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HomeMy WebLinkAbout1661 FALMOUTH ROAD/RTE 28 - Health r1661 Falmouth Road (route 28) Centerville (' q = r I� 1 l No. 42101/3 URA 0 ESSELTE 4. 10% 0 o m o �u►1 .es�. a_;..»:�.:.:y...6rs.. .-W.�: �_._ ..�.raw�aa6e 4x .: .:.,�— - - - — — � — - aoq-oB� - ion c Commonwealth of Massachusetts I Title 5 Official Ins Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments µ% 1661-1675 Falmouth Road (Rt 28) Property Address �{ Centerville Plaza First Property MGMT .; Owner Owner's Name m'?; information is s required for every Centerville MA 02632 4-9-18 page. Clty/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 and of the form. Important:outforms When fillip out f A. General Information �IkA OF'Mq i�,� on the computer, S �, use only the tab 1. Inspector: `��� s��s' key to move your JAMES u' cursor do not James D.Sears i use the return Name of Inspector — key. Capewide Enterprises Company Name 153 Commercial Street Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 4-9-18 pector'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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""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. 15ine.doc-rev.6116 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �Cv�VS {� abed xed dH SZZZ 21.0Z 06 Jd`d c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1661-1675 Falmouth Road(Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E!always complete all of Section D A) 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 system is a 5000 Gal. Tank. 1000 Gal. & 1500 Gal. G,T.'s.Three D Box's and twelve 500 Gal. Chamber's. B) 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); t5ins.doc-rev.6116 Title 5Official Inspection Form:Subsurface Sewage Disposal System-Pap 2 of 17 g a5ed xed dH RZZ 81.0Z 01, Jd'd Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owners Name information is Centerville MA 02632 4-9-18 required for every page. CityfTown State Zip Code Date of Inspection B. Certification (cant.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ 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): C) 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 t5ins.00c-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 9 a5ed xed dH SEZE 860E 06 Jdy 1 f Commonwealth of Massachusetts UVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ; 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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. 3. Other: D) 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 ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in MEMO is less than 6"below invert or available volume is less than '/day flow L EACY1 Ny t5ins.doc-rev.W16 Title 5 Official Inspectlor.Form:S bswface Serwage Disposal System-Page 4 of 17 L abed xed dH SZ:ZZ 8 60Z 0 6 Jd`d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® 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 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 200Dgpd- 10,000g pd. ® 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. E) 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 D. 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 Zane II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered Y "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins.doc-rev.W16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 9 a5ed xed dH 9ZZZ 81.0Z 01, JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: 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)] D. System Information 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): t5ins.doc•rev.6il 6 Title 5 Official Inspection Forth;subsurface Sewage Disposal System•Page a of 17 6 a5ed xe:1 dH 92:22 8 U 0 6 Jdf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1661-1575 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. CityrTown Stale Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No 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 Commercial/Industrial Flow Conditions: Type of Establishment: Retail and Food Buisnesses Design flow(based on 310 CMR 15.203): 1815Galion$per day(9Pd) Basis of design flow(seatslpersonslsq.ft., etc.): 58 Seats- 10100 Sq. Ft. Grease trap present? ® Yes ❑ No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: NA t5ins.doc•rev.U16 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 7 of 17 06 abed xeJ dH LZ:eE 860E 06 Jdf Commonwealth of Massachusetts : Title 5 Official Inspection Form 1. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Y 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page, Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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): G.T.'S t5ins.doc•rev.&16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 abed xed dH LZZZ ME 06 udV c Commonwealth of Massachusetts t qTitle 5 Official Inspection Form Cs Subsurface Sewage Disposal System Form-Not for Voluntary Assessments wv 1661.1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. City/Town State Zip code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank and D Box 1980's/and Leaching 2006 Permit#2006 -2331 New D Box 4-2015. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3' 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.): Pipeing is C.1 and 4" PVC SCH 40. Septic Tank(locate on site plan): 2' Depth below grade: 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: 5000 Gal. Precast H-20 2° Sludge depth: t5ins.doc•rev.SM6 Title 5 Official Inspection Form!Subsurface Sewage Disposal system-Page 9 of 17 ZI, abed xeJ dH R:ZZ 81.0Z 06 Jdf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle NA 1, Scum thickness Distance from top of scum to top of outlet tee or baffle V. Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Plan -Asbuilt Sludge Judge Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 2" below grade w/steel covers. Four inlet tee's outlet tee wlaable filter. No sign of leakage or over loading. Grease Trap(locate on site plan): 2' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions; 1000 Gal. & 1500 Gal. Scum thickness 1" 1" Distance from top of scum to top of outlet tee or baffle 811 8" Distance from bottom of scum to bottom of outlet tee or baffle 3' 3' Date of last pumping: NA Date t5ins.doc-rev.6115 Title 5 Dmclal Inspectlan Form:Subsurface Sewage Disposal System-Page 10 of 17 £l, abed xed dH R:ZZ 8 OZ 0 6 Jd`d I .�t\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments v 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): G.T.s are at working level wlsteel covers. In and out let tees. No sign of leakage or over loading. 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 Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date I Comments(condition of alarm and float switches, etc.): •Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i5ins.doc•(ev.E116 Tltle 6 Official Inspedw)Form:SLtsurface Sewage Disposal System•Page 11 of 17 b 1, a5ed xed dH R ZZ 81.02 01, JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. CityrTown State Zip Code Date of Inspection D. System Information (cont.) 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,): Two older D Box's are clean and solid with steel covers. No sign of over loading. One new D Box w/steel cover at grade 4-2015. 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.016 Title 5 Official Inspection Form subsurface sewage Disposal system-Page 12 of 17 Sl a5ed xed dH 62?Z 860Z 01, JdV Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. City/Town Slate Zip Cade Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 12 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is twelve 500 Gal. dry well chamber's w/steel cover's. Leaching is two sets of six each Chamber's w/3'stone between and 4' stone on sides. 8"water in chambers. No sign of over loading. Wall's clean like new. 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 l5ins.doc•rev.6115 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 9t a5ed xeJ dH 62:22 860Z 06 udf Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.).- 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.): 15ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•PaGe 14 ar17 abed xed dH 6Z:ZZ 8 U 06 JdV c Commonwealth of Massachusetts vTitle 5 Official Inspection Form vv Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) 1�50_ Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 pays. City(rown State Zip Code Date of Inspection D. System Information (cont.) 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 t5ins.doe-rev.6/16 Tale 5 Official Inspection Forth:Subsurface Sewage Disposal System Page 15 of 17 g a5ed xe, dH 6Z:ZZ 860Z 0L Jdf N 1 � I r. 1 � f M i Q I . Y x • I ti wa [4. 6 6 a5ed YP� dH DUE M2 M JdV i Commonwealth of Massachusetts -� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661-1675 Falmouth Road (Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NJ Estimated depth to high ground water: 20'+ 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: 3/10/06 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: No G.W. 20'+ Per Past Report, T.H. on Design plan 3-10-06 noG.W. at 11'-6" . Bottom of chambers at 6-6" below grade. Bottom of chambers at 5'above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. Mns.doc-rev.6l16 Tille 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 16 of 17 OZ a5ed xed dH 0£ZZ 260Z 01. JdV Commonwealth of Massachusetts Title 5 Official Inspection Form c Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661-1675 Falmouth Road(Rt 28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 4-9-18 page. Cityr town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed % System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached In separate file t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 6Z a5ed xeJ dH ORE 81.02 06 JdV Apr 10 2018 2230 HP Fax page 19 E i w � � t t O 1 . r �I 1 Q 0 1 r N 5 No. Lf Vv,615 f�AzA ee ' THE'COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for 3hgozOY �bpztem Cowgtruction permit Application for a Permit to Construct O Repair� Upgrade O andon O ElComplete System Individual Components Location Address or Lot No.to6 " O Owner's Name,Address,and Tel.NO. 16 6'Aja rV5 I -4 Ap%�i Assessor's Map/Parcel Ad ncz Aw!&$ atom I L-0 A Installer's Name,Address,and Tel.No. 3 a�9y esigner's N ,Address.and T 11..No. SC15 Ca kP o n O Na ��19/*r`� y'{�'�" '9100-AIDDs gas Dr"r VA Ot6) y Type of Building: f- ' I Dwelling No.of Bedrooms Lot Size + 1q , sq.ft. Garbage Grinder Other Type of Building caw �Noi of�ersons Showers( ) Ceria( ) Other Fixtures / afet 1 Design Flow min.required)_ b_ gpd Design flow provided gpd pT11 Plan Date Number of sheets Revision Date Title Size of Septic Tank 5_ T Type of S.A.S. — /QS Description of Soil �- C Z , Nat re of Repaily or Alterations(Answer when applicable) Date last inspected: sgn- Agreement: The undersigned agrees to ensure theovi d maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Tit, oftal Code and not to place the system in operation until a Certificate of Compliance has been issued by th' o n Si /Vo/9 LCR ►YO'l`VIA Date Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. �p '— Date Issued Y II n b""" "�� x 't` 0-7 _.TH1E" t Entered,n computer: ! COMMONWEALTH OF MASSACHUSETTS k _ PUBLIC HEALTH DIVISION - TOWN .OF BARNSTABLE, MASSACHUSETTS 'Yes Application for �Mpo!6al 6pg;tem Construction i3erm t Application for a Permit to Construct( ) Repair(1() Upgrade( ) Abandon( ) ❑ Complete Complete! iJ Individual Components 'Location Address or Lot No./ r�r n� , ` �,/� O Owner's Name,Address,and Tel.No.� ��� kkA Assessor's Map/parcel 1 ��2(/VCL;� Z Sod-3q�, yE / g (� � .►(iV�7>2� 5�,� , Installer's Name,Address,and Tel.No. / esi ner's Nam ,A,yrd��dress )�and Tel.No. `DA00no SC )� 826 - Cho ,7 Y Type of Building: Dwelling No.of Bedrooms Lot Size I jq & sq.ft. Garbage Grinder �/ v " . Other Type of Building T iNo.noff ersons Showers( ) Cafeterta;( ) Other Fixtures �iJ Design Flow min.required)j gpd Design flow provided f �, gpd " Plan Date p Number of sheets nn Revision Date ' Title Size of Septic Tank `J 000 6A L X' ST. Type-o S.A.S. Sr,7,dFPS Description of Soil '"� h Q 1 Nature of Repai or Alterations(Answer when applicable) T rT Try E r G Z) lti 2 A Gam' M-V 1 �• 5 Date last inspected: S F ?1000 ,*Agreement: The undersigned agrees to ensure the cogstr etion and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title if nvirfi ntal Code and not to place the system in operation until a Certificate of Compliance has been issued by thi51 a d o eat „,•µ E Z Z �(J Signe lvp1��a4n Puk Date — Application Approved b�. _ Date Application Disapproved by: Date for the following reasons Permit No. QW (D �� Date Issued n -------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by at has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 11C)L "3 3 dated ✓`'!/ Installer Designer #bedrooms Approved design flow gpd The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector O No. Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS =t5pogar,6p5tem Construction Permit Permission is hereby granted to Construct Repair ( `� U rade ( ,,`�Abandon ( ) System located at (� n1UV c11 r )i "cl V I and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construct•on m st be completed within three years of the date(of this pe Date b Approved ____ CENTERVILLE PLAZA -Wastewater Design Flow Comparison WASTEWATER DESIGN FLOW CALCULATIONS- MAY 2006 /r Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 pd/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1667 Ba side Design & Remodeling Office 1,200 sf office X 75 d/1000 sf 90 1669 Light Speed Mortgage 2,400 sf office X 75 d/1000 sf 180 1671 Cape Cod Chicken fast food 16 seats X 20 d/seat 320 1673 Kelle 's Music 1,500 sf retail X 50 gpd1000 sf 75 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,815 GPD WASTEWATER DESIGN FLOW CALCULATIONS-JANUARY 2015 Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 d/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1665 New Thai Restaurant fast food 10 seats X 20 d/seat 200 1667 Vacant Office 1,200 sf office X 75 d/1000 sf 90 1669-1671 Cape Cod Pie fast food 16 seats X 20 d/seat 320 1673 Centerville Cleaners 1,500 sf total 80% Storage &20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,805 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW(May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING & ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 I� tit -a /°(/o CENTERVILLE PLAZA -Wastewater Design Flow Comparison WASTEWATER DESIGN FLOW CALCULATIONS- MAY 2006 Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 pd/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 pd/1000 sf 180 1667 Ba side Design & Remodeling Office 1,200 sf office X 75 d/1000 sf 90 1669 Light Speed Mortgage 2,400 sf office X 75 d/1000 sf 180 1671 Cape Cod Chicken fast food 16 seats X 20 d/seat 320 1673 Kelle 's Music 1,500 sf retail X 50 gpd1000 sf 75 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,815 GPD WASTEWATER DESIGN FLOW CALCULATIONS-JANUARY 2015 Unit Address Use/Area Title 5 Design Flow d 1661 Pinocchio Pizza fast food 42 seats X 20 d/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 pd/1000 sf 180 1665 New Thai Restaurant fast food �a 10 seats 20 pd/seat 200 d - SF S e S 65 1667 Vacant Office 1,200 sf office X 75 d/1000 sf 90 1669-1671 Cape Cod Pie fast food 16 seats X 20 d/seat 320O c C-P .4 of a. & fie. 1673 Centerville Cleaners 1,500 sf total 80% Storage&20% Retail = 300 sf x 15 50 d/1000sf + 2 em to ees x 15 gpd 30 1675 Rt. 28'Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,805 GPD -� G % //' EXISTING APPROVED TITLE 5 DESIGN FLOW(May 2006): 1,815 GPD "u`� EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 ,. «m ---- P�C` Pin e A C�� rF.s C� s l? ml—, (� � 2Z) ht to Z5F P &-av is, 1,and Sr __---_--___ �} /s oo s F 707-0'Z- AA s' _ 7 TOWN OF BARNSTABLE C. �7 LOCATION - � �H v✓� fit SEWAGE# a U U� - 233 ;PILLAGE ,"ki "IbE ASSESSOR'S MAP&PARCEL).C° - INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �90 y LEACHING FACILITY:(type) CLP--�r�size) �- NO.OFBEDROOMS OWNER rnr t o u PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on • site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY 1I�TGwnwalERlll _-- (( le lufllftsnq I\ ./— 1 y��s—�yT_I� 1 snNGe-sao GNuaN @ �fi'TUWN WAI'ERIIIJ[IYIREY(<GiFl:l101al 1\�` l / �i�l�. NTB LEACNWGCNAMBEPB 9 a Ewsr.BamJ=(xmvaGx' E0114llIDis) q I.10AC.x / 1 F' 4 _J / r� BunnwacauuNtrvP) v v _ _ c v BAYBERRY: CONDOM \\ ( 13eMnuk Y18M E%I —G COMMERCIAL \\\ \ Appox.MaSV.L.D�xn (13A S.F..TOTPL) CENTERVILLE PLAZA \ E%IBT.BOpRlET N239BO%' BG �� <s j WHEFL � } s (d FlFlOW EGUALlTff15) \ ) \ RISER�I P(UYE•COVFAT—E(M STING 8-SOOGAILON LEA .GClULIBERS S •\ C61011 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: 2-' i Fill in please: APPLICANT'S YOUR NAME/S: a BUSINESS YOUR HOME ADDRESS: ca TELEPHONE # Home Telephone Number 0�i NAME OF CORPORATION: NAME OF NEW BUSINESS T---ouy ►1�, ( �'t�fl TYPE OF BUSINESS Mn; I SaImi IS THIS A HOME OCCUPATION? YES NOS_ ADDRESS OF BUSINESS MAP/PARCEL NUMBER — — PE-(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%he R'S OFFICE This individu e o an pe it requirements that pertain to this type of business. zed 8tgnat * r I4 COMMENTS: 2. BOARD OF HEALTH This individual has been i r ed of th permit requirements that pertain to this type of business. A th Kized Sig COMMENTS: 2 n1 C 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature �: COMMENTS: c , Kristin Terkelsen c. Physical Therapy Solutions z 1663 Falmouth Road Centerville, MA 02632 ay Thomas A,.McKean Town of Barnstable , Director of Public Health June 20, 2016 Dear Mr. McKean, Thank you for your prompt and thorough attention with regard to the permitting of a nail salon. Within the Centerville Plaza.We are all concerned with the plaza's wastewater discharge and the maximum allowed by Title V and the Saltwater Estuary Protection Regulations. l would appreciate some clarification, if possible,with respect to a few issues 1 feel of relevance with the licensing of the nail salon. Referencing the wastewater design calculations drafted by Pesce Engineering I understand that the maximum discharge of 1815 GPD will be enforced for the entire Plaza. 1. If the proposed nail salon would add a third employee,either a receptionist or manicurist, would this be in violation of their permit?Which town department would enforce such a violation? 2. It has been brought to my attention that there is the possibility of an option to expand the nail salon into the Bayside unit. l assume that units 1665, Bayside and 1667,Nail Salon would be limited to,a combined output of 1,8.0,.GPD._Since the Baysitde unitIs.now limited to 68.2 GPD,what would the limit of employees'and or pedicure chairs in the combined spaces provide for? 3. Will the license issued by the board of health list the maximum number of employees at the location?Will the license issued list the maximum number of pedicure chairs? 4. Would a washing machine for soiled linens be allowed on the premises? 5. In reference to an email dated 4/16/1610:56am from Ed Pesce toThomas McKean the plaza has an`extra 57.8 GPD to work with'.Will this be available for future calculations or Will we be held to your 1815 GPD for the plaza and 108 GPD to the nail salon?Who would be entitled to the extra 57.8 GPD.Would the Pie Company be able to use it?It certainly would add to the value of any unit. How would the capacity be allocated to unit owners? Thank you for your attention to these questions. Sincerely K stin erkelsen CENTERVILLE PLAZA -Wastewater.Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address d 1661 Pinocchio Pizza fast food 36 seats X 20 d/seat 720 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1665 Office Ba side Builders Showroom 90'9 X,75�gpd/1000sf "� 5$��2 _ �� ' - t x NO � pedreures. 20cutornrs/daX3Vie .. 9f-offi`c'6e X�75 gpd%100 sf (office, 1'8 4 a P ca eandtoil t area,t Abe ducted from "' �ad acentunit#1665 1669-1671 Centerville Pie Restaurant 16 seats X 35 d/seat 560 1673 Centerville Cleaners 1,500 sf total . 80% Storage & 20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 ' d 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD. EXISTING TITLE.5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 -� From: Ed Pesce [mailto:epesce@comcast.net] Sent: Monday, April 25, 2016 9:13 AM To: McKean,Thomas Cc: karenonthecape(-ahotmail.com; Chris D'Aveta; epesceo-comcast.net Subject: Centerville Plaza - Proposed Nail Salon Good Morning Tom, I stopped by the office on Thursday to try and speak to you, but you were tied up with meetings and interviews. Knowing you were planning to be out on Friday, I thought I would follow up with you in an e-mail today. I dropped off some hand notes and drawings on Thursday and attached is an updated wastewater flow table showing the proposed nail salon and office space changes shaded in Blue. The highlights are: 1. The nail salon will have just 2 employees (husband & wife) 2. They expect to do manicures and pedicures 3. They are estimating 15-20 pedicures(max) per day— so I used 20/day (10 per employee) 4. The pedicures will be done with a special chair (manufacturer's cut sheet attached), which uses water —the basin in the chair holds about 4 gallons, and they only fill the basin about half way (since the customer's feet take up some of the volume:) — but I used a volume of 3 gallons/pedicure as a worst case estimate. 5. The Salon is proposed to occupy a unit that does not have a toilet, so they are planning to use the connecting door to the adjacent unit (#1665) to gain access to,a toilet, which can be separated from the rest of#1665 by a locked door. This space also has some room for an office, so I have used that 245 SF in my calculations (for office flow): I left copies of floor plans to better explain this. So overall the proposed nail salon use does not exceed the existing septic system capacity, as shown on the attached table. Please review this, and let me know if the proposed tenant can proceed with their plans. Thank you, ED Edward L. Pesce, P.E., LEEDI�AP Pesce Engineering &Associates, Inc. 451 Raymond Road Plymouth, MA 02360 office: 508-743'9206 Fax: 508-743-021.1 Cell: 508-333-7630 epesceCaD.comcast.net 2 i McKean, Thomas From: Ed Pesce <eP esce@comcast.net> Sent: Tuesday, April 26, 2016 10:56 AM To: McKean,Thomas Cc: brian.dudley@ state.ma.us; Brian Dacey; karenonthecape@hotmail.com Subject: RE: Centerville Plaza - Proposed Nail Salon Hi Tom, I had a good meeting with Brian Dudley yesterday afternoon at his office in Barnstable. Brian reviewed my approach and wastewater flow calculations,and has endorsed my methodology. He found it reasonable, and asked that you contact him if you have any questions. Also, while I was there discussing this with him, he noticed my calculations of design flow and leaching capacity on the table I sent him. He wanted you to know that the actual approved capacity is the calculated leaching capacity in this case, not the Title 5 Application design flow. He explained that the design flow number only applies to systems installed under the.,1978 Code. All newer systems (1995 Code) can be allowed to use the total calculated leaching capacity of the leaching system that was installed as the actual septic system capacity. So based on the above, we actually have an extra 57.8 GPD to work with at this site. ` Again, please contact Brian is you have any questions on this. Thank you Tom, ED Edward L. Pesce, P.E., LEEDI�AP Pesce Engineering &Associates, Inc. 451 Raymond Road Plymouth, MA 02360 Office: 508-743-9206 Fax: 508-743-0211 Cell: 508-333-7630 epescea-com cast.net From: McKean, Thomas [mailto:Thomas.McKean tow n.barnstable.ma.us] Sent: Monday, April 25, 2016 9:27 AM To: Ed Pesce Subject: RE: Centerville Plaza - Proposed Nail Salon HI Ed, Please ask Brian Dudley of DEP if he agrees with this methodology. 1 . i Town of Barnstable WE Department of Health, Safety, and Environmental Services * BARNSTABLE, : Public Health Division MASS. 039. ,0� 367 Main Street,Hyannis MA 02601 �E4 MA'S A Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health June 17, 2016 Ms. Kristen Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dear Ms. Terkelsen, I am in receipt of a copy of your letter dated June 9, 2016 addressed to the Chairman of the Board of Health. Paul Canniff, DMD regarding the nail salon at 1667 Falmouth Road, Centerville. In regards to the wastewater concerns expressed in your letter, the following issues were recently addressed by this Office: a) The limited size/capacity of the septic system; and b) The site location within an Estuary Protection Zone which limits the wastewater discharge flow to 440 gallons per acre per day. The existing septic system has a capacity of 1,869 gallons at Centerville Plaza, 1661 through 1675 Falmouth Road, Centerville. In the past, 1,815 gallons per day (GPD) of discharge was permitted at this site. This site is therefore grandfathered for a wastewater discharge flow of 1815 GPD. As you can see from the attached chart, each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day, which is the maximum wastewater discharge allowed for this site. The nail salon itself is restricted to 108 gallons per day maximum discharge as shown on the attached chart and as reviewed and approved by Brian Dudley of the Massachusetts Department pf Environmental Protection (DEP). Please also see copies of his a-mails from the engineer, Ed Pesce P.E. attached. Your questions regarding construction, permitting, subdivision a unit, sinks, bathrooms, and drain pipe connections should be directed to the Acting Building Commissioner Paul Roma at (508) 862-4038 and to the Plumbing Inspector Laurent Lemieux (508) 862-4028. Sincerely, Pomas McKean Cc: Paul Canniff, D.M.D. Paul Roma, Acting Building Commissioner Laurent Lemieux, Plumbing Inspector f CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address ( d 1661 Pinocchio. Pizza (fast food) 36 seats X 20 pd/seat 720 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1665 Office (Ba side Builders Showroom ti y 245 sf office Xk75 gpd/1000 sf (office' =4 F* 18 41. 1669-1671 Centerville Pie (Restaurant) 16 seats X 35 pd/seat 560 1673 Centerville Cleaners 1,500 sf total) 80% Storage & 20% Retail = 300 sf x 15 50 pd/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 pd/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING & ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.203: continued MINIMUM ' k= ALLOWABLE `1 GPD FOR GALLONS SYSTEM TYPE OF ESTABLISHMENT UNIT PER DAY DESIGN (3) COMMERCIAL(continued) Factory,Industrial Plant, per person 15 Warehouse or Dry Storage : . Space without cafeteria Factory,Industrial Plant, Warehouse or Dry Storage :. Space with cafeteria per person 20 Gasoline Station per island***** 75 300 - with service bays •per bay 125 Plus flows for bays,if any I KenneYVeterinary Office per kennel 50 pj? Lounge,Tavern per seat 20 Marina per slip 10 500 ?` ,,�; Movie Theater per seat 5 ' Non-single family/ per washing 400 �l automatic clothes washer machine _` $I Office building per 1000 sq.ft. 75 200 Retail Store(except supermarkets) per 1000 sq.ft. 50 200 Restaurant�, _ •. per sea[ 35 1000 Restaurant,thruway per seat 150 1000 3 service area Restaurant,Fast Food per seat 20 1000 Restaurant,kitchen flow per seat 15 t`r; [for sizing of grease tl: ,�, trap only] `y',I� ` Service Station per bay 150 450 [no gas] a=t'' Skating Rink per seat 5 3000 Supermarkets per 1000 sq.ft. 97 IN Swimming Pool per person •10 Tennis Club per court 250 Theater,Auditorium per seat 3 " $-i"'"':' Trailer,dump station per trailer 75 (4) INSTITUTIONAL Place of worship without kitchen per seat 3 with kitchen per seat 6 Correctional Facility per.bed 200 Function Hall per seat 15 Gymnasium per participant 25 Gymnasium per spectator 3 Hospital per bed 200 Nursing Home/Rest Home per bed 150 Public Park,toilet per person 5 waste only a r:: 4121/06 310 CMR-510 McKean, Thomas From: Ed Pesce <epesce@comcast.net> Sent: Tuesday, April 26, 2016 10:56 AM To: McKean, Thomas Cc: brian.dudley@state.ma.us; Brian Dacey; karenonthecape@hotmail.com Subject: RE: Centerville Plaza - Proposed Nail Salon Hi Tom, I had a good meeting with Brian Dudley yesterday afternoon at his office in Barnstable. Brian reviewed my approach and wastewater flow calculations, and has endorsed my methodology. He found it reasonable, and asked that you contact him if you have any questions. Also, while I was there discussing this with him, he noticed my calculations of design flow and leaching capacity on the table I sent him. He wanted you to know that the actual approved capacity is the calculated leaching capacity in this case, not the Title 5 Application design flow. He explained that the design flow number only applies to systems installed under the 1978 Code. All newer systems (1995 Code) can be allowed to use the total calculated leaching capacity of the leaching system that was installed as the actual septic system capacity. So based on the above, we actually have an extra 57.8 GPD to work with at this site. Again, please contact Brian is you have any questions on this. Thank you Tom, ED Edward L. Pesce, P.E., LEEDpAP Pesce Engineering &Associates, Inc. 451 Raymond Road Plymouth, MA 02360 Office: 508-743-9206 Fax: 508-743-0211 Cell: 508-333-7630 epesceCacomcast.net From: McKean,Thomas [mailto•Thomas McKean(a)town.barnstable.ma.us] Sent: Monday, April 25, 2016 9:27 AM To: Ed Pesce Subject: RE: Centerville Plaza - Proposed Nail Salon HI Ed, Please ask Brian Dudley of DEP if he agrees with this methodology. i c From: Ed Pesce [ma i Ito:epesceOlcomcast.net] Sent: Monday, April 25, 2016 9:13 AM To: McKean,Thomas Cc: karenonthecape(ftotmail.com; Chris D'Aveta; eepesce@comcast.net Subject: Centerville Plaza - Proposed Nail Salon Good Morning Tom, I stopped by the office on Thursday to try and speak to you, but you were tied up with meetings and interviews. Knowing you were planning to be out on Friday, I thought I would follow up with you in an e-mail today. I dropped off some hand notes and drawings on Thursday and attached is an updated wastewater flow table showing the proposed nail salon and office space changes shaded in Blue. The highlights are: 1. The nail salon will have just 2 employees (husband & wife) 2. They expect to do manicures and pedicures 3. They are estimating 15-20 pedicures (max) per day— so I used 20/day (10 per employee) 4. The pedicures will be done with a special chair (manufacturer's cut sheet attached), which uses water —the basin in the chair holds about 4 gallons, and they only fill the basin about half way (since the customer's feet take up some of the volume)— but I used a volume of 3 gallons/pedicure as a worst case estimate. 