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0212 GREENWOOD AVENUE - Health
CAPTAIN'S CHOICE .212 GREENWOOD AVE. , HYANNISPORT i i t I i C TOWN OF BARNSTABLE LOCATION �'�`� '�y SEWAGE # VILLAGE ��y ASSESSOR'S MAP & LOT yr -/ y �'M,SPiM' :t INSR'S NAME&PHONE NO. 4 SEPTIC TANK CAPACITY L LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR'OWNER C U m In s!>SP F c i'a� PERMITDATE: DATE: �" v2 oZ ` 0. J 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 -� _. a 0 �. � _ � �-s', �- -�' � .r V l I J� � I _� h. (� —Off .�. Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ' UQ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppfitatiou for Disposal *pstem Construction Vermit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon Complete System ❑Individual Components Location Address or Lot No. a la Gc e c., � PA;.e Owners Name,Ad/dress,and Tel.No. Assessor's Map/Parcel �.$V !7 ; tv l_o)fc-v 44 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 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) z— ti v v� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Signed Date 3 _ 2013 Application Approved by (( Date 3 --)0 --( 3 Application Disapproved by Date for the following reasons Permit No. 10 3 --D eS Date Issued .- 2 0 - ( 3 No. U G Fee, q0� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: U 0 I> R Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ti j p t 01ppfication for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon Complete System ❑Individual Components i Location Address or Lot No. a 11 G c e, a wire Owner�'LName,Address,and Tel.No. l ff Assessor's Map/Parcel 2 $ 1-7�-( - 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 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) e 5 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in` accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Healt Signe ( Date 3"2d' �o 13 Application Approved by Date 3 " 4 _( 3 Application Disapproved by Date for the following reasons Permit No. U�'0 Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS VV Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned/ by ( . r at ! 1 Gr3 wv(� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.Z U►3 -on dated 3 Installer ! Designer #bedrooms + Approved design flow X�' - gpd The issuance of this permit hall not be construed as a guarantee that the system will function as designed. Date T 3 Inspector No. Z 1 3 - OR(l Fee 2 THE COMMONWEALTH OF MASSACHUSETTS + PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon System located at a P✓". , and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permits I ` ^ f n Date U C 5 Approved by G /� AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION n'` k'dp� EJv� SEWAGE# VII.LAGE P y ASSESSOR'S MAP&LOT Yg 7 y II tS R S NAME k PHONE NO. X SEPTIC TANK CAPACITY S£ P // LEACHING FACILrrY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER C U JNSPic• rrr PERMITDATE: S IV DATE: y`a2 0� ° 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(U any wetlands exist within 300 feet of leaching facility) Feet Furnished by y� 0 lti http://issgl2/intranet/propdata/prebuilt.aspx?mappar=288174&seq=1 3/20/2013 r ZO3G - < qAP ° COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r i d DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED c, o O,9M 9�0v MAIN STREET WE WEST YARMOUTH,MA MAY 13 2004 L 508-775-2800 TOWN OF BARNSTABLE HEALTH DEPT. TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Map 288 Par 174 Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner's Name: John Cummiskey Owner's Address: 212 Greenwood Avenue Hyannis,MA. 02601 Date of Inspection 04/22/04 Name of Inspector:(please print) James D.Sears Company Name: A&B Canco Mailing Address: 350 Main Street West Yannouth,MA 02673 Telephone'Number: 508-775-2800 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of 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 Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: '171-a D y trl 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 tot he buyer,if applicable,and the approving authority. Notes and Comments ***,*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. Title 5 Inspection Form 6/15/2000 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 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:N/A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined" please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)" broken pipe(s)are replaced obstruction is removed ND explain: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 C. Further Evaluation is Required by the Board of Health: N/A 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 salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,y g p p c ea th,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 I of 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 D. System Failure Criteria applicable to all systems: N/A 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 