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Home My WebLink About0414 OLD STAGE ROAD - Health 414 Old Stage Road Centerville A = 190 115 �►IIl1 gcuo'�41-- IN UPC 12543No.53LO1 -t'on NASTINGS, MN Date: 65/Z� / I TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM : NAME OF BUSINESS: H i of`I A �i& IPA I ►V f c-o -� Co r �a7 BUSINESS LOCATION: C - vy-FFv-, V jUr- pr) pf- INVENTORY MAILING ADDRESS: kj oL 0 S4 W q G 'r D TOTAL AMOUNT: TELEPHONE NUMBER: '� y�3 2- 3 0 3 3 ME CONTACT PERSON: AevDa , �i EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: A)+ INFORMATION / RECOMMENDATIONS: Fire District: �rIr^ PC 00D ,E ®h NA2iA1-P,-)vS r, w1�n►ilA/.� .��ope�c� �N Waste Transportation: K R,I P"P OIJ 5 W A D E P V p L��t s�ipment 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 material 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) Miscellaneous 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 1�111NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) a Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's � �� ins, varnishes, stains, dyes Other chlorinated hydrocarbons, 5FLIt�acquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil & stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash �'�.vDR® g�t�r/'j�•�� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials /`� �1 iJ 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: CL41 2 S Fill in please: . RE APPLICANT'S YOUR NAME/S EA02o 8 € BUSINESS YOUR HOME ADDRESS: <-1 f 44 IDL h S ft1 lc-- ►^D C E r- 6 TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS l h V 1 k 1Qf 6-S o TYPE OF BUSINESS i 41fUT t (V C] IS THIS A HOME OCCUPATION? :�L_YE _N115 ADDRESS OF BUSINESS 41-t E f-t) E7A1fE-^Ui(,LF rn 4 MAP/PARCEL NUMBER (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 Mai t. - (corner of Yarmouth Rd. & Main Street) to a sure you have the appropriate permits and licenses required to legally opera Mai in this town. 1. BUILDING CO MI SIO ER'S OFF MUST COMPLY WITH HOME OCCUPATION This individ alV-11eenform d[�nyrmi require ants that pertain to this type of businesUL�S AND HCa(a;./ TI(�7NS. FAILURE TO 07 e i ature COMPLY MAY t SUL"I IN FIDES. iCOMMENTS(DA i_n 0 'n 2. BOARD OF HEALTH MUST COMPLY WITH This individual has been me 4he..pe_�rm_itrequirements that pertain to this type of business. HAZARDOUS MATERIALS RED JLH; MUST C -M�?-1N i1jTH Al I_ tho i ed ig3ature** / HAZARDOUS MATE ALA=REGUf ATIONS COMMENTS: 2.c3 � � !�s 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: i TOWN OF BARNSTABLE M � ' BARNSTABLE• OFFICE OF TOWN ATTORNEY BARNSTABI,E MASS.39- a O s -.. �ar�C A,� 367 Main Street _a,s-zai-s Hyannis, Massachusetts 02601-3907 575 Phone 508-862-4620 Fax 508-862-4724 RUTH J.WEIL,Town Attorney ruth.weil@town.barnstable.ma.us T.DAVID HOUGHTON, 1s'Assistant Town Attorney david.houghton@town.barnstable.ma.us CHARLES S.McLAUGHLIN,Jr.,Assistant Town Attorney charles.mclaughlin@town.barnstable.ma.us December 7, 2015 Jennifer Benzel AVP, RMDM Support Manager Residential Mortgage Default Management- REO 200 South Sixth Street, EP-MN-L22R Minneapolis, MN 55402-1403 Re: REO Property 414 Old Craigville Road, Centerville,MA Dear Ms. Benzel, This letter is to inform you that The Town of Barnstable Health Department has determined that the Septic system located at 414 Old Craigville Road, Centerville, MA has "failed"under the guidelines of 1995 Title 5 (310 CMR 15.00). Enclosed for your records is a copy of the Order to Comply with State Environmental Code, Title 5 that was sent to US Bank Nation Association on November 10, 2015 by the Board of Health. Clearly;this failed septic system is posing serious environmental concerns and must be addressed no later than the time the frames contained in the Board of Health letter. Please contact the Board of Health should you have any questions. i cerely yo rs, RJW/aep ( Ruth J. Weil Town Attorney Town of Barnstable cc: George A. Karambelas, Esq., Bendett &McHugh, P.C. Thomas McKean, Agent of the Board of Health Mary Sullivan, Massachusetts Attorney General's Office 2013-0189 141 Old