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HomeMy WebLinkAbout0601 STRAWBERRY HILL ROAD - Health 601 Strawberry Hill Road Centerville F/R A = 249 017 Y A Outford, NO. 1521/3 ORA 10% a � a a 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: l l G Fill in please: b APPLICANT'S YOUR NAME/S: - BUSINESS YOUR HOME AD ESS: Id # � TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME.OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME:OCCUPATION? YES .NO MAP/PARCEL NUMB - � ADDRESSOFBUSINESS / E (Assessing) Cps j• S71Zow � �(���'' When starting a new business t ere 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 ISSION R'S oFFIC MUST COMPLY WITH HOME OCCUPATION This individu I ha a irSfofm a mit requirements that pertain to this type of business. i'�L/ RULES AND REGULATIONS. FAILURE TO Aut ze S' -atu e COMPLY MAY RESULT IN FINES. OMMEN d 2. BOARD O EALTH USA This individual has been informe ar� t eq ent hat pertain to this type of business. HAzpRD0 INATERIALS REGULA710 IS. 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* g - COMMENTS: 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. Ii DATE: Fill in.please: APPLICANT'S YOUR NAME/S:� Tc-,? � BUSINESS YOUR HOME ADORES : 7 GG 1 A� 1 e!�);2 A 7 r TELEPHONE # Home Telephone Number NAME'.OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS:THIS A HOME,OCCUPATION? YES. NO ADDRESS OF:BUSINESS ©t t>j GC MAP/PARCEL NUMBER 6q"R 1 (Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO ER'S OFFICE This individua h e in d of n er it a uirements that pertain to this type of bus VIMT COMPLY WITH HOME OCCUPATION uth 'zed Signatu * RULES AND REGULATIONS. FAILURE TO COMMEN S: 0 COMPLY MAY RESULT IN FINES. iY i - i177 Qorq4 iOu. 2. BOARD HEALTH ��c,2 On S This individual has been informed of a per re ire t at pertain to this type of business. MU.&COMPLY:WITH ALL Authorized Sign e* HAZARDOUS MATERIALS REGULATIONS 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: Date:/f l loll o"q(..- l TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: % LANDSC�4 BUSINESS LOCATION: /. <'�j�h� F q p�jry UILL D Z- /7,5;R1i,t_i&INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: '__02_�.. _2, n -4 �2 6 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: 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 material use, storage and disposal of 111 gallons or more a month re uires 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 ❑ NEW ❑ 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) 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 Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer 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) NG, Spot removers &cleaning fluids ` ' (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applic is Signature Staff's Initials 4 i NOVA ------------------------- 3c. k4 TC,frA/ 4-1 - k J show CAs.F -ZO i �:iz �M 1 ?J101-A 401 SrAAWSCRR� 1,t7 cG 2D 0163 VaD Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M. 601 Strwberry Hill Road ' M `•4M Property Address tom* Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. City/Town State Zip Code Date of Inspection 4�6 4?t 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: forms When fillip out f A. General Information s/ aaa �- on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael T Bisienere use the return Name of Inspector key. Cape Septic Inspections rab Company Name 624 Old Barnstable Road Company Address Mashpee Ma. 02649 Cityrrown State Zip Code 508-280-3356 Si3938 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 04/07/2017 In ector'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. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 ,l0 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -'Not for Voluntary Assessments 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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: ® 1 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: This 3 Bedroom home has a H-10 1000 gallon septic tank and a H-10 D-Box feeding infiltrators. At the time of the inspection the leaching was dry and there were no visible signs of past hydraulic failure. 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.