HomeMy WebLinkAbout0638 MAIN STREET (CENT.) - Health (3) 638 Mein Street (Cent.)
Centerville
A = 207 011
1521/3 OAA 101YO P2
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Town of Barnstable P#_ 15 g�
Departinont of Regulatory Services
6 r�nnan+ale F Public'•Health Division' Date I1 Zl '�Dtt
MAal
id3y. 200 Main Street,Hyannis MA 02601
rill � D/ « •
Date Scheduled Time_ 10 Fee Pd._I d(D D "
Soil SuitabilityAsses went` or S
.f ge Disposaz r�7
Performed-By: IV Witnessed
LOCATION&.GENERAL t ORMAT ON
Location Address l waer's Name
Address
Assessor's Map/Parcel: .�o�I - Enginocr's Name 1AAA'�OL^4
NEW CONSTRUCTION REPAIR Telephone# sve? ro
l
Land Use Slopes(96) Surfkco Stones
Distances from: Open Water Body tt Possible Wet Area ft Drinking Water Wcll ft
Dralhago Way : ft Property Line ft Other ft
SKETCH9(Street name,dimensions of lot,exact locations of test holes&Pero tests,locate wetlands-in pmxlmlty to holes)
Parent material(geologic) Depth to Dedroak
Depth to Groundwater. Standing Water In Hole: Weeping from Pit Rea
Bstlmated Seasonal High Oroundwater
DETERMINATION FOR SEASONAL'IIIGH WATER TABLIM
Method Used:
De th Observed standing in obs.hole: Id. Depth to sell tnottleet
D, th to weeping from side of obs.hole: In. Uroundwater Adjustment ft.
Index Wall-i Reading Data: Index Well level„ A�,•faotor Adj.Clroundwator1evel,,._
,�;.. ---�: .� ._ - -. ---_�'l�'.L�( (�Li,Pi`l'XIJ.IV �.'1!;►`a'�` �Uute,,,,_„,;.�, 'AYtng �` - - ;�; -- - _-- .
Observation
Hole# Time at 4"
Depth of Pero Time at 6"
Start Pro-soak Time @ Time(4"41)
r
End Pro-soak
Rate Min./Inoh
Site Suitability Assessment: SIh Passcii SItp Pallod: 'Additional Testing Needed(YIN)
Original: Public Health Division Observation Halo Data To Be Completed on Back '
***If percolation test is to be conducted within 100' of wetland,you must first notify the
Barnstable Conservation Division at least one(1)week prior to beginning.
Q:ISBPTIC,PBRCFORM.DOC
DEEP.OBSERVATION HOLE LOG Hole#
Depth from Solt Horizon Soil Texture Sdil Color Soil• Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stonei;Boulders.
o lalstcncy.%'aravcl)
OAS
Imp
DEEP OBSERVATION HOLL LOG Hole#
Depth from Soil Horizon Soil Texture Soil Color Soli Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.
DEEP OBSERVATION HOLE LOG 11010#
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.•
f
w '
DEEP OBSERVATION HOLE LOGS Hole#
Depth from Soff Rrulzon Solt Texture Soil Color soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.
Consistency. Q[tivoll
i II
Flood Insurance Rate Man:
Above 500 year Mood boundary No._ es ,
Within 500 year boundary No—'+ Yes
ill .
!�lrithin 100 year floodood boundary
I)et)th of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring porvl u titorlal exist in all gross observed thrpughout the
area proposed for the soil absorption system?
If not,what is the depth of naturally occurring pervl us material?
Cer'ti fication
I cord fy that on _ (date)I have passed the soil evaluator examination approved by the
Department of Enviro enta Protection and that the above analysis was performed by me consistent with .
the required training,c rtise�atid ex erlenco described in�10 CMR 15.017.
Signature Datb
Q.\SBPTIGIPRRCPORM.DOC
1
TOWN OF BARNSTABLE
LOCATION GiC SI �'Z" 9 SEWAGE #
VILLAGE ASSESSOR'S MAP & LOT�-d�`�6A
INSTALLER'S NAME&PHONE NO. ,.
SEPTIC TANK CAPACITY 5 efb
1;.EACHING FACILITY: (typcA, � �kt,t1� (size)
NO.OF BEDROOMS �? sz: `-
I:UTILDER OR OWNER <f a 10
PERMITDATE: I COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table and Bottom of Leaching Facility t`. 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
-, J.