leaching is less than 6"below invert or available volume is less than day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply of or privy p-I Xhin a Zone I of l4tibliAWPortion of a cesspool N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) NO (Yes/No)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: N/A To be considered a large system the system must service a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 Check if the following have been done. You must indicate"yes"or"no"as to each of the following Yes No Pumping infonnation 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 nonnal 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 infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)has been determined based on: Yes No 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(3)(b)] Title 5 Inspection Form 6/15/2000 5 Page 6 of i l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 FLOW CONDITIONS RESIDENTIAL 4 Number of Bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms: 440 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): YES Seasonal use(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no) NO Last date of occupancy: PRESENT COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of infonmation: N/A Was system pumped as part of the inspection(yes or no): 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) Tight tank Attach copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 1997 PERMIT#97-136 Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 BUILDING SEWER(locate on site plan): Depth below grade: 12 Materials of construction: Cast iron 40 PVC _ other(explain) Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK(locate onsite plan): Depth below grade: 18" Material of construction: ./ concrete metal fiberglass polyethylene _ other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 GALLON PRE CAST Sludge depth: 2" Distance from top of sludge to the bottom of outlet tee or baffle: 28" Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 8" Distance from bottom of scum to bottom of outlet tee or baffle: 17" How were dimensions determined: AS BUILT&TAPE Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,TANK&COVERS 18"BELOW GRADE,OUT LET TEE. NO SIGN OF OVER LOADING OR LEAKAGE. GREASE TRAP(located on site plan) N/A Depth below grade: 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: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 TIGHT or HOLDING TANK: N/A (tank must be pumped at time of inspection)(]ocate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no) Alarm level: Alarm in working order(yes or no): Date of last pumping Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: 4 (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.,): D BOX IS 23"BELOW GRADE,ON LINE IN,ONE LINE OUT BOX IS CLEAN&SOLID. NO SIGN OF OVER LOADING OR SOLID CARRY OVER. PUMP CHAMBER: N/A (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: —v7— leaching chambers,number: 4 leaching galleries,number leaching trenches,number,length leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) LEACHING IS FOUR RECHARGER'S 330'S. TOP OF LEACHING IS 30"BELOW GRADE LEACHING IS DRY. CESSPOOLS: N/A (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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation etc.): PRIVY: N/A (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.) Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least tko permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. C i5 i �� 33 3.f Title 5 Inspection Form 6/15/2000 10 Page l 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 212 Greenwood Avenue Hyannis,MA. 02601 Owner: John Cummiskey Date of Inspection: 04/22/04 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to no groundwater 12 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: T Observation 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 DUG TEST HOLE 12'NO WATER. ooi/o; r- ,L 1 Fr'cYj; i-. Title 5 Inspection Form 6/15/2000 Town of Barnstable RECEIVE© Regulatory Services Thomas o� . Thomas F. Geiler,Director rec NOV 19 2003 Mass. 9lb�fDM ,�� Public Health Division TOWN OF BARNSTABLE Thomas McKean,Director HEALTH DEPT. 