water........................ Li, Test Pit No. Z�P_... 7-.minutes per inch Depth of Test Pit.................... Depth to ground water-__. P4 ---------•-------------•-----•-----••---•-•------•------•..... . .._.... - O Description of Soil----•-.tom `�/7iZ S i V jIN� �,r.�..1/c-� ... / . x --- •----•----•-••------•-••-••-•---••-•--•-•----- --- ••- .....-.................................. w 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 TIT12 5 of the State Sanitary Code— T indersigned f itl:er agrees not to place the system in operation until a Certificate of Compliance has be issue e board,of 1 th. -c-�J Signed........... .. .......... ...•••...... --•-•------....-•-•--•-••------- _.... Application Approved By................. ••.•---•-•...........:. D ............ Date Application Disapproved for the fo wing reasons:.............................................................................................................. .................................. .....---•-•---•----•....•--•---------•-••---......_..............---•---•-................._....------...._....................••.....-•--•-.... ............._ Date PermitNo......................................................... Issued....................................................... Daze THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7_ vJ wf / 2 r✓ .S�— 3 - ..........................................OF..................................................................................... Tntif irFatr of ToutpliFaurr THIS IS TO CERTIFY, T t h I :vd m }'� al Se. Disposal Syste constructed ( or Repaired ( ) i , a I taller !" 1 at �3'-- L!�G' � �/-r f l c_5, e ��'''ef'7 _Sj">; �J-�� �cr- %2�C� Z �' _ n ��o,--✓.J/� / ------------ has been installed in accordance with the provisions of TITLE of The state Sanitary Code as described in he application for Disposal Works Construction Permit No................�'._�_____.._7 dated__..-__:_ ___....`�' ........_..g6.... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE7NCONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 0✓►� O F.......�� ..._ �...S T r9:i3 L.f� No....... 6 a4 7 FEE........................ Diopos a1 rko %ons ` rrutit Permission is hereby granted...............TtvL..........--• t •---- .............................................................. to Construct ( t4l"or Repair �(�) an Individual,.Sewage Disposal System at No... LG� .........1!_!.//c�/ _C'...._�.�..1.. --e e. , t+ �- ��.e✓ �� e 2� Cr+� e�✓1�e ................ PP P Street c76 act 7 A-q 94 as shown on the application for Disposal Works Construction Permit No..................... ated........ .... -__._... .............. ..................................................... U---•- --...... . .. Board ealth DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS No.................`.�:9 FER............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Appliration for 11iipoottl Works Tous rurtion thrmit, Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: C-j .... --- ---------------- ---- . -- ----- .... Location-Address or Lot No. ................ - --------------------------- W !. Ownez Address Installer Address 4, Q Type of Building ( �j�'�jc /f` �j � �- Size Lot............................Sq. feet Dwelling—No. of Bedrooms_—�-_._-----------------------Expansion Garbage Grinder -- aOther—Type' of Building ............................ No.DL+ersew............................ Showees--C--j---Ca eteri d Other fixtures ....L 1...�-•-�1-- .�cav v j�T � ._ . t W Design Flow..................•....... ^..__gallons per person per day. Total daily POW-------./?.Z.?...............•....--•gallon �� W Septic Tank—Liquid capacityIf gallons Length l/_.��-.. 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...7.f..._:..sq. ft. z Other Distribution box ( Dosin tanl�( minutes r e inch l Dat - Test Pi a Perct`No,+-Results Performed per b -- e.• Depth of Test Pit.... Depth to ground water------ Test .. minutes per inch Depth of Test Pit___._/.......... Depth to round water...... ..�..�.. Gz, Pit No.&_..r2. P P P g l P4 •---- ••--•-------------•••-•----.........-•-•--••-••••---•---.............._....._..----....•--..................................................... O Description of Soil......... ...� ._--- x x ••-••-----------------------------•----•-•----••-•--------------•--•-•••••-•••--•••--••---••-----•------•-••-•-•-----------••---••-•-----•••--•-----------•-------•••--••-••-•-•-•••......-•---......... U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------••--------------------------•-•----.........•--.....--•-•.•--•••-•••-.....••••--•-----------•---•-••-•----•--•---•••-••-•--•.....-••----•-•-•......•----•......---•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT1E 5 of the State SanitaXend e undersi d further agrees not to place the system in operation until a Certificate of Compliance has theboar f health. Signed.... -------- -----------------------------•----•---••-•--•--- ----------- ........__..-- DateApplication Approved BY--••---••-••••-- ------------- - - ._ • -•-------------------- ..... Date Application Disapproved for the f of wing reasons---------------------------------•------•----------------------•-------------------------- Da.t.e._.........._ -----.--•-----•--•-----•--••----•------•-•-----•-----•................••--------••--•-------••--•......--••-----•........-•---•------•••---------••-••••-••---•-•--•-••-••-••----••-----•--.......------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH dw wrtifirate of Toutplianre THIS IS TO CERTIFY, That the Indio ual Sewage Disposal System constructed ( r) or Repaired ( ) by...................... ............................ . jL e ---------------------------•---------•----•------------------------------------------- at..I�/_ . . ,/�� V rI GL Stail�1 has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No-------1.3k____,).'` ........... dated-------3-T 3 2 __Ord.................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANJEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... f No....... g .:.. 9 Fi$..................._..... THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH " q j' co vl/N .0 F........;3�,7N 5............ ............................ ..............................---.------------....------................._...----- d Appliration for Disposal Works Tonstrnrtiun Errant Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: % Z— D G7 ...1/,_1/........................................•------------- �..__... - --•---------......... ....................................................................... Location-Address or.. t No _� v G [ c��/►" S 1� V. ©,2 }�. ' ,. '1 oLJ j2r�=13 2 / �� -- ---- _. .............................................. --- Owner Address W ................... ...........................•.........__._._....._ ........................................................... Installer Address Type of Building �/= ' >e !=�/ %`3/ Size Lot............................Sq. feet ng— tExpansion --- — tic ( ) Garbage Grin-— )— PL4 -- —._ Other o, o Bedrooms- :_ .�- --. ....__. 7� �ho_wer-s ( ) — Cafetena(-)Other—Type of Building _ No.-a ns._.. 17 dOther fixtures .-------------------------------•-----------------------•---••---------------..