'-�
0
6
Cat -3
I o
TOWN OF-'BARNSTABLE
LOCATION �r�d G/ �' �� SEWAGE #
VILLAGE_ ASSESSOR'S MAP & LOT (}
INSTALLER'S NAME & PHONE NO."3j'1 &g2&rK1 d
SEPTIC TANK CAPACITY � /
LEACHING FACILITY:(type) % (Z _(size) �/
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER.
BUILDER OR OWNER _
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED: _
VARIANCE GRANTED: Yes No
r _ -
►ot
of
TOWN OF BAMSTABLE
In accordance with the Massachusetts State Building Code, Section 106.5, this
CERTIFICATE .OF INSPECTION
is issued to HARBOR DEVELOPMENT
31 Certify that I have inspected the premises known as:
638 MAIN STREET MULTI-FAMILY
located at 638 MAIN STREET in the Village of CENTERVILLE
County of Barnstable Commonwealth o Massach
usetts.
husetts.
Construction Type:
Use Group(s): R2
The means of egress are sufficient for the following number of persons:
Location Capacity Location
6 UNITS Capacity
Certificate Number:. Date Certificate Issued: Date Certificate Expired:
Map Parcel
201004212
6/1/2010 6/l/2015 20 O11
The building official shall be notified)within (10) days of any
changes in the above information.
Building Official
S
r
Town of Barnstable
°Fz ram, Regulatory Services
ti
Thomas F: Geiler, Director
HARNSfABLE. ` Building Division
y MASS.
�Ar 1639n. Aim Thomas Perry, CBO, Building Commissioner
200 Main Street, Hyannis, MA 02661
www.town.ba rnsta ble.ma.us
Office: 508-862-4038 Fax: 508-790-6230
MEMORANDUM
TO: Tom
FROM: Lois
DATE: 8/16/10
Here is the COI for 638 Main Street, Centerville, along with the folder.
In 2000, we issued the COI to the MacNeely's for 5 units. The form they submitted was
for 5 one-bedroom units and owners' quarters.
In 2005, we issued the COI to Daniel Hostetter. The form he submitted was for 5 one-
bedroom units.
The form Adam Hostetter has submitted this year is for 4 one-bedroom units, 1 two-
bedroom unit and 1 four-bedroom unit.
Board of Health lists 5 units: 41one-bedrooms and 1 two-bedroom.
There is a letter in the file from Jeff Lauzon to Adam Hostetter dated June 11, 2009,
stating there is an illegal basement bedroom and that a building permit is required to
bring the property into compliance. No building permit was pulled.
The previous COIs were for 5 one-bedroom units. I have prepared this one for 6 units
without listing the number of bedrooms.
Do we need to list the number of bedrooms in each unit? k
Has the issue of the illegal basement bedroom been resolved? ,Q,�
r
Certified Mail#7012 1010 0000 2850 8593
Town of Barnstable
Regulator Services
IAENSI'AHLE,
Richard Scalif irector
qLp 1M�A�8�4
Yv b Public Health Division
Thomas McKean, irector
200 Main Street, Hy s, MA 02601
l
Office: 508-862-4644 Fax: 508-790-6304
July 8, 2014
Adam Hostettern D
770A Main Street /� —
Osterville, MA 02655 !� jG/
I
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
Gam -
The property owned by you located at 63 8 Main Street.was inspected
on July 8, 2014 by Timothy O'Connell, R.S., Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500 — Owner's Responsibility to Maintain Structural Elements
Back concrete steps are missing blocks and are in need of repair.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by repairing or replacing steps.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served. Non-compliance will
result in a fine of$100.00 per violation. Each day's failure to comply with an order shall
constitute a separate violation. Should you have any questions regarding the above
violations, please contact the Town Health Division and ask to speak with the inspector
who performed the inspection.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. cKean, R.S., CHO
Director of Public Health
Town of Barnstable
i
I
i
I
QAOrder letters\Housing violations\Rental ordinance\638n main street 7-8-14.doc
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Certified Mail#7008 3230 0002 5178 0554
Town of Barnstable
' Regulatory Services
Thomas F. Geiler,Director
i6394 ♦�
Public Health Division
Thomas McKean, Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
September 11, 2012
Adam Hostetter n /'��
770A Main Street
Osterville, MA 02655 � ,y to—((—
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 638 Main Street Apt. C, was inspected
on September 11, 2012 by Timothy O'Connell, R.S., Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. The
window sill within bedroom and the corner board trim on the side of the dwelling unit
was observed to be rotted.