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLI SHMENT DATE: -I PD 3 A NAME OF FOOD ESTABLISHMENT�_//�-/tts .41e ' &0 eA,,C f--dST 'v d2 ADDRESS OF FOOD ESTABLISHMENT:_ 1qm-ki�V/S A4 m1- d;i 6117 MAP AND PARCEL OF FOOD ESTABLISHMENT: MAP:'aer PARCEL(S)_/ 7 TELEPHONE NUMBER OF FOOD ESTABLISHMENT: ( o�) ??r- 6101 NUMBER OF SEATS: INSIDE: OUTSIDE: ® TOTAL: (P TOTAL NUMBER OF BATHROOMS: 1 . ANNUAL OR SEASONAL OPERATION: AkJ OJ U 0 �-- TYPICAL HOURS OF OPERATION MON-FRI: $ ; d 0 TO : O DAYS CLOSED EXCLUDING HOLIDAYS (I.E. MONDAYS) IF SEASONAL: APPROXIMATE DATES OF OPERATION: / / TO / / ** MNEUNDEW" SEASONAL ESTABLISHMENTS MUST CALL FOR INSPECTION PRIOR TO OPENING TYPE OF ESTABLISHMENT: PLEASE CHECK ALL THAT APPLY j�_FOOD'SERVICE RETAIL FOOD ,C BED &BREAKFAST CONTINENTAL BREAKFAST RESIDENTIAL KITCHEN MOBILE FOOD TOBACCO SALES FROZEN DAIRY DESSERT MACHINES CATERING (OVER---4 OUTSIDE DINING QAHea1th\AppHcation Forms\Foodappl.doc ***REMINDER*** IF OUTSIDE DINING,YOU MUST BE APPROVED BY THE BOARD OF HEALTH AND LICENSING,AND MEET ALL OF THE OUTSIDE DINING CRITERIA IS WAIT STAFF PROVIDED FOR OUTSIDE DINING. IS AN AIR CURTAIN PROVIDED AT WAITSTAFF SERVICE DOOR(S)9 CONTACT INFORMATION: FULL NAME OF APPLICANT 'U0 tt'V 'V( aPFr0 0 In M �/ SOLE OWNERS®/NO ADDRESS AIA �AfC-4,U-)00d IfIA.91s T 1411 U9617 PHONE# (26") 77S-- ®/0 IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FOOD SERVICE ESTABLISHMENTS CONDUCTING FOOD PREPARATION (EXCLUDES RETAIL FOOD ESTABLISHMENTS THAT DON'T PREPARE FOOD AND CONTINENTAL BREAKFAST): LIST THE NAMES OF YOUR FOOD SANITATION CERTIFIED STAFF (I.E. SERV-SAFE) EFFECTIVE JANUARY 1, 2004, EACH FOOD SERVICE ESTABLISHMENT IS REQUIRED TO HAVE AT LEAST TWO FOOD SANITATION CERTIFIED STAFF. AT LEAST ONE FOOD SANITATION CERTIFIED STAFF IS REQUIRED ONSITE DURING ALL HOURS OF OPERATION.***PLEASE PUT THE NAME OF THE ESTABLISHMENT ON THE CERTIFICATE*** 1� 4 lw y EXPIRATION DATE: &PC.- 2, EXPIRATION DATE: a 3. EXPIRATION DATE: / —CY60OD ✓69"°7 4. EXPIRATION DATE: SIGNATURE OF APPLICAN AND DATE Q:\Health\Application Forms\Foodappl.doc Town of Barnstable 0,FSNE roy, Regulatory Services do Director eiler,Thomas F. G BARNSTABLE, ' Public Health Division AlED nw�A Thomas McKean,Director 367 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Renewal: No Fee SEATING ( v2�Ts ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. AD /7 7l DATE o ' APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT 00 M. S NAME OF FOOD ESTABLISHMENT C�`M( ► Aj 5 C «e- 9Ct"bT—U8+eA9-S7- ADDRESS OF FOOD ESTABLISHMENT 6'f e/v WOOD N `MLSA�e—f 10�07- -7 9 0079 TELEPHONE NUMBER SD 7%�� d i a l TYP O ESTABLISHMENT OOD SE R RETAIL FOOD MILK '� ONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES' FROZEN DESSERT CATERING SOLE OWNER:_.X YES NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.:!L/ _ _ STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT RESTRICTIONS: U�L.C/_ HOME ADDRESS './A �Q Ec�oG�®O D 7 � HOME TELEPHONE# 5'D L Foodesdwp/q SITE PLAN REVIEW MEETING �Jv March 12, 1998 APPLICANTS: John F. and Carol A. Cummiskey 217 Greenwood Avenue Post Office Box 503 Hyannis Port, MA 02647 Tel: 775-0905 Fax: 778-4235 PURPOSE: Approval to Operate Bed&Breakfast (Captains Choice) SECTION 3 - DISTRICT REGULATIONS Number 3 - Conditional Uses Paragraph F -Bed &Breakfast LOCATION: 212 Greenwood Avenue Hyannis,MA 02601 BACKGROUND: Purchased property at bankruptcy auction one year ago, because of the location, directly across the street from our house. We renovated it so that we could care for Carol's 80 year old father who suffers from severe emphysema. To ensure a proper environment for him, we removed all carpeting,woodwork, etc., and sanded all floors walls and wood his health, with products safe enough forh, d refinished them wi � surfaces an P and durable enough for his wh��lc-�hair. The old oil burner was replaced c/ with a new natural gas furnac nfortunately,he will not be occupying the house as planned. Now that we have taken these extensive measures however, the property is ideally suited for a Bed &Breakfast. The stated intent of Paragraph F of Section 3 of the District Regulations is to "... allow Bed and Breakfast operations in larger older homes to provide an adaptive reuse for these structures, and in so doing, encourage the maintenance and enhancement of older buildings which are part of the community character." Constructed prior to 1970, and containing a minimum of four bedrooms as of December 1, 1996, it now has been updated with Title V as of March, 1997 by Joseph P Macomber& Son. ZONING: RB Under the provisions of the above stated District Regulations, Section 3 Conditional Uses, Paragraph F Bed&Breakfast. Page 1 I • SITE PLAN REVIEW MEETING March 12, 1998 ABUTTERS: We have met individually with each of our abutters to discuss our plan, and to ensure they have no objection before proceeding. No one had any objection. Moreover, they have been very supportive and complimentary about how much we have improved the entire neighborhood. The encouragement we have received from our abutters and many, many others throughout the neighborhood has been a tremendous boost, making us confident that a Bed and Breakfast facility will continue to be a positive contribution to the neighborhood, and to the community. Following is a list of abutters, their addresses, and a plan showing the location of each lot in relation to ours. Both of the abutters who live on Greenwood Ave. on both sides of us(Lot 173-1 and Lot 175) are very 'much in favor of our plan. They have both written letters, and attached are copies. 