Craijzville Septic Violation.doc oFt"�T Town of Barnstable Barnstable plt-ftedcaCity j Regulatory Services Department I fARNSTABI�, 1 i63q. ,.P' Public Health th Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7026 November 10, 2015 US Bank National Association % Secretary of HUD 4400 Will Rogers Pkwy STE 300 Okalahoma City, OK 73108 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system a Greywater System located at Old Craigville Road, Centerville, MA was last inspected on Oct 24,2015 by Michael McDowell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines .of 1995 TITLE 5 (310 CMR 15.00) due to the following: . • Discharge or ponding of effluent to the surface of the ground. • Laundry room must be connected to existing septic system OR you may install anew septic system for the laundry waste water. You must submit permits to the Health Division once work is completed by the licensed plumber. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\Septic Letters Septic Inspection Failutres or Further Eval\414 Old Cragville Rd,(Graywater)Cent Nov2015 Nlynn, Judith From: Stanton, David Sent: Wednesday, December 02, 2015 3:15 PM To: Crocker, Sharon; Heath DeptMailbox Subject: RE:414 Old Craigville Beach Rd Cent/Hyannis line It shows a failed septic system according to our database, not sure if that is what they are looking for? ----Original Message----- 0 g From: Crocker,Sharon Sent: Wednesday, December 02,2015 2:07 PM To: HeathDeptMailbox Subject: 414 Old Craigville Beach Rd Cent/Hyannis line Richard Scali has been forwarded a request which Legal received asking for documentation on a violation at the above address. The owner is Five Brothers Management Solutions. Please let me know if anyone here is familiar with this Thank you. Sharon 1 '[FIE Town of Barnstable Barnstable Regulatory Services Department MRNSTABM Q ; p "`" . Public Health Division 1439.�1 ". .200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0000 1971 7026 November 10, 2015 US Bank National Association % Secretary of HUD 4400 Will Rogers Pkwy STE 300 Okalahoma City, OK 73108 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system a Greywater System located at 414 Old Craigville Road, Centerville,MA was last inspected on Oct 24, 2015 by Michael McDowell, a certified . septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: he surface of the round. Discharge or ondin of effluent to s g P g g • Laundry room must be connected to existing septic system OR you may install a new septic system for the laundry waste water. You must submit permits to the Health Division once work is completed by the licensed plumber. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. • PER ORDER OF T E BOARD OF HEALTH QALetters Septic Inspection Failuresor Further Eval\414 Old Craigvile Rd,(Graywater)Cent Nov2015 LAI 10 ,�V, VrA - . tie, Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 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 r � on the computer, use only the tab 1. Inspector: I IU//IJ key to move your cursor-do not Ricky L. Wright use the return Name of Inspector key. B & B Excavation, Inc. rab Company Name 14 Teaberry Lane Company Address Sandwich MA 02563 Cltyrrown State Zip Code 508-477-0653 S 14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the g ', 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 r C`' sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of ' cF Title 5(310 CMR 15.000). The system: h- c.4_ ®e Passes ❑ Conditionally Passes ❑ Fails 9:. " ❑ Needs Further Evaluation by the Local Approving Authority 4/4/11 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. t5ins-09/08 Title 5 Official Inspection Form:Subsurface4SewageDl System• age 1jo f 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 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: 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•09/08 , Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) f 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 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 %day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 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 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. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 l I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown 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): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•09/06 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 M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a g ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 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: t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments , 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 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: 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): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 2001 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good shape no signs of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 16"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: 5.8x5.8x10.6 Sludge depth: 611 t5ins•09/08 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 ;M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown 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 . 31 Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? scour stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good shape tees present no sign of back up Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain).- Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Citylrown 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.): 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 Comments(condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•09/08 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 �M 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown 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.): At time of inspection d-box appeared to be in good.shape no sign of leakage or carryover. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M ,•''� 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): At time of inspection leaching appeared to be in good shape no sign of staining or hydraulic failure.Leaching was dry at time of inspection. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 414 Old Stage Road Property Address I Catherine Poitras j Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown State Zip Code Date of Inspection i 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 IVA A3 C: Al A2= 33 i ( = z4' B2= 2..0' B3 2& C3: 33 ' i i I t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 I Commonwealth of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. Cityrrown 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: >12feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Hand augered hole threw leaching. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 p Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 414 Old Stage Road Property Address Catherine Poitras Owner Owner's Name information is required for every Centerville Ma 02632 4/4/11 page. CityrFown 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 L Town of Barnstable Regulatory Services �oFIME Thomas F.Geiler,Director °^ Building Division BMWSTABLY. " Tom Perry,Building Commissioner 9 MAS& � 039• ,0�' 200 Main Street, Hyannis,MA 02601 p Office: 508-862-4038 Fax: 508-790-6230 Noticeo Zoning Ordinances Violation(s) and Order to Cease, Desist and Abate: Aldo J Mazer.and all persons having notice of this order. As owner/occupant of the premises/structure located at 414 Old Stage Rd.Map 190 Parcel 115 you are hereby notified that you are in violation of the Town of Barnstable Zoning Ordinances and are ORDERED this date,January 9,2004 to: 1. CEASE AND DESIST EWgEDIATELY,all functions connected with this violation on or at the above mentioned premises. SUMMARY OF VIOLATION: Violation of Town of Barnstable Zoning Ordinance Home Occupation Section 4-1.4 2. COMMENCE within seven(7)days,action to abate this violation. SUMMARY OF ACTION TO ABATE: Remove beauty parlor from premices And,if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by filing an appeal with the Town Clerk of Barnstable,a Notice of Appeal(specifying the ground thereof) within thirty(30)days of the receipt of this order(in accordance with Chapter 40A Section 15 of the Massachusetts General Laws). If, at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires will be taken. By order, J k Fitzgerald ocal Inspector Q/FORMS/viozonel j" � b r No. _ Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitatton for Oigpooal bpotem Conotruction 3permit Application for a Permit to Construct( )Repair(X )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 414 Old Stage Rd. , CentervillE George Bent Assessor's Map/Parcel 1 9 0—1 1 5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E.Robinson Septic Service C.R.. Short P.O. Box 1089 Centerville P.O. Box 1044 S. 5eL11dL;D Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. 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) i n t a l l n Pw T i t-1 P 5 G,2I1t i C sTs J-em to plans of C.R. Short 1 -969 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health. 3 Signed r. Date Application Approved by Dat Application Disapproved for the following reason Permit No. ._ Date Issued • t s' No: ', Fee 50 00 THE COMMONWEALTH OF MASSACHUSE'1TV I"" Entered in computer. PUBLIC HEALTH DIVISION - T N OF BARNSTABLE., MASSACHUSETTS Yes ricatior� for ig gar *potem C65truction Permit Application fora Permit to Construct( )Repair(X )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. ^ _. 414 Old Stage Rd. , Centerville George Bent Assessor's Map/Parcel 1 9 0—1 1 5 Installer' 'Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E.Robinson Septic Service C.R. Short 1 .P.O. Box 1089 ¢enterville P.O. Box 1044 Type of Building: P. Dennis Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder(no) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures /J Design Flow gallons per day. Calculated daily flow gallons. Plan Daie Number of sheets Revision Date Title Size of,Septic tTank ! Type of S.A.S. YJ. Description of Soil Nature of Repairs or Alterations(Answer when applicable) install new Till& 5 s en t i c- system to plans of C.R. Short 1-969 9 Date last.inspected. ° Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in ac 'drdance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo d of ealth. Signed A Date 112 Application Approved by ✓ _a l _ Date. Application Disapproved for the following reasons f Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS Bent BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired ( x )Upgraded( ) Abandoned( )by W.E. Robinson Septic Service at 414 Old Stage Rd Centerville ha cbb constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit NAM ated Installer Designer The issuance o�, s er`rmit shall not be construed as a guarantee that the system ti Date UJ Inspector No.---�T------------------------------Fee 50.00---- Bent THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mtgoar *pztem Con.5truction Permit Permission is hereby granted to Construct( )Repair( x)Upgrade( )Abandon( ) System located at 414 Old Stage Rd Centerville 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:Cons truc io ust be omp�let d within three years of the date of thi ertnic._. Date: Approved by TOWN OF BARNSTABLE LOCATION Y/Y Q& 51 e 9 Y ( SEWAGE # VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. / � i�",3 o i►- j SY �f '� li SEPTIC TANK CAPACITY ` J LEACHING FACILITY: (type) (size) I NO.OF BEDROOMS 3 BUILDER OR OWNER 4�2 PERMITDATE: G 3 COMPLIANCE DATE: 3 ®" 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 f within 300 feet of leaching facility) Feet Furnished by i J I �^f I ' TOWN OF BARNSTABLE LOCATION I f 0/ (5 I o SEWAGE # 6 3 I Lr VILLAGE_ % '`� / ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. jSEPTIC TANK CAPACITY / LEACHING FACILITY: (type) Ce (size) S` v NO.OF BEDROOMS 3 BUILDER OR OWNER OTC. ;54� 7 PERMITDATE: •--- G 3 COMPLIANCE DATE: 3 O 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 p .r -UA) '1 f �p 4 i OW VA `mot'- Q- or ---- -- _..._. - --- 1� (OU �%%q \-21l0/Ala �o- IDP _ . J� - ----._.._- _.._.._. _---------- _.. .