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements.
Window within the bathroom not capable of being opened. (Missing crank handle)
105 CMR 410.190—Hot Water. Hot water temperature at 170°F.
105 CMR 410.600 - Storage of Garbage and Rubbish. Observed four trash barrels
over filled. Property has six units.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by repairing or replacing said windows and trim so
they are weather proof; by providing at least one trash barrel per dwelling unit.
Note: Water temperature was turned down during inspection although water
temperature must be kept between 110-130 OF.
Q:\Order letters\Housing violations\Rental ordinance\638n main street Apt.E.doc
1
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served. Non-compliance will
result in a fine of$100.00 per violation. Each day's failure to comply with an order shall
constitute a separate violation. Should you have any questions regarding the above
violations, please contact the Town Health Division and ask to speak with the inspector
who performed the inspection.
ZPER ORDER OF E BOARD OF HEALTH
mas A. McKean, R.S., HO
Director of Public Health
Town of Barnstable
Q:\Order letters\Housing violations\Rental ordinance\638n main street Apt.E.doc
i
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date ' - Time: In Out
Owner Tenant 1
Address 77 O rk "n � Address t" e-�
b �• \ n 1 L
Compliance Remarks or
Regulation# Yes NO Recommendations
2. Kitchen Facilities
3. Bathroom Facilities
4. Water Supply
5. Hot Water Facilities
6. Heating Facilities 3
7. Lighting and Electrical Facilities `o�'f
8. Ventilation
9. Installation and Maintenance of Facilities ap
10. Curtailment f 0 e t o Service
11. Space and Use _
12. Exits
13. Installation and Maintenance of Structural
Elements
14. Insects and Rodents
15. Garbage.and Rubbish Storage and Disposal
16. Sewage Disposal (2 , — o�-i 7
17. Temporary Housing
18. Driveway Width
19. Number of Tenants Observed — `1
PART II p
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms I Number of Vehicles Allowed (max)
Number of Persons Allowed (max).
Person(s) Interviewed Inspector r
If Public Building such as Store or Hotel/Motel specify here
SENDER: COMPLETE THIS SEChON COMPLETE THIS SECTION ON DELIVERY
■ Complete items 1,2,and 3.Also complete A. ature
item 4 if Restricted Delivery is desired. X /,J ❑Agent
■ Print your name and address on the reverse / 'w� "`'� ❑Addressee
so that we can return the card to you. B. R ceive by(Printed Name) C. Date of Delivery
■ Attach this card to the back of the mailpiece,
or on the front if space permits. e g /
D. Is deliv ry address different from item W❑ es
1. Article Addressed to:
�. y- . If YES,enter delivery address below: ❑No
_ Adam Hostetter
' 70A Main Street
p.terville, MA 02655
l 3. Service Type
I _ U6—rtified Mail ❑Express Mail
d i ❑RegisteredC�Retum Receipt for Merchandise
❑Insured Mail ❑C.O.D.
4. Restricted Delivery?(Extra Fee) ❑Yes
2. Article Number €; } 7006:;0812 l0000 3524a 5225 ��C�
17ransfer from service label)
PS Form 3811 February 2004 i Domestic Return Receipt 102595-02-M-1540
L'
UNITED STATES POSTAL SERVICE First-Class Mail
Postage&Fees Paid
LISPS
Permit No.G-10
• Sender: Please print your name, address, and ZIP+4 in this box •
i
Town of Barnstable
e Health Division
200 Main Street i
Hyannis,MA 02601
Certified Mail#7006 0810 0006 3524 5225
Town of Barnstable
Regulatory Services
snxivsn+sz.e. •
'1 ' Thomas F. Geiler, Director
Public Health Division
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
December 7, 2011
Adam Hostetter 1) y 16
770A Main Street
Osterville, MA 02655 ��✓�
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE CODE CHAPTER 170.
The property owned by you located at 63 8 Main Street Apt. E, was inspected
on December 5, 2011 by Timothy O'Connell, R.S., Health Inspector for the Town of
Barnstable. This inspection was conducted on the basis of the rental registration in
accordance with Chapter 170 of the Town of Barnstable Code.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements. The
front porch windows and trim were observed to be rotted and are not weather proof or
rodent proof. It was also observed that there are many holes and deteriorating siding
within the back of this dwelling. Holes were located at ground level; soffit areas, siding,
and gutters.