1 Attachments: -List of abutters with lot plan - Copy of Bestford letter (Lot 173-1) - Copy of Hoey letter(Lot 175) Page 2 T 173-1 173-2 o O � � 174 172 175 171 176 Lot # 173-1: -Jim--& Pat Bestford Lot #174 - John & Carol Cummiskev, ppli ants 200 Greenwood Ave. 212 Greenwood Ave. Tel: 775-4930 Hyannis, ?VIA 02601 Tel: 775-0905 Fax: 778- 235 Lot # 173-2: John & Rosemary Jadick 15 Point Lane Summer Residence - New Jersey Tel: (908) 522-1009 Lot # 172: P-AIU T- Matthew & Catherine Conley 35 Point Lane Tel: Unpublished - (spoke personally also) Lot # 171: Robert & Nancy Kennedy 45 Point Lane Tel: 775-3878 (Summer Residence) Lot # 175: John & Maura Hoey 224 Greenwood Ave Tel: 775-8530 (Summer Residence) Lot # 176: Russ Hayes 234 Greenwood Ave. Summe Re idence - Reedville Tel: �617� 364-5020 Mr. & Mrs. Yames Bestford • 200 Greenwood Avenue Post Office Bob,591 9�lannis Port, Mq 02647 ♦ + March 8, 1998 To whom it may concern: Our property at the above address abuts the property at 212 Greenwood Ave., now owned by Jack and Carol Cummiskey. We are thrilled with the work they have done to improve , the property over the past year, and regret that Carol's father will not benefit from their efforts. However, they have told us of their intention to keep the property ♦ anyway and operate a bed and breakfast. + Knowing them as we do, we feel that this will be a great benefit to the neighborhood and we whole heartedly support them in their effort to obtain approval from the ° Town. O Sincerel� �, ° i Jim and Pat Bestford , -tt SENT BY: 3- 9-98 ;10:14AM ; BOSTON ®[SON CO., . 915087784235;* 3/ 3 March 9, 1998 jack and Carol CummiBkey 217 &Cenwood Ave- post Office Box$03 Hyannis Port,MA 02647 near lack and Carol, Maura and I ale sued to hear that you will be keeping the property at 212 Greenwood Ave. Which abuts our property.despite the tact that Carol's father wt`!1 not be living these after all. The kw&caping and improvomems you have already made tn the grounds increase propaty yal to hear t9 you have a plan to continue values of others is she nei�borinood, and wo.are happy to Vnaintaia it. A well tun Bed and Break&g thcility,wdl bC juvAer added value, r ds, jo►n+Hn �4 wood Avbn e 3- 9-98 ;10:14AM BOSTON ®[SON CO., 915087784235;# 1/ 3 - Boston Edison , Sales Department Date: March 9, 1998 To: Jack& Carol Cummiskey Phone: 508-775-0905 Fax: 508-778-4235 From: John Hoey Sales Department Phone: (617)424-2064 Fax: (617) 424-2738 Number of pages (including cover sheet): 3 Message: Jack& Carol Best of luck on Thursday! See you this weekend. c Thanks, John & Maura .:V .1 SITE PLAN REVIEW MEETING March 12, 1998 FLOOR PLAN: There are four bedrooms existing at this site. There is no plan to add any more bedrooms, nor will there be any more than four bedrooms at any timer The lodging arrangement will be'as follows: LODGING ARRANGEMENT: Three bedrooms for guests (in compliance with Item"b",Par. F of Bed and Breakfast): • First Master bedroom has private bath • Second bedroom can have.:a private use of the adjoining-bath • Third bedroom will be used as an overflow for one of the other two bedrooms if one couple has a traveling companion, and will have to share their bath. A private sitting room will be furnished for the guests with comfortable chairs, TV, and books. As owners, we will occupy the room with half bath at the other end)of the house to ensure a sense of privacy for our guests, and to give us the ability to prepare the breakfast table and maintain the sole use of the kitchen. In compliance with Items"c" and "d",Paragraph F Bed &Breakfast, 1. No cooking facilities will be available to guests, and no meals except breakfast will be served to guests. 2. We shall be"...resident when the Bed and Breakfast is in operation." That is, we shall be in residence at this address during its season of operation. Deck Second Bedroom ow sir* Sitting Dining 1/2 :I i Room Kitchen Room Bath Bath Bath Proprietor's Room Third Living Bedroom Room Master Bedroom Page 3 x SITE PLAN REVIEW MEETING March 12, 1998 CONTINENTAL Breakfast will be offered in the Dining Room from 6:OOam to 9:OOam BREAKFAST: and will consist mainly of whole foods organically grown or produced. As members of an organic food Co-Op,we purchase only organically grown produce, grains, nuts, soybean products, coffee, tea, etc. Our groceries and household supplies come directly from a supplier of natural foods and products. Menu items will be fresh whole fruit or juiced (we have both a Commercial Vitamixer and juice extractor); granola and other whole grain cereals and baked goods(we have a bread machine) coffee, tea, rice and soy beverages. PARKING: There is ample space for parking in the driveway and beside the driveway (just to the right edge of the driveway) as shown in the picture below. Driveway dimensions: 57 ft. long X 16 ft. wide Adjoining area: There are 2655 SF in the adjoining area. There are 59 feet between the edge of the driveway and the property line to the right. There are 45 feet from our fence to the street. Parking will be provided in the driveway and along the edge of the driveway,to the right, well away from the property line as shown in the picture below. 