5. The Salon is proposed to occupy a unit that does not have a toilet, so they are planning to use the connecting door to the adjacent unit (#1665) to gain access to a toilet, which can be separated from the rest of#1665 by a locked door. This space also has some room for an office, so I have used that 245 SF in my calculations (for office flow). I left copies of floor plans to better explain this. So overall the proposed nail salon use does not exceed the existing septic system capacity, as shown on the attached table. Please review this, and let me know if the proposed tenant can proceed with their plans. Thank you, ED Edward L. Pesce, P.E., LEED@AP Pesce Engineering &Associates, Inc. 451 Raymond Road Plymouth, MA 02360 Office: 508-743-9206 Fax: 508-743-021.1 Cell: 508-333-7630 epesce(cD.co m cast.net 2 J Caf gt Kristin Terkelseno Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dr. Paul Canniff Town of Barnstable Board of Health June 9, 2016 Dr. Canniff, I appreciate your interest with regard to the permitting of a nail salon within the Centerville Plaza. In addition,we appreciate your work on the board with regard to water quality issues facing the town of Barnstable. After some research I was able to find regulations from the state as well as the town of Halifax. David spoke with Cathleen Drinan at the Health Department with the town of Halifax and was involved with drafting their regulations. She was very helpful and informative. As I stated, a nail salon will be opening at the vacant unit, #1667 between Bayside Designs and the Centerville Pie Company. Please reference Condominium Building Plan prepared by Baxter and Nye 08/05/08. Unit 5 is the proposed Nail Salon. The prior usage of units 4 and 5 were as an office and or mortgage business. Historically unit 5 NEVER had plumbing or a bathroom because it was part of a double unit. At some point units 4 and 5 divided into two separate units, the Pie Company taking one side with the bathroom/plumbing which currently services their retail store,while unit 5 was left without a bathroom/plumbing. We certainly respect the rights of property owners within the plaza as there might be a point in time that Ms. Terkelsen may want to sell her two units. Our concerns are two- fold. One, how was it that a unit that previously had no contribution to the flow into our septic was allowed to add plumbing without any change of use or regulation or consideration of the impact on our commonly shared septic? The use of the space as a nail salon will add to the flow into our system. Each chair has its own tub producing waste water. Also there is additional waste water from washing towels, tools, equipment, hands, floors etc,. Secondly, we would like clarification on the process by which a unit owner could potentially divide an existing double unit. Would the addition of bathrooms and/or wastewater contributing plumbing be allowed in a subdivided unit where none existed prior?Would we be entitled to add plumbing and bathrooms while subdividing our units? � As stated, it seems there will be the addition of plumbing to unit#1667 for the nail salon, which until now has had no plumbing. Would the addition of plumbing require a change of use for this space from the perspective of the town? Would this added discharge to the existing system need to be considered for permitting this business? We are aware that even the addition of a seat within a restaurant in the plaza is closely regulated, specifically a removal of chairs within the Centerville Pie Company had been recently enforced. Eventually, I believe, some compromise has been worked out Wastewater Concerns A major consideration prior to the purchase of our property was the condition and maintenance of`the septic system. Our attorney Phil Boudreau, felt that in the case of a septic failure, we would most likely be required to upgrade to a de-nitrification septic system at a tremendous cost and disruption to the businesses in the plaza. A septic consultant I asked felt that certain chemicals potentially discharged by a nail or hair salon could eliminate the bacteria in a leaching field causing a system failure. With these concerns in mind, is the quantity of anticipated discharge from the nail salon not regulated by the town or permitting process? The contribution to the septic from the nail salon would be a result of the number of workstations, number of employees, number of clients served daily, etc.? Is this regulated by the permitting process? Is there concern for the chemicals discharged into the septic system as demonstrated by the permitting process for this type of business? Would having a clothes washer for cleaning the linens be regulated by the town permitting process? Should there be a holding tank for the discharge from the nail salon? Could the business expand into the adjacent unit 6 without regards to these concerns due to the nature of personal services permitting? Would there be any cap on the workstations and or discharge with a potential additional unit? Permitting We were surprised at the speed at which the renovations and retrofitting occurred. Monday 5/23, the noise of jackhammers seemed to be coming from our bathrooms located against the common wall with unit 1665, Bayside Designs, giving us cause for concern. In the past, we had multiple episodes of sewage backing up in our bathrooms from the waste line ultimately I observed the workers were tying into. It was an ongoing issue not long after opening the clinic and all too frequent to the point of being a potential health issue for employees and patients alike. My partner, David Stepanis, decided to follow the noise to the adjacent unit where I he two men working on the plumbing in the Bayside unit. David expressed his concerns to them about an engineering plan, permits and the scope of the work, but an apparent language barrier left questions unanswered. He observed the toilets had been removed with the cement floors cut open exposing our sewage drain pipe. Trenches had been excavated below grade from our common wall shared with the Bayside unit, all the way across unit 1665, into the nail salon unit 1667. 1 am guessing that the outfall from the nail salon will be directed across the Bayside unit into the waste line that we use for our `i bathrooms. Certainly we are concerned that the additional waste could cause our sewage problems to reoccur. This prompted David to go to the town offices building department and speak with Sally just before noon Monday, 5/23. He asked if any permits had been issued for the work and Sally responded no. This was surprising since I had a phone conversation with Ms. Anderson at regulatory services Tuesday, 5/17 in which I was led me to believe that all required permits were in place. This included a reconfiguration of the space, plumbing and electrical alterations as well as an engineering assessment provided by the unit owner. It was our understanding from the conversation that the zoning label of"personal services"would not require the town's regulation with this new business. There were no concerns to be addressed with any septic,wastewater, parking or traffic in the permitting of the new business. Following the conversation with the building department, David called both the enforcement agent, Ms. Anderson, and building inspector, Mr. Lauzon. Neither person answered so he left messages explaining that construction had begun possibly without permits in place. I asked if they would come out to inspect the construction being done at both units 1665 and 1667. Upon phone conversations with both Ms. Anderson and Mr. Lauzon Tuesday morning, an inspector stopped at the unit during business hours on Monday. The nail salon unit was locked, windows covered and no one responded to knocking at the door. I was at our adjacent unit 1663 between 5 and 6pm Monday and there were still many work trucks outside the entrance as there had been all day. Although I was not present, our office staff noticed there were again many construction vehicles outside 1665 and 1667 the morning of 5/24, even into spaces in front of our unit. It is certainly my hope that all the work has been done by licensed plumbers based on an engineering plan. It is my understanding a permit for the nail salon was issued late Monday, but not for unit 1665 that we share the sewer waste pipe with. Summary As I am sure you are aware,the town is currently dealing with a new problem of contaminated well supply water in Hyannis. What initially had been considered"Safe" practices of chemical disposal into an area of contribution now turns out to be a potential health concern for residents and possibly a very expensive issue for the town. Taking into consideration there are already 3 nail salons between Phinney's Lane and Old Stage on route 28,would it not be prudent to direct location of future nail or hair salons to existing sewered properties? I would consider a salon as a non-essential service and in an already saturated area with traffic,parking and sewage concerns. Would it not be wise to consider a moratorium on permits for nail or hair salons in areas of contribution using private septic systems? Regards, Kristin Te k sen � I i i a� yg• 8 $ I LL pal u _ - JT! -TI g �iY ®AT ` vi � MIN POCFOSID 17, list Jo 1 td Town of Barnstable �(NE Department of Health, Safety, and Environmental Services BARNSTABLE, *MASS. _._Public Health Division y i639. 367 Main Street, Hyannis MA 02601 f0 MP Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health June 21, 2016 Ms. Kristen Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dear Ms. Terkelsen, Thank you for your letter dated June 20, 2016 regarding the nail salon at 1667 Falmouth Road, Centerville. This type of establishment is not licensed by the local Board of Health; nail salons are licensed by the State of Massachusetts. As indicated in the June 17th letter, the existing septic system has a capacity of 1,869 gallons at Centerville Plaza, 1661 through 1675 Falmouth Road, Centerville. In the past, 1,815 gallons per day (GPD) of discharge was permitted at this site. This site is therefore grandfathered; each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day which is the maximum wastewater discharge allowed for this site. To answer your question #5, there is no extra capacity available above 1815 GPD due to the Saltwater Estuary Protection Ordinance which restricts wastewater discharge flows to 440 gallons per acre per day. Mr. Pesce was in error in his e-mail dated April 26, 2016 regarding 57.8 GPD; there is not any extra capacity available. He was immediately advised of this restriction. The nail salon is restricted to 108 gallons per day maximum discharge as approved by Brian Dudley of the Massachusetts Department of Environmental Protection (DEP). This is based on two employees, not three. The Health Division should be contacted if additional employees are observed there at the same time. A washing machine is allowed on the premises. If this business expands into another unit, the proposed wastewater discharge will have to be recalculated and reviewed in regards to the number of employees and pedicure customers by the engineer prior to the issuance of an approval of a building permit. Sincerely, omas McKean Cc: Paul Canniff, D.M.D. S; t Kristin Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dr. Paul Canniff Town of Barnstable Board of Health June 9, 2016 Dr. Canniff, I appreciate your interest with regard to the permitting of a nail salon within the Centerville Plaza. In addition, we appreciate your work on the board with regard to water quality issues facing the town of Barnstable. After some research I was able to find regulations from the state as well as the town of Halifax. David spoke with Cathleen Drinan at the Health Department with the town of Halifax and was involved with drafting their regulations. She was very helpful and informative. As I stated, a nail salon will be opening at the vacant unit, #1667 between Bayside Designs and the Centerville Pie Company. Please reference Condominium Building Plan prepared by Baxter and Nye 08/05/08. Unit 5 is the proposed Nail Salon. The prior usage of units 4 and 5 were as an office and or mortgage business. Historically unit 5 NEVER had plumbing or a bathroom because it was part of a double unit. At some point units 4 and 5 divided into two separate units, the Pie Company taking one side with the bathroom/plumbing which currently services their retail store,while unit 5 was left without a bathroom/plumbing. We certainly respect the rights of property owners within the plaza as there might be a point in time that Ms. Terkelsen may want to sell her two units. Our concerns are two- fold. One, how was it that a unit that previously had no contribution to the flow into our septic was allowed to add plumbing without any change of use or regulation or consideration of the impact on our commonly shared septic? The use of the space as a nail salon will add to the flow into our system. Each chair has its own tub producing waste water. Also there is additional waste water from washing towels, tools, equipment, hands, floors etc,. Secondly, we would like clarification on the process by which a unit owner could potentially divide an existing double unit. Would the addition of bathrooms and/or wastewater contributing plumbing be allowed in a subdivided unit where none existed prior? Would we be entitled to add plumbing and bathrooms while subdividing our units? As stated, it seems there will be the addition of plumbing to unit #1667 for the nail salon, which until now has had no plumbing. Would the addition of plumbing require a change of use for this space from the perspective of the town? Would this added discharge to the existing system need to be considered for permitting this business? We are aware that even the addition of a seat within a restaurant in the plaza is closely regulated, specifically a removal of chairs within the Centerville Pie Company had been recently enforced. Eventually, I believe, some compromise has been worked out Wastewater Concerns A major consideration prior to the purchase of our property was the condition and maintenance of the septic system. Our attorney Phil Boudreau, felt that in the case of a septic failure, we would most likely be required to upgrade to a de-nitrification septic system at a tremendous cost and disruption to the businesses in the plaza. A septic consultant I asked felt that certain chemicals potentially discharged by a nail or hair salon could eliminate the bacteria in a leaching field causing a system failure. With these concerns in mind, is the quantity of anticipated discharge from the nail salon not regulated by the town or permitting process? The contribution.to the septic from the nail salon would be a result of the number of workstations, number of employees, number of clients served daily, etc.? Is this regulated by the permitting process? Is there concern for the chemicals discharged into the septic system as demonstrated by the permitting process for this type of business? Would having a clothes washer for cleaning the linens be regulated by the town permitting process? Should there be a holding tank for the discharge from the nail salon? Could the business expand into the adjacent unit 6 without regards to these concerns due to the nature of personal services permitting? Would there be any cap on the workstations and or discharge with a potential additional unit? Permitting We were surprised at the speed at which the renovations and retrofitting occurred. Monday 5/23, the noise of jackhammers seemed to be coming from our bathrooms located against the common wall with unit 1665, Bayside Designs, giving us cause for concern. In the past, we had multiple episodes of sewage backing up in our bathrooms from the waste line ultimately I observed the workers were tying into. It was an ongoing issue not long after opening the clinic and all too frequent to the point of being a potential health issue for employees and patients alike. My partner, David Stepanis, decided to follow the noise to the adjacent unit where I he two men working on the plumbing in the Bayside unit. David expressed his concerns to them about an engineering plan, permits and the scope of the work, but an apparent language barrier left questions unanswered. He observed the toilets had been removed with the cement floors cut open exposing our sewage drain pipe. Trenches had been excavated below grade from our common wall shared with the Bayside unit, all the way across unit 1665, into the nail salon unit 1667. I am guessing that the outfall from the nail salon will be directed across the Bayside unit into the waste line that we use for our bathrooms. Certainly we are concerned that the additional waste could cause our sewage problems to reoccur. This prompted David to go to the town offices building department and speak with Sally just before noon Monday, 5/23. He asked if any permits had been issued for the work and Sally responded no. This was surprising since I had a phone conversation with Ms. Anderson at regulatory services Tuesday, 5/17 in which I was led me to believe that all required permits were in place. This included a reconfiguration of the space, plumbing and electrical alterations as well as an engineering assessment provided by the unit owner. It was our understanding from the conversation that the zoning label of"personal services" would not require the town's regulation with this new business. There were no concerns to be addressed with any septic,wastewater, parking or traffic in the permitting of the new business. Following the conversation with the building department, David called both the enforcement agent, Ms. Anderson, and building inspector, Mr. Lauzon. Neither person answered so he left messages explaining that construction had begun possibly without permits in place. I asked if they would come out to inspect the construction being done at both units 1665 and 1667. Upon phone conversations with both Ms. Anderson and Mr. Lauzon Tuesday morning, an inspector stopped at the unit during business hours on Monday. The nail salon unit was locked, windows covered and no one responded to knocking at the door. I was at our adjacent unit 1663 between 5 and 6pm Monday and there were still many work trucks outside the entrance as there had been all day. Although I was not present, our office staff noticed there were again many construction vehicles outside 1665 and 1667 the morning of 5/24, even into spaces in front of our unit. It is certainly my hope that all the work has been done by licensed plumbers based on an engineering plan. It is my understanding a permit for the nail salon was issued late Monday, but not for unit 1665 that we share the sewer waste pipe with. Summary As I am sure you are aware, the town is currently dealing with a new problem of contaminated well supply water in Hyannis. What initially had been considered"Safe" practices of chemical disposal into an area of contribution now turns out to be a potential health concern for residents and possibly a very expensive issue for the town. Taking into consideration there are already 3 nail salons between Phinney's Lane and Old Stage on route 28, would it not be prudent to direct location of future nail or hair salons to existing sewered properties? I would consider a salon as a non-essential service and in an already saturated area with traffic, parking and sewage concerns. Would it not be wise to consider a moratorium on permits for nail or hair salons in areas of contribution using private septic systems? RegardsKristin Ti, k sen D r i a � Ir PAN ------------ b» gi _ ap CA- C�3 Y I .m a A Ku ' I I . Rill s PROPOSEDWALL LOCAOM °> 2� Halifax Boar!of Health Regulations Pertaining to the Operation of Manicuring Salons Providing Artificial Nail Services TABLE OF CONTENTS I. Purpose-and Authority II. Definitions In. Board of Health Permit,Application,and Fees IV. Standards of Establishments V. Instrument Disinfection and Personal Hygiene vt. Prohibitions VII. Emergency-Closure vrII. Suspension of Permit UL Orders for Suspension x. Revocation of Permit M. Effective Date xII. Severability REGULATORY LANGUAGE L PURPOSE AND AUTHORITY The Halifax Board of Health finds it necessary to issue permits for the practice of nail enhancement in order to protect the public health and safety and fulfill its statutory authority and responsibility to protect workers and clients of artificial nail salons from, tome substances such as,but not hm ted to;Acetone,Tohrene;Methacrylic Acid(MMA), Ethyl Methacrylate(EMAJ Ethyl Cyanoachc,Formaldehydes,BenzoylPeroxide,and- other chemicals which cart be absorbed through the skin,eyes,and nails and by inhalation: It is the Board of Health's intent that only individuals and facilities which meet and maintain minimum standards of competence and conduct may provide such services to the public.The intent of the promulgation of these regulations is not to conflict with 240 CMR 1.00—7.00,Board of Registration of Cosmetology Regulations. Rather,these regulations are intended to supplement 240 CMR 1.00—7.00 with more stringent standards where necessary to protect the public health. The following regulations apply only to salons providing the services of artificial nails and sculptured nails. These regulations are adopted pursuant to the provisions of Chapter 111, Sections 5 and 31 of the Massachusetts General Laws. II. DEFINITIONS For the purpose of these Artificial Mail Salon Regulations,the following terms shall have the following meanings,unless the context clearly requires otherwise. Artificial Nails: The application and removal of sculptured,non-human,or non-natural nails at a manicuring salon. Breathin Zone: Area around the mouth and nose from which a person inhales air. Board of Health: The Halifax Board of Health and/or any person authorized to act as their agent. B.O.H.: Board of Health Disinfectant: The chemical or physical agent used in the disinfection process. Disinfection: A process that prevents m&vtion by killing pathogens. Usually applies to a chemical or physical process that kills the vegetative forms of bacteria. t Halifax Board of Health Regulations Pertaining to the Operation of Manicuring Salons Providing Artificial Nail Services Dust Masks: Devices worn over the nose and mouth to prevent inhalation of dust created by filing.Dust masks offer no protection against dangerous vapors and mists. They shad not be substituted for proper ventilation. Establishment: Manicuring Salon. Klement: Any instrument,either disposable or reusable,used in the practice of manicuring. License: A license issued by the Board of Cosmetology,to operate a manicuring salon. U DE>Ef iNiTIONS contd. Local Exhaustl An exhaust device that glues vapors,mists,and dusts at the source and expels them from the breathing zone.Local exhaust consists of a hose or tube which is moveable and can be placed at the source of the contaminant.Local exhaust is intended to remove the contaminants at the source and prevent them from reaching the breathing zone. Local exhaust is the preferred method of ventilation where possible. Exhaust must. be vented directly to the outside whenever possible. Exterior exhaust pipes must not impact neighbors or be located near any ventilation intakes. When venting directly to the outside is impossible,the salon air shall be filtered through a HEPA filter and at least a five gallon canister packed with activated charcoal or an equivalent filter. Manicurins: The act of cutting, shaping,polishing,or enhancing the appearance of the nails of the hands or feet. The application of these regulations is limited to the application and removal of sculptured or artificial nails. Manicuring Salon: Any establishment,room,group of rooms,office building,place of business,or premises,where manicuring services are performed by a professional or student/apprentice practitioner with or without monetary compensation. N n Sanitaars Sewage: Liquid waste discharge from any source other than domestic, ii—commercial,and other non-industrial sources.For the purpose of these regulations,this includes any discharge containing chemicals, solutions,or solid waste created by,or used in,the process of the application,removal,or sculpturing of artificial nails. Permit: A permit to operate a manicuring salon will be issued by the Halifax Board of Health only after the pertinent sections of 240 CMR 1.00—7.00 are met. Salon: Manicuring Salon. Includes home salons and all other locations where manicuring is being practiced as a business,serving the public,with or without monetary compensation. The word"salon'in these regulations includes home salons. Also see 240 CMR 1.00-7.00. Sanitize: Reduction of the number of pathogenic contaminants to safe levels as judged by ,public health requirements. Ventilation)Introduction and circulation of fresh air while simultaneously replacing foul air.Filtration devices shall not be substituted for ventilation. :ill. :BOARD-OF-HEALTH PERMIT',APPLICATION,AND FEES i) No salon shall engage in the practice of providing artificial nails in the Town of Halifax prior to receiving a permit from the Halifax Board of Health. 2) The Board of Health will not process an application until a) All pertinent provisions of 240 CMR 1.00—7.00 are met: b) All licenses are obtained as defined in 240 CMR 1.00—7.00 3) All applications must be submitted-on a form approved by the Halifax Board of Health and be accompanied by a fee determined by the Board. -2- Halifax Board'of Health Regulations Pertaining to the Operation of Manicuring Salons Providing Artificial flail Services 4) The Board of Health will not issue a permit until a satisfactory inspection of the facility is conducted by a Board of Health representative 5) All permits small be for a maximum time of one year and expire on December 3l of the year issued. 6) All Permit renewal applications must be submitted to the Board of Health a minimum of 30 days prior to expiration of the existing permit. Permits are not transferable to another owner,manager,person or location. 7) The Halifax Board of Health permit will be issued to the establishment in the owner's mute,and not to the individual'employees. Alt employees practicing the manicuring trade must possess an appropriate license from the Board of Cosmetology. Upon application for a permit issued by the Board of Health,the applicant shall provide copies of the license(s)granted by the Board of Cosmetology. Every manicuring salon shall possess one license issued by the Board of Cosmetology for the facility. Each employee must possess their own personal license,issued by the Board of Cosmetology,and carried on their person or posted inside the salon,in order to practice manicuring. IV. STANDARDS OF ESTABLISHMENTS 1) All toxic substances used in manicuring must be properly stored and labeled.This includes chemicals that have been removed from their original containers. a) Material Safety Data Sheets(MSDS)must be kept on site for every chemical used in the salon and be readily available for review by the Board of Health,clientele, workers,and citizens b) All chemicals shall be covered when not in use,including between uses. c) Whenever possible,dispensers with as small an opening as feasible should be used. d) Every container,regardless of size,must be labeled with the name of the chemical and the percent concentration. e) Disposable wipes and other materials contaminated with chemicals shall be enclosed in zip-lock type bags before disposing in covered waste receptacles. 2) Covered Waste Receptacles: Must be provided at every work station and emptied at least�once rper day. 3) +Drsposal Methods.all lrqurd wastes from the manicurung process are co_nstdered non _tary sewn. ge,a�rd mttstst b orecl and disposed of ashazardo� us Disposal of saw non-sanitary sewage to the ground or to the facility's septic system is prohibited: 4) Eyewash'Stations:At least one eyewash station must be readily available in all nail salons. a) It must be located within a ten(10)second walk or 100 feet of any potential hazard. It must be visible and in good working order,allow hands free operation and provide dual eye flushing. b) The eyewash station must meet ANSI Z358.1 1990(or revised)eyewash requirements. Use of squirt bottles is not allowed. c) If chemicals come in contact with the eyes of a technician or a client,they must immediately call 911 and flood the affected eye(s)with cool or tepid water for fifteen(15)minutes while holding the eyelid open. 5) Hand Wash Sinks: Every salon shall have an adequate number of hand wash sinks sufficient to accommodate the number of manicurists working. There shall -3 - Flafif"Board ofI>lealth Regulations Pertaining to the Operation of Manicuring Salons Providing Artificial Nail Services be at least one hand-wash sink located in the salon area and separate from the sink provided in the bathroom. 