----------- y`...�..._._._...._..... W Design Flow....................................- __._gallons per person per day. Total �laily�flow____.._y.`...�.........__._____.___..gallons. ,. WSeptic Tank—Liquid capacity.a.*...gallons Length."... "... Width................ Diameter................ Depth................... x Disposal Trench Ng..................... Width" :....... Total Length__....�....._.... Total leaching area......//..�..sq. ft. Seepage Pit No_________ __________ Diameter......-............. Depth below inlet._._._............_. Total leaching area..................sq. ft. z Other Distribution box ( Dosin tank- 7 "-' C. �7 i C H�✓/ee W/C Z �-3,1 5 Percolation Test Results, Performed by--------------------------------------------------- --- ------. Date a Test Pit No. _-minutes per inch Depth of Test Pit.......... ........ Depth to ground water....... ~" (s, Test Pit No. 4 ..............minutes per inch Depth of Test Pit.....�..L. .. .._. Depth to ground water....... _` �... __ o ,fir �7�Z �- ;/ ✓ fyL Descriptionof Soil -----------------------------------------------------------------------------------------------------------------------------------------------•-------- W V -------------------------------------------------•-------- ----------- .------------------------------ --.-.----------------------------------------------------------------------------------------------- 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 iITl,;u. 5 of the State SanitaVe The undersi ed further agrees not to place the system in operation until a Certificate of Compliance has by the boar ,of health. Signed... ----•- .............................. • -- Date rr Application Approved By................... -----3-- I`'---._. .. e. Date Application Disapproved for the f ollo° �ng reasons:-------•------------•-------------------------------•---------•-------------.._..------------•----•------------ ------•----------------------••----•-----•-------••---------•-----•--------------._......--•-•-----•......--------•----•-•--••-----------------•---------•-----------------•------•------------•••------- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............................OF..................................................................................... Tntifiratr ,of f omplianrr THIS IS TO CERTIFY+Tl;ilttAe In*id�4 7ewage Disposal System constructed ( � or Repaired ( ) by........................................,.......�................•.......------.....---•-•=-•---------.........------------.....-------•--•----•--------t-------....-----....._...�-----._......---- � � V /! / G f� //" �nrstjaller�/7 C" r. C. C"'7 C�/ /22 C. � ,'? "P_✓'✓i /e at -�---- --- ......................... --------------------------------------------=�------------......-------•------------------•--------------•-------------------- has been installed in accordance with the provisions of TjV-E-a.*4 The State Sanitary.P2� scribed in the application for Disposal Works Construction Permit No......................................... dated:.._.- ____.___�___.___.__.__................. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.--------.........------------------------------------------------------------...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.......................:. FEE.. . ........ Nasal rk� �n 1 nrinn rani# Permission is hereby granted. G. 1 ---• �� ,........._.... to Construct ( �r Repair ( ) an Individual Sewage Disposal System = - at No..... �j._/ /C,. ... G y 2......................................................Cr, e e n ��. /�Street as shown on the application for Disposal Works Construction Permit No. Dat 1.__ ..._. °............... ............................................ .. . .................................. rd of Healt DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS - �Tdo..... 6:. ..`.fs FxiP.................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . ........OF.. ` � �V f � ----------- 38 Appliratilan for Uispoii al Workii Tomitrudiun thrmit Application is hereby made for a Permit,to Construct ( <or Repair ( ) an Individual Sewage Disposal System at: Location-A M ddress or Lot No. - L . ,�-'L • mow✓ �', C t o� -' ....-----••--------••-•-•------------- ....-------............f 12T % i !a. ���� . is c� Owner Address W _ Address:E 4g U Type of Buildin =n�1!'rC" /��/. /L, Size Lot.............. ..............Sq. feet �. Dwelling—No. oLZedpo=s__.�..................................Expa . Garbage Other—T e of Buildin N a yP g ------- n�.� Shows(} — Cafetm ) Other fixtures ... yam_ ? _ . �.. X �� = 18 S _ d ................•-------------•----------••...........---- --•------• W Design Flow.....................•_�:_---....._.gallons per person per da Total daily flow....._.__.__.` 4,1�....... gallons. WSeptic Tank—Liquid uid ca acit J��� allons Len th/.9....G�. Width.6`._ `" �t p q p y g g ._.. Diameter................ Depth.___ Disposal Trench—No ..__. Width__rff............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......4..: ... Diameter.Z tel: .... Depth below inlet......4.......... Total leaching area.. !�_%._sq. ft. z Other Distribution box (lo-� Dosingp _ aPercolation Test Results Performed by...1(---r___- ................ NI �G. .... Date..... Test Pit No.+_.._�.-_-__minutes per inch Depth of Test Pit-----k?....... Depth to ground water...... f=, Test Pit No. &.....- ..Z.minutesper inch Depth of Test Pit-----LZ_-..... Depth to ground water....... a ........................................................... -----... -- O Description of Soil-•----..... . ?� -S ... '/--�----- -� -------- x W 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 TITiE 5 of the State Sanitary Code—The undersigns further agrees not to place the system in operation until a Certificate of Compliance has been ue -the boardqf Yealth. Signed._ � o 01(A. .................... .... --D.... .._ Application Approved By........... ---_'U-• ---•- ........................ -•----•-.--�Ir_ Date Application Disapproved for th ollowing reasons:.................................................................................................. ._ --------------•------•-•-•----•---•--.....--------------•--•••-----------•-----•--••---•••-••-----•-•••....•----------•-------------•---•--•-------------------------------------•--- ----••----•--- Date PermitNo................................................--------- Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS �` �¢,✓V„"� BOARD OF HEALTH .......J.... .. ....OF... l .e:c?%.. �..4qa... C�rrtifirate of ToutpliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( or Repaired ( ) by--------------- -----------•------------------.---•-------------•--•----•--•-------•--------------------.-------------.-----•-•-----•-------------------. ----------•------------•-•---•--------- Installer -- has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Co as escribed in the application for Disposal Works Construction Permit No------ -_z 4 2......... dated_-... -:a . .g THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GU RA EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... :NO.....`.a 6.:....:`}-c Fps.... ..............