7 i ..a SAFETY: To ensure a clean, healthy, and safe environment for everyone, we will maintain a smoke free facility. We have spoken with Lot. Donald Chase, Jr. C.F.I. Fire Prevention Officer of the Hyannis Fire Dept. He explained the type and placement of the fire/smoke alarms and switches, and we are prepared to comply with the requirements as soon approval is obtained for a B &B. Page 4 SITE PLAN REVIEW MEETING March 12, 1998 GROUNDS: After the installation of Title V, we re-graded the lawn area away from the house, replanted the lawn, and replaced the walkways which were destroyed by the excavation. We have continued the English Garden landscape theme to compliment our property across the street. This theme allows us to easily incorporate plants that are native to Cape Cod such as Rugosa Roses,Bearberry, Scotch Broom, and Holly shrubs and trees. We have already planted 35 shrubs and well over 200 perennials,bulbs and rhizomes on the front and sides of the property, and will continue to lavish the gardens.with more shrubs, perennials and colorful annuals this year and in future years as we always have. There will be no outdoor refuse storage area of any kind anywhere on this property. oje2 k&e ye% oPGAUIc 14eC/,,vas T� � V� "'• ; i0 i�Fi�Pf-'�r Oc/,� ,Uvme�Ov S G�ak 0��5 OTHER Atiy e/se i riF�� •� :z� > .r CONSIDERATIONS: We intend to employ a Reservation Service which is dedicated to Cape Cod Bed and Breakfast accommodations. We have spoken to people from`Bed&Breakfast Cape Cod,Nantucket&Martha's Vineyard", as well as"Orleans Bed&Breakfast Associates". They have provided us with invaluable information, and through this service, we can attract patrons who are seeking what we have to offer. For example: those who wish to continue personal workout routines may obtain one-time free passes, or purchase daily or a week long membership in the health club to which we belong. Our location provides easy access to Main St.,Hyannis and all the surrounding businesses, churches, and other conveniences. Those interested in things such as organic food, clean surroundings, an invitation to join us in our morning walks to enjoy the beauty of Cape. Cod and the nearby beaches will find the Captains Choice B &B as an ideal choice. SUMMARY: We are anxious to begin advertising through our reservation service so that we can be assured of adequate bookings this season. Therefore, we are requesting approval of our plan so that we can obtain the necessary license, register with the required departments, and comply with the fire regulations immediately. We will move into the house and be resident for the season of operation from May to October. Page 5 1 Greenwood Avenue 19 , 40 wide �ske i. �co-►k�ol er(~ ... aep It c��-. n, • rv�vse' Obht�� a YCS.d�n�iaC• off : , T6 N OF RARILSTABLIE BUILDING D �`T. D MAR 2 5 '1998 Site Plan of Land in Hyannis, MA For Jack Carol Cummiskey _.. . 13eing. lots: 6 & 7 as shown in plan book 84 page 5. Scale 1"=20 ' Date 3-23-98 All Cape Engineering 49 Harbor Road Hyannis, MA 02601 i SITE PLAN REVIEW MEETING uF. March 12, 1998 CONTINENTAL Breakfast will be offered in the Dining Room from 6:OOam to 9:OOam BREAKFAST: and will consist mainly of whole foods organically grown or produced. As members of an organic food Co-Op,we purchase only organically grown produce, grains, nuts, soybean products, coffee,tea, etc. Our groceries and household supplies come directly from a supplier of natural foods and products. Menu items will be fresh whole fruit or juiced (we have both a Commercial Vitamixer and juice extractor), granola and other whole grain cereals and baked goods(we have a bread machine) coffee, tea, rice and soy beverages. ti PARKING: There is ample space for parking in the driveway and beside the driveway (just to the right edge of the driveway) as shown in the picture below. Driveway dimensions: 57 ft. long X 16 ft. wide ;. Adjoining area: There are 2655 SF in the adjoining area. There are 59 feet between the edge of the driveway and the property line to the right. There are 45 feet from our fence to the street. Parking will be provided in the driveway and along the edge of the driveway,to the right, well away from the property fine as shown in the picture below. I , SAFETY: To ensure a clean, healthy, and safe environment for everyone, we will maintain a smoke free facility. We have spoken with Lt. Donald Chase, Jr. C.F.I. Fire Prevention Officer of the Hyannis Fire Dept. He explained the type and placement of the fire/smoke alarms and switches, and we are prepared to comply with the requirements as soon approval is obtained for a B &B. Page 4 Yohn F & Caro(A. Cummiskey P.O.Box503 217 Greenwood Ave. Hyannis Port,MA 02647 Telephone:(508)775-0905 Fa; (508)778-4235 Email.