You are directed to correct the violations listed above within thirty (30) days
of your receipt of this notice by repairing or replacing windows and trim so they
are weather proof and rodent proof within apartment (E); by repairing all damaged
areas on the outside of this dwelling so that it excludes wind, rain and rodents.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served. Non-compliance will
result in a fine of$100.00 per violation. Each day's failure to comply with an order shall
constitute a*separate violation. Should you have any questions regarding the above i
violations, please contact the Town Health Division and ask to speak with the inspector
who performed the inspection.
QAOrder letters\Housing violations\Rental ordinance\638n main street Apt.E.doc
TA
RPF OARD OF HEALTH
McKean,R.S., CHO
Director of Public.Health
Town of Barnstable
QAOrder letters\Housing violations\Rental ordinance\638n main street Apt.E.doe
I
TOWN OF BARNSTABLE
BOARD OF HEALTH
ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION
Date ' / ' Time: In Out
Owner Tenant L""'�- e�-fi( �
Address -7 7 0 Address
Compliance Remarks or
Regulation# Yes O Recommendations
2. Kitchen Facilities
3. Bathroom Facilities -7C)
4. Water Supply
5. Hot Water Facilities ✓ - N 70
6. Heating Facilities
7. Lighting and Electrical Facilities
8. Ventilation }cft
--
9. Installation and Maintenance of Facilities
10. Curtailment of Service
11. Space and Use
12. Exits
13. Installation and Maintenance of Structural +'
Elements c C -
14. Insects and Rodents
15. Garbage and Rubbish Storage and Disposal ✓r 6 ?
16. Sewage Disposal o D 5 6a c7 3
17. Temporary Housing l (3
18. Driveway Width
19. Number of Tenants Observed E y
PART II
37. Placarding of Condemned Dwelling;
Removal of Occupants; Demolition
Number of Bedrooms Number of Vehicles Allowed (max) /v
Number of Persons Allowed (max)
Persons Interviewed Inspector
If Public Building such as Store or Hotel/Motel specify here
Certified Mail#7008 3230 0002 5178 0462
Town of Barnstable r
Regulatory Services
IAENSPABLE f
MAM
Thomas F. Geiler, Director a 39. Public Health Division Aa,
Thomas McKean,Director
200 Main Street, Hyannis, MA 02601 —
Office: 508-862-4644 Fax: 508-790-6304
August 13, 2012
Adam Hostetter
770A Main Street
Osterville, MA 02655
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY
CODE II—MINIMUM STANDARS OF FITNESS FOR HUMAN HABITATION
The property owned by you located at 638 Main Street Centerville, MA was inspected on
August 13, 2012 by Timothy B. O'Connell, R.S., Health Inspector for the Town of
Barnstable because of a complaint.
The following violations of the State Sanitary Code were observed:
105 CMR 410.500 —Owner's Responsibility to Maintain Structural Elements:
Failed storm water run-off drain is allowing water to enter home through drain pipe
within enclosed porch area. This water is causing chronic dampness throughout dwelling
unit.
You are ordered to correct the violation listed above within twenty-four(24) hours
of your receipt of this notice by repairing or replacing said storm water run-off
drain.
You may request a hearing before the Board of Health if written petition requesting same
is received within ten (10) days after the date the order is served. Non-compliance will
result in a fine of$100.00 per violation. Each day's failure to comply with an order shall
constitute a separate violation. Should you have any questions regarding above
violations, please contact the Town Health Division and ask to speak with inspector who
performed the inspection.
PER ORDER OF THE BOARD OF HEALTH
omas A. McKean, R. ., HO
Director of Public Health
Town of Barnstable
t
QAOrder letters\Housing viol ati ons\Rental ordinance\638 main st cent.8-13-12
Hazardous Materials Inventory Sheet Checklist
Date
✓/ Physical Street.Address-Check database to ensure it exists
— iWorking Phone Number
Actual Amounts -( ie. gas being used to fuel machines,thinner to
clean brushes all count as hazardous materials-no blanks)
Storage Information -location of storage, how,long is storage for?
/If none, note that.
Disposal Information -where and who? If none, note that.
Applicant Signature -understand what is listed and noted
Staff Initial -any questions, know who to ask
Vehicle Washing/Rinsing? -give a vehicle washing policy and
explain it
Attach the Business Certificate with your sign off--and comments
**The inventory form should explain what the business consists of and the procedures
thev are doing. Notes need to be left to explain what you discussed with them.