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is Centerville Ma. 02632 04/05/2017 required for every page. Cityrrown State Zip Code 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): ❑ 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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 cesspool is less than 6" below invert or available volume is less than 1/day flow t5ins.doc•rev.6/16 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 ° 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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 u ? ® ❑ Y 9 P 9 9 p ® ❑ 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): 4 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): >440 t5ins.doc•rev.6/16 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 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is Centerville Ma. 02632 04/05/2017 required for every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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: occupied 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. Cityfrown 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.doc-rev.6/16 Title 5 Official Inspection Form: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 ;M 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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: 06-16-2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 42"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.): Septic Tank(locate on site plan): Depth below grade: 36" 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: Standard H-10 1000 gallon Sludge depth: 2" t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. City/Town 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 331, Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 12" How were dimensions determined? Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I would recommend the new owner put the tank on a maint. plan with a local septic pumping co. The Barnstable Health Dept. has a list of local septic pumping co. 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.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. Cityrrown 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 I t5ins.doc-rev.6/16 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 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. Citylrown 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 the time of the inspection there were no visible signs of leakage. 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.6/16 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 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: infiltrators ❑ 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 the time of the inspection the leaching was dry and there were no visible signs of past hydraulic failure. 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 I ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. City/Town 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.doc-rev.6116 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 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 page. Cityrrown 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 19f - f7/-d t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 1V\T 1\VILl11V\JAL LI.: LOCATION �r��/� �� 6f1���P/l'�//GL. SEWAGE# VILLAGE—J� ��'i f ASSESSOR'S MAP& INSTALLER'S NAME&PHONE NO, /'y Ccl�.� 9l`.J''o/�✓ SEPTIC TANK CAPACITY /-sOo 9"lL ele`7�{l LEACHING FACILITY:(type). NO.OF BEDROOMS BUILDER OR OWNERLo PERMrrDATE�1�1--'- 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 �'y «'�` A /5 3� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 601 StrwberrY Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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: 11 Plus feet feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: I augered a hole to 11 feet to show five plus feet of seperation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 601 Strwberry Hill Road Property Address Carlos Ferras Owner Owner's Name information is required for every Centerville Ma. 02632 04/05/2017 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 I� a)jS Fee n 5 PP 5 Fier AUK t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN 0- B _ o� iGGl1 4,e^SEWAGE# .:: � LOCATION 2 �— VMLAGE �� "'`v-'_ ASSESSOR'S MAP &LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �/CE{ (size) NO.OF BEDROOMS BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: l Feet Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility (If any wells exist / Feet on site or within 200 feet of leachingfacilitywetlands exist Edge of Wetland and Leaching Facility (If any /— Feet within 300 feet of.leaching facility) Furnished by b I � C3 � TOWN OF BARNSTABLE ✓� LOCATION t�� ZWI e SEWAGE # I VILLAGE �" 1 r ASSESSOR'S MAP & LOT-2"—n''✓ INSTALLER'S NAME&PHONE NO. /°'? �" �C'�i�- i'%'�"''�,�✓� SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size),,;,,� NO. OF BEDROOMS BUILDER OR OWNER � c'�� 'r /iP✓S PERMITI) rS 11 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 