-cummiske@capecodnet April2,1998 Mr. Thomas McKean,Director of Health The Town of Barnstable • 367 Main Street Hyannis MA 02601 Re: SPR-013-98 Captains Choice, 212 Greenwood Ave., Hyannis (288/174) Proposal: B&B for not more than 6 guests Dear Mr. McKean: Today we received the site plan which has been signed by all members of the Site Plan Review Board as required, and forwarded to the Zoning Board of Appeals. In response to your request noted by your signature, enclosed is the floor plan. It has been enlarged, and copied for your convenience, and as you can see, the kitchen remains the same, and the location of the sink has not been changed. We will of course, apply for the kitchen permit immediately as you noted. We appreciate the kind comments we heard at the Site Plan Review, and would also like to thank you for the help we have received from your staff. This process can be overwhelming to ordinary citizens. We could not have succeeded without the help of the patient and knowledgeable people of The Town of Barnstable. As you already know, we plan to open on May 24, but our reservation service cannot begin to book guests until we receive our special permit from the ZBA. We believe that all requirements have been met, but if there is anything else you need, please let us know so that we can comply immediately, and avoid any unforeseen delays. R pe�tfullyYn John and Carol Cummiskey w 00 x Q rill iii)T k Cl) r• .� ii •I ln. Ln Iw w 0 O r 00 � 0 Q 3 ^' G� This room will be offered (D with a private bath. This room will be £ offered with a privat o a bath. a an Ga (D 0 Q c CL 0 En E. 0 0 Q o wz w_ his room will be off red o guests who are tra ellin ogether and are willing to share a bath with eft her of the other rooms. v r —• N /� • • Cn W � •I 7� r r 1 I v � 0 :4 G w m 0 �. cn m G rt N m / 171 rt cn 0 —• 0 w 00 w (D 0 F1 0 �• d H C H (D (D (D 0 (Q � �-h w m 03 o0 e � rt 7 � \ (D (D N M n C '� rt W 0 r N 0 Oho N G' � q0 �• o. O O 0 H• 5 � E rt W G y :V rt rt (D =1 C N N ti w lJL rCL 0 Ln O w O V CL No r O ."3 This room will be offered m with a private bath. This room will be w offered with a privat o a bath. 0, c-) . _ w a �I m ° G a m r W , C7 O .' O �• C �0 wz . w his room will be off red - o guests who are tra ellin ogether and are willing to share a bath with either of the other rooms. N Ln >4 r r 1 v C1 O E G T r"' pip FJ' r rt H N rA O fD H. W 1-� rt MMD) ' O O F-A N 3 rt co " o F1 Cr03 ( O 3 M M 0 "' '^ M w o Fh M W EO n N• oho rr r• � C E w rt r• rt �r M M coo rt c � CO FA- 0 T O N M :3ti OG N T1 •� — M 011 O O CD rt W G m � r' N N N M + E w 00 4) A) w (n x CL � Q r ln. "Z N r W 0 r O (D O 3 V 3 3 Q Nx .may This room will be offered N with a private bath. This.room will be € Ib offered with a privat °o a bath. a 0 an o M � a M r n CL M. �• 0 PV O o O CL o wz w_ his room will be off red o guests who are tra ellin ogether and are willing to share a bath with eft her of the other rooms. Ln " r I I V o £ G r �� � �3P• M rr N m O F'• I � t � � � H. r o Hw 3 w w o 0 0 O one ° O —� M M () M rh (D N• w b U) n N• o0 rt H. O C E Dw rt r• rr p' F� (D (D m rt C rt r• TT O r (D O OC r N N N MPI � O O �• CD EI rqk O rt w c ,w rt rt III N , N M • E w w w x Q � � S x Q n �_. Ln O � o w 0 3 - v -, Q N0 This room will be offered with a private bath. This room will be E offered with a privat o a Acp bath. a. n C o rD F- G a M . o O CL a . wz w his room will be off red o guests who are travelling ogether and are willing to share a bath with either of the other rooms. b � X y N AX 1 I v C] O E G T r OQ G rt F- rt _ M m w cr pi m O n C N E woo M rn fD F'• m n W 00 rt H. G C E co rt Wn : H M M ~ (j) r M n C rt H. O 0 H- N G GGotI r+ � ■� N N V 1 O O M ■ W 0 CD EI f"!` K W G O M y r* N C N N M E w 00 r A` w' T 0) r 7) W W / ) CD r x Q S x l!t r Ln O W O O r 0 (DQ Q V N 0 N � G� This room will be offered with a private bath. This room will be E 0) offered with a privat o 0, bath. 010 an 0 G a m • a r '"' ♦A G CL —� V—/• -1 S M O O :; r O —• 7V Q Q o 3 wz w his room will be off red o guests who are tra ellin ogether and are will ng to share a bath with eft her of the other rooms. v " b r r 3 r I I r V o V. r G w (D —� F- o0 0 w `O O <' � 17J o w o v nFj- o' w M O M M 0 W 0 M (D N. w F'• 000 rt F'• :J CD rr C TT F• rt :::r W F-' (D (D ~ m r T ? (D n C "Z rt H. O r (D H. aGo N O �. °' o 0 O rt 3Q rt M G V rt y N N M J R E w 00 a) a) = x r r t-n. r CD V� r � V O � w p O O M p 3 - .� a N r O N � This room will be offered with a private bath. This room will be w offered with a privat o M bath. a. c0 - - an M � a T m • r W n a .