YOU WISH TO OPEN A BUSINESS?
For Your Information: Business Certificates cost $30.00 for A Business Certificate ONLY REGISTERS THE BUSINESS
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 C,
signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street,
Hyannis, MA 02601 (Town Hall) and get the Business C I ertificate. that is required by law.
} � no
$ Fill in please: Date: L
APPLICANTS NAME: b n
Eli ik YOUR HOME ADDRESS:
BUSINESS TELEPH 9 51 HOME TELELPHONE #.
NAME OF CORPORATION: TYPE OF BUSINESS
NAME OF NEW BUSINESS ! N
IS THIS A HOME OCCUPATION? x -YE MAP/PARCEL NUMBER :- � )(Assessin
g)<
ADDRESS OF BUSINESS
When starting a new business there are s veral things you must do to be in compliance with the rules and regulations of the Town of
Barnstable. This form is 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 town.
1. BUILDING COMMISSIONER'S OFFI E
This individual has been.informe f any permit requirements that pertain to this type of.business.
v
uthonzed�Si nature MUST COMPLY WITH HOME OCCUPAT04N
COMMENTS:
2. BOARD OF HEALTH
This individual a nformed&e re hat pertain to this type of business.
Authorized Signature*'
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: i (i p4 r a'in 5Ta Uc7-,'onN
BUSINESS LOCATION: 6 U - INVENTORY
MAILING ADDRESS: 44= TOTAL AMOUNT:
TELEPHONE NUMBER: O
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: O <, MSDS ON SITE?
TYPE OF BUSINESS:
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: M Uj Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) __. Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
a�j L+Degreasers
#ulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes J Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint & varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removers t(rrnQm� 6 0A LP,"; 2fto0,- 'H
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
No: S Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _�—
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
ZI pplication for 3WZpoai Or5tem Cou6truction Permit
Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) 11 Complete System �')�tidividual Components
Location Address or Lot No. 3& �fli N 5T Owner's Name,Address and Tel.No. `�
CEM', E1ZVI Pke:TJri M�cIJ�L,v
Assessor's Map/Parcel �RM6
204 I t
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
i�ob��s vEanL S�VIcE 5*��cr E'hlvteen)�ntN'�wL S�iC:S
046-530o � t-�9tQtQ
Type of Building: t �2T p f He0SE,
Dwelling No.of Bedrooms 3"O SI40N �Lo Size .5Yalh sq.ft. Garbage Grinder(/J/
Other Type of Building oaryE' No.of Persons ID Showers( PI) Cafeteria
Other Fixtures LajA-roe? tyrre IS41\161 ravC 2�v
Design Flow .,3 Z gallons per day. Calculated daily flow gallons.
Plan Date p�13 h s Number of sheets Revision Date
Tide �L
Size of Septic Tank w Type of S.A.S. oZ' SC0 !aak csr�Q CN
Description of Soil 4j
Nature of Repairs or Alterations(Answer when applicable) -Q?C: ` p
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 Ejyironmentalt Code and not to place the system in operation until a Certifi-
cate of Compliance hash 7trad f Heal
Sig Date
Application Approved by Date -�
Application Disapproved for the following reasons
Permit No. Date Issued O
-----------------------
F- �yi Aid
cog:—' -fad Yi ..- .. Fee DG
THE�COMMONWEALTH OF�MASSACHUSETTS Entered in computer: Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
2pplication for -Migaal bp5tem Con0truction Permit
Application for a Permit to Construct( . )Repair Upgrade( )Abandon( ) ❑Complete SystemXdividual Components
Location Address or Lot No. 4k.3e "t11 N sr Owner's Name,Address and Tel.No.
CANTER L c.E,M q M A wr I r4 M Ac.M Cs 1,"
Assessor's Map/Parcel Z64 1t SA ME
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
�Q�pQ.c}S �P'T'tC- SEQVIGE 5N►art 6�Jui2.a.1MtNT��.. SAC
(0 L15 1S'510 -539- +9 talo
Type of Building: �-'' Of' tAOO-C
fi
Dwelling No.of Bedrooms 'O�'s��N o t Size 5(a9 sq.ft. Garbage Grinder
r Other Type of Building Ur)£ No.of Persons 10 Showers( Pl Cafeteria
Other Fixtures LAywmeY. Derr[ 4N SjrJk! L,Au"Oe-V
Design pow 'J 3 d _ '1 gallons per day. Calculated daily flow gallons.