bye'`% G� ` �� r ���-i Of ,�'s�S�'� �, �a �� � �� i -� 3� C� 3 ��� f' �� �`� c.L� � � * � - �. No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippiication for Miopaal bpgtem Congtructiou Permit Application for a Permit to Construct( , )Repair Upgrade )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. J�;Wle C Owner's Name,Address and Tel.No. Assessor's Map/Parcel _,7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building 0re�,P_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �e� gallons per day. Calculated daily flow mil'`yam gallons. Plan Date Number of sheets .1e Revision Date Title Size of Septic Tank �14/J'T�%i� /o®®b Z1 Type of S.A.S. 1'A�110 0PV 4d/" Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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 Bo d of Health. _ igned Date Application Approved L Date Application Disapproved for the following reasons Permit No. c' Date Issued No.r7�Y i+ �0 / # Fee 4 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pprication for Mizpogal *ps�tem Construction Permit Application for,a Permit to Construct( . )Repair )Upgrade)&)Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.4<4P ool /r/!E�/� Owner's Name,Address and Tel.No. Assessor's Wp/Parcel = fj 9 p/) Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling XNo.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building®TG �.� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 15;�Jl gallons per day. Calculated daily flow gallons. Plan Date 9"--/0 O_ Number of sheets .0e Revision Date Title Size of Septic Tank /o d o.�,[�� Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) a 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. igned Date — Application Approv4b.L Date w Application Disapproved for the following reasons a, Permit No. 0003 "'�b Date Issued fir �a 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 Si ni e 4woe-G'-0' at <m/ j7oh!!� J/ AIL Z V-V• !!!O i(/ A/V e- has been constructed i ac ordance with the provisions of Title 5 and the for Disposal System Construction Permit No.20�'3' 2C 7 dated 1 63 Installer S/rn «`�4G°y/ Design ` 0i0 l The issuance of tho pe it shall not be construed as a guarantee that the system w' nctid a d i ,Date 03 Inspector O�/� —r9 � ------------————————————— No. Fee '�"' •.i" THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Migogal *pgtem (Construction Permit Permission is hereby granted to Construct( )Repair )Upgrade ')Abandon( ) System located at C�v/ ,/y id lGl1jP/��' �F/L Z of 4 �9yifirw�!✓' 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: Construction must be completed within three years of the dat of tthi -it. Date:_ 116 I o 3 Approved by t 3 Y YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in please: APPLICANT'S YOUR NAME: � f'' tS �d�/164s r ' ye'l BUSINE S YOUR HOME ADDRESS: 6 Or S�/? 1(�/ ic,�l1 ; ///�C�, CP f Ten TELEPHONE # Home Telephone NumberSffP f,9 31j7 � NAME.OF NEW BUSINESS. N "l i/J vn iA" ' TYPE OF BUSINESS n . T,4y C C IS THIS A HOME OCUUPATION YES „_NOS � a Have you been given approval from the building d: si n? YES NO ,l ADDRESS OF BUSINESS (v6I ST�'b / /i �� 7� L MAP/PARCEL.NUMBER When starting a new business there are several,things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has en info ed of he per it re rements that pertain to this type of business. Authorized nature* 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: Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: l BUSINESS LOCATION: e Gal 7-Aor,/1 MAILINGADDRESS: 451O_A- Mail To: Board of Health TELEPHONE NUMBER: J��� ��D 7�?,� Town of Barnstable CONTACT PERSON: Ci9A Z6;j F�° ,P4S �//� �// 1'"�G/S'�i' P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 275/ F C OQID Hyannis, MA 02601 TYPEOF BUSINESS: 11al-7 01 Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity d Antifreeze(for gasoline or coolant systems) _ Q Drain cleaners C/ NEW USED ® Cesspool cleaners Automatic transmission fluid (9_ Disinfectants O Engine and radiator flushes �/_ Road Salt (Halite) L7 Hydraulic fluid (including brake fluid) _� Refrigerants o Motor oils D . Pesticides NEW USED (insecticides, herbicides, rodenticides) O Gasoline, Jet Fuel L2 Photochemicals (Fixers) D' Diesel fuel, kerosene, #2 heating oil NEW USED O Other petroleum products: grease, 0 — Photochemicals (Developer) lubricants, gear oil NEW USED 17 Degreasers for engines and metal Printing ink 0 Degreasers for driveways & garages a Wood preservatives (creosote) O7 Battery acid (electrolyte) _ Swimming pool chlorine 0 Rustproofers d Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes 0 Leather dyes '(7 Asphalt & roofing tar IJ Fertilizers Paints, varnishes, stains, dyes d PCB-s 19 Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers G Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) ® Metal polishes a � Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous please list): C/ Spot removers & cleaning fluids (dry cleaners) O Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE Loc ,TION-'�O/ gtl& AV SEWAGE # 4V 1_ iVILLAG)r ��". .,.