^v._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....... ................. ......................................................................................... . Appliratiun for Disposal Works Toustrnrtiun Prrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: U"i IF : 2 � e z ....�.� .. _ _ Strd mo/ Sa Z'/ 3/ C °r1 ?L 4 %� /3 Z /4 y o,e�rY_Sl alY, ? ... ............................................................. ............................................. .._..--•-------- ..........................•.... Owner Address W ..................... Installer Address —!5; 4 3/ &Q Type of Building O��i �/�?c i r9/G Size Lot........•..................Sq. feet U DwellingNo. of-Bedrooms.......Z..................................Ex anion A't is Garba a-'"ender — _ P �) g (--y— _ 04 Other—Type of Building ______________•____..._.r_. No:-•-of persons:_.._...._____ Showers ) — Cafeteria (_ ) Otherfixtures ----- -----------------------------•--------------------•----•••-•-••-----•-•-------•------•----•---------•--=..... ••-------------------------- W Design Flow............................................gallons per person per,day. Total daily flow.......................... ...........gallons „ WSeptic Tank—Liquid capacity.!`S%allons Length. Width..S..._.'�_. Diameter................ Depth..--�._'.-.---.�t- x Disposal Trench—No .................... Width_____ .__�_.._.____ Total Length............. Total leaching area......... =_.sq. ft. Seepage Pit No.__....._�..Z... Diameter.-�.©7i_-. Depth below inlet....._.......... g ..................f° .. q.. Total leaching area s ft. Z Other Distribution box Dosing-tar>l�'(�l— — /C OY`f i C 1� '1/i �5 W/C Z Percolation Test Results Performed by................................................... ..._........... Date...... '4 c .* .minutes per inch Depth of Test Pit......_ L r.... Depth to ground water.......j_ "...Test Pit No. � � 44 Test Pit No. Xi2.... per inch Depth of Test Pit.................. Depth to ground water.................... � •---•------------------------------------•------•------..... ....--•••- r O Description of Soil----.......C_ 2� 3 /Z.�/�. e c� ...__/ ........C�-I�l x U •••---•-----•--•---•-•--•.................••-•-•--••--------•----••.....-•-•-•••-••-------•••-••-•••-•••••---•-••--••--••-••------•--•--•------•---------•-•--••-------•••-•-•---•-..__......----...-•-- 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 prov7isions of TITLE 5 of the State Sanitary Code—The undersignevprther agrees not to place the system in operation until a Certificate of Compliance has been ed the board o alth. Signed .... - ---�r -� Application Approved By................. .-.__.. Date Application Disapproved for the f o l wing reasons:---•-•----------------------•••----------------------------•-•-------------•-•----------•-•---•-•---•---•---- •-•••---••••-••-•-••-•-•--•--•-•---••-•-----•--••-•-•-------•------••...••-----•••-•-••----------••-••--•.......-----•--•-••-••----••-•------•--••-•--•---•-•••-••••••••-•---•-•-•---•-•----•-----•----- Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trr#ifiratr of ToutpliFanrr THIS IS TO CERTIFY, That the I 1.ndividual Sewage Disposal System constructed ( or Repaired ( ) by....................•---........;........ .-•-•----.....---------------.....----••----...------•-------•--••--•--•-----••--`--.....---...........-•-•--•-----�--�•©--C----•------------- 73 L..L7 G, C ✓r J u P r-Q e-� S �� t?rs t e )�. _.. `'.._....e P�,,.1/e yi p Installer t r at has been installed in accordance with the provisions of TITLE ��The��t Sanitary Code a8 %eti %n the application for Disposal Works Construction Permit No................ ...... ...... date ........ _................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS S •-' BOARD OF HEALTH 9 TCl �O F..... No......................... FEE........................ Disposal Works Tunutr ion Fermi# Permission is hereby granted .................... ...... .. ..•- to Constru t ( or Repair �) a ,Individual Sewage Disposal S stem r _ Z8 ���� ¢r✓/� I1O .fie.-, .S �ap e ... 6� at No.- L� ��� ..........................•-•--..C� /�� ....... Street 6 as shown on the application for Disposal Works Construction Permit No................. .. Date .._r_.______... :__r ........ --------- -f----� ----------- --------- --------------•-- Boar of Health DATE....................................................................•---•------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS C - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ApplirFa#ion for Ui ipau al Vorkfi Tonstrurtann Prrmi# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ;I 1---D C .......... .._.. ..................................... ....`_ ....... ... .._ _........ ..._......._. ................._...._____ Location- r s Addes or Lot No. 01 Owner Address W ••----•--•• .-----.....-••-•----•.......... ` Installer Address dType of Building � � � �% r Size Lot_______________ ________ q. feet Dwelling—No. of Bedrooms___/__________ ____________________Expansion,,Art� Garbage Grinder-�)— a Other—Type of Building ----••.••�------ -.••. No. of — Other Sh s ) — Caf a"� Otherfixtures ...1--�--------=----------�._1.--------•------------------------------�-�-- ------------------------..,...-- W Design Flow__._..__._�_ .__.___gallons per person per day. Total daily flow..__._..__j_r_ ___.____.._ lons. WSeptic Tank—Ligmd capacity` gallons Length_(1__!I___ Width_.fo___.f,:____ Diameter________________ Depth___________'. x Disposal Trench—No,___________________ Width___._..-.._._..__ Total Length...... #---,�------- Total leaching area....................sq. ft. Seepage Pit No._._ ___ Dlameter._._Z .-_ Depth below inlet___ ____________ Total leaching area___/'_e�...sq. ft. Z ( tank -( / JZ r►'1 i c :�N) �vt c z ���rl Percolation Test Results Performed by___ _____________________________________________________________________ Date__-____..__...... ..______:________... Other Distribution ox osln a Test Pit No. ..... minutes per inch of Test Pit____ _ @____ Depth to ground water.__�_ r__= - f= Test Pit No. i�,_.=Z-_minutes per inch Depth of Test Pit..... ......Depth to ground water__.1_Z.... Description of Soil .52 '- ----------------------------------- •• ••••.. it x x ••••-------•----------------•----•-••---•-••----•••---••--••-----------•---•--••-•-••••-••••-•--•••---•----------------•-•••---------••------------••-•---••-----•••--••-•--•----••---•--•-••---...•••- V 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 iITL v 5 of the State Sanitary Code—The undersigned furthe rees not to place the system in operation until a Certificate of Compliance has been • su d b t board of heat Signe -•-••---_..._. _. `....... < _•-•-- •-J----•�ie� _ Application Approved BY - •--------- = Date Application Disapproved for the following reasons:.............................................................................................................. ---•-•-•••-•••••--------------•-•----•-••...•••••••-••--••••••---••••-••••-----•--•-•-----•---•-----•_••_.._..•••••-•--•--•-------••••-••---•---••-----••-------•--•-•--...