Plan Date 1 113 1 h cT Number of sheets 1 Revision Date
r Title
{ Size of Septic Tank 0-W I SUU ";® Type of S.A.S. S ' t W 5,ak
x 41- uL AB-OUt
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) Qr
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 E ironmental Code and not to place the Sy'.stern in operation until a Certifi-
cate of Compliance ha!jJbx ssae'dty-t ' o Heal f, .
Sig Date
Application Approved by - l IL4 / Date y ��
Application Disapproved for the following reasons `
a
Permit No. Date Issued O
=— ---- ———————— ————————————————
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 n6ey�S Su',--OL L f-
at (0 11? OUNILI STt r>!t' ��eti�rrU���Phas been constructed in accordance
with the provision} of Title 5 and the for Disposal System Construction Permit No. dated
Installer `
s V rl he?,\:S Designer- A
The issuance of this perquit sh ll not be construed as a guarantee that the syste 11 nction as designed.
Date I I 'io ic,5 Inspector
No. �� � ^O�� ------------------------Feel—
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
lwigogaf *pgtem Con! trurtion Permit
Permission is hereby granted to Construct I )Repair( )Upgrade( L. Abandon( )
System located at �0� r' mc,✓`-- <'1 t _
- �t°•ti'tt'r U t,
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Co structio must be completed within three years of the d Cby:
oi i
Date: 0Approve
i° fj 002/002
Town of Barnstable
THE Regulatory Services
s r Thomas F. Geiler,Director
•�xsras�,
M Public Health Division
Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862A644 Fax: 508-790-6304
Installer& Designer Certification Form
Date: 1/20/05
Designer: Shay Environmental Services Inc. Installer: Robert Septic Services
Address: P.O. Box 627 East Falmouth Address: 5 Trenton Street
MA 02536 Yarmouth, MA
On 1/18/05 Robert Septic Service was issued a permit to install a
(date) (installer)
septic system at 638 Main Street, Centerville MA based on a design drawn by
(address)
Shay Environmental Services Inc. dated 1/16/05
(designer) -
XX I certify that the septic system referenced above was installed substantially according to
the design, which. may include minor approved changes such as Iateral relocation of the
distribution box and/or septic tank.
1 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.
��a��N of MAss
(Installer's gnature) °� CARMEN °
o E. "
SHAY v,
No. 1181
Designers Signature) (Affix D Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE V TLL Nffy BE ISSUED UNTIL BOTH TI�I>[S FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certiticaiion Form
JAN-20-2005 THU 07: 13PM ID: PAGE:2
VENT PIPE ((® Least 24 inches tall) QMKD44T4aLU
10' min. from *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. Schedule 4?PVC w/Charaool Odor Filter SECTION A -A '
- -- ALL OUTLET PF'ES FROM THE i t
ExistingFoundation house to septic tank DISTRIBUTION Box SHALL BE
I-- eP PROF L� E VIEW OF LEACHING SYSTEM
Septic tank covers must be D-BOX Cover must be SET LEVEL FOR AT LEAST 2 F7. _12' CONCRETE COVER a
TOP OF FOUNDATION = ELEV, 100.00 (Assumed) 'TO finished grade WITH STEEL MANHOLE COVERS to GRADE WITH STEEL MANHOLE COWER
?_' 4
Grade over Septic Tank - 99.00 Grade over D-Box- 99.00 /-'.rode over SAS - El.f Va 94.00 3 _
.. ``
►.died C-h.4 Sd- Of 1/e•- 1/2• W-h d P*.et.a. /� ``� KNOCKOUTS 4
i INSPECTION cover must ba ` 5'S" OUTLET , I (-) 12• INLET Pr r
within 6 in. of finished grade '
S e 0.02 3 HOLE H-20 B• __ w
O 16' DIST. BOX 3' ►Poxkno'n cover Top of SAS-Elev.=89,75
O NEW 5=0.01 or Greater S� 0.010' per foot • - 1 2 a„c ne i�il MAIN St '
EXIST. PIPE `- u'I 1,50CI GAL /
o r` o ,5' O 4" - SC f 40 Te FROM EXIST. FOUNDATION rn SEPTIC TANK N ED CD ED o M p -•----15.5'- K 3 fi y?r'
m 00 20' o Effective Depth C3 C3 C3 O -- o
> p H-20 °°'Ben' m U rn o 0 2 Units @ B.5' PIT 9,.,r , r•,e P1 f Fa
PLAN SECTION CROSS-SECTION
CONCRETE Full FOUNDA F a, au Co , 9• , fr m
w n F m 3.5' 5' 3.5' rn 4 4 ®0
SYSTEM PROFILE 6 in.of 3/4"-1 1/2' v �-' �' ` 25, 3 HOLE H-20 DISTRIBUTION BOX + �
compacted atone - - 12' 11 b o
c Effective Length NOT TO SCALE t5BT lb ''
Not to Scale - c Effective Width r> �SB�tf + �{, n•,^,n ,
j m tel:DGi P.and LkMapy B f a+nDa+y®:'W4 N&TEQ
- _ c ro S❑IL ABS❑RPTI❑N SYSTEM .(SAS)
6 In.of 3/4'-1 1/2' 0 500 C H-20 LEACHING UNITS/ WIGGINS PRECAST GENERAL NOTES
compacted stone m
NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE Bottom of Test Hole 1 Elev.= 80.00 j Not to Scale 1. Contractor is responsible for Digsafe notification
v Obs, Groundwater - Test Hole 1 Elev.= NONE OBSERVED and protection of all underground utilities and pipes.