� 0 O N O -• o a c 3 M 3 wz . w his room will be off red - o guests who are tra ellin ogether and are willing to share a bath with either of the other rooms. b r -M T N M s CA W ♦, Un r M I 1 r C� G) rt H D] O � (D rt < raj 171 OQ (D 0) O v :j F-j N Pd rt M CD o w o m v n Q w V OQ �• W PI C F� � (D (D 0 /A m O W (M D �ii w b m n w oQ rt H. d E w rt F• rt :3, M n C rt H. T Q r+ (D � OQGQ r N N N C 7d — �■ 11 � EI 3 0 • rt W G 'Ow rt M =r V N N M Y r - w OD r W W r cn CD ^ A' W X CL CL r (J) 0 ln, r OW O 0 r (u 0 v � . N � This room will be offered with a private bath. This room will be S 0) offered with a privat o a bath. a. n _ w an C o m . TT a W n ~' CA G -, :r ,� O O -� O o Q CL 3 wz Ithis room will be off red o guests who are travelling jogether and are willing to share a bath with eft her of the other rooms. 0 N ^ Pr \/ P r r I I r V 0 P. (D N p rr r (n En M OQ M 03 � O y o r o � v n P. cr w c£v w M o P7• w EI rn m w w b ca n H o0 rt N• �J C P. rrt : F- (D (D m r .O ? , M rr F'• O r M 0 DO i j N Q° 7d - O F� � El O r N t G M : rt N N N M + the The Town of Barnstable t Department of Health Safety and Environmental Services A� Building Division i6 p• 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commissioner March 30, 1998 John and Carol Cummiskey Captains Choice 775 — 9O 217 Greenwood Ave PO Box 503 Y Hyannis Port, MA 026477 V U Re: SPR-013-98 Captains Choice, 212 Greenwood Ave, Hyannis(288/174) Proposal: B&B for not more than 6 guests. Dear Mr. and Mrs. Cummiskey, Thank you for submitting the site plan for the above referenced proposal. The plan dated 3/23/98 was reviewed at the Site Plan Review Staff Meeting of March 26, 1998 and approved under Section 4-7.4 (2) of the Barnstable Zoning Ordinance and referred to Zoning Board of Appeals. Enclosed is the signed plan. Should you have any questions, please feel free to.call. Respectfully, Ralph Crossen Building Commissioner TOWN OF BARNSTABLE LOCATION 112 G R eed wo®d A inf SEWAGE # F7 /3 VILLAGE fiT�f/ISL�D/�t y- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. A4 A C j2 A4/-?eX.¢ 5 aze SEPTIC TANK CAPACITY /, S::FD O LEACHING FACILITY: (type) 6 e, 5(size) 3,56?S" NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 3-`a V—?7 COMPLIAN DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 c� o� r. G h i �\ � i +F � �1 � � N � � 7 `\ h e' � �� �� d � � \ � � ti� \�, \ ,v �, _ j c,. �'� �` � __ � . t�, Sy, � t No. N7— 1 Fee$ 5 0. 0 0 / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS ZIpphration for Oigoml bpgtem Construction 3perutit Application for a Permit to Construct( )Repair(X))Upgrade( )Abandon( ) X1 Complete System El Individual Components Location Address or Lot No. 212 Greenwood Ave Owner's Name,Address and Tel.No. 217 Greenwood Ave Hyar -port,Mass ., Hyannisport,Mass . 02672') Assessor,Om Map/Parcel 7 7 5-0 9 0 5'-` CUly ASK �f Installer's Name,Address,and Tel.No. J.P.Macomber & Designer's Name,Address and Tel.No. J.P.Ma o mb e r&S O Son Inc. Box 66 Centerville ,Mass . Inc . Box 66 Centerville ,Mass . 02632 02632 508-775-3338 508-775-3338 Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(NO) Other Type of Building RES No. of Persons 1 Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 4 n gallons per day. Calculated daily flow 4 x 1 1 0 gallons. Plan Date �2 4F/97 Number of sheets Revision Date Title Size of Septic Tank 1 500 Type of S.A.S. 4-330 Cultec Recharhers Description of Soil Medium Sand Nature of Repairs or Alterations(Answer when applicable) 1 —1 5 0 0 gallon tank 1 -Distribution box 4-330 Cultec rechargers . Omitting cesspools . Date last inspected: 3/2 4/9 7 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 thisjBo d o ealth. Si Date 3/2 �97 Application Approved by Date 7 Application Disapproved for the following reasons Permit No. Date Issued 17 M 00 No. Fee r'==` 5. p THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZIpprication for Migpooar 6pelem Corigtruction Permit 'F Application for a Permit to Construct( )Repair(K)D Upgrade( )Abandon( ) XI Complete System ❑Individual Components Location Address or Lot No. 21 2 G r e e nwo o d Av e Owner's Name,Address and Tel.No. 21 7 'Greenwood A v e Alganis-oor t,Mass . Hyannisport,Mass . 02672 Map/Parcel —0905 S ) _ 775 / Installer's Name,Address,and Tel.No. J.P.Ma c o Ill b e r 1 Designer's Name,Address and Tel.No. J.R.M o mb e r&S o n Son Inc. Box 66 Centerville,Mass . Inc. Box 66 Centerville,Mass. 02632 02632 508-775-3338 508-775-3338 Type of Building: Dwelling XX No.of Bedrooms 4 Lot Size sq.ft. Garbage Grinder(NO) Other Type of Building RES No. of Persons 1 Showers( ) Cafeteria( ) Other Fixtures Design Flow 4 4 n gallons per day. Calculated daily flow Z x 1 1 n gallons. Plan Date 3/P//Q 7 Number of sheets Revision Date ` Title ` Size of Septic Tank 1 500 Type of S.A.S. 4-330 Cultec R'echarhers ' Description of Soil Medium sand t Nature of Repairs or Alterations(Answer when applicable)1—1500 gallon tangy 1-Distribution box 4-330 Cultec rechargers. Omitting Oi syhpools. .......... ' s Date last inspected: 3/24/97 R r 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 pf the�En46nmental'Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of hi%ealth. sigma :_ Date 3/24/97 , ,�// Jy `� ie n Application Approved by t..