--•-•••••-•-••--•••---•------- Date PermitNo......................................................... Issued..................................................... Date — --- - - - - THE COMMONWEALTHI OF MASSACHUSETTS � �- >BOARD OF HEALTH � � .......1..... � /1/....OF....... / �cl' -� f�rr�i�irtt� laf f�u�t�li�anr�e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (kr,�r Repaired ( ) has been installed in accordance wrth the provislons of TIT 5 of The State Samtar Code s de crtbed in the PP - P ermit No•---__�6_----a>--`�•`�--•---. dated-------���-� --�'�--------------•- a hcahon for Dis osal Works Construction P THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARAN EE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... No........:�� ....... °k Fps....` '' ... THE COMMONWEALTH OF MASSAtiGHUSETTS J BOARD OF HEALTH .._..7 .3" V^.. .....OF.......3'?2N..5j 1 3 L,r�' Appliration for Disposal Works Tontrurtion Frrutit Application is hereby made for a Permit to Construct (k<or Repair ( ) an Individual Sewage Disposal System at: - - Dl � CX @ (R r-e ,a �.� �,. a � � rim 14 --•- -• . `._. ... ...----••-•---•-•-•..... •-••-...... ........•.... ..•-, Location-Address ,�r3�'G. —� ,Lt_�✓�.5 ✓ �Q3U� L°t�t...1� /c T i32f���?i�it0 ......................... .............................................................. .....................-•--------•--• ............--- ---.............. s Owner Address W ....•-••••-•••••. ...._..•-••••... .......................................................... ........... Installer Address d Type of Building �, �jC �fC %� /�.. Size Lot............................Sq. feet V Dwelling—No. of Bedrooms............................................Expansion Atfic( ) Garbage Grin'er PL4 Other—Type of Building ........Y........ No. of_-ersons.._,_..,------------------ ShoWe"s( ) — Cafe er�) PL4Other fixtures .._�.�,� L '` �V -----------------------------•......----•••-•---••••••--•----••-•-•-•-•--•-••--•......-..-•......":Z:r............................ Design Flow..................." "` gallons per person P d�.y. TotalGdgily flow._._.........__.... ......-. ._._.._..._gall�ns�u W G - WSeptic Tank—Liquid capacitygallons Length-__-•...-_..._.. Width................ Diameter................ Depth.....-_..•...._. x Disposal Trench—No,..................... Width....o_``_-..i_._...... Total Length...... -A....... Total leaching area.....;......... sq. ft. ....... Diameter....�_�`-l.-2... Depth below inlet...G'......•..... Total leaching area.. /.......sq. ft. Z Other Distribution box ( ;' Dosing tank-('`) C !� ! C H/Nf.E W/C Z Percolation Test Results Performed by................................................,---.........._.__..._._. Date..... Test Pit No. .... _minutes per inch Depth of Test Pit.... .............. Depth to ground water--_r_Z__-__--------. (s, Test Pit No. _._.minutes per inch Depth of Test Pit.................•.. Depth to ground water........................ ------------------------ �...... -- -•.......... Description of Soil.....-- 3-� --•••-......-•..... --•••-•••-••••--...•-•---•-••-•.............•------ ...... Z_ U -•-•-••-•--••••••-•----•--•-••-•-•----•--...•-•-••••-•••••••--•••-•-......•-••••-••-••----••---•••-•-••••--•-••••-•-•---•--••-•-.....---•••-------•--•--•----•••.....--•--....--••••--••- W ....................-................................................................................................................................................................................... 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 TITLE 5 of the State Sanitary Cote—The dersigned furthe agrees not to place the system in operation until a Certificate of Compliance has been b t le board�f healtSigne .... _•••... •-•-•...'"...............:Application Approved By•••-•• .----• �G Date Application Disapproved for the following reasons:............................................................................................................__ ....•.................................................................•••-•••••••---•.••--•-••--•••••--••--••••-••••••••-•••--••••••••-••••-•--••-••••-•-------••-------•••--•••-••••••-•-•-••••-•-..... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH To, t/ ..OF...... _% - iGs3,L Trrtifirate of Tontplionrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( 41'or Repaired ( ) / .--by............••.....--••-------••--••••••---••..............................__.._.....__. nsaller................................................................_. r------------------------- a, ✓� -i e 2 ... . .. ` P r✓r p r has been installed in accordance with the provisions of TIT ,,5 of The y�tate Sanitary Codes desgribee,d in the application for Disposal Works Construction Permit No.----- _ �_`.._`....... dated-.-------�� � 4 A------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................••---••-•-•----•-•-•-•-------••--•--••--•-•......--•---....... Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS -� BOARD OF HEALTH aW1/ F.........1 .......................................................... No......................... FEE._...................... Disposal Works Tontrurtion rrntit Permission is hereby granted.............................................................................................................................................. to Construct ( )o Repair ( ) an Individual Sewage Disposal System at No.•••�)�. %-/>--ri ✓ Q Z� e ?8 777 !" ....••.... as shown on the application for Disposal Works Construction PermittNo.._..�'... .�'... D nd------... Z__... Ma'�?......... ; ---- IL oard of Health DATE.....................------•.._...-••--•-•-••-....•-•••-...•••• �j FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS N ol --.& (' . o....................•d ems.. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH P- 43k99�yo Appliration for Disposal Works Tonotrnrtion Prrmit Application is hereby made for a Permit to Construct ( �or Repair ( ) an Individual Sewage Disposal System at: 4:2;7 C ...Y!..�.1_�?:. ._ .....�..." Sate r^ � . � ZQ q.-: er'►rd/. ................. ..........................?.5.--------- : ..... ..--. ---- _ or Lot Now 1� '01 ...................... .................. ..... ................................. ....... ......... ..................... ...._ c Owner Address W ............. ............•.. ...................._......................................... _._..__.._....... Installer Address 4 3�� tE G dType of Building � �L �/ ,�i>9% Size Lot............................Sq. feet Dwelling—No. of Bedrooms....,,1--- •-•••--••••-__.__...--Exp�tnsier' ) Garbage �_lPL4 Other—Type of Buildingv �r ............................ Show C a Other fixtures ... :;- '_ W Design Flow....................==....._..__..___._..gallons per person per day. Total daily flow......9•1..-Q...._.............--...gallons. WSeptic Tank—Liquid capacity,/ gallons Length.0 g.'C_ Width.!' ._-' .-. Diameter................ Depth... x Disposal Trench—No ------------ Width.__ ....... Total Length.................... Total leaching area............ sq. ft. Seepage Pit No......... Diameter....t9.2.... Depth below inlet........._.......... Total leaching area. rB_ .sq. ft. Z Other Distribution box Dosing tank-t—T _ `-' Im Percolation Test Results Performed by.. _.M-f_.. �................ :'-�..•� ............. Date....�� .'mil___.... Test Pit No.'s._4- .�...minutes per inch Depth of Test Pit.....�__�....... Depth to ground water..-_1 .-_.