2. The septic tank and distribution box shall be set
level on 6" of 3/4"-1 1/2 stone.
3. Backfill should be clean sand or gravel with no -
stones over 3" in size.
PERCOpp 4. This system is subject to inspection during installation
LATION TEST �p by Carmen E. Shay - Environmental Services, Inc.
cD c0 5. The contractor shall install this system in accordance
Date of Percolation Test: JANUARY 12, 2005 1 with Title V of the Massachusetts state code, the approved plan
Test Performed By: CARMEN E. SHAY, R.S., C.S.E. O 4a 1 I t\ \ and Local Regulations.
Results Witnessed By. Waiver per BARNSTABLE B.O.H. O 6. If, during installation the contractor encounters any
Percolation Rate: Less Than 2 MPI 0 30" \\ I 1 soil conditions or site conditions that are different
160.00' from those shown on the soil log or °in our design r
I ± �` \\ t \ installation must halt & immediate notification be
Test Hole 1 1 1 , \ \\ tt made to Carmen E. Shay - Environmental Services, Inc.
No. 1 i EXISTING 9�1 \\ \\ �� 7. No vehicle or heavy machinery shall drive over the
DEPTH SOILS ELEV. I + I i Leach Pit -� ` \ \ septic system unless noted as H-20 septic components.
0 92.00 i j I i \�\\ \` i 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends.
Sandy I \\ 1l 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes.
Loom
1 All
\ 0. I solidpiping, tees & fit 'n Ifittings shall be i
10 YR 3/2 9
4" diameter
A s8.3o j i j � "\\ 1t Schedule 40 NSF PVC pipes with water tight joints.
11. Municipal Water is Connected to The Residence and Abutting
Loom
Properties Within 150 Feet.
Loam I 1 / 1 / I \\ \ � 1 p
10 YR 5/6 I i 1 1 EXISTING
B. / I / i Leach Pit `\ \\ t 5 THE PROPERTY LINES ARE APPROXIMATE AND
8'- so" 89.50 / 4(ISTING I \
I r , \ ` COMPILED FROM THE SURVEY PLAN GENERATED BY
Med / I a \VET` I1IPE
Sand // li keach Pit 21.5' GRAVEL `\ I`I• DES LAURIERS & ASSOC. OF WALPOLE, MA, ENTITLED
2.5 Y 7/6 I i / i I I "CERTIFIED PLOT PLAN OF LOT 14 MAIN STREET, CENTERVILLE, MA"
28"-144" c, 80.00 / / f i DRIVEWAY \\ \\ DATED 03/13/92
& THE DEED DESCRIPTION ( CERT # 152536)
IT SHOULD BE USED FOR NO PURPOSE OTHER THAN
FAIL
0 1 1`i EACHING' \` THE SEPTIC SYSTEM INSTALLATION.
Ir i i AREA • f 1 Leach �It� --
// O - i 0 EXISTING LEACH PIT TO BE PUMPED OUT AND FILLED IN PLACE OR
REMOVED TO FACILITATE NEW SEPTIC SYSTEM INSTALLATION
100__, f /! g �l 1 H-20 D-BOX I O \ \\ NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE
TEST HOLE #1 1 + NEW 1500 god
1 H-20 Septic o,T, FROM THE EXISTING LEACH PIT TO BE DISPOSED
i 1 - ELEV.= 92.00 t 20`I � p � �\ �\
OF AS PER BOARD OF HEALTH SPECIFICATIONS.