6) -Ventilation:)Every salon shay meetthe` dnowing ventilation requirements: a) Every shop shall provide adequate ventilation which draws air away from technicians and clients and vents to the outside. b) Local exhaust at point of use is the preferable method of ventilation where possible. -See page 6 for design and installation specifications for ventilated tables. c) Exterior exhaust pipes must not impact neighbors or be located near any ventilation intakes. d) A minimum ventilation rate of 60 cubic feet per minute(efin)per manicuring station shall be provided to protect the health of the employees and patrons. e) Ventilation units must be kept in proper working condition. f) The use of filtering devices which merely remove odors and not gases,mists, vapors,dusts,etc.,shall not constitute ventilation. Simply circulating air around the establishment shall not constitute ventilation. g) When venting directly to the outside is impossible the salon air shall be filtered through a HEPA filter and at least a five gallon canister packed with activated charcoal or an equivalent filter. h) HEPA filter and activated charcoal canisters or equivalent filter shall be maintained and replaced in accordance with the manufacturer's specifications. i) The salon shall maintain a log of equipment maintenance. V. INSTRUMENT DISINFECTION&PERSONAL HYGIENE 1) All manicurists shall wash their hands thoroughly with antibacterial soap,from a dispenser,and hot water immediately'before and after rendering service to any patron. 2) The requirements in 240 CMR 3.03 Board of Registration of Cosmetology Regulations Equipment and Hygiene Procedures apply equally to manicuring equipment This includes but is not limited to clippers,nippers,cuticle pushers, scissors,reusable forms,manicure and pedicure bowls. 3) Buffers,files,porous drill bits and wooden sticks which absorb water cannot be disinfected: Therefore they must be discarded after each patron. 4) Formalin is prohibited for use in manicuring salons permitted by the Halifax Board of Heap because safer alternatives are now available. V. INSTRUMENT DISINFECTION&PERSONAL HYGIENE coned. s) Manicurist tables shall be disinfected between each patron. 6) Ultraviolet ray sanitizer and bead"sterilizers"aie ineffective disinfectants and me prohibited for use as such. VI: PROHIBITIONS 1) No manicurist,demonstrator,instructor,or student shall provide services to a person who is afflicted with impetigo,pediculosis,or any fungal infection of the hands,feet, or nails. Nor shall they provide services to any person with open cuts,scratches,or wounds to the hands,feet,or nails. 2) Smoking is not allowed in any area of the salon. 3) Use of any product containing Methyl Methacrylate(MMA)is prohibited -4- I lifaz Board of Health Regulations Pertaining to the Operation of Manicuring Salons Providing Artificial Nail Services 4 The multiple use of an implement which cannot ) Y P be disinfected,between each use,is strictly forbidden. Instruments or implements which cannot be properly disinfected must be discarded after a single use. This includes but is not limited to clippers, nippers,cuticle pushers,scissors,reusable forms,manicure and pedicure bowls. Buffers,files,porous drill bits and wooden sticks which absorb water cannot be disinfected and must be discarded. VII. EMERGENCY CLOSURE 1) The Board of Health or its authorized agent,acting in accordance with NiG.L. Section 31 may,without notice or hearing suspend a permit to operate a manicuring salon or may order the suspension of one of more particular operations if an imminent health hazard is believed to exist. 2) Whenever a suspension is ordered in this manner,the permit holder or manager,or person in charge of the establishment shall be notified in a written statement which shall.include but-not be limited to-the following-information: a) The Board of Health has determined that an imminent health hazard exists which requires the immediate suspension of operations. b) The violations leading to the determination that an immediate health hazard exists. c) That a hearing will be held if a written request for a hearing is filed with the Board ofHealth within 7 days ofreceipt of the notice of suspension. VUL SUSPENSION OF PERMIT t) Artificial Nail Salon permits shall be suspended immediately upon an inspection which reveals that any procedure in the salon is creating an imminent health hazard. 2) Due to the potentially serious hazard which exists regarding bloodborne and other pathogens,strict adherence to these regulations is mandatory. Repeated violations of these regulations is cause for suspension of the B.O.H. permit to operate. 3) Failure to disinfect implements properly between each customer shall be cause for immediate permit suspension. Frequent or continued failure to properly disinfect implements will result in revocation of the Artificial Nail Salon permit. IX: ORDERS FOR SUSPENSION' 1) If the Board of Health orders the suspension of an Artificial Nail Salon Permit,the permit holder shall be notified by written order. The order shall include,but not be limited to the following information: a) Name and address of the establishment. b). The reason(s)for the suspension. cj Thd-date and time'the suspension will:become effective. d) A statement informing the permit holder of her/his right to a hearing before the Board of Health. It shall be the responsibility of the permit holder to request,in writing,a hearing before the Board of Health. The time limit for requesting a hearing shall be 7 days after receiving notification of the suspension of the permit. 2) Orders for suspension or revocation shall be served to the permit holder, salon manager,senior manicurist or her/his authorized-agent as follows: a) By sending the permit holder a copy of the order by registered or certified mail return receipt requested,or -5 - i Halifax Board of Health Regulations Pertaining to the Operation of Manicuring Salons Providing Artificial Nail Services b) Personally,by an authorized person from the Board of Health authorized to serve civil process. X. REVOCATION OF PERMIT 1) The Board of Health may,after providing opportunity for a hearing order the revocation of a permit for the following reasons: a) Serious or repeated violation(s)of any section of these regulations. b) Any activity that the Board of Health deems as presenting a serious threat to the public health. 2) Notice of the order for permit revocation shall be given by the Board of Health to the permit holder in writing. The order shall specify the reason(s)for which the permit to operate an Artificial Nail Salon should be revoked. It will be the decision of the Board of Health to permanently revoke a permit. 3) A request for a hearing may be requested by the permit holder in writing,submitted to the Board of Health within 7 business days after notice of revocation. Operations if suspended,will remain suspended until the hearing before the Board of Health takes place. XI. EFFECTIVE DATE These regulations shall take effect immediately after notification has been published in a local newspaper. These regulations were adopted by the Board of Health at a scheduled Board of Health meeting held on December 1,2004. All new and currently existing manicurist salons will be required to comply fully with these regulations immediately, except that existing salons shall have until January 1,2008 to comply with Section IV as pertains to ventilation. Full compliance will be required of all new salons prior to permit approval. New salons are those applying for permits after the effective date of these regulations. RIII. SEVERABILITY If any section,paragraph, sentence,clause,phrase or word of this Board of Health Regulation is declared invalid for any reason whatsoever,that decision shall not affect any other portion of these regulations. Adopted:December 1. 2005 by the Town of Halifax Board of Health. Signed By: John DeLano—Chairman John Weber—Co-Chairman Jeffrey Anderson—Clerk —You can receive an official signed copy of regulations at the Board of Health office- -6- GUIDELMESFOR,THE IMPLEMENTATIONANAENFORCEMENT OF BOSTON;PUBLIC{HEALTWCOMMISSION'S;NAIL SALON REGULATION {p.ltf'rt 1[,' '.. .LTa=Ji.' t� {Ii •�fi,t .il".{1x„�1 �i' j-S°GI°?.,:1'I'�'�.t'= t,(; .r) APPROVED: to (1o1*'1 i"-�!i;a`-,oi r1i,a taf,"r,.lfTtz 4i .rfT '?'J':tf,•, T','st1;"ii:�'tfs_`:;'41 f�T,,r �:i; :�}3C'',')= ��w�. 'T�"¢'r r€ Barbara Ferrer Executive Director January 8,2014 SECTION'I:0,t,r t"4'PURPOSE'sttI`�r(rc!rT :,•,;sxli trT The Boston Public Health Commission has determined that,standardization-of the practice of professional nail'enhaucement is necessary'in ord&to protect the health of nail technicians;clients;and visitors[of nail salons from&-risk of injury or infection due to unsanitary conditions and exposure to hazardous chemicals. These guidelines are promulgated to set,forih the implementation and enforcement procedures of.tt a Boston Public HealthCommissioWs Nail Salon Regulation(1feieindte0`Regulation"). 'i ,��• �f{{,�,G`�`st�'i,[,�i � ; i,`ii,;ii�Ilf;I'?!f. �t'�C17.3'.i► in �a±i419.����: `r '"T'.Iti SECTION ll:`>=1) -": 1'DEFINITIONS­,,'W1;. r„1] Tall E i 5r,, lift �.ITI_,.t; !+r;}ter13s'�'. i'si1;'., �r,,� ?wt�:t.•°'�T ? ;I:; €).`'iti,:rf 1 dl'�'!r�'�•rtFy 1. Autoclave means an apparatus for sterilization utilizing steam pressure at a W-A specific i6nperature'over a period'of time.u,;A 1 €,�i�llJ'iii �If�� � 'a:;tr'Ifi:fCl�3t� 3!T"i'•_� (=C$: �3�(.t•x i'I,9t.�t�; �.>•:,�if3r� '-')}�t !iI?0a �j'�,f%'!� r 2,:j[Chemical meansia,productused in the salon.for.the provision�of salon services 4-,and/or cleaning or disinfection. This`includes;but is`not-•hmited,io,polishes, glues;'liquid monomers;acrylic pawderst cleaners,=sanitizers;alcohol, f ea��cetone,,`lacquller; {a^^il polish-re nover;'acrylic-pQQrim((et,nail hardener,'cosmetics, r ii',rdllotions. j ",A [1 �rf`.iZ - +�a•!I !• -f:it(:316 1= ''il'e -� 7• S 5� { 'T � '�, :�'t!si.t'�iff�:.t .'3 i �I'S �)r (f'�;:frF �;tlt;=.'':so }•'c,(#(f3 ' '{ �.: '3.3!,, Clean mearis ld wadi with water and'liquid i soap;detergent,antiseptic;.or _;,,,}t3'othei adequate riearis`to=remove`all visible°debris or residue:'-p l, ,,;, 'tI!(((: �;•� tt,1 ( _ ��j��� i��,€ S;rlT. ,i'.:3ii[:ti!Tt J=.{ f+.! ('f =)r,t.j r'}",ti3� 4. Client means a customer,patron or other individual who receives or will -Mireceive,sal'on+services?t1 Y)`�rtit rw'}='1i3 t {ti�'l df .f +FtF.(T: f>s�: )o ",-Jt;"7'.Ttl Al.,(!t Sr". �t �(•ti��Ira?t, �lf�'= %�:ta}:E ;t 3(�t „ilt €T;t#J€fy "±fi )�l:� 5. Commission means the Boston Public Health'Commission,the-Board of Health of the Boston Public Health Commission,and/or any authorized agent x} t wf! Ahereofii -M 6. Disinfectant means a chemical or physical agent used in the disinfection "'txt')s,!�process.t>�,Thefollowing caiegories�of chemicalsand/or=prcicesses'gaalify as disinfectants under this definition: '�} �� it 't °: `«4 `yet •+i Page I of 46 e #t ) ;a. a properly fiuictioriing"and verified autoclave orFDA listed dry ��I r�..t J•' j'ry ,� }heat sierilizef tised according io`manufactui•er instiiictions;°" b. an EPA-registered bactericidal,fungicidal,and virucidal disinfectant(with the exception of formaiin)used in accordance with manufacturer instructions; c. a 10%solution of chlorine bleach mixed with water(and no t.arJ other chemicals), d. isopropyl alcohol used at 70%or greater concentration(for wiping surfaces)or immersion of tools;for a minimum,of j0-I, minutes; _ tJte. . ;! t Ultraviolet_light boxes are not an effective.means of ',, ,# ,s,,#J;r I"1 ,r) , Alt.Ii'!.L disinfectionaudmay;no0e,presentinany,salon.,.; .`:t!i':+s°?s'' `.%':,i; (• s•'f'.3!ft1:.'t� .I: tt;?'r''.irts "! s`'iPi r 'r � i"S .ld `ter. , Jii jsrt.r.f• , Disinfection means a process that prevents infection,by,killing microorganisms on,metal implements and non-porous surfaces using one or.,- more of the defined disinfectants. Porous materials(pumice stones,sponges, wooden:tools,etc.)may not be disinfected for reuse;because they,;cannot be-s effectively cleaned and disinfected using chemlica agenis__.` i 1�: '?tFfe'`:3!"f 4rt?'its:•�.fi1 `:ilS ­J n"-J. f .Jr w r flf, 1(.. 8. Da Heat Sterilizer means an apparatus fousterilization,utilizing.dry heat listed with the United States Food and Drug Administration. This method „r should be;used,only�formaterials that might:be damaged by moist heat. The advantages for.dry heaf`include the followung;:r't is nontoxic-and does not i:,harm the.environment;a dry heak,cabinet is easy to install and has relatively low operating costs;it penetrates=materials;and.it is noncorrosive;for metal and sharp instruments. The slow rate of heat penetration and;microbial killing makes this a time-consuming method and the high temperatures may not be ,o ..i suitable.for some,materials.;,Theinostcommon time-temperature relationships for sterilization--with.hot air sterilizers are 170°C✓(34001F),for 66 minutes, 1600C(320°F)for 120 minutes,and 150°C(300°F)for 150 minutes. ?.-a !I A:5'/ )� i "__tr i'. R �1.(.f:',^ i � a3•' li'� ' S�a.t- .. 9. Foot Bath means any basin(self-contained unit or,connectedrto the nail salon's plumbing)that holds water,circulating or not,for the purposes of ' soakin�r the;.elient's foot 10. Implement means an instrument or tool,either disposable or reusable,used to provide nail salon services. t: 1id,'`tf?e fr, i .` fj2 + .tf411w "; � ' �sl�: t!ti4lf J3:'e i c' r3 ;!s i..',Flj} ^jra r} { ;.11;,License.,means a.license:issued-by the Massachusetts Board of.Cosmetology to operate a nail salon^ Page 2 of,I6 -Nail�Salon and Salon means any,establishment„facility,room,group of Iz j �. �;,rooms,place;of,business,or,premises;licensed by;the MA Board.of Cosmetology,where salon services are performed on the person,of another, with or without monetary compensation. !!fJf,��(•t �: ! ;r(il'.f,l� !:1):tl 4tt�f! " �'(ftt..( i , r•ln:,t (l f:ail f'e ft.' '.�rt r { r 13.Manicuring Station means the workstation where a manicurist performs salon 110.r services on individual•clients,including such'devices;chairs,tables,counters and other equipment as may be necessary to provide such services. (19'f r4; i tall1(, .'! fig €i U 14. Manicurist or Nail Technician means any,person;providing salon services upon the person of another, with or without monetary compensation. ­;',A, )IIII i':- €I J 'I I floll e !I' f} 'fil-1�t aft' '. . 15. Safety Data Sheet(SDS)means a,document,thatis.supplied by the product manufacturer which explains the risks,precautions,and response actions L,., , frrelated to e_xposure to a particular product or chemical used as an ingredient in It ,a product. rThe Hazard Communication Standard(HCS)requires chemical manufacturers,distributors,or,importers to provide:Safety'Data Sheets(SDSs) (formerly known as Material Safety Data Sheets or MSDSs)to communicate .. the hazards,of hazardous chemical-products.As of June 4 p201.5,the HCS will ,require new;SDSs to be in,a uniform format. f1(li ;,r , 3(;t Gtti tll,ir.• _ rt Y .rte ..,rr Tii j' F J, ' � ;i"'� 1+iif{ + •,, 116.MultimUse•Tool,means an item constructed of hard materials with smooth non- ;,, E ,porous surfaces such as metal,glass,or,plastic-that,cawbe,effectively cleaned and disinfected for used on more than one client: The term includes but is not. ,,j,,,I AU limited to such items as clippers,scissors,combs,nippers;manicure bowls, !and some nad-files,) r; ,stc,ttr,Jf'tii',';fJ i€€'�a--fib 1;€>+'' rt'-Jjtr• "i'12 17.Permit means a written document as prescribed and issued by the Commission 07,_7grantingapproval•to anail salon to,operate:;; ,,, ;, ._ r- „,! I 18. Salon Service means any practice carried out in a salon that includes,'but is not limited to,cutting;shaping,.polishing,or,otherwise enhancing the appearp4pe,of the nails gfithe hands qr feet,M=Ct ring pedicuring,callus r; ,<,I -remoyal and-pt er,skin treatment,waxing,and eyebrow threading. 19. Single Use Tool means a non-metal and/or,porous item•that;is made or constructed of cloth,wood,sponge,pumice stone,or other absorbent materials 4, r r t..i having-rough surfaces which cannot,be a ffectiyely cleaned and disinfected. t ,• ;, Single use;items include;but,are not limited to;gloyes,sflip Pops,toe 1 ,,,,.;separators,pumice.stones,non-metal nail files,non-metal,emery boards, buffers;buffing discs on electric files,wood and/or non-metal cuticle pushers, .wooden wax,,aPPiicator sticks;cotton balls,.and tissues. ? p `J"} - ;rti4_ :i. '1+�, t lii'f t�iii:' . 'i?�T.,i',1''. rt3►f�f' .J f ;+rr� 'a!: ,i tit Section III.:. : .:; _ APPLICATIONAND PERMITS,, f' , Fj.fr::'{'..� �� !�}l?ft I-:llt..�' = :-i•I `•4.If� f�fi.'t : ��3 i# i.'/ •Js��€�(r.•t�/r',-. iJt:'al Page 3 of,16 11?A'nail'salon'shall annually apply for a Permit for Operation of"Nail Salon 'from the Boston'Public Health,Commission's Office oftfiVironmental Health, 7::r+W11 1010'MassachusettsuAveinue,2n'Floor;Briton;MA 02118': 2. To apply for a new or renewal permit,a salon must submit the following: +-a`a. a completed'Application for Peiinitf'r Operation of Nail Salon; if V! -.1, Ire' fl,q b. a copy of the nail salon's Use and Occupancy Permit from the Boston Inspectional Services Departlhent;!!1?fir"i ?1!�•'fi.'.lfrtt,Mr i if i:' ofi! J+S+rr(r! ';v 01 '/ b r i'o'-t-'+ '.flr, f '!i!, c. a copy of the nail salon's license/permit from the Massachusetts Board 3-'0-1 Al ' 1of Registration of Cosmetology;"1 ,I ,j l' +;'..JC!f', d!Igj l Ij! r rrij r1t & 'a-dopy of the'cosmetologist;'aesthetician,,or ianicurist license issued by'the Board of Registration of Cosmetology for each manicurist or ' r r►�' ' '' t''r.'-"nail technician providf ing'salon services on`behalf,of the nail salon. I, r re. A'repoit from a duly licensed engineer or contractor,and/or proof of inspection fron the eityof B6st6n's'b4e66d6a1,Se><&sDepartment shall be provided to the Commission showing.that the salon's ttri i}iFt,A,., f(!,rr *`ventilationlsysteiri meets'the minimumwentlation rate'requirements setforth'in'the regulations and 4n Section,VII,below. In,the case of a salon that first applied for a'pennit under this regulation before October 48,2013;'that has not yet met these ventilation'r"equirements, the salon shall present documentation of all steps taken to achieve compliance with the ventilation requirements,and . L_rf Fs'li If; _. £ i .- JIfI , 1 £ the permit fee in'the form of icheck or money order made payable to the`Boston Public Health Commission." '! 11,1df r1;.w 4fil. a' .► !",I :" .. ,If :11+ l:."'l10; iJIrJ+{fi r' 'J. Cfi;',,ir! i1f✓i;f. f rrti� f .1f�,3'3il The'anniWl p*ermitfee is'one hundred dollars($i00)plus twenty dollars ($20),for each nail service station;`including rrianicuring`tables and foot -jit baths;ibeyond the first fourr�For example;'the�annuahpermit fee for a salon with four manicuring tables and four foot baths(8 stations total)is '1+1'rt)>l,one'hundred eighty dollars($180): ,'1 -r .rs""� .;,'+ {ff1L:+, `+., T._ itr , rr al'1E'f rt '� .t: , 1! i:F'' rt i mot- •rr ,. 'j'j"W`!+,4.+'Upon'submission of a"complete Application"for Permiffor Operation of Nail Salon;`the Comm'issionf will conduct an inspection of the salon as part of the'a}plication review and'approval'process'.'If the salon`is'found to be Jrf rf .unsatisfactory during the inspection;the inspecto"r`wiil infornn the owner or his/her-representative of the corrective'action"requi.red for issuance of the permit. Boston Public Health Commission staff will provide guidance and technical-assistaia`&to the�alon'owner.to help'..himlher..brin'g the7salon into compliance with the Nail Salon Regulation prior to issuance of a permit. `Page 4 of 46 I 4r•trit(� r�f(�ifi'+i '+' •{L�3'r'J.i:t.! '= P•.S! ' ``Jtii .i J+� rZf �� f..+ 7.'_ .r(•f!. `1f 5.,-A Permit for:Operation of a Nail Salon is valid for a period of one year ;�• r and requires annual renewal. ,,, I :! ,. 't' I � 'r. tr' EJr'.�t� t,•� ! r iat`:',e}t'Ji. .t t f ,', i•i •r. ,�7 6., The Permit for Operation of Nail Salon•shall be displayed in a manner conspicuous to patrons at all,times. v. , ,. 1 � .'# `i •. '! ..7 T#'x` �1 Jfr' Yr 1. •r•.' `a;:� SECTION IV. 'FACILITY REQUIREMENTS AND PROCEDURES .'1' 3.i: Gi. / �•[,. _ �l Ef 1.. :ij Ir}el 110i,!J.#(«tell) 4'IS ti"1 1—r .Jt!'t, t j; t .,•A.,Safety:;Data Sheets(SDSs) Material Safety!Data,Sheets(MSDS);,and {#+ r , Chemical Storage #N.rbr ITiod ;11 ,-f r ,. f.J i•a' a fe,},fir rJR�� +6 'r(i(•i`.a 4��� �Ilx;{,7� - "- (..{(1-�l . L(i. .� ..,. > , r l., ,The following categories of chemical.products;if.present in the-salon,must be ,stored in closable containers properly;labeled with-the product/chemical name t,,(this includes smaller dispensing bottles as well as original packaging)and must have a Safety Data Sheet(SDS;formerly,'Material Safety'Data Sheet or MSDS)available and on file in the salon: a. Cleaning chemicals/detergents used for cleaning salon fixtures, surfaces,and equipment r# ib. Chemical disinfectants used for salon surfaces,,fixtures„and tools ­j,c., Artificial;nail.compound&(powders and liquids). (f, .�, ,e,-,d. f Artificial nail'adhesives,„ n,o,, ;ryf'tr. �,;, fs .,�,,; e. Nail polishes,paints,and sealers f. Nail polish remover/thinner Z. SDSs must be available and accessible to salon employees-at!all times. The ;Office of-Environmental Health recommends a salon maintairi{all SDSs in a binder or file folder in a central location that is easily accessible to employees and Office of Environmental-Health inspectors. or, :;t l.. .i�,r . , ,{ - Jr, ,.. , :;_., r �� tit• t(f 3. An SDS for a chemical product is available from the distributor and/or manufacturer of the product and shouldbe obtained at-the.time of purchase. An SDS may also be available on4the:product manufacturer's website. �1t11 � # r�' _.i' �?. `tr {�j J,#f�l]f. .Is J'•f.J �lj (.E. - ^, r,+,:.leJ `#',:�',�1;!/,. 4. All flammable chemicals shall be kept away from heat and'shall be stored in a r1, iflammable storage'cabinet in compliance with applicable•law.and approved fire reference standards when not in use. Applicants must•secure all necessary permits from,Boston Fire Department•as soon a's.possible. Whenever possible,small mouthed dispensers or pump dispensers shall be used. 5. All chemical storage containers(including smaller dispenser bottles as well as original packaging)must be kept closed when not in use.;, ; t'%- 1 i::1 (i s'l'31qud'. A. i f!'t?!t. "/lb- i; ;".rrtr i.�{1 ffrf. "J�H J1 B. Eye Wash Station fz;r r, J a i f r r ,Page 5 of 16 1. The salon eye wash can be either a station connected to the building plumbing r 'and.capable of continual-operatioti•,a-staid:alone,syst m:specificalfy.designed- and marketed for use as an eye wash station;or-a'clearly marked station containing two or more personal eye wash bottles. Stand-alone eye wash �- stations are,typically a plastic wall-mounted`unit that holds several gallons of sterile water or saline solution while a personal eye wash bottle station may have a plastic or metal shelf that mounts to the wall to hold two or more sealed btottles of sterile saline org water. ! r ���_` �«».+A ��...3�.i�' I f a r�•t,�,.v F�.!4.,� }� •� � {-'� '��...-+-...-�._.�-.� C«� 1� I F `r 2. Manufacturer guidelines for installation and maintenance of any stand-alone system91''bottles'mu9fbe'followed'to`prevent-contaminants Vol `getting into the wash water. Eye wash bottle nozzles must remain'clean and'cl6r`and the water must be replaced regularly. Adhering to the manufacturer r, tr r N ' ecommende&water or sahne`replace'me'nt-schedule as well'as expiration dates - is required:;Should the liquid in the eye wash'device ever become cloudy or - odorous;it.must be discarded and replaced immediately regardless of the manufacturer recommendation-:' 3:''Arhand washing sink is not an acceptable eyewash station.' r , , . 42 UThe eyewash•statiowcannot"be iodated in the-salon bathroom. The eye wash station must be easily accessible to staff and-custoiners within I the main work area—within 10 feet of the work area or reachable withinl10 seconds. C. Z+ir st Aid•Kit if, ril . . ,,. 't. ' �r+rl;•�. .. ' .. t 1: •A•fully,stocked basic first aid kit must contain,at,least the following: r...;)rn``, •,,. ,t .sCl -;+.J:2. .'f+ ',_ �� 'F ,,• 11 ,:t,.,.�r•• .•11(�_ ,.. - 1,.43i s ','rl , •1 a. one absorbent compress 32-square in: (no side smaller than 4 in.) b. four sterile pads(3 in. by 3 in.) c.,t,one triangular bandage,(40 in.by 40iin:by 56 in) t r., &•I sixteen adhesive bandages l in.'by 3:in.', e.. fiveyards:of adhesive,tape,. .' +- 'r".i,� ,r� , /t,r*+ : r r, t�r f. Antiseptic cream/ointment—at least 10 applications of 0``.5g(0.14 fluid t. '� lot; ', ,I.oz.)each I., sli .i :•': : i• r..� �.' �. / , ',I .'.•. {. '! f+. r r<«r;•r g.viBurn'treatment cream/ointment—at.least 6 applications of 0.5g(0.14 .,,.fluid ozr)each.,I: ;. I ►.; h. '.two.pairs,of medical exam gloves(nitrite preferred) r i.' ,iAlcohotprep'pads • r „ . .. . : ,c+: -, 'r , if; i j. Alcohol hand sanitizer r, ; C, Roll'of gauze'bandage(2•in.wide) ! '' 1. Instant ice pack ' f '• '` rr ' >t l m.":Bandage scissors n. Acetaminophen and/or aspirin and/or ibuprofen(at least two of these) o. Disposable thermometer or fever strip Page 6 of 1.6 2. The first aid kit must be easily accessible to salon:,employees,and technicians at all times. i) AAn;, �;wffe;vl ble j 1,::n fl AJ i-:' . iia DASingle-use Toolsi!; 1i1,1114 "I !,.r(i li.', Af.a Single-use tools are,any salon.todis,made of foam..wood,.or other,porousr-,-.l -,v, �:materials tMt cannot be,effectively cleaned and diknfected between clientsand/or 1,,r!,ar6.degraded byuse ono:clientli These-products;must be discarded into a covered labeled waste container at the work station-immediately after-use on,a'smgle' J. client. Examples of common single-use tools include,but are not limited to,toe separators,flip-flops,non-metal cuticle pushers,cotton swabstballs,..non-metal nail files,pumice stones,gloves,and waxing stidWspatulas. ;OeOIT 11 SECTION-V;­ -STANDARDS"OF-PRACTICE'S A. Use vf Gloves V ,f "'Ilf1l tl7j "P, Glo'v&'prowidea ba' 'er between thd-employee and thetlimt chemicals ,; 'with Whichhe/sIfe'IS working:k -­ Idn -"S6tne'individuilsiiia:yhaVelatelx'allergies, -,therefore;"'nitril6'ekAffi�gloves-'a're- recoinmen'ded?!!r,I I J­1�I "Wi. 2. Some gloves have stronger resistance to penetration byceftain chemicals. For most chemical handling,nitrile is the best choice. However,when handling �14cetdfte,laidx glo' v' es should be used because acetone breakithrbugh m6trile 4' gloves.faster than latex:In theevent-df a lk6x allergy-or allefgy to natural 'rubber products;you may double glove(layer 2 pairs of,gloves'on top of one - . ''`another}with gimil Aitrile'glo'ves.' I,-, �, lo .n, 'fl F, -,Itj -10 ;GIIDVes 01, must be woikwhen:,,r1 r, b,-,, f I'[ la!,, transferring ch6micA1s,fr6m­larger storage containers-to�smaller i`)Iiet cz6jlta"�'r-sLfof-usle'iitlie`work station- Aut.i,w , If 1,filt'l, !,Jt 1,41A ,, ,'I -in, I A, J,,Jr• j tf,jrl b.&ckaning and disinfecting-W6rk an manicuring stations and tools; c. assisting a client or employee in treating a:.cut or'6th6wis6 stopping bleeding;and L"d. a the fit' 1-4.1jGloves shouldi,be replaced ifthey tear during the performance,of the above activities and before performing anywork on,a new,client., f1f, ,;,Ij t!tff vif"j, �ik IV,1 it a 4 17'111 1 1161 SECTION VI. . rri >CLEANING AND.DISINFECTING :Page 7 of 16 A.­:Hand Washing:Sinks, u 1, i�f' ✓'J3 i,' IMF ire A hand washing sink must be maintained free of debris,utensils and dirt at all times. The sink must supplyhot�and cold running'water and there must be liquid'soap and-disposable towels at each hand washing sink. Nail technicians must wash their hands thoiougl ly-vvith hot water and soap(1)prior to the start of each work shift;(2)between each client; (2)any time they arevisibly,soiled,(3)immediately,afterloilet use;(4)prior to and after :t,,� consumption of any,food'or drink:and(5).at the end of each work shift,'Hand washing shall be done,as often as;necessary to.remove contanunants:aA nail;technician may,use alcohol- based hand sanitizes between each client instead;of washing with soap and water.;r ; r `` ?r raj a '.}irr�ff lrriti ::it.. Ift{1 'r,+E3t:l /: o; 311411u., f'.r:trii(N)J !r) J_j `fa�.ta-at (r �t,;,j'rC.fi Nr 7r�1 ✓�� r;110 iijnjj:; ,;-0II ,t5)r.L:+1r. .l .r, .� ... ,'`. .J f.+;:1: .i:{� .:+l.tlx, .� .,li ,u_ :i?t a. ' .;;'rl1'f �,'y •i B. Multi-Use Tools 1. After a tool has been used' a.chent;-preparing it, use on a second client..is a 2-step process of cleaning follo�by disinfection.­__ •_ . �._. . .. •r�' 1 tc rf r•" .. . 2. Cleaning removes any large debris and readies the tool for disinfection. + ,1.a Cleaning can be done using any,form,of soap.omd soap,.dish detergent,etc.) r.-land water.,along with physical;scrubbing with..a;brush followed,'by;a thorough water rinse to remove detergent and particulate matter:;Wash,water must not be reused,but be discarded(down the drain to sanitary sewer)after each batch of tools is cleaned. s •�1:.r11.. _ .._:ti 2 .►t„ ." ! 1.i�.r ,{ {� •jrj i ; ��",t;. i"{�;.'t.f: i:•wrr[t: f:� ;-rrrfT 1.:,After.cleaning,sterilization must.be_administered by using.a properly , functioning and.verified autoclaue.meetiugthe standard :below US FDA-: registered dry heat sterilizer used according,to,the manufacturer's instructions, or one of the alternate methods described below.,;All salons receiving a permit for the first time after October 17,2013 must install and use either an autoclave or US FDA registered dry heat,sterilizer as,described in-section `a' below. Those salons that applied for a permit before October 17,2013 have I r two rYe, (uptil October'17;•2015),to meet_this requirement and.may use the alternate methods described *in section VI(3)(b),below,until such time as an autoclave or dry heat sterilizer is installed After that date,or once an te,r' 2. r i '. . r.':. i•o.. r,.r n�•- •.r tr :;.. { , ri• i autoclave or dry heat sterilizer is installed,the salon must follow the processes vwggf-f: described in.section,Vl(3)(a). Commission staff will offer technical assistance to salons regarding sourcing and procurement of acceptable autoclaves. i,After Cleaning,all non2disposable instruments must be sterilized using an autoclave or'dry,heat'steriiizer. :n --,i Je _,fr o 3(, u . i 1! Autoclaving means a.process that results in the destruction of all forms of microbial life,including highly resistant spores,by the use of an autoclave far a muiiinurraoftlutar„(3Q)mnutes,at a'temperatue'bf 270;' Page.8.of.16 J'A,1,,• . degrees Fahrenheit.,Autoclaves shall be,used and maintained according to manufacturer s specifications: Dry heat sterilization means a process that results in the destruction of all forms of microbial life,including highly resistant spores,by use of a dry.heat sterilizer. The most common time=temperature relationships for ,} r .!sterilization with hot air;sterilizers are,170°C(340°F)for 60 minutes, :-160°C(3207).for 120 minutes,or 150T(300°F)for 150 minutes. Dry .. heat sterilizers shall be used and maintained according to manufacturer's i�i vi L.specifications:.:., .