��, Ze'1P SESSOR'S MAP & LOTS Fe gL7' INSTALLER'S NAME&PHONE NO. A� C-O'.S 4 SEPTIC TANK CAPACITY btu n A' LEACHING FAClLl TY: (type) v $ (size) e!; "MV e AW NO.OF BEDROOMS 3 OR OWNERIV PERMTTDATE: ,f`� °''G 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 le hing facility) w Feet Furnished by A LT JJ6,; aSo c� 3, •3 e No. t —� Fee ! 1 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ►' Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(pprication for Migogar *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Com nents Location Address or Lot No. d/ S {!" . Owner's Name,Address and Tel.No. - `.G'IJ �f'J'rR G Assessor's Map/Parcel c2 t G` ®/ 2 Installer's Name Address,and Tel.No. Designer's Name,Address and Tel.No. rj�� , r� ' � � Type of Building: Dwelling No.of P- Ins Lot Size sq.ft. Garbage Grinder( ) Other Type! tng No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow t; r.'1 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 N"e of Repairs or Alterations(Answer when app 'cable) L)L ,dd& 5�I S ' / �`� CLG6 ed /J- o k -- (,�- ice` !l lje V c r T t--)4 k2A—., /.s0� )C-( W to 4d 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 prgy-isrMiTUff9e 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance ha een issued b H Sig Date Application Approved by Date 2 Application Disapproved for the following reasons Permit No. a Date Issued No. Qom/ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: _Y_ Yes --PUBLIC HEALTH DIVISION"-'TOWN OF BARNSTABLE, MASSACHUSETTS + RpOication1or Piopo.5aY 6poteni Congtructiort Verri� t Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Component Location Address or Lot No. 601 Owner's Name,Address and Tel.No. 941112- Assessor's Map/Parcel ,j c p/ ^y --Innsstall^er''s Name,Address,and Tel.No. / Designer's Name,Address and Tel.No. V y •. AA Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures c Design Flow S gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Z STo C 64-111 "� 5 �- Description of Soil Natu of Repairs or Alterations(Answer when applicable) X-3 6 -1,t�� G,G/r Pl, D — l V /l lee 1,aw_d, J-+ (_,o 4 tti ISM R( /,�-/U 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 pro aions-of-Rde 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has ee issued by,byAto o e r Siged .."' Date 17,6 Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued =; ----------------------,---------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On- 'te Sewage Disposal System Constructed( )Repaired O Upgraded( ) Abandoned( )by ! C at O 1 ISO v. has been constructed in accordance with the pgvis on of Titlepnd the fo�Disposal System Construction Permit No. dated Installer r M o i f Designer The issuance of thii permit shall t be c tru d as a guarantee that the i function as des• d. Date Inspecto No. Fee � �— J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migool *p5tem Construction 3permit Permission is hereby granted to Construct( )Repair(k)Upgrade( ) bando�nnrr( System located at_(� / r A 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:Construction must be completed within three years!f the date of this ermit. ` Date: 7 " Z�-/ Approved by i i 116199 r NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. - CERTIFICATION OF SKETCH AIND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT DESIGNED PLANS) r NV fig/moo rS hereby certify that the application for disposal works construction permit signed by me dated_ �� concerning the property located at 601 ai e P `�� meets all of the following criteria: j • The failed system is connected to a residential dwelling only. There are no commercial or business uses associated with the dwelling. • The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes per inch. • There are no wetlands within 100 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than five feet above the ma.dmum adjusted groundwater table elevation. (Adjust the groundwater table using the Frimptor method when applicable] • If the S.A.S. will be located with 2j0 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be locatedless than fourteen(14) feet above the maximum adjusted groundwater table elevation, Please