__.._...__......... ....��m.., - ry SOIL TEST BMIMAIM 20 FT. MINIMUM FROM CELLAR DATE OF SOIL TE LL of ST S / 0 3 _ TOP OF FOUNDATION SOIL TEST DONE BY w- 547 r ELEV. _ 10MOO 10 FT. MINIMUM 10 FT. MINIMUM FROM SLAB OR CRAWL SPACE _ _ CLEAN SAND WITNESSED BY � �� 4'� -t�`• (ASSUMED) CONCRETE OBSERVATION HOLE 1 ELEV.- 97, COVERS 4" SCHEDULE 40 PVC PIPE LOAM AND SEED PERCOLATION RATE 2 MIN./INCH AT INCHES MIN. PITCH 1/8" PER FT. 2" LAYER OF DEPTH HORIZ TEXTURE COLOR MOTT. OTHER 1/8" TO 1/2` A Loa r" y ' E-L 98.75 X EL WASHED STONE VENT G ,_S'Lelcrk 411z 4" CAST IRON PIPE 9T,SM�w►. NOT. REQUIRED 2� (OR EQUAL) MINIMUM PITCH 1/4" PER FT. FLOW LINE Ete v 9S. 7S °i 973 10" ❑ D ❑OOO ❑ DOD ❑MIN. ELEV. = PLUMBING — o o ° CcG.^s TO BE RAISED LEV. 9.f7S LEVEL ° o 00000000000 ° -sa''d / AND RE-PIPED BY GAS 9J;So 6" SUMP 9S3p 0 LICENSED PLUMBER ELEV. _ �L _ ELEV. ELEV. _ ° ° 00 ❑ 00000 000 0 2' 0 BAFFLE DISTRIBUTION ° 0 AS NEEDED 0 ° ELEV. _ ° ° ° ❑ � OODC7DOODD LIQUID OUTLET BOX 9s'oo 0 0° 0 ° ELEV. DEPTH TEE (TO BE PLACED ON FIRM BASE) TO BE WATER TESTED 5 FEET 14 INCHES INCHES IF MORE THAN ONE OUTLET 5010 � DIR)1iEYLS IM1H SIGYV£ , ^/0 WATER ENCOUNTERED AT /.�8 ELEV. 8S. 5 FEET 24 INCHES 1�+5W GALLON /N AM lg-1�� 7�Oi �A n� 7./ WELL "f 8 FEET 34 INCHES SEPTIC TANK (TO BE PLACED ON FIRM BASE) ZONE 3/4" TO 1 1/2" CLEAN SOIL .ABSORPTION INDEX _ DOUBLE FREE OF WANES SILT STONE SYSTEM SAS ADJUST DESIGN CALCULATIONS 3 NUMBER OF BEDROOMS USGS PROBABLE WATER TABLE ELEV. GARBAGE DISPOSAL UNIT NOT ALlaw. 1i SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( / / ) ELEV. = A-,14 TOTAL ESTIMATED FLOW 33c NOT TO SCALE BOTTOM OF TEST HOLE ELEV. = GAL./DAY REQUIRED SEPTIC TANK CAPACITY l.S�e GAL. ACTUAL SIZE OF SEPTIC TANK GAL.GAL. SOIL CLASSIFICATION r DESIGN PERCOLATION RATE <-Pp MIN./IN. EFFLUENT LOADING RATE 7LEACHING AREA (��XPS)�Gt'�r 7L J =r GAL./DAY/S.F. SQ. FT. LEACHING CAPACITY (AREA X RATE) 35"L GA L/DAY 4 77>c ,71r RESERVE LEACHING CAPACITY �� GAL./DAY NOTES: 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. • 103.6 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 6" OF FINISHED GRADE. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF - -(102)- WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN N 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL _ -(100) LOT B BE MORTARED IN PLACE. 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 97.3 } DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. 97 2 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR / IS TO CALL,"DIG-SAFE" AT 1-888-344-7233 AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE. / /s A S. 7. CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS 97.6 SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. ANY VARIATION \ �97.4 / O / DiST. +c3oX IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER IMMEDIATELY. LY IS 8. IN FLOOD ZONE _ _ - 97 y 9. LOT IS SHOWN ON ASSESSORS MAP 190 AS PARCEL »s_. 10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND v� FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, IN, ` SE�T/C AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: (3) » 97»5 7 9 LOT 8 O TANK (I.E. TITLE 5) IF ENCOUNTERED BELOW S.A.S. PIPE INVERT. 45,084 t S.F. ,�� 8.6 \ r f � � \ 11. EXISTING SEPTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND 7.9 u, OR REMOVED ' , ,� NIT_ r»'?�-r�"��H OF�.�4Q c k S• r SNORT , APPROVED: BOARD OF HEALTH 8.7. CIVIL CIO 0 � / .197.6 ^ No. 1 8.0 ` . -�2,�� DATE AGENT T EWELUNG B 3 DWELLINAVEPROPOSED SEPTIC DESIGN �OLLINs A FOR 97.E �p CARL TON LN WM ROBINSON/GEORGE BENT Tr\ - WLCOX LN �RE.a r M Loc. LOT 8, 414 OLD STAGE ARsy Ro BARNSTABLE, MASS z 'I LOCUS CEN TER VILLE ` 98.0 2 p ,a o CRAIG SHORT, P.E. 508- 235 GP E0.. BOXT1044 ROAD 398-8311 SOUTH OENNIS, MASS. 02660 98.0 DATE MAY SCALE M '� = 20—� {� 1 _, 5, 2003 ' Q) REVISED JOB NO. _ 5i4 IL / LOCATION MAP REVISED [ SHEET 1 OF C. SB PROD 2444-00 dw 2444-00.D►V 0 2002 CRAIG R. SHORT, P.E.