�..i ,,i . 114!' Alt111.r+t Multi-use.tools may.be autoclaved:in individual sterilization packs containing a sterilized indicator or internal temperature indicator to verify that the.tool has been successfully sterilized by the autoclave. This i&the J,J preferred method of autoclaving multi;use.tools.as they may be stored in i n -their individual sterile packages in.a clean'drawenuntil needed when they can be opened onto a�cleaned work•surface in front of the.client immediately before use. , _, r r: Alternately;multi-use,tools maybe autoclaved without individual t sterile-packaging following-the manufacturer's°operating instructions for .. f,.1 the:autoclave:,A piece of autoclave tape'should be included with each batch of tools to verify that proper temperature was achieved to sterilize t I the tools:--After autoclaving,the loose tools must be stored either in clean previously unused,zipper.type storage bags or in clean sealable plastic storage containers,that have been,cleaned using the same process as outlined below for,cleaning in tables until needed to perform 11 r, service on a client.. Storage bags should;never be reused and a tool should - never be returned to the clean plastic storage bin once taken out for use on a client. ' f r if t� The salon must verify and document the proper functioning of the „• ',�,.£E.1 autoclave on a regular;basis.,This'may be done following either of these Al r',two processes: ,. , r. , ► ,* .,'�� At least once per day;an indicator test strip or"autoclave 13 (o V.1 taper'must be processed in the autoclave or dry heat r,jtn:�1a vtir t bfr, sterilizer'along.with any tools being sterilized. These test =Uf Vj c i f �� I`I,i M?.. 11) e'E.strips/indicators/tape generally change color when exposed {tt I r [If ,to sufficient,temperatures,to achieve sterile conditions;-the -A ri +5 esr , 1,0 jiur.? Vsalon should refer to the individual product instructions for specific details:-t The salon must maintain a log book of these daily tests that notes for each test the date and time j { ' �� -;t ,:��•. n,the test strip was run,the type of treatment method(dry heat sterilizer or autoclave),the model and serial number of thedevice>used,the brand and product name of the test u r r: r1,r,F1141 ';t•i 31, ­•s i_Ir':.strip or indicatonused,the printed name and signature of r •,,Ihe person running the test, and the result of the indicator after the cycle. BPHC inspectors will examine this log =i /, -/,`1 I ffa w, book=during any,inspection of the salon. Notes for each test must be kept for at least one year,or; Page 9 of 16 An independent commercial testing laboratory contracted by the salon shall perfoim,monthly biological spore testing nleJS • •' of the.Autoclave:A provision'shall`be included in the contract between the salon and the commercial testing I "laboratory requiring th&commercial testing facility to r ',..t i, 4 ' 16, t r notify the Commission of any failure of the'Autoclave to i 3 . • +'t' . :# r 'f 'eradicate all living organisms,including'spores. The salon - •. s, .x 'N t r •,J ,,n f y u,• inust keep a log book containing the laboratory reports of the monthly testing that is available for review by BPHC n0,44 ,fr,,t• '.,,'1,a{+i"TI inspectors during any inspection of-the salon. Test results . A,.• +1b..f , mustbe-kept for at least one year. ,�,� t,t + _• b. Those,Wong that,applied for,a permit under the regulations before October 17,201.3,have two>years,(until COctober.17;2015)..to meet the {requirement for installation and use'of an autoclave or dry heat sterilizer and may use one of the following alternate methods. In the interim period before an"autoclave is procured,Commission staff may conduct additional inspections to ensure that existing disinfecting methods are being used in r: [compliance with'the regulation and established standards. These existing ::methods hatmay be`used in the interim period'include: .,_ d, _A i:3 T+Immersion%soaking/rinsing the" ol(s)in an-EPA-registered I. bactericidal',f nigicidal;arid virucidal disinfectant(with the .'-', exception of formalin which may not be used)following the manufacturer directions for use in disinfecting objects. rt- 'f, , -7 This should be followed by thorough rinse with clean, ,coltl'tap water., The tool(sj'can'then•be dtied-with disposable paper towels. p' ;ii. Soaking£or ten(10)ininutes mi a mixture of 10%chlorine bleach and tap water that is freshly.prepared on a daily a' „ _, c;t s s. ,•,a .t• basis:;,No ether chemicals may be mixed into this solution as mixing,chemicals may reduce the effectiveness of the Utz , ' 'solution as a sanitizing agent and may create a hazardous 7 exposure for worker's'and clients or similar dangerous t 1 ,reaction'.•This soak-should be followed by a thorough rinse k ;• t � try :�' r �. with clean,cold tap water.',The tool(s)can then be dried -r-tr,l+ iwithdisposable-paper towels. . ir1`� `• .'k. . ..€ ' i 1.. J, f,j , ,ram jr ..'t'.1 t ii.. Soaking for ten(10)minute§in a solution of 70%or greater .isopropyl alcohol that is fresh every day. No other t. :., chemicals maybe combined with this solution as mixing [ •, . r. :, .;; .r F,t _ +,chemicals may reduce.the effectiveness of the solution as a ;_!sanitizing agent and may,create a hazardous exposure for a or-kegs-and.clients- r-iimi,lar g-ervusreaction. This tF soak,should be followed.by i thorough rinse with clean, Page-.1-0..Of,16 t , ;{, cold tap water., The tool(s)can then be dried with ,. :r.;disposabie paper towels,-,,. _ c. -After use of any,one.of these-disinfection methods;the tools must be stored either in clean previously-unused sealable storage bags or in clean b ,�sealable plastic storage containers:that have bee&cleaned_using the,same. r .,3 processsLas outlined below;for cleaning manicure tables until needed to ,,;, perform service on a client.;Storage bags should never be reused and a L ► tool should never be returned to the clean plastic storage.bin once taken out for use on a client. 4. Any substance that comes in contact with a client, including wax used for the removal of body hair shall be free and clear from contaminants:Measures must be taken to ensure that any substance or implement that comes in contact including wax;is not contaminated between customers.+Any such,substance must either be.poured into a container that is used only for one individual client and is replaced or sterilized between clients,,or,alternatively, if using-a-common.eontainer.that is.used.for,moreahan one-client,>a single use tool must be,used.and discarded after each contact-with-a,client's skin. 5. Ultraviolet light boxes are NOT an effective means of disinfection and MAY ..NOT be used as a method of cleaning or,disinfe_cting multi-_use tools and may not be present in a salon. This prohibition does not.include,light boxes used solely to dry or cure nails. {{ 6. Disinfectants must be prepared as specified. No other chemicals maybe included in the water,as it could be hazardous to nail technicians and clients. l�,' >�•s �a t� F.I. I i+{fji Ij 3: it 'i,tt n. . A 3•.!5 ...if,1,r ,(I� ,,7.,,�;Once disinfected;tools-should be.stored in,a clean sanitary drawer,cabinet,or �.. i } , box.-(cleaned at least once daily following the,procedures outlined below for iManicuring Stations)that can be,closed to prevent dust and dirt falling on them until needed for use. ,Storage,.in,individual,zipper closed storage bags in such a clean drawerlcabinet/box is recommended., 's'{SNo—. C.-,Manicuring Stations , 1. All manicuring stations,including tables,drying stations,and similar surfaces ffi and devices,must be cleaned and disinfected after,,each client and;before use by the next client as follows: _ . l .�,:")il',iTi(j.s .!!,�t , e'3;13[. 4;, ,� 3',i,.'f�f.)�t;E—;faf# •.; a. Use'a damp disposable paper towel to wipe down the entire surface to remove dust,nail clippings,and other debris.. Dispose;of this towel in the trash. . 1.',till,-b-1,. n. ix>"' 'tri l; jir, b. Use either.a mixture of,10%o,bleach in tap water(prepared fresh each day with no other chemicals added to this mix)or 70%or greater Page I of 16 L {r s•J :concentration of isopropyl(rubbing)alcohol,or an EPA-registered disinfectant(use according to manufacturer`,instructions)to wipe down the surface using a damp paper towel. Be sure to wet the entire surface with ,r' Pulff' this. 'Dispose of the paper•towel.in a?lidded trash receptacle. - r,• 10 P'•t;4 ram':•!(+: ,',![J!;., i�l ti I,,-l{:c '! ! _ ., I'3"3{:1 ,rl ."11-J Ir r'I C.,.elf using..alcohol,no other steps are necessary. For any other disinfectant, ►wipe down.,the swface'one last time with a disposable paper towel damp. :,.w: Pa:,-tr j with.tap.waterto rinse off any disinfectant'residue and dry;with a second ,r +.t r,paper towelo,Both of:these paper,towels should be'disposed of in a lidded trash receptacle. r .! •rf•. .,.Iti,.II,. T, D. Fobt Biihs i.;ii ' :r J fii`Jl, i':r'' 1J" ?1 i i', f..r 'J,: • v t.r 1 ' ✓ 'It e j it, i Id] :All l.� 'Regardless of type(poitable basins,whirlpoolsfoot baths plumbed into the !; r, - ` buildmg;etc.);all'foot baths should be'cleaned after each Ghent m'accordance with the following'p'rocedures lyric' Drain'the'water from"tlie foot"spa'basin bi bowl and reiiiave any visible debris_ t/1 buI, floI :} r3II.-I` I ft ".''ff {)s`,1F t t 1, ;Ili ,I ! „1 !��'rrlt r• �' " 1, ' 'T1, ,!1 ,r Clean the suufaces of the foot spa,1 i&S'o'ap`or detergent' Rinse with clean .7f' °)y',`r i t.. c,` 11fJ rR. � d.A(C1•, . ..r;' i f '. fit, Water andrdrain. c. Disinfect the surfaces with an EPA-registered hospital disinfectant ''' I;r► according tc the manufacturer's directions on the label. Surfaces should rj I •r`remain wet with the`disinfectant for ten minutes or longer if recommended on the product label. A 10%mix of bleach and water(but no other "chemical)maybe used'as an alternative disinfectant.'•For'whirlpool foot trj • ""�`' 'spas,air jet'basins, =appropriate { s''foot spa's,and other circulating'spas,fill thebasin with water amount of liquid'disinfectant(or '•- '"t f J'-'"'r'10%bleacli'solution)and•tiuri the'unit on to circulate tile'disinfectant for at least ten minutes.,, •,:f,)"J,t r . : I 1. ,,it , d. Drain the footbath and rinse with clean,cold water. For circulating spas, refill with clean hot water,turn the unit on to-circulate for-at le'ast'one' :minute,and drain the unit. r•J ;l,ri!'. t �Ift!! 1, .r Ir!°rtrt t� .'t.lJ ' J .�; r'1 I 'r'.� 1}Jli2 .,j',t, � r .tt r, �, 1 1h addition,ifootbaths must be cleaned uighdyupon closure'of the salon. For non-circulating foot baths,follow this process: ' . t�.l r :ti 7 a !.� IJ:F Cr. tr t; ,...lf't !:•'.1 .i a - r1i�'. r'. � , a. sDrainthebasinand remove`any visible.debis.-;"'riJ b. Scrub the bowl with a clean brush and soap or disinfectant(following cleaning direction"s)? Rinse w1 th hot}water and drain' ~ ; gage 12 of 16 a c. .Disinfect basin surfaces with and,EPA-registered hospital disinfectant according to manufacturer instructions or with 10%bleach solution. ;1 ,Surfaces should remain wet with the disinfectant for ten minutes.or longer ;{ if recommended on the product'label: ,.±, % d. Drain the.basin,rinse with clean,hot,water,and,let air,,dry. For,whirlpool foot spas, air jet basins,t,pipe-less",fo_of spas,:and other circulating spas follow,this process: , /:s s 11 `E ,t ,. {- , J t<. . r t i t, r # r�_ ! ir:Ji l .( !c(lrr( .'`, r.; 1• i.r r a.�s 1r IY� ', !_r .�. •I +iI y .r1 ,r- 1tf•l ill r I' va:;1 Remove the filter-screen,-inlet jets,;and all other removable parts from the 1 :1. 1 , ;''; , basin and clean,out any debris<trapped behind or,in them. ;.:,:1• ,,.,, b. Using a brush,scrub these parts with soap or disinfectant'(following cleaning directions). c.; Rinse the removed parts:with clean water and place themlback into the rs'J, basin apparatus..'fF. : r (i , , J1. r , r Fill the basin'with clean,hot water and add`an EPA-registered,hospital .,r,'disinfectant;<following,label directions.°Turn the unit on and circulate the system with the disinfectant for ten minutes or the-length,of time ,', i.. iri '±., irecommended on.the label;;whichever`is longer. The whirlpool ('1 mechanism:ofthe tub must be operating:for_the entire'disinfection period +t so the piping'and internal•components.that:'contain hidden bacteria are tP±l,i.:'1^J Wdisinfeeted. v l,11.1;,: ���'r ' ��tuit 5',i1;'r' tJ i}:I $dt.,iI!-II • ;1 I i , {( i f 1 e. t,Drai 1,minsemith hot water;and atLL±dry.Il� i irr... 'l• .r7{�1' i .}',l i'r ij.i' i•'JfJ .,i r r7 ` ,r' •,.r nr }' ! /•:r` a. (+ _ ��lc P',E ,.;� "(yt•7-IV 3. The salon must maintain a log book of each nightly cleaning of the foot baths specified in section VI(D)(2):-Records of.nightly,cleanings must lie kept for a minimum of one year with±each,entry4ncluding the date/time,ofthe cleaning, printed name and signature of person cleaning,and the number.of foot baths cleaned r J r'±Tit.. ,.._ , _. ►s "0'. +.!. SECTION'VIL,1 (;,rr,VENTILATION ;A,: ,1l 11 , :',rl�r ,� •, : _rid ...•,�r,�� r13 1�i1r :s'7 'PAk 1'.,`�. AIL r±11}1„1;'t .1­.,Any,newssaion,-.or salon that has applied for the first time for a permit under this lot"i regulation after'October,17;2013 shall attain'compliance with the minimum ventilation rate specifications set forth in the version of the International Mechanical'Code incorporated into the State Building.Code at 780 CUR 28 and 271 CMR 6,as amended.,As of the date of this'guidehne,,the relevant version of the International Mechanical Code is 2009.'Ohis code sets specific requirements r1.1• Il for�ventilationof-a�nail%salonincluding--minimum,aan ounts:of,-fresh outdoor'air ±r t and mechanical exhaust(duct work-:that-blowsair4 out of the salon)-that does not: recirculate any air back into the salon or other,spaces in the building.' The International Mechanical Code can be found online at: •Page 13 of 16 I_ i 1 3,�e•s J., -tlhttp://p!blicecodes.cybei-regs.com/icod/inic/indeic.htmS' ..Ilj /•ier `�JY:• 'tG 1.. r..:�1'.�' tl ' flri..''JJri a•'- Salons are advised� consuli with several licensed and knowledgeable heating, ventilation,and air conditioning(HVAC)contractors on ventilation options before selecting one for installation or making upgrades to existing systems to meet the requirements of the code.= To document compliance with this requirement;:the salon must submit with its permit application a report from a duly,licensed engineer-or contractor,and/or proof of inspection from the City of Boston's Inspectional Services Department . KI showing1hat the•salon's=ventilation system meets-the minimum,.Ventilation rate requirements. -This ventilation system must be inoperationany time the salon is open for business.-, . {t ,"; 1, , •,�•!, ,.rs . t •'0► Any.salon.that has applied for a permit under this regulation before October 18, 2013 shall have until five years from said date of adoption(i.e.,until October 18, .t2018)to achieve compliance!;In the interim:period,r,the salon must document,as ' part of its annual permit application,all intermediate steps taken to achieve compliance.with-this,section's ventilation systemiregnirements,:These steps can include;but are not limited to;obtaining'price quotes from licensed`engineers or ::. icontractorsl�submittirig applications for financing-or other plans for funding the 'if.installation of compliant-ventilation-,or,pulling pertinent°city permits for the installation. This documentation shall include a timeline for,installing ventilation upgrades. Failure to provide,adequate documentation of affirmative steps toward meeting this requirement may result in non-issuance of permit renewal. , 'A; Additionally,,salon owners,shall'take reasonable steps to improve and maintain air : H ,, quality,and to reduce the Ilevel of.chemical.vapors,mist;or dust within the salon i► in the interim period before fully compliant.ventilation system is installed ► _ . . 4.: 2. Fans that circulate air inside the salon do not quahfy.;as.aventilation=system= because they do not remove air from the salon or bring yinifresh outdoor air.! Similarly, air purifiers and other products designed to remove odors�do not - qualify as a ventilation system. Air purifiers do'not bring in fresh,outdoor air or r,remove contaminated air and many produce'ozone which is'a respiratory. .,irritant. L} .3. Salon owners are encouraged to call the Environmental Health'Office at 617-534- ' . t.."t 5965 with any questions about the ventilation requirements. The Commission ,.r .will providetechnical,assistance in understanding the requirements of the . International Mechanical Code.as they apply to hail salon ventilation as well as 1,,t, .:assistance connecting,with available resources for the selecting acid paying for ventilation,equipment installation. f t t;, . ".,I .i r, Is" �t t !t}`i. ' _ ! !'. , .!1 •.} �r littr:lr.'+!/ ' r!! ..'t'=Its, 1 Page 14 of 16 i SECTION VIII: ,,i,PUBLIC•HEALTH-NOTICE;, i', rfr •rr,3, :;.:I t; i ;, 1. Every nail salon shall display a public health notice in a manner and location conspicuous to employees,clients,ori++visl1itors of the salon.uponentry.; , A . 2:. The.public health noti:ce;.mustbe permanently affixed.and shall-be: •,,� ,aI:c,� . 'r+ti ,i„ 'ri 'r � ,. r. �.e ��- ca• 1 � � l 1 ;i, aa. made of,durable material;,. , _ , I,r ; ,a; .►� '.f . r, ,s�,� ire, b. at least 8.5 inches by l 1.inches in size; c. printed in 12 point or larger type &%in strongly contrasted'text on abright background(for•example,black text on a white or yellow background,':white;text on adark blue or red background,etc)to allow for ease of reading and to f .e, an exact replica of the language included:on the:Boston Public Health ,I., Commission's public health notice templates,;;' it ' ':j 'd-tr, is 6 ! 3. An approved public health notice may be obtained from the Office of Environmental.Health,.1010 Massachusetts:Avenue Boston Mok 02118..V SECTION IX. ENFORCEMENT ., _ ►; 1. The Office of Environmental Health may enforce the provisions of the Regulation through any of the following means: f-'V1 A Pt ',' I a.; inspection of the nail salon poor,toa permit issuance; .investigation of;a complaint;and/on rrs ' .�.. ;.c.,i unannounced inspection ofthe nail salon t E .;' 1 '.il rr'.:::i ..'LS 10( 2:. Owners;,business agents,or other,,persons having control of a nail;salon-who ' obserye,or.are;made aware of a violation.of the.Regulation-should take all, reasonable steps tosensure.that the violation is not repeated.:_ 3. A single inspection or investigation may result in multiple citations if multiple violations.are-found:.and correspond to different sections-or elements of the Regulation. 4. Fines shall be paid within twenty-one(21)days of the date of issuance of the citation. _5. .Notice.ofz citation.may.be prmdded within.fourteen('14)calendar days of the violation by: a. in hand service to the owner,business agent,or other person having control of the nail salon; or I Page 15 of 16 b. first class mail to the owner;business agent;,of other,person having control of the nail salon. . (I �r•� { fr. -,II LM r 6. Fines maybe paid bymail or in person in'the form'of a check or money order made payable to the`Boston Public Health Commission", Office of Environmental,Health;i1010'Massachusetts Avenue,2°4,Floor Boston,MA 02118. If a check is returned for insufficient funds or account closure,an additional $25.00 fee will be assessed!f In the case of a returned check,all subsequent fines levied must be paid by moxiey order..'8 '.+tj ', )'{ .,,{ it !rt l� �i !it �.��(li'`1 ✓ 4:,•7+ Failure to pay a fine within'twenty-one(2-1)'days will resultlin an additional ► ' $50.00 late payment penalty. e, iF ?l'1 •f(e .'_!i-`i "lu, :,"111, {A. ,11 WS.I ,Complaints under Section-.10 of thelReguiation may.be'submitted in writing to the Office of Environmental-Health'J010Massachusetts Avenue; 2`1 Floor,Boston, MA 02118 or by calling 617-534-5965. i„ }f t ) "fN (rl! i1 if:s i.' ' 'i, `.t{ !; . it" ' 1•: , I,i(1 9.,'AlYcitations and fines issued pursuant to'the Regalation'may be appealed in accordance with the Boston Public Health Commission's Administrative Appeal Procedures. A copy.of such procedures is available on the Commission's website at www.bphc.org or at the Office of Envir6rffif iitalHealth!_._ SECTION X. WAIVERS X , 1. Requests fouwaivers from this regulation maybe made4o the Executive Director. All requests for waivers must-be made in writing,addressed-to,Office of Environmental Health;1010'Massachusetts Avenue,2'�;Floor,Boston,MA 02118. Requests for waivers must present a showing of facts that compliance with a provision-of the regulation is not possible due to circumstances that are unique to the'salon":Regnests?must also show that-an.acceptable level,of safety can.be achieved m the interim period. Any.waiver.must.be time-hmited:j' � 1 fi '+j'b� t !f .lf% p ` . fL,i�3( '� ff'! t:(f l I Id L 11 JJ(s ''_' Ori • 91 f ,Page 16.of46 , CAMBRIDGE PUBLIC HEALTH DEPARTMENT 3 - Cambridge Health Alliance ILVJ The Boston Nail Salon Regulation 1 C', _ •' i,. ' f, :s Given these health concerns,the Boston Public Health Commission(BPHC)promulgated a local nail salon regulation in January 2011. The regulation is intended to standaazdize practices of nail salons to protect the health of nail technicians,clients,and visitors from the risk of injury or :',, infection due to unsanitary conditions and exposure to hazardous chemicals. The regulation also requires that BPHC inspect and permit all Boston nail salons,which in turn will create opportunities for educating workers and owners about infection control and prevention of exposure to hazardous chemicals: - Among the'requirements'of the Boston regulationn:' ■ All chemicals used in the salon shall be properly labeled'and stored,including chemicals that have been removed from their origin a l'c`ontaine`rs.` !, A Material Safety,Data Sheet(MSDS)that:lists the ingredients in each chemical and the risk of,exposure must be kept on site and_readily available for review.by public health,;, inspectors and salon employees.,j, j, .1 '11 0, 1 X.J!1. ,0,f{E a Multi-use tools,including manicuring instruments;must be'cleaned and disinfected after each use' (.. .rP+r` ? I .�.. ■ Single-use tools may not be reused. , • Foot spas must be sanitized before and after each client and at the end of the day. •'*= • Nail technicians must wear impermeable gloves when handling chemicals that are potentially damaging to.,the skin or when performing any procedure that has a risk of y r f breaking the client's skin. ` (.t ( i( `1e_ ✓ 't. ,f i' III( .!"sTr I �' (_, `�li � ` ahit 4 ' Do r• t`''J et" J:_r 1. / (' I*h_„•i '•i' .. 7i.,! f^+•, IJ`. .Ir�I a . i.. W is`Canibridge ing. + 'I 'I i",'� J.i,"'rlr ' :. f'i )-,;r t 11' 11 le,. _'err rr)4tr'))• t r a' ( . ,'i + ►!r r ,,, " !t( ,3 + + ii 1 1'.({.• /i ! During the past five yea rs,,CPHD staffhave received'four1.na,il salon complaints—all against ' manicurists=vvhicl were then fonrvvarded to state inspectors. This small number does not ,. accurately-reflect the degree of concern among customers of cosmetology establishments.._ According to' information received froTr the Office of lrivestigations lnspections at the 'Massachusetts+Division of`Professional°Licensure,there were``i4 docketed complaints against, Cambridge nail salon establishments during the 12-month period between July 1,2009 and June 30, 2010.,ihe,complaints invofved either'consumer complaints orlcomplai is arising from salon. inspections.. { { rl,.(1{ ``I fi% I f-ry rf f'.Ji!'""Ij,, �:! ..ti .I.' 7;(.t l f +jrr'i I­ 1,t;, �rri, 'e I�'7U• ` + bi'l r'.Id )(f1(r.J IO", Al 1 J, +.., SI ')"+. . ...ice. To address existing regulatory gips at the state level: ■ Sam•Lipson;the department's'Directwof Environmental Health;participated on the )• i ► Massachusetts Healthy.Cosmetology.Committee from 2003 until it disbanded in 2009: • . ■ In fall 2010,Mr`I;ipson testified m favor of ih Boston Public Health Commission's ' ' proposal to r6&ilte Hard'salons in Boston.CPHD was th`e only local healili deparlairent'that presented testimony. 119 Windsor St.'•Ground Level•Cambridge,MA 02139 617.665.3800•Fax 617.665.3888 CITY OF CAIAMWE CAMBRIOGE PUBLIC HEALTH DEPARTMENT Cambridge Health Alliance TO: Robert W. Healy,City Manager s.uit,. Ira`-,}1 FROM: Claude-Alix Jacob,Chief Public Health Officer s � �' 's it s`.., i' .;f; •'u4 } , 'f`1 �ic.•e, t', i =l"4_�..,1 iit'i_'� fit 1� .'V . r'1�s9"1J 1.'"! .i , , ! 1 DATE: February,15,2011 ,,,._. r�t s { ir' rr�,'• _. ;, , SUBJECT-.', ''+ Response'to Policy Order#6,'adopted-112.4/i 1 �' ' • '' i " 't Text of Uirder:It ll�g bonne to'the atteniiori of tliisCity`Council that the Boston"Pubhc Health •' � Coinmission has voted to improveeahh`tacid safety conditions at local nail salons;and the ' new regulations include mandatory single time use for,emery boards;cleaning gurgling foot baths between every use,and a shift toward improved ventilation to reduce chemical vapors; and Cambridge has 23 nail salons listed on the Commonwealth of Massachusetts Division of Professional Licensure website with these salons serving any number of Cambridge residents; now therefore be it ordered that the City MaAagejr be and hereby is requested io took into the t< ,.ii,!,,,cli7ent licensing,standards for nail salons,,and in light of the experience in the City of.Boston explore the possibility of strengthening llicensing standards; _ E�, i r f1 i C�Atn`ail and beauty,salons and practitioners in•the state'are licensed by the Massachusetts Board of Registration'of Cosmetologists(formerly'thelViassachusetts'Boardbf Cosmetology)and enforcement of state regulations governing their safe operation is the responsibility of this" agency and its inspectors.Local health departments are typically not notified by customers who have concerns about an establishment,but in'rare instances CPHD staff have heard from concerned residents who are unsure whom to contact. State oversight rules are fairly limited and the number of inspectors statewide is considered by many public health"advocates and:." ` professionals to be insufficidnt.r , ,, + t ,, ,.. r• . , ,. _ i ' i „ n . _ , . '. . ; The Massachusetts Healthy Cosmetology Conimittee,comprised primarily of staff from the ( , ; ,. ., Toxic Use Reduction Institute(IJ1VIass Lowell)and 1ocal public Health departments(including Cambridge)attempted to strengthen state oversight of nail salon establishments and practitioners, and presented formal recommendations to the Massachusetts Board of Cosmetology in January 2009. This committee sought to increase public assurance that nail salon establishments are'} " safely operated,that hygienic conditions are maintained,and that staff are properlyfcredentialed and"ned to`practice their specifiCidislc pOine within cosmetology(e.g.,beautician,manicurist, aesthetician)':An'equally compelling concern'wasthat of worker safety,as nail salon employees are exposed to`certain potentially hazardous products,over a period of months or even years. The recommendations were not implemented and the committee disbanded shortly thereafter. T'.!+` ` {, , I:i(� •J . .F'i ;( ' - � 1 ..'1 ,.tin ..i !'..,f '1 1`° .. . .T it i � ,li.s • According tothe Bostoh:Publ c Health Commission,which ha§'operated the Safe Nail'Salon"s Projecfsince 2001 and is now+regul'tQ nail salons"at"the'local•level,'nail techiiician's'are exposed to"a myriad of potentially hazardous chemicals every day"that can cause them to"''" experience headaches,dizziness,fatigue,breathing difficulties, and reproductive,problems. Clients.of nail salons;while'at less risk from,these environmental exposures.,can,experience bacterial and fungal infections from'incidental cuts or other treatments•invotving unsterile equipment(e.g.,cuticle trimmers,foot baths)or contaminated products(e.g.,pumice stones, . emery boards).'Manicuin&t can also`spread infection if they do not sanitize their hands and work area between clients. J 119 Windsor St. Ground Level.-Cambridge,MA 02139 617.665.3800-Fax 617.665.3888 cm oc CAMBR oce CAMBRIDGE PUBLIC HEALTH DEPARTMENT Cambridge Health Alliance ■ CPHD staff will participate in a new iteration of the Healthy Cosmetology Committee, which is being convened by the Boston Public Health Commission and will be holding its first meeting in February. The goal of committee is to develop public health standards and goals for Massachusetts nail salons and partner with the Massachusetts Board of Registration of Cosmetologists in implementing these guidelines. Members of this statewide committee include city and town health officers,university faculty,individuals and business people,as well as representatives of the Occupational Health Surveillance Program of the Massachusetts Department of Public Health and Massachusetts Division of Occupational Safety. ■ CPHD is currently considering proposing a local public health regulation similar in scope and intent to the Boston regulation.The department intends to develop a strategy to f improve nail salon oversight by late fall 2011. I 119 Windsor St Ground Level•Cambridge,MA 02139 617.666.3800•Fax 617.665.3888 WYQFCe BRME _. 