�. f= Test Pit No. `' minutes per inch Depth of Test Pit----- Depth to ground water...._t L!.. a -•--•-----•-----•----------•------••-•-•••-•.........................•_..-••---------------....---••--- .................................... O Description of Soil..........-a--`a i ......-TO....... �---- ...... L aJ -•••------------------------ ----- ..---------------------------------------------------- •---------------------------------------------------------- W ----------------- ------------------------------•-----------------------------......---•-••-------------------------....--------------•---------------------------------------.._.............--•--••-- VNature 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 TITLE 5 of the State Sanitary Code—The undersigned furthe5 agrees not to place the system in operation until a Certificate of Compliance has been issu by t board of healt gned �✓_-_ -- -------- --------------------------- ate Application Approved BY =---.--••-- ---••-----••� Z- J Q�3 Date Application Disapproved for the follow g reasons------------------------------•--------------•----------•------•------•--------------------•-••-•-----••......._ -----------------------------------•----•---•---------------------•---•--------------------••--------------••---------•-----••-••-•-•--•-•-------...._..-------•........................................ Date PermitNo......................................................... Issued_..................................................... Date THE COMMONWEALTH OF MASSACHUSETTS SaC./ `��/�f� /)BOARD OF HEALTH J \ ...... .........................OF..... �� ! ........ . ... .......... Cnrrtifiratr of font liFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( L-<Or Repaired ( ) by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at fa L'�C_'-1 !�r!)Jc yL v c . -G,-V e'-V �`_�"?.Q �t� 7 �:� '� ta.-��T11�..fl7ct.. has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE FUNCT!®N SATISFACTORY. .......................... inspector.................................................................................... No.............. ems............._.....---------- THE COMMONWEALTH OF MASSACHUSETTS ' BOARD OF HEALTH .------•.......................................... Applirtttinn for Disposal Works Tonstxnr#iun jhrmit A Application is hereby made for.a Permit to Construct ( P or Repair ( ) an Individual Sewage Disposal Syst,--at 3 5�.. e .... �er,✓, / . t7 Location-,Address t/ o Lot13o r , �jr�� , .e L -SAC Lvy✓S T� S/. �'OfZ�. 13/ ®z /c1 t )32, / !/ /Y1/-? Owner Address W __ Installer Address 2 4 +j Type of Building ct l �c. �1�c i s"'3>�-- Size Lot............................Sq. feet V Dwelling—No. of Bedrooms._.__ Expa s._--_:`=-------------------•--. 6riAttic( ) Garbage G-rizrdei( ) pal Other—Type of Building,_ Nor of- ersons__---___--__--_-__-r----- Showers" ) CafieTer` i ( ) QI Other fixtures ._. .` '�"" �`',` �..` t1�J !S ?` — v ................................'••• .................................. _ ------------ --..------•-----••----- W Design Flow....................- ..""-" "`--..gallons per person pe> day, Total daily flow._._...'.................................gallons. „ WSeptic Tank—Liquid capacity.?!. gallons Length.!. __ `. Width..'....'d.__ Diameter________________ Depth................ x Disposal Trench—No...,.z................ Width o.....P-....... Total Length........,.•.... Total leaching area...... �_ -sq. ft. Z Other Seepage Pit Distribution box Diameter..... Dosing...Depth below inlet................... Total leaching area..-_---...........sq. ft. `-' Percolation Test Results Performed by__....`.....�..._... tl'... �� uv�� Date-------------........._.....:..._...... W � -C z ............................� J e •r-- 14 Test Pit No. <i=-...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. ..:............minutes per inch Depth of Test Pit............_....... Depth to ground water........................ O Description of Soil.....------�"d-. .�5 �...-......... .............. a- ..C'°.................................... x U .............---•-•-•••-•••••••-••--•••......•-•........-•--•-•••--•-•--•-•---••--•..........•-••••-•-•-....••--•-••----.....-•--•--••••-----•-•.....•••-••-----•-•••...........-•--•-•--•-•••..._•••... W ---------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------..._.....-•-•-.._.._...... V 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 TITi.I 5 of the State Sanitary Code— The undersigned furth agrees not to place the system in operation until a Certificate of Compliance has been issuXytardof healtS ned..-•••••----••.• ----------- -- .......••. ....---• •••--..........__.... Application Approved By.. � ............ 2 Date Application Disapproved for the following reasons:--------•-------------------------------------------------------------------------------•.......--•--•......---- ---------------------•-------------•--........_...••--------•-------------.........-----------------•••---••-•-•---------•--•••••-•-••••---••--•-•••••--•-•---•-•••-•-•--•----•••••----•••--•-•••••••••. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............I.............................OF..................................................................................... �rx#i�irtt�.e laf f�nut�littnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( L- or Repaired ( ) �� ��G by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- j3 nstaller�at -•••••........1 ° e i Pe .�----©---- ------ ' � --. c�r 28 �P.7�r��/J/--•/ `/ has been installed in accordance with the provisions of TITIE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE _,SY$TFM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH V6 Z4 ..........................................,V OF....... .�F�.,� /..� Lr........ o� .............. No......................... FEE........................ Disposal Vorkv Tunuirttrjtinn Upautit Permission is hereby - to to Construct ( or Repair ( ) an Individual Sewage Disposal System 3 BAG, C ✓� �/� � e e S �� C. P� t e rr- , Q 7Z C-. P�-te�1/Q at No........ Street 6 Zq as shown on the application for Disposal Works Construction Permit N� ...............___�Dated.31.:?-�/ .............. •---•---••-•--••••-••--..._.. �- - ---------------- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 7No._ Fx$ Sc�.... ...... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 9 T"0.Y�111......OF...... ......... ....................09u- ..._.... Applirtt#ion fui Dispnsttl Works Tanstrurtintt firrmit Application is hereby made for a Permit to Construct ( Kor Repair ( ) an Individual Sewage Disposal System at: 7 �� `,. ..--•...........__...... �.......�....--••- --•--_• -•-••••---. ........ ... -`' ,�yamy Location-Address �'-•---••---•-•---.....--•----or Lot No.---•------------------------------------- �. ._.._... ......................... Owner Address W ...------•----...2........... .--•-••..................... ................................................•------•-•_-_----........._....-----.....--•-^-- Installer Address 31 �t CSO d Type of Building i' ��'/a>�����_`« Size Lot .............. 4.....Sq. feet U Dwelling—No. of Bedrooms....... --------------•_-_Expansion Attic,' Garbage Grinder, Other—T e of BuildingNo. of persons....... .F-:-_-__-- Shower Cafeteria< d laths 53'349a. . �-i'es© 0 X:7 W Design Flow............................................gallons per person �perd ay. Total daily flow.............7.40_ -............gallons. ` WSeptic Tank—Liquid*capacityd_5_..