Pe c #1 _ _ -__. \ 1 r l i \\;.. � NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY
Depth to Pere: 32" to 50' I �- \ -- _ I Porch 1 Porch �\
Perc Rate= Less Than 2 MPI 1 1 � --__ --L_._-_____ � �
l 1 �� ASSESSORS MAP 207, PARCEL 011 ->f
Groundwater Not Observed I 1 I - \
No Observed ESHWT I �\ -Porch--- \ `\ LEGEND
ADJUSTED H2O Elev. = None 1 ` " EXISTING \ \\
\\ EXISTING BEDROOM
00 ` O WNERS
3-24' OIAM. ACCESS MANHOLES \�� 5 BEDROOM \
v � � � �'� DENOTES PROPOSED
APARTMENT HOUSE QUARTERS �\ \\ ` 104X 1
R
10' -e• SPOT GRADE
\ \
#638 DENOTES EXISTING
(UNIT l) GRAVEL \
m �` --- (UNITS A through E} I �\\\� DRIVEWAY �\\ `\\ X 104.46 SPOT GRADE
INLET ' er*
C�0-
TO \\ \ PL PROPERTY LINE
INLET \ OU TTHE ACCESS COVERS FOR THE SEPTIC TANK,DISTRIBUTION BOX AND LEACHING COMPONENT � \ 96P PROPOSED CONTOUR
SHALL BE RAISED TO WITHIN 6" OF `FINISHED GRADE. LOT #45 0 ` - - - - -
-g7 EXISTING CONTOUR
STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALSPLAN VIEWON ALL OUTLET TEE ENDS i_---- I ° a18;560 Square FeetDEEP TEST HOLE &
3-z+' aEMovABL1 covfhsPERCOLATION TEST LOCATION
ASPHALT4• t .. + �� / - 6 FOOT STOCKADE FENCE
3mta d.aranceDRIVEWAYINLET 8•min.r 12"min. inlet to outlet " 'j _� _ ry 1NlE ` 0' TiLiquid Cave1- OUTLET1/5`00'u�,10 mi.. 1IGRAVEL ------ ---------- pT pDRIVEWAY _ 1 LO I { LAI V` yT------ --- ------------ ---------------~' µ - OF PROPOSED SEPTIC SYSTEM UPGRADE
CROSS SECTION END-SECTION ��� I- ,S �'�-E PREPARED FOR
MARTIN MacNEELY
TYPICAL 1500 GALLON SEPTIC TANK (40 FOOT RIGHT of WAY) AT
NaT To SCALE 98 -- L / # 638 MAIN STREET
(H-2o GOADING) CENTERUIALE, MA
Design Calculations PROJECT BENCH MARK
TOP OF FOUNDATION � F PREPARED BY:
Number of Bedrooms: 2 Equivalent to 220 Gal./Day (330 Gal./Day Min, per Title V) ELEV. _ 100.00 (Assumed) ��Garbage Grinder: No o A /�/��j �juLeaching Capacity Proposed: 330 Gal./Day Minimum (Min. Per Title V) CAR,1 EiV li Sll•A Y
Septic Tank : - 2 x 330 Gal./Day ='680 USE NEW 1,500 GAL. Septic Tank , SHAY Cn ' ONMENTAL SERVICES,, INC.
SOIL ABSORPTION AREA: Using percolation rate of G2 min./inchBottom Area: 0.74 gal/sq. ft. x 300sq. ft. 222.00 gallons 0 20 40rjQ � QP.O. BOX 627
Sidewolt Area: 0.74 gal./sq. ft. x 148 sq: ft. 1os5o gallons - sE EAST FALMOUTH, MA 02536
Providing: = 331.50 gallonsNTEL/FAX 508-539-7966
Use: (2) PRECAST 500-C UNITS, HAVING A 2' EFFECTIVE DEPTH,
BE USED WITH 3.5' OF WASHED STONE ON THE SIDES AND _ SCALE: 1 -2 0-' DRAWN BY: CES DATE: JANUARY 13, 2005
4' OF WASHED STONE ON THE ENDS. SCALE: 1 "=20' PROJECT#SD681 FILENAME: SD681 PP.DWG SHEET 1 OF 1