1 r" Town of Barnstable �fNE Department of Health, Safety, and Environmental Services BARNSTABLE, : Public Health Division 9 MASS. i639- aim 367 Main Street, Hyannis MA 02601 QED MAC Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health June 24, 2016 Ms. Kristen Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dear Ms. Terkelsen, I am in receipt of two additional letters from you dated June 23, 2016 and June 24, 2016 regarding the proposed nail salon and its wastewater discharge flow at 1667 Falmouth Road, Centerville. On June 21s, I responded to your second letter and on June 17th I responded to your first letter. As indicated in both the June 17th and June 21st letters, the existing septic system has a capacity of 1,869 gallons at Centerville Plaza, 1661 through 1675 Falmouth Road,Centerville. In the past, 1,815 gallons per day (GPD) of discharge was permitted at this site. This site is therefore grandfathered; each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day which is the maximum wastewater,discharge allowed for this site. There is no extra capacity available above 1815 GPD due to the Saltwater Estuary Protection Ordinance which restricts wastewater discharge flows to 440 gallons per acre per day. The nail salon is restricted to 108 gallons per,day maximum discharge as approved by Brian Dudley of the Massachusetts Department of Environmental Protection (DEP). This is based on two employees and 20 customers/pedicures per day. If this business expands into another unit with additional employees and additional pedicures/customers, the proposed wastewater discharge will have to be reviewed and recalculated in regards to the number of employees and pedicure customers by a professional engineer, prior to the issuance of an approval of a building permit. The wastewater calculations were not based on a washing machine nor were they based upon the number of pedicure chairs. The engineer's calculations were based on number of employees and the number of pedicures/customers per day. To the best of my knowledge, this will not be a public clothing washing business. The applicant informed us this will be a nail salon. If any other changes are proposed within this plaza (i.e. a new use, change of use, additional seating at a restaurant), the proposed use would have to be reviewed by a professional engineer at the applicant's expense and the wastewater discharge flow would have to be recalculated prior to the issuance of an approval of a building permit. Sincerely, omas McKe n Cc: Paul Canniff, D.M.D. Ed Pesce, P.E. Kristin Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Thomas A. McKean Town of Barnstable Director of Public Health June 24, 2016 Dear Mr. McKean, Enclosed,please find a copy of the plumbing permit application. It does show six(6)pedicure chairs being requested. If the salon would be limited to 2 employees and an estimate of 15—20 pedicures per day,what would the purpose of six chairs be? Finally, as expressedin-my-letterrdated-6/23'/1�6b'you,would wastewater calculations fora washing machine at the location be added to the total of 108 GPD? FYI:The permit application for the salon gas work listed at the permit website is incorrect. Permit G-16-557 is shown and G-16-556 should be there. Thank you for your attention to these questions. Sincerely, t Kristin°Terkelsen I �- �t_ .V6WvP,MAW O=PANCY TYPE COMMERCIAL00fEDUCATIONAL RESIDENTIALD WNW swowniiiiiiii BOB RIMM wwow ;.yam_•®;�_`�__ _�::��_i_�__��_��:,,._._, S : «. r-, I OWNER'S INSURANCE WAIVER:I am that M: the Insurance -t!- required by Chapter 142 of the v 1.. If. 1• :1.my sipature an_ - permit applicado. CHECK ONE ONLY: OWNER Ll AGENT SIQNATURE OFOWNER OR - #QSMrjr JWM32a IV . �,�,acl,�rm a�q sr�er+gn xd av�uad,�ri,ptB,�ert�r dmifad,,�sa�auadPu�x s�ud'�q.�?s ���T • �$O9 Ai PA4TP—�'a4 � ao Pms?apa aS MornB SNPAD'US a4dao g 4��3iQ�QiQ1l�d .S 43fl �T iss�aea X�' �014���OS`L °3 da=S Qw 4 ' b�M 4,U�Z ,tea e'at tdrV= nM � °as• eAr rcpnl '�,.x* �Ra�auaaq, adotI a� asa�g�na�ir4� ��u��g9m�p ya�c paa�ampa�pti��4��� � v 1p-q-pP Epp pe�� �ILV- 21M11R� r �A'_T+ i^i_".T-Y'�..:�.'.Yr...•1'.L^.'i-__F�-��Tf�^11^�t�i'--r r-a r-J.��•�4i 'saor{:gg x-m sus ftqmqa[]-IT ►$ + 41aft nv 2utop 3w=smmqxm:m I ❑ saaz pe m edai rnH E'4Y ais al$ ❑' P=M=m-&=,•smat aml p mo ❑ I dtiaa�. bm-Maaz�2an�nna ri�PP � sng �s Om�pas�dma ' vrra�a4 Mlwd Dias.2 MR -� pMPMP�uo PWI .� saaSalca D da2Vm$ I� I��UMI fi— 1 I I =oq I�,iC°�ata arx a SAD Ak. .dim fit' Mal-0-040 . I CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address d 1661 Pi occhio. Pizza fast food 6 seats X 20 d/seat 720 1663 P sioTherapy Associates ,400 SF office X 75 d/1000 sf 180 1665 O ice Ba side Builders Showroom 01 � � P4'oealS�t _ �b aw .. a 1669-1671 C nterville Pie Restaurant 16 seats X 35 d/seat 560 1673 C nterville Cleaners (1,500 sf total 80% Storage & 20% Retail = 300 sf x 15 5 d/1000sf + 2 employees x 15 gpd 30 1675 R.. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006 : 1,815 GPD EXISTING.TITLE 5 LEACHING CAPACITY INSTALLED (May 2006 : 1,869.2 GPD. PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rc Plymouth, MA 02360 Fax 508-743-0211 I r ) Knstin Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Thomas A. McKean Town of Barnstable Director of Public Health June 23, 2016 Dear Mr. McKean, Again,thank you for your prompt and thorough attention with regard to the permitting of a nail salon within the Centerville Plaza. My understanding is as follows: 1. The proposed nail salon will be limited to two(2)employees maximum, either office staff or manicurists, enforced by the Town of Barnstable Public Health Division. 2. Unit 5 @ 1667 Falmouth Road, Centerville will be restricted to 108 gallons.per day maximum discharge. 3. Centerville Plaza,in.its entirety is restricted to a maximum of 1815 GPD and NO additional capacity is available. Finally l am left with three more questions that I hope you might clarify: 1. Would the wastewater design flow calculations provided by Pesce Engineering dated 22 April 2016 with its allocations to each of the individual units be!used bythe Town of Bamstable Health Division moving forward for permitting a change of establishment or business? 2. According to the wastewater design flow calculations the salon uses two(2) pedicure chairs. Would that be the maximum allowed with unit 5? 3. A supporting document from emails between Ed Pesce and Brian Dudley of the DEP labeled 310 CMR: Department of Environmental Protection list gallons per day calculations. Under commercial establishments'non-single family/automatic clothes washer'list usage as 400 gallons per day.Why is a proposed washing machine not listed in the wastewater design flow calculations? Thank you for your attention to these questions. Sincerely, 5t'0�' Wd 9 Kristin Terkelsen i Unit Use/Area Address occhio.Pizza (fast food)_ 1 • •• 1 • 111-1-py Associates • 1 -■•� � 11 • dim e •• 111 • ■ • e•• • t .r ' -•? SY..�`M! ✓ZS tHr+,� 'l'r a �t p'7i` 'h�-rt�1ml�+"5"%°�Pa�", 'ti 'c'a^5F np`IT FQ ti RJR?r IMF E 0 © 0 ® Nt �' to f ; f^ 2.....� ❑ tT"k''C'' W,"` y.?:t` 1i ze f b.,f'-,,•^-tea Rr' i n Y7�" 1 f 1 rtrf -'3-+ �p E- _a v!� .�+) r, 3 = r t w+ ,. zAi §{ 69 wxf(�.l f� .i;' .s�p�G[�,f71 �d t YrF.tSi H T..r t' i i�ik'k Ae4.'+`IL t�L � �+. Te-'7 "� .'�i 3 a p+c ^�rF' ;�491�Lq d Ct g ��{�f'I� - xe),�` .m✓ �3.t z {, c��i '�1� ]�" .y,+ .. s n� i 77', ...r }✓%S'�3�a��: '4§s� t8 � {�}��5��X���a`����'-f�� '., y5_ '� L�r`t,Fxa�,� �x .. '�������x�� '4�-��'-' r��.a6��aF,u. ?s�€u�L. ' Q . _ 1669-1671 1% Retail = 300 1• •• 000sf Convenience Store 611 retail sf &Nvll 11�y1, sf 1 'at�{ R _SSVr a � :e�^3v'asct ' • , , i 1 • • • • 1) I 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION 15,203: continued I MINIMUM s z ALLOWABLE GPD.FOR GALLONS SYSTEM ` YPE OF ESTABLISHMLNT UNIT PER DAY DESIGN 3) COMMERCIAL(continued) ;x Factory,industrial Plant, - per person 15 tYa` Warehouse or Dry Storage Space without cafeteria get, actory.,Industrial Plant, Warehouse or Dry Storage Space with cafeteria per person 20 Gasoline Station per island***** 75 300 'with service bays_ 'per bay 125 **** Plus flows for bays,if any ennel/Veterinary Office per kennel 50 ounge,Tavern per seat 20 vlarina per slip 10 500 l.f jiE vlovie Theater per seat 5 on-single family!- per washing 400 automatic clothes washer machine ffice building per 1000 sq,ft. 75 200 etail Store.(exceptsupermarkets) per IOOO sq.ft. 50 200 estaurant per seat 35 - 1000 estaurant,thruway per seat 150 1000 " - serv}ce area I estaurant,Fast Food per seat 20 1000 estaurant,kitchen flow per seat 15 f 1 [for sizing of grease } trap only] ' Service Station per bay 150 450 [no gas] l f= kating Rink per seat 5 300..0 Y upermarkets per 1000 sq.ft. 97 wimming Pool per person .10 ennis Club per court 250 heater,Auditorium per seat 3 Trailer,dump station per trailer. 75 '(a O INSTITUTIONAL lace of worship without kitchen per seat 3 with.kitchen per seat 6 « Correctional Facility per bed 200 E!� € �`� I unction Hall per seat 15 ! ymnasium er participant 25 v.T::I. 4-4":1. ymnasium per spectator 3 :x<; I Ifospital per bed 200 Dfursing Home/Rest Home per bed 1.50 public Park,toilet per person 5 n• waste only q t f i I 4/21/06 310 CMR-310 Town of Barnstable 1NE Department of Health, Safety, and Environmental Services BARNSTABLE, _ Public Health Division MARS. 367 Main Street,Hyannis MA 02601 FD MA'I Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-775-3344 Director of Public Health June 21, 2016 Ms. Kristen Terkelsen Physical Therapy Solutions 1663 Falmouth Road Centerville, MA 02632 Dear Ms. Terkelsen, Thank you for your letter dated June 20, 2016 regarding the nail salon at 1667 Falmouth Road, Centerville. This type of establishment is not licensed by the local Board of Health; nail salons are licensed by the State of Massachusetts. As indicated in the June 17th letter, the existing septic system has a capacity of 1,869 gallons at Centerville Plaza, 1661 through 1675 Falmouth Road, Centerville. In the past, 1,815 gallons per day (GPD) of discharge was permitted at this site. This site is therefore grandfathered; each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day which is the maximum wastewater discharge allowed for this site. To answer your question #5, there is no extra capacity available above 1815 GPD due to the Saltwater Estuary Protection Ordinance which restricts wastewater discharge flows to 440 gallons per acre per day. Mr. Pesce was in error in his e-mail dated April 26, 2016 regarding 57.8 GPD; there is not any extra capacity available. He was immediately advised of this restriction. The nail salon is restricted to 108 gallons per day maximum discharge as approved by Brian Dudley of the Massachusetts Department of Environmental Protection (DEP). This is based on two employees, not three. The Health Division should be contacted if additional employees are observed there at the same time. A washing machine is allowed on the.premises. If this business expands into another unit, the proposed.wastewater discharge will have to be recalculated and reviewed in regards to the number of employees and pedicure customers by the engineer prior to the issuance of an approval of a building permit. Sincerely, omas McKean Cc: Paul Canniff, D.M.D. -7 1z/� c�)le� Sophia Christakis A&S Realty Trust/Pinocchio Pizza & More 1661 Falmouth Road Centerville, MA 02632 Town of Barnstable Public Health Division 367 Main Street Hyannis, MA 02601 Dear Mr. McKean, I was recently informed that a nail salon is in the process of opening in a vacant unit in our plaza.While the addition of such a unit has the potential to attract walk-in traffic to our own business, I became concerned when I learned from a fellow tenant that the work being done to the plumbing in the unit may not be up to code and that the salon maybe lacking the necessary permits. Each condo owner has made a significant investment in their respective unit and as you can understand, each of us has an interest in making sure the issues that affect all of us are carefully monitored. The town has been very helpful in helping us navigate matters such as these in the past.We appreciate your continued assistance and attention to this matter. Sincerely, Sophia Christakis w i CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address d 1661 Pinocchio Pizza fast food 36 seats X 20 d/seat 720 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1665 Office Ba side Builders Showroom 909 sf office X 75,gpd/1000 sf v,%,V68.2 0,11 1667 Proposed Nail Salon 2 employees X 15 gpd k 1 30. Pedicures 20 customers/da X 3 gal o- 60 , 245 sf office X 75 gpd/1000¢sf (office F , 184 : . space and-toilet area to<be°11. 4cated from adjacent unit-#1665 1669-1671 Centerville Pie Restaurant 16 seats X 35 d/seat 560 1673 Centerville Cleaners 1,500 sf total 80% Storage & 20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING & ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 McKean, Thomas From: Ed Pesce <epesce@comcast.net> Sent: Tuesday, April 26, 2016 10:56 AM To: McKean, Thomas Cc: brian.dudley@ state.ma.us; Brian Dacey; karenonthecape@hotmail.com Subject: RE: Centerville Plaza - Proposed Nail Salon Hi Tom, I had a good meeting with Brian Dudley yesterday afternoon at his office in Barnstable. Brian reviewed my approach and wastewater flow calculations, and has endorsed my methodology. He found it reasonable, and asked that you contact him if you.have any questions. Also, while I was there discussing this with him, he noticed my calculations of design flow and leaching capacity on the table I sent him. He wanted you to know that the actual approved capacity is the calculated leaching capacity in this case, not the Title 5 Application design flow. He explained that the design flow number only applies to systems installed under the 1978 Code. All newer systems (1995 Code) can be allowed to use the total calculated leaching capacity of the leaching system that was installed as the actual septic system capacity. So based on the above, we actually have an extra 57.8 GPD to work with at this site. Again, please contact Brian is you have any questions on this. Thank you Tom, ED Edward L. Pesce, P.E., LEEDI�'AP Pesce Engineering & Associates, Inc. 451 Raymond Road Plymouth, MA 02360 Office: 508-743-9206 Fax: 508-743-0211 Cell: 508-333-7630 epesce(o)-comcast.net From: McKean, Thomas [mailto:Thomas.McKean@town.barnstable.ma.us] Sent: Monday, April 25, 2016 9:27 AM To: Ed Pesce Subject: RE: Centerville Plaza - Proposed Nail Salon HI Ed, Please ask Brian Dudley of DEP if he agrees with this methodology. 1 a From: Ed Pesce [mailto:epesce@comcast.net] Sent: Monday, April 25, 2016 9:13 AM To: McKean,Thomas Cc: karenonthecape@hotmail.com; Chris D'Aveta; epesce@comcast.net Subject: Centerville Plaza - Proposed Nail Salon Good Morning Tom, stopped by the office on Thursday to try and speak to you, but you were tied up with meetings and interviews. Knowing you were planning to be out on Friday, I thought I would follow up with you in an e-mail today. I dropped off some hand notes and drawings on Thursday and attached is an updated wastewater flow table showing the proposed nail salon and office space changes shaded in Blue. The highlights are: 1. The nail salon will have just 2 employees (husband & wife) 2. They expect to do manicures and pedicures 3. They are estimating 15-20 pedicures (max) per day— so I used 20/day (10 per employee) 4. The pedicures will be done with a special chair (manufacturer's cut sheet attached), which uses water —the basin in the chair holds about 4 gallons, and they only fill the basin about half way (since the customer's feet take up some of the volume) — but I used a volume of 3 gallons/pedicure as a worst case estimate. 5. The Salon is proposed to occupy a unit that does not have a toilet, so they are planning to use the connecting door to the adjacent unit (#1665) to gain access to a toilet, which can be separated from the rest of#1665 by a locked door. This space also has some room for an office, so I have used that 245 SF in my calculations (for office flow). I left copies of floor plans to better explain this. So overall the proposed nail salon use does not exceed the existing septic system capacity, as shown on the attached table. Please review this, and let me know if the proposed tenant can proceed with their plans. Thank you, ED Edward L. Pesce, P.E., LEE&OAP Pesce Engineering &Associates, Inc. '451 Raymond Road Plymouth, MA 02360 office: 508-743-9206 Fax: 508-743-0211 Cell: 508-333-7630 epesce(a comcast.net 2 a CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 c ��� i /��'►�e_Unit Use/Area Title 5 Design Flow Address d 1661 Pinocchio Pizza fast food 36 seats X 20 d/seat 720 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1665 Office Ba side Builders Showroom 909 sf office X 75 gpd/1000 sf 68.2 1667 Proposed Nail Salon 2 employees X 15 gpd 30 Pedicures: 20 customers/day X 3 gal 60 245 sf office X 75 gpd/1000 sf (office � ; ,' a_ 18.4 sP ace and toilet area to be dedicateVrom m } adjacent unit#1665) = - 1669-1671 Centerville Pie Restaurant 16 seats X 35 d/seat 560 1673 Centerville Cleaners 1,500 sf total 80% Storage & 20% Retail = 300 sf x 15 50 d/1000sf + 2 employees x 15 gpd, 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 d/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address _ (gpd) 1661 Pinocchio Pizza (fast food) 36 seats X 20 gpd/seat 720 1663 PhysioTherapy Associates 2,400 SF office 75 gpd/1000 sf 180 1665 Office (Ba side Builders Showroom) 909.sf office X 75 gpd/1000 sf 68.2 1667 Proposed Nail Salon 2 employees X 15 gpd 30 Pedicures: 20 customers/day X 3 gal 60 245 sf office X 75 gpd/1000 sf (office 18.4 space and toilet area to be dedicated from adjacent unit#1665) 1669-1671 Centerville Pie (Restaurant) 16 seats X 35 gpd/seat 560 1673 Centerville Cleaners 1,500 sf total) 80% Storage & 20% Retail = 300 sf x 15 50gpd/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 gpd/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE,5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 -f Crocker, Sharon From: McKean, Thomas Sent: Friday, June 10, 2016 12:46 PM To: Crocker, Sharon; Stanton, David; Desmarais, Donald; Miorandi, Donna Subject: FW: Seating Restrictions at Centerville Pie Company Attachments: SCAN-FILE_1of1 jpg; CENTERVILLE PLAZA- WW Design Flows - 22 April 2016.doc. -FYI - -----Original Message----- From: McKean,Thomas On Behalf Of Health Sent: Friday,June 10, 2016 12:45 PM To: 'tboduch@verizon.net' Subject: RE: Seating Restrictions at Centerville Pie Company Good Afternoon Karen, Every unit in this building is restricted, not just this one unit. This particular establishment added additional seats without first requesting permission from the Board of Health and/or Health Division, as required by the Licensing Board. However, we worked with the professional engineer, Ed Pesce. Attached is the chart he submitted which allows Centerville Pie to increase the seating from 12 to 16 . Attached is the State of Massachusetts Title 5 sewage flow table, which requires us to use 35 gallons per seat as the wastewater discharge flow rate. This is based on both kitchen and restroom wastewater discharges together. There are two issues here: -The limited size/capacity of the septic system; and -The site location within an Estuary Protection Zone which restricts the wastewater discharge flow to 440 gallons per acre per day. However, 1,815 gallons was previously approved;therefore this site is grandfathered for this higher wastewater discharge flow. As you can see from the attached chart, each unit is restricted so that the overall wastewater discharge flow does not increase beyond 1,815 gallons per day which is the maximum wastewater discharge allowed for this site. Pinocchio Pizza is restricted to 36 seats maximum. The nail salon is restricted as shown in the attached chart and as reviewed and approved by Brian Dudley of DEP. (See copies of his e-mails below). The applicant has the option of requesting a variance from the Board of Health; however the Board has been very strict in regards to enforcement of both Title V and the Saltwater Estuary Protection Regulation for many years. Sincerely, Thomas McKean 1 ----------------------------------------------------------------------------------------------------------------------------------------------------- April 26, 2016 Hi Tom, I had a good meeting with Brian Dudley yesterday afternoon at his office in Barnstable. Brian reviewed my approach and wastewater flow calculations and has endorsed my methodology. He found it reasonable, and asked that you contact him if you have any questions. Thank you Tom, ED ------------------------------------------------------------------------------------------------------------------------------------------------------- April 22, 2016 Good Morning Tom, I dropped off some hand notes and drawings on Thursday and attached is an updated wastewater flow table showing the proposed nail salon and office space changes shaded in Blue. The highlights are: 1. The nail salon will have just 2 employees (husband &wife) 2. They expect to do manicures and pedicures 3. They are estimating 15-20 pedicures (max) per day—so I used 20/day(10 per employee) 4. The pedicures will be done with a special chair(manufacturer's cut sheet attached), which uses water—the basin in the chair holds about 4 gallons, and they only fill the basin about half way(since the customer's feet take up some of the volume)—but I used a volume of 3 gallons/pedicure as a worst case estimate. 5. The Salon is proposed to occupy a unit that does not have a toilet, so they are planning to use the connecting door to the adjacent unit(#1665)to gain access to a toilet, which can be separated from the rest of#1665 by a locked door. This space also has some room for an office, so l have used that 245 SF in my calculations (for office flow). I left copies of floor plans to better explain this.So overall the proposed nail salon use does not exceed the existing septic system capacity, as shown on the attached table. Please review this, and let me know if the proposed tenant can proceed with their plans. _Thank you, ED -----Original Message----- From: tboduch@verizon.net [mailto:tboduch@verizon.net] Sent:Thursday,June 09, 2016 4:05 PM To: Health Subject: Seating Restrictions at Centerville Pie Company Hello Tom. Karen Boduch here. I have stopped in to the office a few times to speak with you, but unfortunately, have missed you. I wanted to voice my opinion and strong disagreement with a recent restriction that I understand was made by the Town of Barnstable Health Dept. at the Centerville Pie Shop. 2 L Apparently, one of the inspectors had the owners remove from the restaurant, a table that would accommodate a party of three. The reason, as I understand it to be, is because of the relationship to the number of patrons that might use the restroom with regard to the size of the commercial sized septic system.This makes no sense to me at all. All this has done is to create-for the same number of patrons being served - just having to wait in line longer for a table because now, they are down to seating for only 16. Very frustrating for customers and not good for business.There appears to be neither any gain nor logic to this restriction especially when, clearly, not every patron uses the restroom. In fact, if one were to measure patron restroom usage, I am confident the study results would indeed be lower than speculated. Additionally, the staff was told that the same restriction was levied on Pinocchio Pizza who currently enjoys seating for 40 yet is primarily a take-out business. However, when speaking with staff at Pinocchio Pizza,they say no such restriction has been made to that business. Further, it is also my understanding that a nail salon will soon occupy the unit next door to Centerville Pie Company.What will be the guideline be for that business? I ask that you kindly look into this matter and do your professional best to restore those three seats to that restaurant to better serve the community and to also prevent the BOH from appearing to unfairly single out the Centerville Pie Company.This is a restaurant is well known as having become an icon and staple of Centerville Village that is owned and operated by people who are compassionate, compliant and who give back to the community ten-fold, to say the very least. Thanks for your time, hope to speak with you soon. Take care, Karen Boduch (cell: 508-728-8710) 3 310 CMR:' DEPARTMENT OF ENVIRONMENTAL PROTECTION 15.203: continued MINIMUM l ; ALLOWABLE GPD FOR ° GALLONS SYSTEM TYPE OF ESTABLISHMENT UNIT PER DAY DESIGN (3) COMMERCIAL,(continued) Factory,Industrial Plant, per person 15 Warehouse or Dry Storage Space without cafeteria Factory,Industrial Plant, Warehouse or Dry Storage Space with cafeteria per person 20 Gasoline Station per island***** 75 300 with service bays per bay 125 ***** Plus flows for bays,if any Kennel/Veterinary Office per kennel 50 ' Lounge,Tavern per seat 20 Marina per slip 10 500 .; Movie Theater per seat 5 Non-single family/ per washing 400 automatic clothes washer machine Office building per 1000 sq.ft. 75 200 Retail Store(except supermarkets) per 1000 sq.ft. 50 200 Restaurant per seat 35 ° 1000 Restaurant,thruway per seat 150 1000 service area #, Restaurant,Fast Food per seat 20 1000 # {' Restaurant,kitchen flow per seat 15 i.: ;j [for sizing of grease q.' trap only] Service Station per bay 150 450 [no gas] Skating Rink per seat 5 3000 Supermarkets per 1000 sq.ft. 97 Swimming Pool per person • 10 ; ( Tennis Club per court 250 Theater,Auditorium per seat 3 Trailer,dump station per trailer 75 (4) INSTITUTIONAL t Place of worship without kitchen per seat 3 ,1 with kitchen per seat 6 Correctional Facility per bed 200 Function Hall per seat 15 Gymnasium per participant 25 �. Gymnasium per spectator 3 1 Hospital per bed 200 r i Nursing Home/Rest Home per bed 150 Public Park,toilet per person 5 waste only j t 4/21106 310 CMR-510 CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address (gpd) 1661 Pinocchio Pizza (fast food) 36 seats X 20 gpd/seat .720 1663 Ph sioTherapy Associates 2,400 SF office X 75 gpd/1000 sf 180 1665 Office Ba side Builders Showroom) 909 sf office X 75 gpd/1000 sf 68.2 1667 Proposed Nail Salon 2 employees X 15 gpd 30 Pedicures: 20 customers/day X 3 gal 60 245 sf office X 75 gpd/1000 sf (office 18.4 space and toilet area to be dedicated from adjacent unit#1665) 1669-1671 Centerville Pie. (Restaurant) 16 seats X 35 gpd/seat 560 1673 Centerville Cleaners (1,500 sf total) 80% Storage & 20% Retail = 300 sf x 15 50gpd/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 gpd/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVED TITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD i PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond R.d., Plymouth, MA 02360 Fax 508-743-0211 CENTERVILLE PLAZA -Wastewater Design Flow WASTEWATER DESIGN FLOW CALCULATIONS- 22 April 2016 Unit Use/Area Title 5 Design Flow Address (gpd) 1661 Pinocchio Pizza fast food) 36 seats X 20 gpd/seat 720 1663 Ph sioTherapy Associates 2,400 SF office X 75 gpd/1000 sf 180 1665 Office Ba side Builders Showroom 909 sf office X 75 gpd/1000 sf 68.2 1667 Proposed Nail Salon 2 employees X 15 gpd 30 Pedicures: 20 customers/day X 3 gal 60 245 sf office X 75 gpd/1000 sf (office 18.4 space and toilet area to be dedicated from adjacent unit#1665) 1669-1671 Centerville Pie (Restaurant) 16 seats X 35 gpd/seat 560 1673 Centerville Cleaners 1,500 sf total 80% Storage & 20% Retail = 300 sf x 15 50gpd/1000sf + 2 employees x 15 gpd 30 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 gpd/1000 sf 130 TOTAL 1,811.4 GPD EXISTING APPROVEDTITLE 5 DESIGN FLOW (May 2006): 1,815 GPD EXISTING TITLE 5 LEACHING CAPACITY INSTALLED (May 2006): 1,869.2 GPD PESCE ENGINEERING &ASSOCIATES, INC. Phone 508-743-9206 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 ' Orrf,/dIII���///yyyppp No. Fee ✓/ T E COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal 6pstrm Construction j3PrMit Application for a Permit to t( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System `Individual Components Location Address or Lot No 1&(o I j4,7;5 F64 tkX 0 VT4 1P Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel TMYeuE dQJTEAVt"Z— VL.4ZA T;WS-T P q $7 PO 3o S G ERA!/c.(..E Installer's Name,Address,and Tel.No. 5 09-—cfT T '$$7 7 Designer's Name,Address,and Tel.No. CAPew1DE LL4- I�/A 193 Go Cl �LLe4SNP Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) RC_P 1-aax 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 Certificate of Compliance has been issued by ' Board of Health. e Date Application Approved by Date Application Disapproved b Date for the following reasons 14 Permit No. Date Issued �o 10, f No. Fee THE'COMMONWEALTH OF MASSACHUSETTS Epteredincomputer:. i , Yes .PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 21pplication for Disposal *pstem (Construction Permit Application for a Permit to C o�n� ) Repair( ) Upgrade( .) Abandon( ) ❑Complete System 'Individual Components Location Address or Lot No lolo j(�-75;rj4wqo,rr�4 i;p Owner's Name,Address,and Tel.No. G TEMV("E CWTEAVrc,C.E 'PLAZA TWJSr Assessor's Map/Parcel ;tog 8-7 — PO r3 !u E Installer's Name,Address,and Tel.No. 5 V9t-4 T-1 -;SIR 71 Designer's Name,Address,and Tel.No. CAoELO l De eW�F"-5-5 LAX- WA 1 Gv cr S'�` n.c SNpL�' Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) LO Other Fixtures Design Flow(min.required) gpd Design flow provided gpd' Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil ~ Nature of Repairs or Alterations(Answer when applicable) cP 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 Certificate of Compliance has been issued by this Board of Health. " n do , C Date �'aO Application Approved by / / v r Date Application Disapproved b Date for the-following reasons Permit No. Date Issued --------- - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance E THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(X) Upgraded( ) Abandoned( )by 0 4P6FU)(nG WTE9041555 LLC at I(o(�! 1(07 S FAL 444 o J-DA has been constructe jinaM with the provisions of Title 5 and the for Disposal System Construction Permi ed RC 09� _E pl�h�&� L� g 1 Installer Q Desi ner J #bedrooms �, j Approved designeo-w,n tlV .�~ gpd The issuance of thi pe it shall not be construed as a guarantee that the system will funt :,as d gg . . Date j > Inspector VVrI� J I ' --a ------------------------------------------------ ------------- �-' No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLI HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal *pstPY1l COnstrUttiou Vermit Permission is hereby granted to Construct( ) Repair( r Upgrade( ) Abandon( ) System located at ( o(o l— 146715 F04-(.w d U Tbr R U ft �,GA)0oV and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Co t ctio must bp-completed within three years of the date of this permit. !