___.gallons Length________________ Width.-----__......__ Diameter.............. Depth....461_'4 x Disposal Trench—No..................... Width___i_.._�._._...... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter... Depth below inlet...... -......... Total leaching area_4ZW..sq. ft. Z Other Distribution box ( tj" Dosinr�to '-' Percolation Test Results Performed by ------�iGjiN/,�id✓!_C__�.... �A�- Date..._6;._ aTest Pit No.�...�'2minutes per inch Depth of Test Pit......1._Z Depth to ground water..._.._I__Z_..f'. fi, Test Pit No. _______________minutes per inch Depth of Test Pit......1._ _ _.__. Depth to ground water........ P4 -•••-•----- --------------------•__•••••--••----_•_--•-•-•--•--•--••---•-_-•-_-••_.........--_..._,_..._...........•_---_••--------------•...._.....-•_••••. Description of Soil P. ?.l - .......... x ---•-••-------•-------------------------------------------------•-•-----•-•----------------------------------....._. Nature of Repairs or Alterations—Answer when U P en applicable-------------------------------------------------------------------------•-•---•----........... --------------------------------•----------------------------------_-----------------_•••-•--•-_--•----••-_--•---••-•-••--•-•---•••--••••--•_•_--•-••-_-•••--••......•••••••----•_•_-•--••-_._..._..---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T11A LE 5 of the State Sanitary Code— The undersigned further agrees of to place the system in operation until a Certificate of Compliance has been issued by the be ai 1 o alth. Signed... .... ...... . ..... ••-• _ //_:..._.__ _........................._.... Dat Application Approved By................. •••.... ....._. .-• ---••--•_-•--•----•-_--•-•-•---- ------3 - -� Da Application Disapproved for the f of wing reasons: - -••-----•-•--__-•••.........•-_-•--•----....•---••-_-•-•-•-•..............•-•-•--•---•----_••----•----------....•------•-----_•--___•---•-•-•-••...---•---•---•••....._...-•-.......................... Date Permit No....................................................... Q_ Issued ...........:.......................................... THE COMMONWEALTH OF MASSACHUSETTS c BOARD OF HEALTH C�ra~iifirtt#..r laf f�um�ltttttrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (Vj�_or Repaired ( ) bY-------•-•----------••--•-•------•-••••••••-•--••-•••-------------------•---•----••----------------•---------•--•_-•--•--•------•-•-----•--------------••--•---•-•----••--•-•-••--•-------•------•-- Zl� Instal er Y -� -- • � at--•�-•---••••�.�---•---•�'--�-� ---------------------------------------�------ ---�-^------���'`� ---��.-►_�c� :e-� `-�,-^volt ............... has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._.._.. _"_.rr� __�..... dated-------- _(__ � ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL,FUNCTION SATISFACTORY. DATE...................=............................................................ Inspector.................................................................................... No................_....... , Fss.......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7—cD vV iV L3 L -•................---- --....-------• -.OF.................... Appliration far Dispati al Works Tomitrn.rtiun 11amit Application is hqr yL aLe f aPe�mit,to Construct or Repair ( ) an Individual Sewage Disposal System Iat: TzT� 28 vrllC � e G-,r-e. en 5h� � , -, �., e e� e—, l er' )Ie. ............ .......... •-----•-------•---............-- - .------•-•-..............--••- ........................... .. Address or; t N . - L - v�-�C!v✓S L71 ✓, Gv� / & T c3 2 H/,9rt/jt/�5 ....--------•-•--•........................•-------•-----••-•---•-----•--------------••--•...._..._ ......••----•------•._........-•------.....-•---••............................................... Owner Address W Installer Address U Type of Building T� 'Er %`'� i L oy=.=i ` . Sq. feet Size Lot ....... Dwelling—No. of Bedrooms......... .................................Expansion,Attic-t—' Garbage Grinder'" aOther—Type of Building, ....t....._.._..r......... No. of persons_-.-........' __�_.__.. Showers-(—) — Cafeteria +( ) Other-fmtures •----------•------------•-•-----•-------------------------------------------------�.........Z; W Design Flow............................................gallons per person per dy. Total daily fl.ow----_....................................... ons. W Septic Tank—Liquid*uid ca acit _�_r_.dp.gallons Length � P q P Y g � -- Width................ Dlameter--------•------- Depth.... xDisposal Trench—No..................... Width+...�........... Total Length....... ........_ Total leaching area....4�_�6.._sq. ft. Seepage Pit No...................._Diameter........ �.._.. Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ') Dosing,tanYt"O '-' Percolation Test Res lts, Performed by._!`....�'.rG.-P>N------. � w,.�C (a...C, ---------------=•---�--•-------..... Date-------- --...._,.----- ,.1 Test Pit No-1........'.-':minutes per inch Depth of Test Pit.................... Depth to ground water..___.__ fs, Test Pit No. ................minutes per inch Depth of Test Pit...........-........ Depth to ground water ...................... O Description of Soil � � �f�--.5� { 1 t- , r .�.r_c.a � Q j x -------•------------------------------•-•----•--. ................................................... U --•---•••-----•----•-------•-----------•--••-•••••--•-------•-•-----------•------•••-----•-----•••-•----•---•------•--------•-•---•-----••-----•••-•--•----------•-•-----------••-•---•-•--•............ 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 TITL%, 5 of the,State Sanitary Code—The undersigned further agree not to place the system in operation until a Certificate of Compliance has been issued by the bC#d o Health. Signed -•---------•..•..- ,,�.. -. c4 •..... Date ApplicationApproved By...............-------------------------------------•............... ....... .......... -------------------- Application Disapproved for the f o ,�e o s Date --•--------- --------------•-•---.....••-••--••-•-----...-•--.•••--•• -t ' ------• .... ��4 ii-...••---•-- I to PermitNo......................................................... Issued-------•--•------------ .............................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 7-4 vt/N 3 9 7Z/% -S 4--,F ............ ...........................OF..................................................................................... (9rdifiratr of Toutphatta �. . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) f ----------Installer- J has been installed in accordance with the provisions of TIP Lof-Tlia hate Sanitary Code td sprted in the application for Disposal Works Construction Permit No......................................... dated-................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... ' w`THE COMMONWEALTH OF MASSACHUSETTS- ` BO RD OF HEALTH V6- 7— ' 231 I-=;;- 7-11 1-\/ 4-- 4�-=— /� 5 0 ..............................OF..................................................................................... No......................... FEE................... Uhipos al 32nrkii Tnnotrnrtion rrntn Permissionis ereby granted......................................................................................................................................... to Construct �)Gor,Re�air (,/)/%CL 9e Individualeve P Disposal System -p — &e - /Z Z e 2 8 6� e,,,!