complete the following: A) Top of Ground Surface Elevation(using GIS information) B) G.W. Elevation _the MAX. High G.W. Adjustment . D17FEREN TWEEN A and B r r (o 19 SIGH G'[/h-tom DATE. t7 160��1 [Sketch proposed plan of system on back]. q:health folder.cert a 4D --- t` &C4,4:lWe p A, i r i i p c, J S Y TOWN OF BARNSTABLE LOCATION SEWAGE # — J VILLAGE ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE �.. `NO. SEPTIC TANK CAPACITY /�, , , / LEACHING FACILrI'Y: (typo) (size) NO.OF BEDROOMS 3 P BUILDER OR OWNER PERMTTDATE:_ :" e , 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) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of le hing facility) Furnished b Feet • r 22 j � I f ' � ,,rIr I F I V� Z J �® i NAME OF OFFENDERtrt� o J ,? D A D 4 4 7 0 3 TOWN OF ADDRESS OF FENDER , BARNSTABLE CITY,STATE, �'Of` f �tME►p� _ MV/MB REGISTRATION NUMBER . OFFENSE I1AN\S7'Ae1.E /. .4 y -JY j/ �,1 Ij,l !1f w4 Ci4X /ry,'. A55. � Y f 1J V Zio -- - TIME D DATE�VIOL .7 } 3 - ILO ATI N OF VIOL TION j LU NOTICE OF /33 (A M / P.M)ON Q PIG OF EN ORCING PERS ENFO CI 6 EP BADGE NO: < VIOLATION Y1 / -I o � OF TOWN I EREBY ACKNOWLEDGE RECEIPT OF CITATION X a Unable to obtai si a ure f offe er.ORDINANCE THE NONCRIMINAL FINE FOR THIS OFFENSE IS S `+ Date mailed 31 - w OR YOU HAVE THE FOLLOWING ALT RNATIVES WITH REGARD TO DISPOSITION OF THIS MATTER.EITHER OPITON(1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD. w a REGULATION 111 You may elect to pay the above tine,either by appearing in person between 8:30 A.M.and 4:00 P.M.,Monday through Friday,legal holidays excepted, w before: The Barnstable Town Clerk,367 Main Street,Hyannis,MA 02601,or by mailing a check, money order or postal note to Barnstable Clerk, a P.O.Box 2430,Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. 121 If you desire to contest this matter in a noncriminal proceeding,you may do so by making written request to DISTRICT COURT DEPARTMENT, FIRST BARNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MAO2630,Att:21 D Noncriminal Hearings and enclose a copy of this citation for a hearing. 131 If you fail to pay the above offense or to.request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be issued against you. ❑ 1 HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature ^ TOWWOF BARNSTABLE BAR-W 399 Ordinance or Regulation ' t WARNING NOTICE Name of`'Offender/$ Manager Address of Offender 149 .� � u Cl,/� /MB Reg.# Village/State/Zip - Oz,,44-.e�.,tSS# C7 Business Name am/pm, on V19 2 Business Address (� ,4 ,c r Sk4hature of E orcing 6fficerr Village/State/Zip / Location of Offense z Enforcing Dept/Division Offense Facts ' ' This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary. compliance. Subsequent violations will result in appropriate legal action by the Town. TOWN OF BARNSTABLE BAR-W 399 Ordinance or Regulation WARNING NOTICE f. A Name of Offender/Manager .. T Address of Offender f " ► /(i4d/MB Reg.# ` Village/State/Zip ( '��{.t - �f ' 0 Business Name ., am/(p , on • } �/ 19 Business Address � � may... Signature of Enforcing Offi.cer� Village/State/Zip ( ,+ Location of Offense Enforcing Dept/Division Offense ji (,P 2.4, �.. E .Facts F` rs This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary. compliance. Subsequent violations will result in appropriate legal action by the Town. TOWN OF BARNSTABLE BAR-W 397 Ordinance or Regulation WARNING NOTICE d'V--7P E0� Name of Offender/Manager P4,-21 14a, 1,Z_Aapj NO Address of Offender /y a 1 e / --bnuye- MV/MB Reg.# Village/State/Zip PAP -A Business Name am/ on 9 19 Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense • C . / Enforcing Dept/Division Offense Facts n This will serve only as a warningY At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary . compliance. Subsequent violations will result in appropri to legal action by the Town., ` ?� V-v lq4,j o461 Z,& PAR Real Estate System - General Property Inquiry Help Parcel Id: 249 017- - Account No: 156949 Parent.' Location: 601 STRAWBERRY HILL RE; NeighborhoodN 55DC Fire Distg C,[:.) Bevel Lot: Lot Size! . 28 Acres, Current Own: HALLAHAN, GEORGE State Classg 101 PA,U11- J HALLAl Vikf No. Bldg, 1 AreaN 1360 14313 ARDEL 014-'. Year Added*-.' W PALM BEACH FL 334 1 Deed Datez Reference! 2121/0) January Ist: HALLAHAN, GEORGE Deed MMOD: 0000 Deed ReQ 2121 /40 Comments9 Values: Landz 25600 Buildingsw 62700 Extra Featuresg 500 Road System: 601 Index: 1546 (STRAWBERRY HILL ROAD ) Frntga 100 , indew ) FrntgN Contra! Info: Last Auto Updg 050695 Status, C Last TACS Updateu 121393 Land Reviewed Byg Datea 0000 Bldgs Reviewed By: DateN 0000 Tax Title3 Accountg Taken", Account Status: Hold Status:; Press XMT for more data Cancei Next screen PAR Action Owners Name Road index Road Name Parcel Number 249 0 1 \ Jy �Ye 4F ` r �N j r +X No....................... Fxs.... 6.............. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF TH ....................OF.. VEAL App'.f r4tiou for Disposal Workfi Cn�aa��r�r�ina� rr�ti� Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ...Gvl. grew? aEr► .f.�i�,�.� ...91671.4rM&............. .................................................................................................. L cation-Address o Lot o. --- A��i4.t}�Ell� P..�N.............................................----------- �ta�#�r�!1��............... t d n Owner ' Addre s Installer Add Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms..__._._.._ Expansion Attic ( ) Garbage Grinder ( )�-, ...•--....._•---..••• — `4 Other—Type of Building No. of persons............................ Showers Cafeteria Pa Other fixtures ....----•-------------------------------------•-•--• w Design Flow............................................gallons per person per day, Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No—.................. Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by................................ Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.____.__............ Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth-of Test Pit.................... Depth to ground water......____--_-__--_-_-_. a ••-•--••-•••-•----------••-------••••---•-•-------••••-•-•-•-•--•----•••......•-••-----•..................................................................... 0 Description of Soil........................................................................................................................................................................ w x ---------------------------------- -// ---------- U Nature f Repairs or Alteration —Answer when applicable._T . _ ___�ilt 1t.4 s _._ _k�..l�DQ� -------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL%� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is d by jhhe board of health. - Signed --------------------••--.. .12.';S' .9_............ D) Application Approved BY- = l _ .... 7 ur --- __......_......_ ate Application Disapproved for the following reasons:.............................................:.�.��:.___.__._.._....._._._. ----------- -•-•-•••--•------•••......----•-•....-•-••••-•--•-••••-•--•----•..............•••-•-••-----•-••------•-----•-----••-----••••...-••--------\ ---- ---•--------------------------- C:T % 7 ..fO Date i Permit No--------------------...................................... Issued.............in�-L. --� Date No.................. FR$........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH GJy?...........OF........ ............................................ ...._..... Appliratiun fur Dispatial Works Tonutrartiun Pjamit Application is hereby made for a Permit to Construct ( ) or Repair (- ) an Individual Sewage Disposal. System at: /1...............:..... ? :..... .....................................•----........................----•---....................._.. Locati Addres or Lot No. caner t Addr a .�.r7.. ............. ....3-5-0•-.... ......... .............=.. ' Installer Address UType of Building Size Lot............................Sq. feet �-, Dwelling=No. of Bedrooms..............3_--_-.---___--__-_------_Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ...........................................-.......................................................................................................... w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity,...........gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water-__---------_-__-___.--. LX, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P ...........................................*.....................t........................................................................................... 0 Description of Soil...................................................................................................------------....-----------------------------------...-----------•- x c., •-•••-•••-••-••-••••--•••-•---••••••-----•----••••--•-•••-••••••••-•-•......------••-•-......•-•-••......-•-•----•-•----•-------•--------•--••--•---------•-••••--•--••----•-------••-------------••--•- w UNature of Repairs or Alte3jations—Answer when applicable.:_._..._�� ._.__.r1�' � -:<-........................ `Olt - ....15:.`J........ 1� 0 r Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. ............................-........ ---•........................... Application Approved / .............................................................' ........... ----•1 AOe --------- Application Disapproved for the following reasons----------------------•-----•--------------------............................................................... --.......-•---------------------------------•---•--------•--•-------------••---------------•------------••----------•--------••-•-••--------•-----....----••---••-•----•--•••---•---•--•-••----...--•--- �� Date ' Permit No......................................................... Issued.............�-/"..��--:- ---�--- ----•----••-- i Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................ ..................................I...................... Trrtifiratr of Tumplianrr THIS IS TO CERTI E ', That the Individual Sewage Disposal System constructed ( ) or Repaired by........�}Z.f:./ ..............� .,o v_..--•--•.......................... .,_ � Installer` � at.......6'0..Z........... '�5'r✓. P_t�,Y.. �. .................`. ................ ---------------- --------------- has been installed in accordance with the provisions of of Zl e to Sanitary C9de� �e l d in the application for Disposal Works Construction Permit No......_�________________....__.._...... dated______.__._. . THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.....;f/R-....�._.....���__-----•--•-•--•-----•----•--...... Inspector---- i ,, - `sr-.� - t .....- ,..--..• THE COMMONWEALTH OF MASSACHUSETTS ,r BOARD OF HEALTH ' N �U FEE.........029 Dispo.oal Vorks Twunutrnrtiun rrmit Permission is hereby granted........ `: .._...._. h_�.. __ __------ __________ to Construct ( ) or Repair ) an Individual Sewage Disposal S stem at No... .,rl----••.5 � �/ r�ry.... :�/......`J-��•J A_K' Street �' assh can on the application for Disposal Works Construction Permit o�.._�.r"Dated.._. �����•-----_----.--_- .,.- '4 1 2 �&G1 Board of Health }. DATE 7 / --- -- ----------- --- t FORM 1255 HOBBS & WARREN. INC �BUSHERS 411 X' J. TOWN OF BARNSTABLE L ATION; of S4k!� j �',,1 go. SEWAGE # y VILLAGE�� j��p_ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) ®i (S1Ze)1C A Ci.,/ NO. OF BEDROOMS PRIVATE WELL.OR PUBLIC WATER 4,C BUILDER OR OWNER,4/4114 -"< DATE PERMIT ISSUED: Z2 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No ,a. . f -77 ASSESSORS MAP: TEST HOLE LOGS PARCEL: Q 1 _ NOTES: FLOOD ZONE: , SOIL EVALUATOR:' VIrJ W Ax, WITNESS : W� 1 (, t1,L REFERENCE: \ VA C) � *A (0 DATE: :5 i - Zoo ) on shall comply with Title V and Town of Barnstable Board of 1 The installation 6 � "� Health Re 2 T rations. PERCOLATION RATE• -� 2 tJUklt, I , The installer shall verify the location of utilities, sewer inverts and septic _ a► �� -• components prior to installation. TH- t TH-2 3) All septic piling to be 4 inch Sch 40 PVC at 1/8"per foot. j 4) Existing leach pits to be pumped and backfilled per Title V abandonment procedures. 6jy_1V. LOW 5) This plan is not to be utilized for property line determination nor any other �Lj j 6,Am(V purpose other than the proposed system installation. r 3,� b) All septic components must meet Title V specifications. LOCATION MAP( �. 7) Parking shall not be constructed over H10 septic components. / f 8) e property is bounded by property corners and property lines as depicted. 1k ) The property owner shall review design considerations to approve of total number -- - of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed� approval of the number of bedrooms. 10)Existing tank to be utilized if the tank is a minimum of 1000 gallons. Size is to be f1h verified at time of installation. If less than 1000 gallons a 1500 gallon tank is to be installed. 11)The design represents the number of bedrooms per the Assessors records. There .: SEPTI C. SYSTEM DESIGN are additional bedrooms to the basement which per Board of Health are illegal and are not included in this design. The office is to be notified if the illegal bedrooms are to be included in the design which will bring the design flow to 7 ` FLOW ESTIMATE bedrooms. -- - 8ED1OOMS AT GAL/DAY/BEDROOM -'FGAL/DAY -S P f I C TANK----- GAS_/DAY x 2 DAYS - GAL USE IDZGALLON SEPTIC TANK 6pg6n_� AE SORPT I ON SYSTEM J / IjL J DE AREA: 2� �9,?l + � �UJ X X S �O BOTTOM AREA: o, 3 4 5� t ; SEPT I C . SYSTEM SECTION (,►�T,,� q All , G _ D-BOX �Z►�� n .- 1000 GAL �JZ, e ' V 4 b _ 2Yf � 15 SEPTIC TANK 4 2' z`'x Ib,83 ' 1od -- ti O DAV M _ __ - m SITE AND SEWAGE PLAN s PREPARED FOR : �'lj Wf 6WI(, 6WICC�2 P s 0 SCALE: 1 . DAV I D B . MASON j g5 DATE: 1� 4 DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833— 2 ! 77