� ° Date Approved by i � t Town of Barnstable Regulatory Services '. Richard V. Scali,Interim Director � HAENbTABLE, s NAM. Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form � g^ Date: JZ ZD6�Sewage Permit# (06'8? As 's MaplParcel��,,�(J�[_ O/"01 Designer: k5C9' Install PAUtAX, (Pay Gtvo� Address: Address: ,Q S �.,� !2" On Ehq Ima A was issued a permit to install a ( a (installer septic system at `�U i g &.� L1!I,�/��based on a design drawn by -r (address) � �fl��„J��� dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if.required)was inspected and the soils were found satisfactory. I certify that the system .referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) OF Mgss9 O EDWARD L. yG PESCE m e) CIVIL N No.32001 9�,�FFC'�S7Ea�Oa��'Q (Designer's ignature) (Affix D A p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU.. Q:\Septic\Designer Certification Form Rev 8-14-13.doc /jam 57, Applcation Center X . Parcel Detail X _ Official Website of The Towr Print Page x ' 'w WWW,townofbarnstable,uslks:,es.in 1 rir�tl�a>>?an= searcl creel=20 087/10A �' r1,p' p— P^ Apps ®http--www,town,barn... Application Center ®Suggested Sites Imported From IE Parcel Lookup [ New Tab Sing r,Videb:5Incredible Tin..Uj = `' Print this page I l Owner Information-MaplBlock/Lot:2091087110A-Use Code:3270 Owner Map/Block/Lot GIS MAPS 209 10871 10A � MARFATIA,NILESH P TR Property Address Owner Name as of 111115 4SYMPHONYLANE 1661 FALMOUTH ROADIRTE 28 SANDWICH,MA.02563 Co-Owner Name AMAN REALTY TRUST Village:Centerville Town Sewer At Address:No GIS Zoning Value:SPLIT HO;HB Assessed Values 2015-MapBlocklLot:209!087110A-Use Code:3270 2015 Appraised Value 2015 Assessed Value Past Comparisons Building Value: $311,600 $311,600 Year Total Assessed Value . Extra Features: $0 $0 2014-$311,600 2013-$311,600 Outbuildings, $0 $0 2012-$347,600 $0 $0 2011-$601,600 Land Value: 2010-$n1a 2009-$n a 2008-$nla 2015 Totals $311,600 $311,600 2007-$nla Tax Information 2015-MapfElocklLot:2091087110A-Use Code:3270 wwruca ha•r..... Road Chrome Prht Page-Google ® List-Google Chrome® Computer name : HEALTH899JF User name : flvnni Operatinq System : Windows NT (5.1) . - mit -71 G .. -- �� ,. �4 -._fi k ®Application Center x , Application Center X Health Parcel lookup x Apps http••www,town,barn..: Application Center Suggested Sites 71 Imported From IE Parcel Lookup New Tab l Bing �{Video;5 Incredible Tio... � J.. ru; t/i�1I�!..[-i'1 �,r.; "Logged In As: TOWN�flynnj Parcel Lookup Application Cente-_ Selection Items Rteports Owner ' ' { s Owner Name dacey l <Prev N0 Pagel of 3 RowslPage:laiv panel` rLocatign a ' a Ownerti i6ge mpp - 208-085-0011170 SOUTH MAIN STREET DACEY,BRIAN ET TR CEN 208085001 2481a 46 ELAINE ROAD v , 'a .m. DACEY,BRIAN T'•l - HY 281Ei8 093-058-007 j 45 LITTLE ISLAND DRIVE DACEY,BRIAN T&CINDY L OST 093058007 957 005 001120 CAITLYN CIRCLE DACEY;BRIAN T TR WN,057005007, 057-005-008 23 CAITLYN CIRCLE DACEY,BRIAN T TR I MM 057005008 058-628-OOK 40 INDUSTRY ROAD . � DACEY;BRIAN T TRH 77 MM 10580280OK 093-016 �0 T BAY ROAD DACEY,BRIAN T TR OST 093016 2Q9087 O i 1661 FALMOUTH ROAD/RTE 28`Multiple Address ' DACEY BRIAN BRIAN T TR CEN 290870Q1 '(1661 FALMOUTH ROAD/RTE 28�PihocchiOizzaY _ 00 209 087 0 1 11661 FALMOUTH ROAD/RTE 28-Multiple Address I DACEY,BRIAN T TR CEN 209087001 (1663 FALMOUTH ROAD/RTE 28-Physiotherapy Assoc,) 1661 FALMOUTH ROAD/RTE 28 'Multiple Address � 1, 09=087-00 DACEY;=BRIAN T TR �`�CEN' 908ml (1667FALMOUTH ROAD/RTE 28-,Bayside 8ui(ders� �� tEi {�o u � 3 1 f�r"Start 1�� Health Parcel Laokup G y®� = - °{ 12;13PM Computer name : HEALTH899JF User name : flvnnl Operatinq Svstem : Windows NT (5.1) -` ' commonwealth of Massachusetts Y Title 5 Official Inspection Forms"��-lh� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1661 - 1675 Falmouth Road Rt.28 Oi *A -01 / ' 'iA4m.e Property Address V Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 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. General Information \��►p►uunup/��/� on the computer, `� `����� �,TH OF MA,ss�,o use only the tab 1. Inspector: key to move your cursor-do not James D.Sears ZrJA M ES m_ use the return Name of Inspector c�: key. CapewideEnterprises,LLC Company Name 153 Commercial Street ,�i���r51I iNSpG������` Company Address Mashpee NIA 02649 City/Town State Zip Code 508-477-8877 S1623 'j Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function.and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority tom- 2-20-15 nspector'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 is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall.submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. a t5ins•3/13 Title 5 Official inspection Fo rface Sewage Disposal Systam-Page 1 of 17 ` k\- Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. Cityrrown .State Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary:Check A,B,C,D or E/always complete all of Section D A) 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: Conpass-Need to replace D Box. The system is a 5000 Gal.Tank 1000 Gal.& 1500 Gal. G.T.'s. Three D Box's and twelve 500 Gal.Chamber's. B) 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): bins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. Cityrrown State Zip Cade Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ® 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): Need to replace D Box. ❑ 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): C) 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment:. ❑ 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .'" 1661 - 1675 Falmouth Road (Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is Centerville MA 02632 2-17-15 required for every page. cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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. 3. Other: D) 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 ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in sssepW is less than 6"below invert or available volume is less than%day flow ,L'9'%e11i•v9 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °< 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town State Zip Code Date of inspection B. Certification (cunt.) Yes No ❑ ® 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 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 2000gpd- 10,000gpd. ❑ ® 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. E) 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 D. 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 If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Mine•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town state Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: 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)] D. System Information 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): t,9ns•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 5000 Gal.Tank 1000 Gal&1500 Gal. G.T.'s,Three D Box's and twelve 500 Gal. Chambers. Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No 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: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Retail and Food Buisnesses Design flow(based on 310 CMR 15.203): 1815 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft.,etc.): 58 Seats- 10100 Sg. Ft. Grease trap present? ® Yes ❑ No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: NA t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts kiwiTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: 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): G.T.'S t5ins-3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments "• 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: Tank and D Box 1980's / D Box's and Leaching 2006 Permit #2006-233. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3'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.): Pipeing is C.I and 4" PVC SCH 40. 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: 5000 Gal. Precast Sludge depth: 3" t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System.Form -Not for Voluntary Assessments y 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name inform required is Centerville MA 02632 2-17-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle NA Scum thickness 1" Qfl Distance from top of scum to top of outlet tee or baffle V Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Plan -AsbuiltSludge-Judge-Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition,.structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Tank at working level.Tank at 2'below grade w/steel covers. Four inlet tee's outlet tee w/Zable Filter. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: 2' feet Material of construction: ®concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: 1000 Gal. 8r 1500 Gal. Scum thickness 1" 2" pn pn Distance from top of scum to top of outlet tee or baffle y O Distance from bottom of scum to bottom of outlet tee or baffle 3' 3' Date of last pumping: NA Date t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'r< 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. Cityrrown state Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): G.T's.at working level w/steel covers. In and outlet tee's. No sign of leakage or over loading. Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 g ( P p Pe )( P ) Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day 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 t5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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.): Older D Box need's to be replaced.Two newer D Box's are clean and solid w steel covers. No sign of over loading. 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. Soil Absorption System(SAS)(locate on site plan,excavation not required): If SAS not located, explain why: t5lns-3113 Title 5 Official inspection Form Subsurface Sewage Disposal System•Page 12 of 17 1�_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ® leaching chambers number: 12 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Leaching is twelve 500 Gal. Dry well chambers wlsteel cover's. Leaching is two sets of six each chambers w 3'stone between and 4'stone on sides.4"water in chambers. No sign of over loading. Wall's clean like new. 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 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner owner's Name information is required for every Centerville MA 02632 2-17-15 page. Cityl-rown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): 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.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y< 1661 - 1675 Falmouth Road(Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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 t5ins-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °y< 1661 - 1675 Falmouth Road (Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is required for every Centerville MA 02632 2-17-15 page. City/Town State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells IV-4 Estimated depth t�gh ground water: 20�+ 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: 3110106 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: Past Report ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: No G.W.20'+Per Past Report.T.H.on Design Plan 3-10-06 no G.W.at 1 T-6". Bottom of chambers at V-6"below grade. Bottom of chambers at 5'above T.H.Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1661 - 1675 Falmouth Road (Rt.28) Property Address Centerville Plaza First Property MGMT Owner Owner's Name information is Centerville MA 02632 2-17-15 required for every i page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 1 ` 5 < t j t3� 1 � _ s--•v3_,_. _ .__ _ S S i t I � � _ _ F .. i I,,,,_._1 -� , j€ 1 4 L �.— 4i - -ijl�-- '7�— f - { — r----�----•-3-___.. _y_.r } s_._.-_x.__�..—�.. 1-_.._.....r_ __ - .—. ; k ° f 7 I tr 3 x + k E 1 _ i I t—� t r 4 ; E Feb. 13. 2015_ 2: 14PM•, _ ,._ _� .._._No 71.23 -P. 8 sft �. �4RN ptrC l;, �'Oeyo'%kr p/poas G 04 ' 6 O PROP \ i 26, QF ftcNr Page 1 of 1 C'11444 166-�-) F" Crocker, Sharon From: Ed Pesce [epesce@comcast.net] �. Sent: Wednesday, March 04, 2015 6:25 PM / To: Crocker, Sharon Cc: lee_bostonl@hotmail.com; Brian Dacey Subject: Request to Withdraw BOH Variance Application - 1665 Falmouth Road (Centerville Plaza) Hi Sharon, Based on our conversation today, I'm writing to officially withdraw the Variance application I submitted last week, regarding the proposed Thai Restaurant located at 1665 Falmouth Road (Centerville Plaza). The applicant has decided not to go forward with the application. Thank you for your help with this, ED Edward L. Pesce, P.E., LEED(�AP / Pesce Engineering & Associates, Inc. 451 Raymond Road Plymouth, MA 02360 Office: 508-743-9206 6 Fax: 508-743-0211 (�,,� Cell: 508-333-7630 CJ / epesce _comcast.net S 3/5/2015 �S11E tICl - DATE: -, FEE: 1659. `6' Yf 5 / REC. BYC� Town of Barnstable SCHED. DATE: Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-8624644 [ Wayne A.Miller,MD. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Conniff;D.M.D. .4SS'elfo,, 1,66 F�a& VARfANCE REQUEST FORM LOCATION mil Property Address: 1665 Falmouth Road(Centerville Plaza), Centerville, MA 6�n ii d26 —ok7 -/0 F Assessor's Map and Parcel Number: Map 209/parcel 87:�f Size of Lot: 1.19 Acres Wetlands Within 300 Ft. Yes Business Name: Proposed"Galanga"Thai Restaurant No X Subdivision Name: N/A APPLICANT'S NAME: Lee Narbunshart Phone (c)617-699-6696 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Brian Dacey,Trustee, Centerville Plaza Trust Name: Edward L. Pesce, P.E., Pesce Engineering&Assoc. Address: P.O. Box 95, Centerville, MA 02632 Address: 451 Raymond Road, Plymouth, MA 02360 Phone: 508-771-1040 Phone: 508-333-7630 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Section 322-4 Toilet Facilities. ' Applicant wishes to use the existing 2 bathrooms as unisex -regarding the requirement for both male bathrooms,since space is limited, and the demand/use and female bathrooms for patrons& will not be significant(restaurant focus is"take-out'meals. employees. NATURE OF WORK: House Addition 171 House Renovation 173 Repair of Failed Septic System X-Renovation of an existing commercial condominium unit(see proposed floor plan) Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified 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 submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chauman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Cannif�D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC t l ' r r 1 r 1 �ME DATE: -TI FEE: t sn WWABLE, Mess. *639..(p j g REC. BYown of BarnstabIle r SCHED. DATE: �j�� t ' Board of Health / `„'200 Main Street,Hyannis MA 026- Office: 508-862-4644Wayne A.Miller,M.D. FAX: 508-790-6304 � Junichi Sa ayanagi V, �YiG(t Paul J.Canniff,D.M.D. /�SSe3'�cs �6�p FALn7d VARIANCE REQUEST FORM LOCATION 1 f►')Ai�n,� Property A^ ddre 1665 Falmouth Road(Centerville Plaza), Centerville, MA ((�C rl ---� a09-087- /0 F Assessor's Map and Parcel Number: Map 209/parcel 87 mil' Size of Lot: 1.19 Acres Wetlands Within 300 Ft. Yes Business Name: Proposed"Galanga"Thai Restaurant No X Subdivision Name: N/A APPLICANT'S NAME: Lee Narbunshart Phone (c)617-699-6696 Did the owner of the property authorize you to represent him or her? Yes X No PROPERTY OWNER'S NAME CONTACT PERSON Name: Brian Dacey, Trustee, Centerville Plaza Trust Name: Edward L. Pesce, P.E., Pesce Engineering&Assoc. Address: P.O. Box 95, Centerville, MA 02632 Address: 451 Raymond Road, Plymouth, MA 02360 Phone: 508-771-1040 Phone: 508-333-7630 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) Section 322-4 Toilet Facilities. Applicant wishes to use the existing 2 bathrooms as unisex -regarding the requirement for both male bathrooms, since space is limited, and the demand/use and female bathrooms for patrons& will not be significant(restaurant focus is"take-out'meals. employees. NATURE OF WORK: House Addition ❑ House Renovation C1 Repair of Failed Septic System 13 X-Renovation of an existing commercial condominium unit(see proposed floor plan) Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. _ Four(4)copies of the completed variance request form _ Four(4)copies of engineered plan submitted(e.g.septic system plans) _ Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian _ Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified 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 submitted(for grease trap variance requests only) _ Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining varia2,`renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) X4 _ Variance request subiititted at least 15 days prior to meeting date VARIANCE APPROVED j Wayne Miller,Chairman i NOT APPROVED "„r- Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. RaIj LLJ C:\Users\decollik\Apppata\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC I � DEEP FRYER STOVETOP COUNTER EX. DOOR WOK SINK HAND WASH SINK SEAT(TYP) I I t A PROP. PROP. WOK GRILL W3SIN S COUNTER To0FRIDGE FREEZ. 0oo — I 1 �I 7.0'1--5.0' w _ _ _ _ _ _ _ t w EXHAUST HOODS c' #1665 000 I 12.6' Iloz.00 PROPOSED OFFICE DISHWAS ER �� RESTAURANT PROP. i-►-8 0' p (10 SEATS) (GREASE 0 ( I TRAP 8'WIDE SHELF E 1,149t S.F. rMECH. HAND SINK — — —PUBLIC EMPL YEEE BATH PROP. KITCHEN WASTE LINE12 2' BA OM IS T(VJ ❑ PROP.HALLWAY— EXISTING DOMESTIC WASTE LINE EXISTING DOMESTIC WASTE LINE CLEAN-OUT I } PROPOSED FLOOR PLAN PREPARED FOR: 1 ,,gy�mm ��.a E ENGINEERING GALANGA THAI RESTAURANT LEE NARBUNSHART& ASSOCIATES, INC. (10 SEATS) 299 OAKLAND ROAD HYANNIS, MA 02601 IIEdWBrd L Pesce, P-E.,ZEED®AP LOCATED AT: DATE: SCALE: 451 RAYMOND RD CENTERVILLE PLAZA 29 JANUARY 2015 1/8" = 1' 5 PLYMOUTH,.MA 02360 epesce@comcast.net Phone:508-743-9206 #1665 FALMOUTH ROAD (ROUTE 28) SHEET 1 OF 1 celi:508-333-7630 FAx:508-743-0211 CENTERVILLE, MASSACHUSETTS PESCE ENGINEERING & ASSOCIATES, INC. 451 Raymond Road Plymouth, MA 02360 Phone: 508-743-9206 FAX: 508-743-0211 epesce(a_comcast.net February 23, 2015 TO: The Abutters of 1665 Falmouth Road, Centerville, MA (Centerville Plaza) Assessor's Map# 209, Parcel # 87-01 SUBJECT: Notification of a Request for Approval of a Variance from the Barnstable Board of Health Regulations TO WHOM IT MAY CONCERN, In accordance with the Town of Barnstable Health Regulations, you are hereby notified that a request for variance(s) has been filed with the Barnstable Board of Health by the owners of the property as described above, regarding a proposed restaurant. Additional details follow: APPLICANT. Mr Lee Narbunshart OWNER: Mr. Brian Dacey, Trustee 299 Oakland Road Centerville Plaza Trust Hyannis, MA 02601 P.O. Box 95 Centerville, MA 02632 PROJECT LOCATION: 1665 Falmouth Rd, Centerville, MA (Centerville Plaza) PROJECT DESCRIPTION: The applicant proposes a new Thai "take-out" restaurant, and requests relief from the Board to allow unisex bathrooms for employees and customers, due to space limitations APPLICANTS'AGENT. Edward L. Pesce, P.E., Pesce Engineering and Associates, Inc. PUBLIC HEARING: Tuesday afternoon, March 10, 2015, 3:00 PM at the Barnstable Town Hall, 367 Main Street, Hyannis, MA Plans for this project and application describing the proposed activity are on file with the Board of Health. Sincerely, Edward L. Pesce, P.E., LEED ®AP Town of Barnstable Geographic Information System February 20,2015 190104 • 210151 210157 210191 210190 210189 4 346 190256 210002� 1464 4 25 #,18 414 465 .: �, #340 465 . Q_ 210146 210145 210179 190105 210147 445 451 422 4330 # W 433 21U192 210001 420 Q 190106 #51 L 210195 .4322 fi �' 210194 45 190107 #56 a#50 210193, •#15 345 IZ . 189136002 210152 #19- V 189136001 #39 21U153 #60 4308 , 209014 209097 209U95 ')10 2U9U8 :. : .;.a:'::•;:"c r: c #1672 ... ..::.::• ## 431 #1652 J.'r:::. 189037 tZ 430 p##4166_ r1#1646 .r.r ••to•,r.::.. #319 #20 ::Q 167U'::::#1658::::Q+41638.-.. 209015 209012 209U13%:::::::::::.:,::: :-:• #iU : ::. 41550 '209010 V 4'41 � .: .. ... .. 4 189035 4283 #16'#169 t1E '.'.-....: ?. isir.':: i•'r.: :{ i:i:.':::::•':;ii::.;; i:;i#162U;i::. d 18993 # J 176 209004 aii::.;i E::::':•:::•::c.:.'?;a;::i: ::: 41776 189036 11684:•:::;:;:: #1758 189132 #17U8 ;• #1696;;., .. �1734 ::. c_209003:::::::.:::. ::•: 209082:: �q 1597 1 5778 4 41521 41597 i•� FALMOVTN RD/RTE 28 �t 1577A #- L„7 0 U85 2 9 #16 2U 9083 17 2U9U86CND:::;.. 4 16 5 ' ••...••.87001CND'. ...... . 189065 #1661'::f>::.::. 209052UU3 �ly_Pj�/ArT ':::::::'•:": .. .i::::.,ii.�iis:::•::::i::::.:::•::::E�..• #185 '-:::•2U9087002•:•. 209091 2U9052001 t#125 209061 E 75 16 .157 J 1 121 e :{•2U9088'i"::>;`:%':::.?.:':i'ii t.<:}:>'::'i.r:.' 189076 189U77 189078 209063004 209063001 209062 1 7�890 9 3 209122 3 •r 36 189U80 [ 4 1 1,3 4# >a 1 26 #111 y 5 4 #16 4203 .64 169 20905200 4171 189071 189075 SY 1209103 "#99 253923 LviALN • 209063002 2 09052 o06 189U83 - 2U9102 95 r '#1 189U82 209063003 412 3 6 09101 2 # 7 r 8 189U8 1 a �Qr #17 rti 2U91U4 189074 R1 .w 4121 19 #187� :`:r:;,'ii:.:i': t:::'..::.;. .:::::• 2091U0 #77 #68 ® 2U9059 209U520U5 467 20912y #169 #73 y �189084 209066) * / 1-14 189073 .428713 189085 4 59' w 97 209105 209119 1#2612 4277 4177 �209U67003 #67 #66 2U9058 209051 U 461 �M R t0 209118 209106 4 #173 189118U08 1890900029300 0 4 6591 209050 v #58 #300 209067 4 0 189147#276 9_• 49 n 209107 443 189090003 2U9117 �t �#46 2 18 9U89 63 1 ® #29 7 209 10 9 #153 2090691 90002 209A116 09108 422 209049 4156 r209068001 209070 20906700120# #5 2#34 87 18908 #31 #298 #142 #128 20904 7V 24 #19 #20 Parcel e ec e 0871OF Board of Health l Selected P l 09 Parcel:DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:2 F-1 f'B boundary determination or regulatory interpretation. Enlargements beyond a scale of Abutter List Type-Direct abutters(no set distance)and the properties located 1"=100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessor's tax parcels. They are not true property across the street. Abutters boundaries and do not represent accurate relationships to physical features on the map •' �,% such as building locations. Buffer ,{f Barnstable BOH Varaince Application 1665 Falmouth Road,Centerville,MA Propoosed Thai Restaurant Applicant: Mr. Lee Narbushart Board of Health Abutter List for Map & Parcel(s): '209087001CND' Direct abutters (no set distance) and the properties located across the street. Map&Parcel owned Owner2 Addressl Mailing CityStateZip Deed 209003 POYANT,MARCEL R TR CENTERVILLE SHOPPING CTR NOM TR 20F CAMP OPECHEE RD CENTERVILLE,MA 02632 12763/217 209013 POYANT,MARCEL R 20F CAMP OPECHEE RD CENTERVILLE,MA 02632 C131734 209086A01 VENDOLA,KATHLEEN STIR VEO TRUST 38 RAINBOW DR CENTERVILLE,MA 02632 11262/131 209086A02 GLATKI,CLAIRE S TR TRAVANA REALTY TRUST 726 WOODCREST WAY MURRELL'S INLET,SC 29576 7009/28 209086A03 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209086A04 GLATKI,CLAIRE TR TRAVANA REALTY TRUST 726 WOODCREST WAY MURRELL'S INLET,SC 29576 7009/28 209086B0l LIU,DIANA W TR L E INVESTMENT TRUST 18 CRESENT HILL ROAD EAST SANDWICH,MA 02537 24552/137 209086B02 KLOTZ,SUSAN A 51 MAPLE AVE CENTERVILLE,MA 02632 7070/261 209086B03 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 2090861304 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209086C01 CROUGHWELL,MARY C PO BOX 88 OSTERVILLE,MA 02655 28544/218 209086CO2 CASE,B LORI TR 49 BELDAN LN CENTERVILLE,MA 02632 10834/203 209086CO3 BAYSIDE BUILDING CO INC P O BOX 95 CENTERVILLE,MA 02632 8167/268 209086C04 BAYSIDE BUILDING CO INC P 0 BOX 95 CENTERVILLE,MA 02632 7435/197 209086D01 NASTASIA,THOMAS V SHAKALIS,R&FALCO,P A 1645 RTE 28 CENTERVILLE,MA 02632 3926/47 209086D02 SHIELDS,JOHN T C/O REALTY ADVISORY,INC 1645 FALMOUTH RD.,STE 1OF CENTERVILLE,MA 02632 26263/108 209086D03 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209086D04 JACOBSON,RUSSELL J TR MMCR REALTY TRUST 1645 FALMOUTH RD BLDG F D-04 CENTERVILLE,MA 02632 22147/335 209086D05 SHAFROTH,JOHN F 21 OXNER ROAD CENTERVILLE,MA 02632 27861/232 209086D06 SHAFROTH,JOHN F 21 OXNER ROAD CENTERVILLE,MA 02632 27861/232 209086D07 NASTASIA,THOMAS V& SHAKALIS,R R&FALCO,P A 1645 ROUTE 28 CENTERVILLE,MA 02632 6113/66 209086D08 NASTASIA,THOMAS V& SHAKALIS,R R&FALCO,P A 1645 ROUTE 28 CENTERVILLE,MA 02632 6113/66 209086D09 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209086E01 LIU,DIANA W TR L E INVESTMENTTRUST 18 CRESENT HILL ROAD EAST SANDWICH,MA 02537 24552/137 209086E02 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209086E03 JENSEN,LAMES N III 353 WILLOW STREET WEST BARNSTABLE,MA 02668 20468/24 209086E04 BOSWORTH,WARREN C 1R PO BOX 685 CENTERVILLE,MA 02632 12552/254 209086E05 BOSWORTH,WARREN C 1R PO BOX 685 CENTERVILLE,MA 02632 12552/254 209086E06 KASL LLC 1 122 JACKSON DRIVE ACTON,MA 01720 27589/163 209086E07 I KASL LLC 1 122 JACKSON DRIVE JACTON,MA 01720 27589/163 Page 1 of 2 Barnstable BOH Varaince Application 1665 Falmouth Road,Centerville, MA Propoosed Thai Restaurant Applicant: Mr. Lee Narbushart ` 209086E08 STATE LEGISLATIVE LEADERS FNDN INC 1645 FALMOUTH RD BLDG D CENTERVILLE,MA 02632-2932 11714/199 209086E09 STATE LEGISLATIVE LEADERS FNDN INC 1645 FALMOUTH RD BLDG D CENTERVILLE,MA 02632-2932 11714/199 209086E10 STATE LEGISLATIVE LEADERS FNDN INC 1645 FALMOUTH RD BLDG D CENTERVILLE,MA 02632-2932 11714/199 209086E11 STATE LEGISLATIVE LEADERS FNDN INC 1645 FALMOUTH RD BLDG D CENTERVILLE,MA 02632-2932 11714/199 209086E12 STATE LEGISLATIVE LEADERS FNDN INC 1645 FALMOUTH RD BLDG D CENTERVILLE,MA 02632-2932 11714/199 + 209086F01 CASE,B LORI TR 49 BELDAN LN CENTERVILLE,MA 02632 10834/198 209086F02 CASE,B LORI TR LORI CASE INV TRUST 49 BELDEN AVENUE CENTERVILLE,MA 02632 23735/130 209086F03 CASE,B LORI TR LORI CASE INV TRUST 49 BELDAN LANE CENTERVILLE,MA 02632 26309/215 209086F04 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209086F05 KASL LLC 22 JACKSON DRIVE ACTON,MA 01720 27589/163 209087002 LYNCH,ROBERT E JR 92 KENDALL AVE FRAMINGHAM,MA 01701 9976/116 20908710A MARFATIA,NILESH P TR AMAN REALTY TRUST 4 SYMPHONY LANE SANDWICH,MA 02563 23141/294 20908710E RIGAS,EMILIOS&ANASTASIA TRS AE REALTY TRUST 1663 FALMOUTH RD.,UNIT 2 CENTERVILLE,MA 02632 23098/66 20908710C DACEY,BRIAN T TR CENTERVILLE PLAZA TRUST P O BOX 95 CENTERVILLE,MA 02632 11186/300 20908710D DACEY,BRIAN T TR CENTERVILLE PLAZA TRUST P O BOX 95 CENTERVILLE,MA 02632 11186/300 20908710E DACEY,BRIAN T TR CENTERVILLE PLAZA TRUST P O BOX 95 CENTERVILLE,MA 02632 11186/300 2090871OF DACEY,BRIAN T TR CENTERVILLE PLAZA TRUST P O BOX 95 CENTERVILLE,MA 02632 11186/300 2090871OG DACEY,BRIAN T TR CENTERVILLE PLAZA TRUST P O BOX 95 CENTERVILLE,MA 02632 11186/300 20908710H DACEY,BRIAN T TR CENTERVILLE PLAZA TRUST P O BOX 95 CENTERVILLE,MA 02632 11186/300 209087101 KRANIOTAKIS,ANNA&CHRISTAKIS,SOPHIA A&S REALTY TRUST 39 BELDAN LANE CENTERVILLE,MA 02632 23141/326 209088 BARNSTABLE,TOWN OF(CEM) 367 MAIN STREET HYANNIS,MA 02601 Page 2 of 2 • r ' Centerville Plaza Trust P.O. Box 95 Centerville, MA 02632 February 18, 2015 Wayne Miller, M.D. Chairman, Barnstable Board of Health 200 Main Street' Hyannis, MA 02601 Subject: Request for Board of Health Waiver Proposed Thai Restaurant, 1665 Falmouth Road, Centerville Plaza, Centerville, MA 02632 Dear Dr. Miller and Members of the Board, In accordance with your requirements for filing a request for a variance from the local Board of Health Regulations, this letter is forwarded to you to provide my approval and consent, as the property owner, for Mr. Edward L. Pesce P E of Pesce Engineering & Associates, Inc. to act on my behalf as my agent for all duties and actions as necessary to apply for and obtain approval of the subject waiver for this project. Sincere , B fT6jD;��XTrustee, ville Plaza Trust r LEGEND ' x 50.0 EXISTING SPOT GRADES — 50 — — EXISTING CONTOUR / 175-0-1 PROPOSED SPOT GRADES / r� PROPOSED CONTOUR E/T/C EXISTING UNDERGROUND UTILITIES W W EXISTING WATER LINE GAS EXISTING GAS LINE TEST PIT LOCATION �O Oj PROPOSED 1,000 GALLON GREASE TRAP f — — — — — — — — PROPOSED 4"PIPE —————- PROPOSED,4"CAST IRON VENT LINE 1 2-20-15 MCP ELP Added 4"C.I.vent line to grease trap REV. DATE BY APP'D. DESCRIPTION r PROPOSED GREASE TRAP PLAN PREPARED FOR: FLEE NARBUNSHART LOCATED AT /1665 FALMOUTH ROAD (PROPOSED "GALANGA" THAI RESTAURANT) CENTERVILLE, MA 02632 SCALE: �1 INCH = 20 FT. DATE: JANUARY 29,2015 0 / 10 20 40 80 FEET tN OF S7�y o`er EDWARD L. G� % PESCE CIVIL USEE N0. 32001 kNd51t:R 0 mb i,�L1rMDIJTH-,-PMA 0z350 Drawn By: MCP epesce@comcast net Phone 508 743 9206.+ JOB No.1023 ce11:508-333-7630 FAX:508-743-0211 Postal CERTIFIED M41-n. RECEIPT .n (Domestic Lr) For delivery Information visit our website at www.us-PS—.C-O—M—@ -- C3 -- Ul O Postage $ 601 Certified Fee !!! h r:I LO P Irk C3 Return Receipt Fee p (Endorsement Required) ere to c Q� C3 Restricted Delivery Fee O (Endorsement Required) Q J ti ru Total Postage&Fees $ oBrian Dacey r- Centerville Plaza First Property MGMT PO Box 95 Centerville, MA 02632 F Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ' ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for dupllicdate return receipt,a USPS®postmark on your Certified Mail receipt is uir■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". . ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. ,I IMPORTANT:Save this receipt and present It when making an inquiry. y PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 Barnstable Town of Barnstable � Regulatory Services Department K"s ' Public Health Division 639.A 2007 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7014 1200 0001 0358 0536 April 6,2015 Brian Dacey Centerville Plaza First Property MGMT PO Box 95 Centerville, MA 02632 The septic system located at 1661 Falmouth Road (Rt 28), Centerville, MA was last inspected on 2/17/2015 by James D. Sears, a certified septic inspector for the State of • Massachusetts. The inspection of the septic system showed that the system"Conditionally Passes" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution box (old) must be replaced. You are ordered to replace the distribution box within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. ORDER OF THE B ARD OF HEALTH c ean, R.S. CHO Agent of the Board of Health • Q:\SEPTIC\Conditionally Passes Ltr\1661 Falmouth Rd Rt 28 Cent Mar 2015.doc No. V 1 3o Fee `to THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 0(ppYicatiou for �Dtopogar �&potem Comaructton Vermtt Application for a Permit to Construct( ) Repair(,A Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 47-z.44 Owner's Name,Address,and Tel.No.