�G'r"✓��� atNo.-- -------••--••-•-------•-••--•-----•---•-•-----•---=•�----...----•-•---•--•---•------•------••------�------ ----- Street as shown on the application for Disposal Works Construction Permit No ..__Y __� aI tt .......... ..__..-1...................._..--.- ......•--....--••-------.---- ....................................................... { .........................................•.... Board of Health DATE......------------------•-------- FORM 1255 aHOBBS & WARREN. INC.. PUBLISHERS �. `n a I•.� _. -+� �1_. u UJE I PRO P. a� 40 PIT- } s ,D;�n _j._?i�~� � Z Ni;►u s � �►.icL4 Pam. ;.��t�4_�.�; OF,a Alm :ALAN � W. JONES R ' � 8�� ` I i ! r , °w 0 s��;�/ �� . ' • w ,' �O�O� ''max ��/��.� . � ` •� .. . `ply..�. v�• i. ' V No. K J F.Ell.... ... THE COMMONWEALTH OF MASSACHUSETTS BOARD O t-iEAL � _ -- OF--- -----0 ...... .. ''✓. ... ... ..................... .....- Applira#ion -for Di.q oiiat Workii Tomi#rurtion Vanift Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal System-- -lei---2'.."i.- � F Loc 'on-Address r Lot N . wner ' ddress W --------------•--------- .... - ---•••••-- ---• .. -------• -- --- � Installer Aress Q Type of Building Size Lot____________________________Sq. feet U Dwelling—No. of Bedrooms___ _ ____ __ _________ ____Expansion Attic ) Garbage Grinder ( ) Other—Type of Building __ _ ________ No. of pens ns_______.___ ____"__�.___ Showers ( ) — Cafeteria ( ) Other fixtures ------------- -----a .._�'���---.. � 1t . t---------------- ------ ---�--------------------------------------------------------------- W Design Flow------------------/15..................gallons per person per day. Total daily Pow---..----..._.... 8---------------.---gallons. W Septic Tank-L Liquid capacitvl_000_.gallons Length------ _.. Width....�—.._.. Diameter-------- _.__ Deptli---------------- x Disposal Trench—No_____________________ Width-------------------- Total Length_.__.__.____...___.. of leaching area---------- �.______s f . Seepage Pit No.........I.......... Diameter._/�'�s ____ Depth below inlet__ of �eac •ng are._ ___ _.�_ ca Z Other Distribution box ( ) Dosing t �)) 7 // 'Y `~ Percolation Test Results, Performed by-------/a(T.S_�__ ��„�_________________ Date........... .._._.. & sffl o. 1.....__�Z _minutes per inch Depth of Test Pit..__.. Depth to ground water.._ .��.�.. r4 Test Pit No. 2................minutes per inch Depth of 'Pest Pit____________________ Depth to ground water------------.__.____.._. P+ ---------------------------•------------•------------•-------•--------•-------------------------------------------------------------------------------------- 0 Description of Soil________ ______ --_A -- ;. W ? ' ------------ ------- -------------------->-'� U Nature of Repairs or Alterations ?Answer'when applicable...________-_.."..._._____________________--------------------------------------------------- --------------------------------------------------------------=-----•-----------------•---••----------"------------------------------••-" .......................................... ---------------- Agreement: The undersigned agrees to install the orede ribed Individual Sewa e isposal System in accordance with the provisions of Article \I of the State Sani ar C.dde—The u der ' ned t'era agrees not to place the system in P � g Y operation until a Certificate of Compliance ha b e issued by oar of th. ' t S, -Sigt D to - 4---- Application Approved By---- __ y' - - ---------------------�.--�•- �`!-- ----- to---7/ Application Disapproved for the following reasons:--.-.•-•---------------•-.-- ---.--_.--.--------.--------_-----.---------------------------..--..-.----- Date Permit No--------------------------------------------------------- Issued.............. .... r ----------------- -------------------- ----------Date` - r ------------ -- No... .................... Fsic #.. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD O i-9EAL .. ..:.. ..-----------OF....... 'j - ... - ---..- - Appliratiun -for Dhipoiial Works,Tonstrnrtinn Prrutit Application is hereby .made for a Permit to Construct (/.<or Repair ( } an Individual Sewage Disposal system t ----- •. �F ' .... .�., •----•------• ..................... ---J -------- Lo n•Ad res r Lot N . 141W jj�A wner t ddress p Installer Address d Type of Building Size Lot___________________________Sq. feet U Dwelling—No. of Bedroom ._ }__ __________Expansion Attic ) Garbage Grinder ( ) Other fiat res ______ .. ...- +----------- -----* 1.4---------- 0.1 z Other—Type of Building No. of perm • ( ) ( ) - Showers Cafeteria d - � W Of I Design Flow------------------ :.................gallons per person per day. Total daily flow...___----.---.__TIP------------------.gallons. WSeptic Tank 1 Liquid capacitvh0_Qgallons Length_:____-!r ___ Width-__ ..... Diameter:..-__ Depth.----.__-_---- x Disposal Trench—No- ____________________ Width_____________ _ Total Length------ _______ - of leaching area---------- ______s i . Seepage Pit No---------/---------- Diameter_1 Depth below inlet_ ._ eac] na are Other Distribution box Dosing to k C a— 3 z ( ) 1t Percolati n Test Results Performed by------- __ _________ 4 ................. Date___._._..q.ho �7 , a & �o. 1______ „-minutes per inch Depth of Pest Pit._..._ Depth'to ground water...1"VAUL . Test Pit No. 2----------------minutes pe'r inch Depth of Test Pit.................... Depth to ground water__-____________--____--- G-�i .......................- ------------ DDescription of Soil-------- -------- -----...---------- --- -- ------------------= ---------------------------------------- 44116, ;- _ UNature of Repairs or Alterations—Answer when applicable---------'-------------------__.........______________________________........._-------_-------- •----------------•-•---_____--------------------------------•-------•--•----------=---•---•---------------=--•-•--•----_-_------___---•------------•--------___.................................==----- Agreement: The undersigned agrees to install the orede ribed Individual Sewa e isposal System in accordance with the provisions of Article XI of the State Sani ar C`de— The u der ned er agrees not'to place the system in operation until a Certificate of Compliance ha b issued by oa of th. ` Sign ----- -- ...... • --------------- -------- --- .. - Application Approved BY---- - -- -- -- ____ _.__ ___r,�� �- Oy --- --.- 7 ` Application Disapproved for the following reasons:.......................... •-••---••-•-••--••---•-•----•- -•--•---••-•----------------••- ........-------------- ------------------------------------------------------------------------ .. Date. PermitNo...............................--------------------------- Issued...................... -------------------------•----•-- . Date ! THE COMMONWEALTH OF MASSACHUSETTS S ' BOARD. F HEALTH .............oF....... Q000 -0 �.............-......-.......................... .fF (11rdifirate of 101umphanrr I TO RTIFY; T t tJie Indi - al)*e Disposal System constructed ( ) or Repaired ( ) b � ---•------ . at-•--='-"- --•-W - -+�--- -04------ I. to er- ,�... .