�, Assessor's Map/Parcel o c ©f5 l `V ID AA Installer's Name,Address,and Tel.No. e4pe,�Jj c"1P)e/ Designer's Name,Address and Tel.No. (�q4 qo4' ® t?aw- ?co'i Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1,2k°-2 Date last inspected: 7-0orj 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 Certificate of Compliance has been issued by this Board of Health. igned Date ' �—] Z-00 Application Approved b Date Application Disapproved by: Date for the following reasons Permit No. !-30 Date Issued --------------_--------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rpprtcation for Migpogal *pgtem Construction Permit Application for a Permit to Construct( ) Repair(*-A Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. (�"�t ��a�vti v k%% (j.s,tic' Owner's Name,Address,and Tel.No.�� 140 4 V4 i Assessor's Map/Parcel 2 0 ai /� Installer's Name,Address,and Tel.No. 6P.t,1,rXP Cam(✓p'��/ Designer's Name,Address and Tel.No. Nu go11 ?0g-�X e Type of Building: Dwelling No. of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) .r Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L•%^\Q_ Date last inspected: ZpQ Agteement: 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 Certificate of Compliance has been issued by this Board of Health. igned Date " ��] -- �tq<j Application Approved b Date a Application Disapproved by: Date " for the following reasons Permit No. 30 Date Issued THE COMMONWEALTH OF MASSACHUSETTS ARNSTABLE, MASSACHUSETTS v� l Y Certificate cate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by (,Id f t,.,! �&k t o V r-S C S `aW {W1 I F 4 ,c kVo,��N,1 w�9r� ,}yin �,��C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated /� A : iq� . Installer C •� (�.� f` ,SG N Designer #bedrooms Approved,design flow- gpd The issuance of this ermit.,shall not be construed as a guarantee that the system will f nth' cton.as designed. Date ( d Inspector • No. -^�[/�.1 "1 -.�— � "------ --------- --Fee `~ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS x1i6poar *p9tem Construction Permit ` Permission is hereby granted to Construct ( ) Repair ( x) Upgrade ( `) Abandon ( ) l; System located d%f 1 (1-1 1 �'A V1 Q v i� a t;Al C.,-e,v� ' kt-1 k�•� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special condition . Provided: Construction must be completed within three years of the date of this p it. Date 1 1 7 [/ . 1 G Approved b ���� MAP PARCEL all, CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508)790-2380/FAX#(508)790-2385 OILIHAZARDOUS MATERIA(f ELEASE FORM F.Q.# LOCATION:ADDRESS OF RELEASE: I(nly I i�� Cyr-$. C vJ . DATE OF RELEASE: PRODUCT RELEASED: k ESTIMATED QUANTITY: CORRECTIVE ACTION TAKEN rBY RESPONSIBLE PARTY: V 4-+'(P itI tY 1 r f r I i c'h t rl c v1 di? *I NOTIFICATIONS: FIRE DEPARTMENT: YES( NO( ) DATE: t f f 0#DAE: ME: NATIONAL RESPONSE CENTER YES{� NO( ) DATE: zTIME:D 7 SO 0A.5e $. (OS(5'�6 DEPT. OF ENVIRONMENTAL PROTECTION YES(( ) NO(� TIME: OIL SPILL COORDINATOR: YES( ) NO(✓)" DATE:^ ,TIME: TOWN BOARD OF HEALTH: YES(vr NO( ) DATE: TIME: /Z �y TOWN HARBORMASTER: YES( ) NO(cr DATE: TIME: OTHER AGENCIES: COMMENTS: r r IL Fr el; f1 it n i✓! L/Li LY g'LY�e'.11 ! ! l ''. REPORTED BY: l__P�2 , >,�'-��v L DATE./ 2 �/1/0 7 i WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALTH ^J C-0-iM FORM#58 b Health Master Detail Page 1 of 1 .x Logged In As: TOWN health Health Master Detail Thursday,October 16 2014 - Application Center Parcel Lookup Selection Items Parcel Septic Perc I Well I Fuel Tank Parcel: 209-087-10A Location: 1661 FALMOUTH ROAD/RTE 28#1 Owner: MARFATIA,NILESH P TR Septic changes have been saved. Septic 1,5/19/2006 New Septic.. Permit number: 2006-233 Permit type Repair Complete system f i Issue date: 5/19/2006 12� Complete date : Septic tank size: 5000 Type/Size of SAS: Installer:I Caterino,Ray,Northern Sealcoat&Paving i; Card on file: r I/A service type: Select service i'' Innovative/Alternative Technology type: Select IA type .....--- Variance date : Abandon complete date . Abandon permit number: in , Repair deadline date :I _.__1 Repair notification date :1 Keyword: Comments: NEED BOTH****** k Delete Septic New Inspection... Number Inspection Date Inspector Result I� Select Inspector Select result 1;= Received Date Comments 10/16/2014 -- -- — -— ---—----------------------- Save Septic Changes ( Return to Lookup http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=20908710A 10/16/2014 UP O p PROPOSED P (FINAL LOCAI DETERMINED \\ \ 0 86 \\ \\ B.M. \\ 6� i� Nail in U.P \ N Elev. 53. \ 336 Approx. M #1663 EXISTING COMMERCIAL BUILDING \ (13,300 S.F. -"TOTAL) \ CENTERVILLE PLAZA \\ o \ - \ \ a is rt. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °µ 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address p� P�s` First Property M^gmt. 2 1 Q%-1 VV 1 Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 very 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. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return p key. Capewide Enterprises,LLC. Company Name °- r� P.O.Box 763 Company Address Centerville Ma. &2632 City/Town State Zip Code--ir:: i`> 508 428-4028 S14454 c a Telephone Number License Number �- B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 8/06/2008 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. 1663 Falmouth Rd.Rte.28•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System"Page 1 of 15 l f / 1 41 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1663 Falmouth Road,Route 28 (Centerville Plaza) . Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 - every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) 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 septic syste3m is in proper working order at the present time. B) 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. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: ❑ 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 ❑ obstruction is removed 1663 Falmouth Rd.Rte.28•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 1663 Falmouth Road,Route 28 (Centerville Plaza) . Property Address First Property Mgmt. Owner Owner's Name information is Centerville Ma. 02632 8/06/2008 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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 ❑ obstruction is removed ND Explain: C) 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. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ 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 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ 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. 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts 7 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 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. 3. Other: D) 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 ❑ ® 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 '/2 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. 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 1663 Falmouth Road,Route 28 (Centerville Plaza) . Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every pag(; City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 2000gpd- 10,000gpd. ❑ ® 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. E) 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 D. 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 If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1663 Falmouth.Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes"or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Zl 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)] 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 f Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information 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): Number of current residents: Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Plaza Design flow (based on 310 CMR 15.203): 1815 gpd Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): 58 seats and 10,100 sf. Grease trap present? ® Yes ❑ No Industrial waste holding tank present? ❑ Yes ® No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ® No Water meter readings, if available: unavailable Last date of occupancy/use: 2/06/2008 Date Other(describe): 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information 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: 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: New leaching chambers installed in 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments M . ,•''V 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ® cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through leaching chambers Septic Tank(locate on site plan): 2'6" Depth below grade: 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: 5000 gl. 911 Sludge depth: 52" . Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle 18" Distance from bottom of scum to bottom of outlet tee or baffle 6„ How were dimensions determined? Measured 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on.pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank yearly.lnlet and outlet tees are'in place.No evidence of Ieakage.Tank is H2O and appears to be structurally sound. Grease Trap (locate on site plan): 2' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: 1-1000 gl and 1-1500gl. - 2„ 1 ot Scum thickness Distance from top of scum to top of outlet tee or baffle 7" 8" �I Distance from bottom of scum to bottom of outlet tee or baffle 31 3- Date of last um in unknown - p p g' 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.): Pump grease traps 3-4 times yearly.lnlet and outlet tees are in place.Both grease traps are H2O and appear to be structurally sound.No evidence of leakage. 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): 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No 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.): System has two distribution boxes.Each has six outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No ~ � r 1663 Falmouth Rd.Rte.28.03/08 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 12-500 LC ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.No signs of hydraulic failure.Chambers had 6" of water in them at time of inspection with no stain line above this level. 1663 Falmouth Rd.Rte.28•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 1 1 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): 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.): 11663 Falmouth Rd.Rte.28•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 16 .� O — 1 .. A„ �� h2p SF�./ r 't• L�C 8`S0 cy0 GA<<O .� AM N . 6 cl tv P,yRKj °,•;::;�s y. �Nb i TyP OF FO ITN \ J NGARF,q \ p / ( INA4 SFD PVc O�ERM tiE T/ON-oNT p/pF Y 1 � i v O �\ \' lam!?: rj�. ,X \ � �F '•• .?•� . O PROP y2pt OSFO6. CIY At PROP \ 3 ,, qM y2 p 6 OUT - \ \ \ O^_@Ok AFT O A J a\ \ 1 I Fx,ST ce _51-1 / Sc�F J.-�qN i ' ----' 20" N OF RAVEMEM Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1663 Falmouth Road,Route 28 (Centerville Plaza) Property Address First Property Mgmt. Owner Owner's Name information is required for Centerville Ma. 02632 8/06/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of chambers 19' 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: 5/18/2008 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 1663 Falmouth Rd.Rte.28.03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 . . a Town of Barnstable P��FTHE r�ti . o� Regulatory Services ,MI,tSTAB,E : Thomas F. Geiler,Director 1163 AlEp,�,�s Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. Q:\SEPTIC:\Disclaimer Private Septic Inspections.DOC' PESCEr ENGINEERING AND ASSOCIATES' 451 Raymond Road fit Plymouth, MA 02360 Phone: 508-743-9206 Fax: 508-743-0211 epesce@adelphia.net May 19, 2006 Mr. Thomas McKean. R.S., C.H.O. Town of Barnstable Board of Health 200 Main Street Hyannis, MA 02601 Subject: Wastewater Design Flow Estimate, 1663 Falmouth Road, Route 28 Centerville Plaza, Centerville, MA Dear Mr. McKean. For the purposes of designing a repaired leaching system for the Centerville Plaza, located at 1661-1675 Falmouth Road, Route 28, Centerville, I have based my design flow on the following calculations: Wastewater Design Flow Summary Unit Use/Area Title 5 Design Flow d * 1661 Pinocchio Pizza 42 seats X 20 GPD/seat 840 1663 PhysioTherapy Associates 2,400 SF office X 75 d/1000 sf 180 1667 Ba side Design & Remodeling 1,200 sf office X 75 d/1000 sf 90 1669 Light Speed Mortgage 2,400 sf office X 75 d/1000 sf 180 1671 Cape Cod Chicken 16 seats X 20 GPD/seat 320 1673 Kelle 's Music 1,500 sf retail X 50 GPD/1000 sf 75 1675 Rt. 28 Convenience Store 2,600 sf retail X 50 GPD/1000 sf 130 TOTAL 1,816 GPD * Design flows based on Title 5: 75 gpd/1000 sf for office, 50 gpd/1000 sf for retail, and 20 gpd/seat for a fast food restaurant Mr. Thomas McKean. R.S., C.H.O. May 19, 2006 Page2 Based on the above calculations, the total wastewater flow for the existing building is 1,815 GPD. This is the design flow used for the attached septic system repair design. Thank you for your help with this project, and as always, please call if you have any questions. Sincerely, Edward L. Pesce, P.E. Attachment cc: First Property Management 'PESCE ENGINEERING AND ASSOCIATES Phone 508-743-9207 451 Raymond Rd., Plymouth, MA 02360 Fax 508-743-0211 I ri � 01, JQ Logged In As: Parcel o Wednesday, August 6 2008 Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options y Street Search , Street# 1661 Street fal Name Village JAII Villages ,-.Search' <Prev Next> Page 1 of 1 Rows/Page 10 ice ' Parcel Location Owner Village Index. Map 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T CEN 0522 209087001 001 (1663 FALMOUTH ROAD/RTE 28 - Physiotherapy Assoc.) TR 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T CEN 0522 209087001 001 (1667 FALMOUTH ROAD/RTE 28 - Bayside Builders) TR 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T CEN 0522 209087001 001 (1669 FALMOUTH ROAD/RTE 28 -Dunnrite Mortgage) TR 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T CEN 0522 209087001 001 (1671 FALMOUTH ROAD/RTE 28 -Cape Cod Chicken) TR 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T 001 (1673 FALMOUTH ROAD/RTE 28 - Kellys Music TR CEN 0522 209087001 Emporium) 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T 001 (1675 FALMOUTH ROAD/RTE 28 - Route 28 Convenience TR CEN 0522 209087001 Store) 209-087- 1661 FALMOUTH ROAD/RTE 28 - Multiple Address DACEY, BRIAN T CEN 0522 209087001 001 (1661 FALMOUTH ROAD/RTE 28 - Pinocchio Pizza) TR COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS SFjO ��'E�+ DEPARTMENT OF ENVIRONMENTAL PROTECTIO}Ny� 2 n ONE WINTER STREET, BOSTON MA 02108 (617)292-55&))4 �� + 9 `00 °F 0 �., TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 1663 Falmouth Road, Route 28, Centerville, MA Name of Owner: Centerville Plaza Realty Trust Address of Owner: c%First Property Management Date of Inspection: September 16, 2000 832 Main Street, Suite F Name of Inspector: (Please Print) James M. Ford Osterville,.MA 02655 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map. Telephone Number: (508)862-9400 Lot. CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passes Needs Further Evalua' n By the Local Approving Authority ils Inspector's Signature: Date: September 21, 2000 The System Inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND COMMENTS .A revised 9/2/98 Page 1of11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville, MA Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. 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. Indicate yes, no, or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a.broken, settled or uneven distribution box. -The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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 obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville, MA Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 C. 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: 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. 2) SYSTEM WILL FAH,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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville, AM Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 E . r • R D. SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: _ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an 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. 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 V2 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 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. If the well has been.analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system stem 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 The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. Pa e4of 11 revised 9/2/98 g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1663 Falmouth Road, Route 28, Centerville, AM Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ As built plans have been obtained and examined. Note if they are not available with NIA., ✓ The facility or dwelling was inspected for signs of sewage back-up.. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees, material of construction;dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ✓ Existing information. For example,Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)l- ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1663 Falmouth Road, Route 28, Centerville, MA Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: _g.p.d./bedroom. Number of bedrooms(design): _ Number of bedrooms(actual): _ Total DESIGN flow Number of current residents: Garbage grinder(yes or no): Laundry(separate system)(yes or no):_; If yes, separate inspection required Laundry system inspected(yes or no): _ Seasonal use(yes or no): _ Water meter readings, if available(last two year's usage(gpd): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Strip plaza(restaurants, offices and retail) Design flow: n/a Qvd(Based on 15.203) Basis of design flow Unknown Grease trap present: (yes or no) Yes-2 Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: 1999-279 000 gals 1998-264 000 gals r Last date of occupancy: Currently occupied OTHER: (Describe) Last date of occupancy: 'GENERAL INFORMATION PUMPING RECORDS and source of information: Pumped on Sep 11198 Feb 17199 and Nov. 23199-per treatment plans System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons Reason for pumping: 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other '"APPROXIMATE AGE of all components,date installed(if known)and source of information: Approx. 1990 Sewage odors detected when arriving at the site: (yes or no) No T ^ revised 9/2/98 Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1663 Falmouth Road, Route 28, CenteMlle,•MA., Owner: Centerville Plaza Realty Trust .^ Date of Inspection: September 16, 2000 •;t BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage, etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: covers to grade Material of construction: ✓concrete _metal Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 5000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: -- _.Scum thickness: 5" _ Distance from top of scum to top of outlet tee or baffle: -- Distance from bottom of scum to bottom of outlet tee or baffle: -- How dimensions were determined: Measuring stick Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) The inlet and outlet tees were present The liquid level was even with the outlet invert. There were no signs of leakage GREASE TRAP: 1(2) (locate on site plan) Depth below grade: Both to grade Material of construction: ✓concrete _metal _fiberglass _Polyethylene _other(explain) Dimensions: 1000 gal.•1500 gal. Scum thickness: 2",4" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: — Date of last pumping: Unavailable Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, - - evidence.of leakage,etc.) The tees were present Recommend pumping four times per year. revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville, MA P Y Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 J, ; OR HOLDING TANK: -None (Tank must be pumped prior to, or at time,of inspection) � TIGHT (T P ►nP (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTI ON N BOX: ✓. . _ ..t . . O _ (locate on site plan) Depth of liquid level above outlet invert: Even Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) There were signs of scum/ solids in the D box There were no signs of leakage Some pipes are slightly lower and are receiving more flow than others. Recommend installing seed levelers. PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville;MA Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible;excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number: 6-6'x 6'1000 gal. pits leaching chambers, number: leaching galleries, number: leaching trenches,number,length: leaching fields, number,dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) Pit#1 was full Pit#2 was full Pit#3 had 2.5'of water on the bottom and the scum line was the same. Pit#4 had 5'of water. Pit#5 had 5 of water. Pit#6 was full The covers were cracked on pits#1 #4&#6 and should be replaced as soon as possible. The bottom to grade was approximately 10'6". CESSPOOLS: None (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(cesspool must be pumped as part of inspection). Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville, MA Owner: Centerville Plaza Realty Trust , Date of Inspection: September 16, 2000 ;;, Map. Lot: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) (Y Side. o /Soo "110n G:r 5000 GAilon S? 1000 Gailo.\ O O O revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 1663 Falmouth Road, Route 28, Centerville, MA Owner: Centerville Plaza Realty Trust Date of Inspection: September 16, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 25 +/- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) ✓ Determined from local conditions ✓ Checked with local Board of Health = Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) The bottom of the pit to grade was approximately 10'6". Using the USGS topographic map and the Cape Cod Commission water contours map, the maps were showing approximately 25' +/-to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11of11 Commonwealth of Massachusetts Executive Office of Environmental Affairs . Department of Environmental Protection William Goarnorr F.Weld Trudyp�Coox@ Y;a.uwa.'J Argeo Paul CNtuccl David B.Strube U.oowmw C anbrAnlonw SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ �CERTIFICATION Property Address: P/lZX' Address of Owner. Date of Inspection:12-/7- ' (If different) `00o - 630 Name of Inspector. Company Name,Address and Telephone Number. ,So C4/ 7 AV-? /Lli9 1 z6 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information re ' and complete as of the time of inspection. The inspection was performed based on my training and experien proper function and maintenance of on-site sewage disposal systems. The system: ' r Passes �44, _ Conditionally Passes S _ Needs Further Evaluation By the Local Approving Authority FailsQr �,J Inspector's Signature: �t �W i � Date: 1Z—l-7—,?7 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)da inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system o submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: • t � _1zI have not found any information which indicates that the system violates any of the failure criteris es defined in 310 CMR 1&303. Any failure criteria not evaluated are indicated below. ,I/II SYSTEM CONDITIONALLY PASSES: /v One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined",explain why not) The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is 1_ 1A imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health., (revised 11/03/95) 1 One Winter Street a Boston,Massachusetts 02108 a FAX(617)$56-1049 a Telephone(617)292•5500 "Printed on Recycled Piper k SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 141—6 3 7 4 4*O Ut4 Owner. AM/ T)AS '�i2 UST Date of Inspection: Jag f/719 B]SYSTEM CONDITIONALLY PASSES(continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four 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(@)are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: IIUI Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH`AND SAFETY AND THE ENVIRONMENT: 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. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER.IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Iwo than 5 ppm. 8) OTHER (revised 11/03/95) 2 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: IZW f/9�fylGLi�� 2� Owner. j/i9/p/9s Date of Inspection: /- A7�f'7 D) SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 16.303. Thel basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an 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. 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 1/2 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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 I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: MA The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into hill compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for fltrther information.. (revised 11/03/95) 3 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:�w��•� / �/�?��c �� Owner. Date of Inspection: Check if the following have been done: i Pumping information was requested of the owner,occupant,and Board of Health. Z None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. v The facility or dwelling was inspected for signs of sewage back-up. V The system does not receive non-sanitary or industrial waste flow j/I'he site was inspected for signs of breakout. /dc!Ji,d.Jy AZAll system components,Anekmlisvg the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum. ,je fhe size and location of the Soil Absorption System on the site has been determined based on existing information or /approximated by non-intrusive methods. 1� The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11/03/95) 4 ar�j�_ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: f/y?Ovi� Ao Owner. �iq/Ofi'sir/3T Date of Inspection:�2//7��� FLOW CONDITIONS RES DENTiA U Design flow pllons Number of bedrooms: Number of current residents:_ Garbage grinder(yes or no):_ _ Laundry connected to system(yes or no):_ Seasonal use(yes or no):_ Water meter readings, if available: Last date of occupancy &/j/L-tn OMMERCIAL NDUSTRIA . Type of establishment: n !o'ae>'>'S Design flow:�allona/day s�ry�, �JoLJ �I"C—,76•j� 4rt.7 n��i Grease trap present: (yes or no=wl� -G!�" /9� S�js /�a •r/a. Industrial Waste Holding Tank present: (yes or no)_ aQ� ����• �� ' � / �ctc, ��� Non-sanitary waste discharged to the Title 6 system: (yes or no)_ Water meter readings,if available: lQ." 000 r9Meow - /9 5F'? 7Z/ d a o Last date of occupancy -11 OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yea or no), ') If yes,volume pumped: gallons `..-30. 7 Reason for pumping. 7- TYPE 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) Other(explain) APPROXIMATE AGE of all componen date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no)�d (revised11103/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Address: 1��44S ,fT Owner. Date of Inspection:j�j`7/,F 7 SEPTIC TANK:j=�-' (locate on site plan) Depth below grade]jy&d5 ,9 T 4', i9a6 Material of construction:4ZO-ncmte_metal_FRP—other(explain) Dimensions: dOd sludge depth: 27:9�,wt.7i2 Distance from top of sludge to bottom of outlet tee or baffle: /K. 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:_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) . �/c°io/�J/lr7s ,/JS�p� LJ�ig2 GREASE TRAP:_ (locate on site plan) Depth below grade:46a 14 (�/1l1/f�3 VZ 6�.9c� Material of construction: _concrete_metal_FRP—other(explain) Dimensions:_e!11J2T TAD 4i91 g' /0".0 9s9lle"' Scum thickness:1479 /)--3-" 3 " s r.c,•^ti Distance ham top of scum to top of outlet tee or baffle: Distance fom bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert structural integrity evidence of leakage,etc.) /�d'1 !9 �>n �� Sli "K'27- �..7; (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C // l SYSTEM INFORMATION(continued) Property Addreee:l�Co �.d Owner. `���if t S `����`' Date of Inspection: lz/7�c7 TIGHT OR HOLDING TANK: I (locate on site plan) Depth below grade: Material of construction:_concrete_metal_FRP—other(explain) Dimensions: Capacity: "Hong Design flow: ¢"one/day Alarm level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX_I,'-' (locate on site plan)(.` 5 Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) 0:21— Oil /9 ,77 !1/l/9 G rJ t'JJ7 Cyr n 05 145*�4 _s PUMP CHAMBER;_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: la65 Owner. twl"P'.95 j�2liS� Date of Inspection: /Z11M77 SOIL ABSORPTION SYSTEM (SAS) � . (locate on aite pla), if posa'ble;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type. leaching pits, number: leaching chambers,number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number,dimensions: overflow ceupool,number: A mments: (note condition of&oil,signs of hydrpac failure, level of ponding, condition of vegetation etc.) enD b/i7 ®,/ / s /Z yP7� g �dyC !'ems /l7�Pio'�'''i�il.F��flrst. CESSPOOLS: ��iSt'//1f —ulst G ld�v 1f'! Cl�S '1�v /J !✓/?!ems ��'�1�L/e�2.O e (locate on site plan)T —S25 7- ,V l 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(cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation etc.) 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.) (`revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: le,11 3 ' ' /,wG � //`?W Owner. f�A/��S TvST Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: ���Ns''' inchide ties to at least two permanent references landmarks or benchmarks u` locate all wells within 100' I If ar ti DEPTH TO GROUNDWATER 799 Depth to groundwater: feet method of determination or approximation: YL (revised 11/03/95) 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: Date of Inspection: `7 f 7� Depth to Groundwater Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record . Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records y Check local excavators, installers V/Use USGS Data r Describe in your own words how you established the.High Groundwater Elevation. Must be completed) ,j,L�/� /g7�YsCdi1'� �/1 r�•C� � /� (revised 04/25/97) Paga 10 of 10 SEP-TECH, INC. SHEET NO.1j/ 12jX'5 _7741$0" O 36 Commerce Park SOUTH CHATHAM, MA 02659 CALCULATED 8V ��I�1-97 DATE (508) 432-7790 Master Uc. 011696 CHECKED BY DATE SCALE _....._,.............:......................_;................._.........:...........................;.....-_................ ..... ...... ...... ..... ..... ...... .................... ...................._.:....... _.........._..... :. .. ..... ..._......... ................:............ ... ... .. ... .. .. -. '' . .._ . .......... ....__....r.._............. ..............:.............:.. ..... .. .. ..... .... _.:............ . : . ... . ........... . . , . ._ .... . . . .... .._ ..... ... ... ... ... ...... ............... ....: . .. ...: .._._ .. . .. _ ... ... ... .... _..... ..... .. .. , . ... �91�I1Sv e�r ...... ... / ----.ads + .. : .... ... ........................ _0 .............. : : ... ° `_ . ....._ __ .. 5'e ... .. . ..__..:. __..--....:..........__ .... ..... ...... .........:.... .:...........: .. .... .................... ........_...... : ... . ...... �.. . ,L� 1 .:...... .. ...... ... . . . . :. ..... ............... ..:...... :........ ...... .... .. ,T�� �. ...� ... � :....G ...:. _.. ..... . .. . .. IL � � � s -�I . � '� � � �-.� }, i ' 4�-. - .. �� - - ---- TOWN OF BARNSTABLE /- LOCATION J iO F�aG,�c"�lf�L� _ /ZOSEWAGE # VILLAGE( ,/!�f[�i/� ASSESSOR'S. MAP.6 LOT INS.TALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) b (sly) NO: OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNS W/ ll%✓I►Nl / �G�=t� . DATE PERMIT ISSUED: DATE COLIPLIA14CE ISSUED: ,- /d ;) / VARIANCE GRANTED: Yes No Flamm U �d L a o ` 14,��,° 47,1c. X'a`QT/-k No.... .yam/ 31— F�$.... ....._..... _ _ `_,e• THE COMMONWEALTH OF MASSACHUSETTS Ltlh BOARD OF HEALTH (,A, �-oTWaJ r�l ......._....-..... ...._..�0..........OF............... 3 4& ._ ...._... Appliration for Diipnsal Works Tongtrurfiun ramit Application is hereby made for a Permit to Construct ( * or Repair ( ) an Individual Sewage Disposal System at: ... ffig..... A.. - Lot 1 J)0Centerville - •.•-••--.....--••-.------. . .t .....Al * .Loc'j'a -Address.. or t No. ':�'� Q►! ..... � ..tion....... .. G', � ._...A..........--•----- -•---....---••------- Owne Address P►'�....�A, d ..... ......'.....Y`�,A .� Installer Address UType of Building Size Lot....5 L.....P0.....o........Sq. feet a Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building Dry__(oOdS No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -----•--------•---••------------ •--•-••-•----------•--.--..----- W Design Flow8�000-_s f__ .._IW0x allo�er person per day. Total daily flow...............��............_...._.... i9ps. a ons , T W Septic Tank—Liquid capacit-y���g 1'� Length.ll•••1Q �V�lidth_.6_.�._... Diameter................ Depth....______...__. x Disposal Trench—No. .................... Width.................... Total Length__....•. ......... Total leaching area------ sq. ft. Seepage Pit No..................... Diameter.._..1:�..__..... Depth below inlet_._.......•........ Total leaching area........�7......sq. ft. Z Other Distribution box (X ) Dosin tank ( ) '-' Percolation Test Results Performed by._.�a;Qe Cod_ Survey Conslts . Date.....10/1/81 aTest Pit No. 1................minutes per inch Depth of Test Pit._ ............... Depth to ground water Noel 4 Tgpt Pit No. 2................ per inch De11 pth of Test Pit..]44...._.•.. Depth to ground water_ .PtN �F MAss9c „ ,� 3 O RENWICK G Description of Soil ------ - m g U ..................•---••-••-•-•-••••--•••••-•-•-••....•••--•••-••••-----••---•-•-••--•••-••----•••-••-•-•-•--•-•-•-•--•-•-•-•-•-•-••••--•••---••--•-•--•-•--•--•-•-•-••------- ......GHAA�VIAN •-------•-•-••--••.....................................•---••---•--•-•----•-•---....-•-•---------•-•-----------------•---------•--•---•----•--•-................--•.---• ao�9FHo.27Bfi�p�� V Nature of Repairs or Alterations—Answer when applicable__________________________ - SSLaAt0.6-�N6 Agreement: 7 8� The undersigned agrees to install the aforedescribe Individual Sewage Disposal System in accordance with the provisions of T'1:1=. 5 of the State Sanitary h undersigned further agrees not to place the system in operation until a Certificate of Compliance has b n i e—ss d the boaya f h lth. + Signed__:.___. j� ----•• > ApplicationApproved By......................................... ------•••......•..... . •.............•--....•-•-• A._ e Application Disapproved for the following reasons:................................................................................................................ ................•---........-•--------...--------------------...-•-•------------------.......-------•----••-•-•-•••••---••••------••------•••---•._.._....•-•-•-••••-•-•-•--•-••----•--•--•-••••--•-..._ Date PermitNo................•---•---•--•-•----••-.............-----. Issued........................................................ Date • J No................_....... FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........Town.--.............OF.............Btirn18t.ab......lE'. .............. ............................................ Appliratiun for Binpunal Works Toustrur#iun amit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .. aLT e_. •• ..(. ' a t. .. cad) Ger ery : le w Lot ...... - r t 1 + 4 Location-Address/^1 or Lot No. ................ ...--©: c''c �'��l'hESZV t` •-.-�1� J '.............................................. --...... a ..-�.T- �� /," aJt+—1 n ..... .... Address Installer Address dType of Building Size Lot._.5?: © --_-----•Sq. feet U Dwelling—No. of Bedrooms................................ _Expansion Attic ( ) Garbage Grinder ( ) y ............... No, of ersons............................ Showers — Cafeteria PL, Other—Type of Building� .. p ( ) ( ) PI Other fixtures --------------------------------•----------------.----•--------------------------- QQ0 Af... 10QA allons per person per day. Total daily'flow......................................... W Design Flo .--� ------ �' � P P P �' yt _ gatllRns. QQ •••-• De th W Septic Tank—Liquid capaclty ....._.gallons Length_ _ ..�. Q.tWldth.6 .T..._ Diameter._._. .. _ p ........... 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 (K Dosmg tank ( ) 1/81 '-' Percolation Test Results Performed by �+"�1pe.. C6 � � 'a l $. Date_ ...._. }} Na Test Pit No. 1................minutes per inch Depth of Test Prt 1 t1 Depth to ground waterNone (i, Test Pit No. 2................minutes er inch Depth of Test`P t 1 _ Deptlh tp ground vy ter�4 tt tt ti 2 It pit st !t �I tt q j�V------ 1 �ij �W OF a' �s gq ----.......-•-•.....•--......•-•---. ---•------------------------••---••-•--••---••--• Mqs a7ee �L • Description of Soil-•---- ----------------�• ------------•--------......_._..---------•---- --------------------------•----------------------•---•---- �-•- 7 (,) '-----------------------------•------•--•-----••-••-....----•------.............-------•-._._.--•-•-----....•---••-•-•-••-•---••--•---•-----•-----•-•••--•----•-------....•.�j'cS. .......... ...._ RQ ••-••-•-••-----------------------------------------------•---.........---------.....••--------•••----••---•--•-••--••-..........-•-•----••••---••-......-••---......-•---•-- J-)------CHAPMAN y U Nature of Repairs or Alterations—Answer when applicable...............................r_ ---------- .,�,� Agreement: ����� S�ONAL EN The undersigned agrees to install the aforedescribfcL Individual Sewage Disposal System in accorda the provisions of A ILTLE 5 of the State Sanitary,CfiMe T e undersi ed further agrees not to place the system in operation until a Certificate of Compliance has Veen is e the bo d ff l h. , Signe ....... ........-• ............ ..... .... ..••--........._ 1. .................... . ApplicationApproved By-••--•-•-•-•--•--••-••---•---------•--•.............................•-----•-•--•-•--•-----•-•--- �1-- te Application Disapproved for the following reasons-----------------------------------------------------.......................................................... ------••--•-----•---•----•-.....------•-•••---•--••-•--••----------••----•..............•-•••••----•---------------••-----•••••••------•-•••---••-••-••-••••-••----•-•••-•••••--••--•-•••-•-•----...... Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.........................f..... ................................................... �s �rr�if ir.tt�r uf�,.f�u-nt�li�nrr p � •:a THIS IS TO C TIFY That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...............7`:i ...... I stallei — `" r ma�yy__ -u_'Sanitary . ' has been instilled in accordance with the provisions of T' 1, ,0fThe State Sanitary Code as described in the application for Disposal Works Construction Permit ................. dated__...-.--_.-.--_--_.--.--_...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI FACTORY. DATE..............................................P/ --- Inspector....------... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH _.. ...........................................O F..-----......._...................................................................... FEE.3.r .............•-----•-•- 14npniial Works T-tomitrurtm- n rrntit Permission is hereby granted............c ...---.. .......................... :.._............................... --...--........ .... . to Construct ( `or Repair ( ) an I�divi` Sewage isposaL Syst Street as shown on the application for Disposal Works Construction Permit No..................... Dated.......................................... -�-r- %✓�. ------ ------ .................................. ..... Board of Health DATE --------------......-•--•......-•-....--•-•-----------•-. '� FORM 1255 HOBBS & WARREN`'INC., PUBLISHERS : l THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH (IIA16) ` 4not, Town Barnstable. Se- ........ ..... OF...................................... Appliratiou for Biipusal Workii TonuIrurtiuu Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .....aQuta..2$,,,,,,,,,,,,,,, Falmouth Rd,,_)„Centerville Lot_ 1__ Units---5- 8 -- ---- - .......-- Location•Address -•- or Lot No. - }t ....T—..0 �t----------------------•-------------------. Own Address A4t .0 .................. .........-. - �..- .,---------------------------------------------------------------------- Installer Address dType of Building Size Lot...5...22 050-----Sq. feet U Dwelling—No. of Bedrooms__''.... .....Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building ..... No. of persons............................ Showers — Cafeteria a r fixtures --------------------•--•... 3�0 Sf o 100X5 al ns er erson er da�. Total dail t flow.._.......•.2 ......................gallons. W Design Flow.---••--•------ - - gSo� P P �' 1� Septic Tank—Liquid'capacity...'r� . . �11ons Length-1 .11. Width.61.__-_.._.. Diameter________________ Depth...3.�.�.�..�� W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. x Seepage Pit No.................... Diameter.___1Q.......--- Depth below inlet...6.............. Total leaching area.... 67......sq. ft. Z Other Distribution box ( X) Dosing tank ( ) Ca e Cod Surve Cons lts . Date..... 10 //1 81 Percolation Test Results Performed by......-----?PAP!�.............. C...�..._._.------.--.. Test Pit No. 1................minutes per inch Depth of Test Pit....l? ....... Depth to ground water..Q 1e.__.___.__ (i Test Pit No. 2................m}putes per inch Depth of Test Pit....-1.4-4....... Depth to ground water._�Ip �� II 1f 2 Depth If II II tl �F M� 3 --------------------------- �� ss .•------- --••-- Description of Soil------_------Sew---A-lan........----IQQo r 'li!:,.�-- �; RENV+IICK c (� •••••-•••-•-••••••-•-•••--• B W ........-•-------------•----••----•---•-•--•-----•--•---------......-•-•---••--........-•---•-•••-•-••-•-------•--------••-•----....•-•-.....•-----.........----..........•• r ---GHAPMAN y VNature of Repairs or Alterations—Answer when applicable____________________ .. .. ... .. .............. _� 9ML-27f�4.p Agreement: , ���� SS70NAL E�6 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in a-corda i the provisions of HTI LL 5 of the State Sanitar od The undersigned further agrees not to place the system in operation until a Certificate of Compliance ha een ' ed by It e o hea Signe ��! 7 Zq��1-- �'z� Date/, Application Approved By....... �,/Q....-- .. . . •-- ................................. ......... `......----- Date Application Disapproved for the following reasons:......................... -••-••----•-------------------------...-----------•-------------•-•---•••--.....------ ...............••-•-•-•••---•--•---•-••-•.............__...-----•....-----••----•-•-••••-••------••-•----......-•..........-•----•••-------•••-•-•••---•-----•--•-_.._...•-•--•---... --._..•-•----- Date PermitNo--------------------------------------------------------- Issued....................................................... Date No................_....... Fmm.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ..........................................O F.....--.--..............--•-•-......................._....----------............_........_ Appliration for Disposal Works Tonstrnrtinn rrmit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: .....RckutA..28---......- .. Almouth/­.C R ..�...Gel�t��'�t���.e.. t...�..._ nits.. .......................................... & Location-Address or Lot No. Own Address d Installer Type of Building SizeAdd Lot Lot____5____�2__sQ50.....Sq. feet U Dwelling—No. of Bedrooms________________________________ _____Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building 9gg4A No. of persons____________________________ Showers — Cafeteria r.fixt res _ g ga S a ........................................ __ ____________________ _______.___________ ------------- _...... .... Design Flow_____ _____ �Qallons er erson er da . Total da,ily flow___._. W g P P ; a t It - gallons. G: Septic Tank—Liquid capacity... .t___�llons Length.11-_�1_ Width.b___9_.__.. p Q Diameter______ _________ Depth W Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area______________.....sq. ft. x Seepage Pit No..___I_____________ Diameter-----10_t.__._.__ Depth below inlet____............. Total leaching area___n�- �7__..__sq. ft. Z Other Distribution box O Dosing ank ( Percolation Test Results Performed by...... BjJ� _ d tkove 1 Consits w Date.......��/_�/__ .f t" `� Test Pit No. 1................minutes per inch Depth of Test Pit____ _.____. Depth to ground water__NOUR____._.__. fs, Test Pit No. 2................mWutes per, i7Fh Depth of Test Pit.....1:4 ___.__. Depth to ground water... aCI it H ),1,is f�---•--•-------x................................. •--AS's9 DDescription of Soil...............See...P1=4.................................................................................................... REf+LW�K yN - ----------------------------•--------------•--------•---------• Ell..... � CHAPMAN W •------•---•-•-----------------•------•---------•-----• ------•••-•--••--•-•._...._••-•---••------•-----------•-•-•..........__....-•-•--...•------••-•-•-••-• ---•------••• •p •. ---•- U Nature of Repairs or Alterations—Answer when applicable------------- ._. _ , 'A--- L7-- p 4+D ��'/STEM •-------•---------------••---------------------....---•--------------•--•-•-----._...__..............-•---•-----------•-- - -�� _Fssf -- -------- Agreement: ����1 oNAL E The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of`�TTL ,p 5 of the State Sanitar od The undersigned further agrees not to place the system in operation until a Certificate of Compliance has een ed by�t o hea Signed ........_.. __ _f--- g i / Date Application Approved By------.. .` ,. -...... ... ��" --------- )j` r L----•--- 7 Date Application Disapproved for the following reasons:-----•--------••---------------•----•------------•-----------------•------------------------._...----------•---- ---••-•--•••••-•-•--•--------••-••---------_-•---••--••-••••-------••••-------•.............•-------•-•-'-•--••••----•••••------•-••------•-•---...---•••••••-•••-•-----••------•...---•---•••-••-•-•--- Date PermitNo...........•------------------------------••------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................................:.......OF................................................_................................_... �rrtifirtt#.e ,af f�rrm��i�anre . THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by................. '_.---•--- Z %...........................................*--------- ------------.._....----------......_..----------...--------- -------------------- nstaller - -------------------------------------------------- has been installed in accordance with the provisions of TITLE 5-of The State ' a.nitary Code as described in the application for Disposal Works Construction Permit _______________ dated-............................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.........................•-••---•-------•---_... .VL .................. Inspector........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF..................................................................................... 4"- No..e ............... FEE...:. ............... Disposal Works TwOnstrudion Prrmit Permission i hereby granted. --_...................................................................................... to Construct or Repair ( ) an In�'vidual Sevva Disposal Sy tem atNo....... ►': 'c'L`-----•-----.._... ......ai�).............................................. Street as shown on the application for Disposal Works Construction Permit No___WBoad Dated.......................................... Health DATE. :_ _ ...-•-------••------•-•-•---•--•-•--- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �QQ co N (� w9: iGG�c�r 'e.4tc t � Q 41) Q ` Z _____... _; - - R-= =- • _ ,_ _ - -=F _ _ _ Lj._-.., `jvi rn f� VC,--�Iz;7- W 7 - SIt�11� SHOP 4, 8„ d IZ' gA 70Tr 70 FALMOUTH ROAD WIDE)) E 28 (STATE HIGHWAY 80 W ) EDGE OF PAVEMENT _ _ _____ _ _ Lit. lfi Wv _ � EDGE OF PAVEMENT � 89 200.08' 52 AS-BUILT SWING- � SIGN/ ,� TC \� \ — ��^ _ — \ --- DESCRIPTION BC-1 BC-2 BC-3 D-BOX(1) 56.5' 43.5' -- 2"TOWN WATER LINE (DOMESTIC) l c'p crj 25 EXIST.CB 10 sr0% EXISTING 6-500 GALLON D-BOX(2) -- 94.5' 50.5' 6`°TOWN WATER LINE (FIRE PROTECTION) H2O LEACHING CHAMBERS \ / CHAMBER(3) 33.0' 65.0' MAP 209 \\ / / U.P. (� co CHAMBER(4) 72.0' 31.5' -- �\/ EXIST. 6-OUTLET H2O D-BOX PARCEL 87 \ ��,`5 (w/FLOW EQUALIZER. aC -- 1.19 AC.± - a1 CHAMBER(5) 70.0' 62.0' EXISTING LEACHING PIT CHAMBER(6) -- 120.0' 33.5' (FILLED WITH CLEAN SAND (3 &ABANDONED)(TYP OF 4) �--- — --- TC NOTE: AS-BUILT INSPECTIONS OF LEACHING CHAMBERS& TC EXISTING PVC VENT PIPE NEW D-BOXES WERE PERFORMED BY THE DESIGN ENGINEER OVERHANG \ p — ON JUNE 10th& 14th,2006. AS-BUILT MEASUREMENTS 1) LP p RETAKEN FEBRUARY 24, 2015. / \ : EDGE OF BLDG. END. O , a BUILDING COLUMN (TYP) PARKING AREA / o BAYBERRY SQUARE B �`� CONDOMINIUMS Benchmark #1663 \ \ (4 \ Nail in U.P. EXISTING COMMERCIAL --=e \ BUILDING �` �\ EXISTING Elev. 53.00' = °� � / (13,300 S.F. -TOTAL) EXISTING \ \�\ 'D-BOX" Approx. M.S.L. Datum CENTERVILLE PLAZA °` 1,O00 GALLOt GREASE TRAP O f` s LP EXIST. 6-OUTLET H2O "D-BOX" .. ; - WHEEL g 2 (w/FLOW EQUALIZERS)--- _ EXISTING 5,000 STOP O GALLON SEPTIC TANK- � \� (TYP) � RISER w/FRAME&COVER TO GRADE(TYP.) EXISTING SEWER PIPE (5 ? �G (APPROX. LOCATION, CONTRACTOR TO VERIFY)- ,® EXISTING 6-500 GALLON \ H2O LEACHING CHAMBERS 2) �l t \ SH OF ASS, 1�S`r CB/DH ti (FND/HLD) EDPESCE L. N� \ CIVIL NO. 32001 �1t�-- ♦ 52\ / % '.� � /one, ` EXISTING DOMESTIC WASTE LINE 9 \ ' ,-� EXISTING DOMESTIC WAST E LINE CLEAN-OUT �5 EXIST. CB ..EXISTING I � \ / ` ,S�JQGALLON r' \ \ _51� / s9� °F SoE.P—TI STEM AS—BUILT- P�A GREASE TRAP.' \ \ \>< // I � PREPARED FOR: IAN DACEY, CENTERVILLE PLAZA TRU T - _ 1 s GE OF PAVEMENT J— \ 1661 FALMOUTH ROAD ED_ ---- _ � 3_ CENTERVILLE, MA 02632ON N86030'25"E' - =X X 1 X X X X X X_X X X X X X SCALOE: 1 10 0 40 8 E CH 20 FT. DATE: FEBRUARY 24, 2015 IV S�f W[i L t � rt �5U[tAYMOND IE p� =P YMOLlTH, MA 023G[L:" Drawn By: MCP epceQ+ejrhCast:n`ek Phone 50s:743 5246 ; JOB No.1023 eiLS $-333- b30 FAX:54$-79' =U211 JOB#1023 52.5± EXIST. C.I. FRAME &COVER TO GRADE TOP OF FOUNDATION = FINISH GRADE OVER CHAMBERS= 51 "1' - 51 .6� PROPOSED VENT WITH CHARCOAL FILTER TO ABOVE GRADE -� GENERAL NOTE S FINISH GRADE OVER D-BOX= 51.0± , SLOPE @ 2% MIN. OVER SYSTEM ! H-20 CONCRETE RISER AND Cl { 1- UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FRAME&COVER TO FINISHED 4"SCHEDULE 40 PVC MIN SLOPE 1% 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE -\ FINISH GRADE @ FND. EL.= 51.8'± FINISH GRADE OVER TANKS EL.= 51.5'± 51.5'± METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL GRADE 5"DIA.OUTLET(S) 2"OF 1/8"TO 1/2"DOUBLE WASHED STONE CODE AND ANY APPLICABLE LOCAL RULES. -F � _ - �-- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE EXIST. BLDG TOP OF SAS = 47.75' CAST IRON DESIGN ENGINEER. f SEWER 9" MIN. RING & COVER 46.75' 36"MAX. BREAKOUT EL = 47.25' PLACE RISERS ON ALL 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PROVIDE WATERTIGHT CHAMBERS TO ! SYSTEM UNLESS OTHERWISE NOTED. FLI EXISTING JOINTS(TYP.) FINISHED GRADE 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 4"PIPE O 4"PVC IN FROM ELEVATION =47.25' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. 48" 48.11 47.95' EXIST.D-BOX LEACHING 4"PVC UFACIILITY T TOo o 0 000�0 o LIQUID 48" O 000 O UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND LIQUID EXISTING "D-BOX" 12^ o o �p op Oo THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. LEVEL LEVEL 47.35 MIN. 47.15' oo �p o O + 5, SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 6"CRUSHED STONE 2 0 O O o j 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. OVER MECHANICALLY O O O O i COMPACTED BASE o a o 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK Op 0 0 0 0 o cp o 00 0 0 0 0 o ; FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS 6 3.0' 3.0' 3.0' NOT TO BE BACKFILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH EXIST. 1000 & 1500 GALLON OUTLET DISTRIBUTION BOX 4.0' 4.0' AND DESIGN ENGINEER. EXIST. 5000 GALLON SEPTIC TANK TO BE INSTALLED ON A LEVEL STABLE 8.5 T 4.83' 8. ELEVATIONS BASED ON APPROXIMATE M.S.L. DATUM OF 53.00' ESTABLISHED GREASE TRAPS BASE. FIRST TWO FEET OF OUTLET 72 0' (TYP.) PIPES TO BE LAID LEVEL. 29.53' FROM A NAIL SET IN U.P. AS SHOWN ON PLAN. SEASONAL HIGH GROUND WATER ELEV.= - - - - - - - 12.83' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION 4.75' OBSERVED GROUND WATER ELEV. (MW)_ *26.03' THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW "see TP data 5'MIN. 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES 12 - 500 GAL. H-20 CHAMBERS 15.22' PROVIDED) TO THE DESIGN ENGINEER. TANK PROFILE H-20 DISTRIBUTION BOX DETAIL H-20 CHAMBER DETAILS �a IAMBER END VIEW NOT TO SCALE NOT TO SCALE TYPICAL CHAMBER PROFILE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE -1 STRUCTURES SHALL BE MADE WATERTIGHT. + + • * + r '" �.• TEST PIT DATA 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING FALMOUTH ROAD (RTE 28) REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM (STATE HIGHWAY 80'WIDE)) -- _ __ -__J_____ • + « + �� AGENT: Donald Desmarais APPROPRIATE AUTHORITY. _ - - - • EVALUATOR: Ed Pesce, P.E. • - �• + `•• 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS " ` • • • •.+., • + DATE: April 10, LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE i_- - J • + • • TEST PIT#: 1 THEY SHALL WITHSTAND H-20 LOADING. MAP 209 / z • p , ~ • �•0• ELEV TOP= 51.40' 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. PARCEL 87 DEPTH TO GW • + . ; '� ¢ ELEV WATER= `26.03' 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE i` 1.19 AC.t // 10 APRIL 06=26.03' N� • - TH ROAD (RTE 2 ) \ •• PERC RATE <2 Min/In MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. FALMOU �-- ,� // REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, / ® , •• * DEPTH OF PERC = 56 -74 FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). (STATE HIGHWAY 80 WIDE)) { � • • • " „ EDGE OF PAVEMENT BAYBERRY SQUARE CONDOMINIUMS EXIST.MW • TOP EL:52.0T ! • • • ' ; •, � " TEXTURAL CLASS: 1 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN •• ` . • SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. wv �pGE OF PAVEMENT / 16. PROPOSED PROJECT IS LOCATED WITHIN. - - - ------- -------- --- - • ; . 0 / c� �IL� �, 3 BUILDING"F• •�• :! , ~ta 0,� Asphalt& 51.40' ASSESSORS MAP 209 PARCEL 87 BUILDING 001 TC ° M -- ----- U P --- - / • / / • Q . ' � 0000 Fill p - - - � Gravel 89 \ -_ / �` •". ' (>,� +��� 26,A Sand Loam 4923' OWNER OF RECORD: BRIAN T. DACEY TRUSTEE OF CENTERVILLE PLAZA TRUST p}86°30'25"€ - - / ✓ // + +r� • y ADDRESS: PO X 95 --- / �� FND HLD)CB/DH ••• • • 33" 10YR 5/6 48.65' CENTOERVILLE, MA 02632 1-00.08, / \ 52 / SIGN// 51 / +r. i w - ' -- Gh i B Loamy Sand FEMA FLOOD ZONE C TC --- / 10YR 5/6 \ l / \ _ �_ �`�'`�.-.. •*» + o �` AS SHOWN ON COMMUNITY PANEL# 250001 0005 C `✓ -"\ /� • ; ••' * • 51" 47.15' 17. DEED REFERENCE: 2"TOWN WATER LINE (DOMESTIC) EXIST. CB � �� , , CB/DH • `- o , f/ 00 • � �� � I 1.)BK. 11186 PG. 300 EXISTING LEACHING __ _ • , f • // 56 46.73 18 PLAN REFERENCE: 6"TOWN WATER LINE (FIRE PROTECTION) / .7 1>y�nL�TI -- ' _ • •,• ♦ • Perc -. f- PIT TO BE REMOVED - - --- _- � _ • + V/ PL. BK. 352, PG. 43 MAP 209 \\ / / PROPOSED 6 -500 GALLON s an erry r •�� •• • E 74" tx 45.33' PARCEL 87 \ off H2O LEACHING CHAMBERS . + + + �' • - " ') 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. INDEX PLAN -� Medium Sa►•d O 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY £ / 1.19 AC. ± _ EXISTING LEACHING PIT TO SCALE: 1" =60' �• .� 2.5Y 6/6 FOR SEPTIC SYSTEM UPGRADE. PESCE ENGINEERING WILL NOT ASSUME ANY LIABILITY /-' BE PUMPED AND FILLED WITH + �►' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. ro CLEAN SAND (TYP OF 4) No GW - •. _`TC .p- �` \ � PROPOSED PVC VENT PIPE 124" 41.40' C OVERHANG \ _ - = _ �\ (FINAL LOCATION TO BE LOCUS PLAN DETERMINED BY OWNER) n ° / SCALE: 1"- 1000' *Water elev.of on-site monitoring well=26.03' located at Building F(Bayberry Square Condos) \\ " °_ - �`� c���ti �\ / DESIGN DATA TEST PIT DATA LEGEND \ � PARKING AREA =- - �- PROP. 6-OUTLET O "_7_� / ,FAGENT: Donald Desmarais x 50.0 EXISTING SPOT GRADES H2O D"-BOX , \ - T. �B ` Ih`I' f COMMERCIAL CONDOMINIUM BUILDING \ LP > =- _ 2 DESIGN FLOW(OFFICE) 75 GAL/DAY/1,000 S.F. EVALUATOR: Ed Pesce, P.E. - - 50 --- - EXISTING CONTOUR B.M. OFFICE SPACE AREA 6,000 S.F. DATE: April 10, 2006 50 PROPOSED SPOT GRADES \ \ Nail in U.P. DESIGN FLOW (6,000 S.F./ 1,000 S.F.)x 75 GPD= 450.00 GPD 0 \ � � TEST PIT#: 2 \ � � Elev. = 53.00 EX{STIN �. b 50 PROPOSED CONTOUR Approx. M.S.L. Datum DESIGN FLOW(RETAIL) 50 GAL/DAY/1,000 S.F. ELEV TOP= 51.50' EXISTING \ \ \ \ "D-BOX" �, / �, RETAIL SPACE AREA 4,100 S.F. GREASE GALLON \ O O�( i �v'� DESIGN FLOW (4,100 S.F./ 1,000 S.F.)x 50 GPD= 205.00 GPD ELEV WATER= '"26.03' E/T/C EXISTING UNDERGROUND UTILITIES GREASE TRAP � �- � �� `r0 w PROPOSED 6 - 500 GALLON w DESIGN FLOW FAST FOOD REST. 20 GAUDAY/SEAT PERC RATE _ <2 Min/In W W--- EXISTING WATER LINE H2O LEACHING CHAMBERS 0 NO. SEATS 58 DEPTH OF PERC = 62"-80" GAS EXISTING GAS LINE \ O '1 ! DESIGN FLOW (58 SEATS x 20 GPD= 1,160 GPD #1663 TEXTURAL CLASS: 1 TEST PIT LOCATION v'o EXISTING COMMERCIAL �TP F TOTAL DESIGN FLOW=450+205+ 1,160= 1,815 GPD O+ �9 _,--EXISTING LEACHING BUILDING \ 5 =_ �� PIT TO BE REMOVED o (13, \ --_ \ TOTAL DESIGN FLOW x 200 /o = 3,630 GAUDAY 0 51.50 EXISTING 1,000 GALLON GREASE TRAP 300 S.F. -TOTAL) CENTERVILLE PLAZA \\ r \ LP T USE EXISTING 5 000-GALLON SEPTIC TANK Fill Asphalt& EXISTING 3_ Gravel EXISTING 1,500 GALLON GREASE TRAP 5000 GALLON O BAYBERRY SQUARE .. SEPTIC TANK - \ ' INSTALL 12 - 500 GALLON H-20 LEACHING CHAMBERS 38 4s.33 CONDOMINIUMS � A Sandy 10YR 5/8Loam O O EXISTING 5,000 GALLON SEPTIC TANK \ O I 43" 47.92' PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE _ SIDEWALL CAPACITY PROP. 6-OUTLET \ O (LENGTH +WIDTH)(2)(2' HIGH 74 GPD/S.F.) = GAUDAY B Loamy Sand H2O D"-BOX CB/DH ) ( 10YR 5/8 p PROPOSED H-20 DISTRIBUTION BOX \ (72' + 12.83') (2) (2') (.74 GPD/S.F.) = 251.02 GAL/DAY 52" 47.17' (FND/HLD) BOTTOM CAPACITY 62" - 46.33' PROPOSED 500 GALLON H-20 LEACHING CHAMBER EXISTING \ Perc 1500 GALLON / f (LENGTH x WIDTH) (.74 GPD/S.F.) GREASE TRAP- (72'x 12.83') (.74 GPD/S.F.) = 683.58 GAUDAY 80" J 44.83' REV. DATE BY APP'D. DESCRIPTION - _ -- \ \ \ TOTAL LEACHING CAPACITY = 934.6 x 2 = 1,869.2 GPD PROPOSED SEPTIC SYSTEM UPGRADE C Medium 6/4nd PREPARED FOR: \ ! TOTALS: (25%gravel) CENTERVILLE PLAZA TRUST EXIST. CB S'sr TOTAL NUMBER OF CHAMBERS: 12 TOTAL LEACHING AREA: 2,526.0 SQ.FT. LOCATED AT / TOTAL LEACHING CAPACITY: 1,869.2 GAL./DAY No GW 1663 FALMOUTH ROAD \ / USGS SEASONAL HIGN GROUNDWATER ADJUSTMENT 'Water elev. of on-site monitoring well=26.03' CENTERVILLE, MA 02632 INDEX WELL: MIW-29 ZONE D, MARCH 2O06 GW ADJUSTMENT=3.5' located at Building F(Bayberry Square Condos) - - RESERVED FOR BOARD OF HEALTH USE SCALE: 1 INCH = 20 FT. DATE: MAY 18, 2006 �_- 0 10 20 40 80 FEET �DGE OF PAVEMENT Assgo - ��_ CB/ o�� EDWARD L. yG� PESCE ENGINEERING -53- (F�' o PESCE u; _ AND ASSOCIATES X-X- , N86°30'25"E- v� X_X X-X_X_X X-X X " No.320010 �Q EDWARD L. PESCE P.E. SITE PLAN �� X X-X-X-X- F �, ENGINEERING SERVICES 451 RAYMOND ROAD f X-X -X�(- A�p�F GIST �� SEE IC SYSTEM DESIGN PLYMOUTYS 0,MA 2360 SCALE: 1"=20' PHON11i 508-743-9206 Drawn By: MCP Designed By:ELP Checked By: ELP JOB No.1023 5 t K. 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