�"') f+.•�. _. 5I �((f �ei has been i s ailed in accordance rth the provisions of Art cle XI of The State Sanitary Code as de theapplication for Disposal Works Construction Permit No............. :. -__�__.,_______. dated-.....� � ''zf/.-__-___ THE ISSUANCE OF THIS.CERTIFICATE SHALL NOT BE CONSTR D AS'A GUARANTEE THAT THE SYSTEM WILL F CTIO SAT SFACTORY. DATES. Inspector...--- --=-•- ----------- --•- --------------------------•------------ ---------------- 1 - i THE COMMONWEALTH OF MASSACHUSETTS S • BOARD OF HEALTH. . 114.-....... FEE Birivn51nd�*-i.' xk Clnngtrnr ' it prr 'f r - Permission is hereby granted.--_to Constr t (V epair ( ) 6 Sew pof'�1 ystemat No.'�_ � � *�../�!��//�:�- 1-----xt.�.41-•--- = stre�'t ,�„� ¢ as shown on the application for Disposal Works Construction P No._ - ---- Dated....-����� ---•-•- > L fl; - Board of Health' DATE.. r/ . -F a FORM -)255 HOBBS & WARREN. INC.. PUBLISHERS *. ' �.. . �. -.•.<� � ,��a:.;j[..�.._t .gam- wt l� �a ..,..;, ,'; :w....ri�,�.r - F L i �INV_-dl .07 TO o' 20' p ., o� p P. ' BLDG a 6 a O'` N. FL. 52.500 00, o Sl- 69 o h I I ¢ Oil ol 10 ' 51 5 02 ri — a, /9 i TO ALL NEW BUSINESS OWNERS DATE: , r r Fill in please: Y r APPLICANT'S ' t` r '«�°' YOUR NAME:E Q-� BUSINESS YOUR HOME ADDRESS: L17_ VL.,• MC-E ;i,v&-I+ou 5C= �-�• r,.y. C- S M/V T /1 C 1A a-#ISS- o'Zs 3"l TELEPHONE Telephone Number Home Soy? S 9'-464 NAME OF NEW BUSINESSLpsec Lj-o-r m GAe-G b/glR TYPE OF BUSINESS J)'Z21 G Lt= ►y i ►y� IS THIS A HOME OCCUPATION? YES L:J_NO F 001 N E Have you been given approval from the building division? YES NO= ADDRESS OF BUSINESS 16nn i-A L-m ou r N y-b- C.,--A, Eey i USE ft 4Si MAP/PARCEL NUMBER When starting a new 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. Once you have obtained the required signatures, listed below,you may apply for a business certificate at.the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.., GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) and you will find the following offices: 1. BUILDINGCOMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. - Authorized Signature COMMENTS: 2. BOARD OF HEA H This individual has b e i nfor med f t per nts that pertain to this type of business. Au ri d ignatur COMMENTS: 3. CONSUMER OFAIRS (LICENSING AUTHORITY) This individual Has been informed of the licensing requirements that pertain to thi pe of.business. Authorized Signature* COMMENTS: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. -it does not give you Permission to operate-you must get that through completion of the processes from the various departments involved. **SIGNIFIESAPP,901AL FORA BUSINESS CERT/F/CATEONL Y. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1. Marine,Gas Stations,Repair 2. Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY t-cAv i cV-v i t-Lc (-LC-ANC (see"Orders") 5. Retail Stores 6. Fuel Suppliers AD PRESS 11,00 LM QU' Class: 7. Miscellaneous ANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATER _Case lots Drums, Above Tanks Underground Tanks IN OUT IN OUTI 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: G LC A ti I n/� 04- van t PL. dtq U.- V ENZ 11--, lV t-t O t- T A A/ O Al Lam/ O V E E C-0 l Al I rA,k C,1 t 1 VA � DISPOSAL/R.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer Public 0 On-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 NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter I Name of Hauler Destination Waste Product YE,�S NO 1. P E T'/. IG LC -N P Ct-H LO V.0 141 A LE N 2. Person(s) Interviewe Inspector Date Date: TOXIC AND HAZARDOUS de�412eliz. MATERIALS REGISTRATION FORM NAMEOFBUSINESS: �4�b/��-S B USINESSLOCATION: ��oOU /�iDT�7 /�OQC/ _ �� �y//��1"47,4 MAILINGADDRESS: c Mail To: TELEPHONE NUMBER: �Oe cam` -is Board of Health Town of Barnstable CONTACT PERSON:�y �. rZ74-al'V—J�1 mac- P.O. Box 534 EMERGENCY CONTACT TELEPHONE N MBER: �'7ld O - la Hyannis, MA 02601 TYPE OF BUSINESS: smacf �"1�`- Does your firm store_ any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO _X 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. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid y1'_ Disinfectants ele(lCl %V/*A� Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote). Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids �� (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS 10 i y I 40 I �! �1 Fl�. tCxil :'tl w J j`37sfI #' f r. .1 Cy. i f co �'',� � N 2ss f �] 1�0 v I L I 4 2. --- -UN I T 17 2 S/ Vr. s- 021) 00 I (� O �7 Ve Q �i 17`t .�n �� =� r UNIT 18 cmm D m M m O N O CO r7l 4777—, 2 S 811 C� 9OSf> CD N CD .i vl 1 v v -�C/ _ _ — — 0,,V r-�.✓-,ma's !_ : --=-- � / ��' ��' '.ray;J K % ,a _ ----•--..... I STa 7 —/ 2 <, 2 _ Z; I 60 7-KJ _GH�'N 8" i I \' . '� O' + /?'• ',~ /0B SL''AT DES 1, T'° rA Z. E-s7� �`/ s '� - /2,2 8 3 +s f 1 S%-:�'z, 1 S-I � N�(,• /yN�q� F dw_ 3�t4oS.12t.4 4, � wG,Ply r �L O w: 00 kA T- // cl,� ;` ! — —CIA- _ tt O n _r— 11 r� ilo ` � \ -r 1. � r� > �O �t __ ��� �T.- ` v� ' R `mot � /. � / / •// / y 1 v7=j �� '�' tiroAlpi be T (fix I� �c 7 iV .` .- '� ! � / ,► J /' / IV a 7- A/ P \ / oA DK °o° / 01, V t �y P y r G 0 ti ;y o > 12 All ¢ ],� - o PLAN OF ,r. /0-1 i ti V SEPTIC S Y S T E M S a WATER SERVICES OF PROPOSED oe V?l BELLTOWER oCN . � v 1 N G CENTER IN BARNSTAB LE CENTERVILLE ) MASS. FOR LEE� EL- SOLLOWS DEV CORP - - _ - �° N AI SCALE : I "= 3 0 ' DATE : 3/18 /8 6 .,gar r REV. 3 2 0 8 7 I / c4Vr. BY: CRAIG R . SH0 RT, P. E. 4•/ 9/ � 1" �7" cxsTE I �, I OLD ROUTE 132 HYANN IS , MASS . 02661 (o/ 7188 Ile e7 '-a / 'Z� a,Q ' ' " DWN• BY cis SHEET E - 3 OF 4 FILE N0. 1 -5555 �. - �0`Z 7X CZ, irr,RAM E 1 �5 E L) IG.. 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A7 IN BARNSTABLE CENTERVILLE MASS . AN of SHO FOR 2 ' C01V7-0 (JfZ So _ � • G— , - LEB E L- SOLLOWS D E V . CORP. 0. /STE VON L BARN. REG . OF DEEDS /5 7-/,,, 5PO 7- Er L E' V. 151, REFERENCE BOOK 393 PAGE 78 f REVISIONS : SCALE : I " = 30 ' DATE 3/18/86 SST 1-,e5 L- 0 x-)-rl o^/ -41 H'49AV Z) <7 l'--)P PA4.,It-OK-/ G; B Y C R A I G R . SHORT , PE. ,574D. 4 P.1/. C 131 OLD ROUTE 132 �-Z/ 2 /8 HYANNIS , MASS . 02661 o cu 13 DWN- BY SHEET E-1 OF 4 FILE NO. 1-555 j ��� ✓E/✓ti ENT ... �.__. . �H 20 CAST IRON FRAME �. GRATE TO FINISHED GRADE , � . ( 24� ) 2 ' L) /N. P a 81T. co A / E MENT G�tAv . 5 C. T L E'',/",C'L O F P.E"� & -� e- 7. LET- INTO •s:� ;;�. -.: :: -.:�.:. .. `'\ BRICK 8 • . 12 DIA CORR . 'MORTAR ALUM . PIPE GROUND � � _ •SLOT ,. - " FUSE AIR - • WITH ELBOW aT., s�'� . % ENTRAINED OT$ C3 .. /7 N L 3' LAYER OF • •: V' • CEMENT) -• , Y DIA. c-- � 4.� v PEASTONE do WEEP HOLES o • . a WASH ID e p Oft • STONE ALL •eH 2 0 • AROUND PRECAST .STQN, o v V�- 7St1F� STO�JE 'o�► LEACH BASIN _ft . " — T -13 EL 43 . `J .�a "� e✓' is j 3 LEACHING - CATCH BASIN ( TYPICAL SECTION ) LEACH TRENCH 1 /-4 A S S. a,p VV. 7-Y?4W Z 3 i T e/^f eJ -1 S !� vJ 6-,14 7t /n/ G, S 'J R F•-3 E ©�/� �' i3 7--C Y. ie T'ED _ 13 f Y 7 G. �' I'cuiv -� -'a 2e u )Tt : .�. 7_• C7 C7/�� ( see r At.� F PARKING LOT CROSS SECTION `n '2.. 0 `, F Sdc7• X?A SEGTQl31 t HEADWALL DETAIL < �• ,.,,• PH lZ�'�'/N G. LOT _. �.. V) 1b � � Q DRAINAGE & PAVING DETAILS w OF PROPOSED C3 (M, r.) 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