�'^i�•--.._. r Date 7 1 :Application Disapproved for the following�reasonsY i Permit No. I '� Date Issued ------------- � 1�. -------------------- r-)C — THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Con tructed(/Z Repaired( )Upgraded(XX)s Abandoned( )by J..P.Macomber & Son Inc at 212 Greenwood Ave H_ annisport,Mass. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -` dated Installer J.P.Maeomber & Son Inc Designer J.T.Macomber & Son Inc. The issuance of this permit shall not be construed as a guarantee that the sys em will function as designed. Date Inspector _. f No. ( � -------------•-- I.3Fee $ 50.00 r THE COMMONWEALTH OF MASSACHUSETTS: PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS ig ogar *psstem Contruction Permit Permission is hereby granted to Construct( )Repair( ).Upgrade(X)5.Abandon( ) Systemlocatedat 212 Greenwood Ave H.yannis.port,Mass . and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty,toy` '' I comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of-this-pe• t. - Date: Approved b� JAl, ' ' t r CERTIFICA'I'ION OF SKETCII AND AP1'L1CA'I'ION FOR A DISPL... WORKS CONSTRUCTION PEItn,11'I' (1V1'I'IIOU'I' DESIGNED PLANS) I Joseph P.Maeombe _ti_Jr... certify t1jut the application for disposal works construction permit signed by my c::t�d 3/24/97 , concerning the property located at 212 Greenwood Ave Fyanni spnot meets all of the following criteria: • There are no wetlands within 300 fcct of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater tably ;S lecl Uf �rCale(bl'101Y IIIC bottolll of the 1CJChlllb faClllly • There is no increase in flow and/or ch-m6e in use proposed • There are no variances requested or necdcd. SIGNED : / DATE: 3/24/97 e. LIC SED SEPTIC SYSTEPA lNSTA,,-LLER IN'I'I-13 "01YN OF BARNSTABLE NUMBER 47 (Attach a sketch plan of the proposed S)Stem. Also if tl;e licensed installer posesses.a certified plot plan, this plan should be submiued). lk p F � I Town of Barnstable Department of Health, Safety, And Environmental Services MA�e t639 Public Health Division �EDNIRI� 367 Main Street, Hyannis MA 02601 Office: 508-790.6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health SEATING ANNUAL SEASONAL X ASSESSORS MAP AND PARCEL NO. DATE 3—ae— 7 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT M 471Sk6 NAME OF FOOD ESTABLISHMENT ADDRESS OF FOOD ESTABLISHMENT o2 02 6-Reed UJ06 Z) 17LV6 TELEPHONE NUMBER TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD _ BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: She IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGMA ?F APPLICANT RESTRICTIONS: HOME ADDRESS ��7 HOME TELEPHONE# 77S-D �'OS' • r - '' ` Mr a Mrs 1.F.eammiskey P.O.Box 503 217 Oremwood Ave. Hyamris Poi,MA 02647 Fax 508 778-4235 March 28, 1997 `'2. .•..gam . F r„ Town of Barnstable 4 Department of Health, Safety, & Environmental Services 367 Main Street Hyannis, MA 02601 Gentlemen: Enclosed is our Application for a Bed &Breakfast at 212 Greenwood Ave. As you requested, below is a sketch showing the location of the sink. As you know,the Title V septic system is being completed today. Please contact us if there is anything further you require. Sincerely, John F. and Carol A. Cummiskey i Encl. 1 } Parcel No. R288 174 Key No. 192749 *' �• TOWN OF BARNSTABLE LOCATION / G n eeAl ulc o l A tle SEWAGE # —�-3 VILLAGE. S,20Xr ASSESSOR'S MAP & LOT :INSTALLER'S NAME&PHONE NO. / • A4 A C am/ eX, SD.!/ SEPTIC TANK CAPACITY LEACHING FACMrrY: (type) ' R PC >C A 'S(size) 3 5d s NO.OF BEDROOMS y BUILDER OR OWNER PERMUDATE: -a 4 7 COMPLIAN DATE: QZ— Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist j 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 i 0 � 5 b 1 Y — TOWN OF BARNSTABLE (F) :^LOCATION # VILLAGE / ASSESSOR'S MAP & LOT .,__ AME&PHONE NO. . SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) /'. NO.OF BEDROOMS a )� BUILDER OR OW�l R POOPMATE: �'�� COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility ('u 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 aching rfaZly) �� Feet ?Furnished by f I �� P�' \ a� V �� \ \` �� � j \^ � p`Yy ' A JI DATE: _2/3./,97`` R��4 FEB EilrE� PROPERTY ADDRESS: 212 Greenwood Ave- ? j Hyannisport,Mass . rowN �yoPTTgq� 9 T 026.4.7 , .r v V On the above date, I Inspected the septic system at the above address. This system consists of the following: 1 . 2-61x8l, block cesspools . Based bn my Inaowctlon, I certify the following conditions: 1 . This is not a title five septic system. 2. This is-a_sewage-syste,m.. `1 The sewage system is in failure. • 4 The -'system. must -be upgraded to a_ title five septic system SIGNATURE: G �( Name: J. P.Macomber Jr., i Company: J. P_Macomber & Son-_Inc . , Address:_-Be-ac-bb-----=�--- --- Centerville LMass__02.632 Phone:---5OZ-7.7-5�3338------- - 1 THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY • CP. MACOM ER & SON, INC.ankrC�upoolFLeachfleIdsPump*d 4 1n8UiledTown Sewer Connections 66' Centerville, MA 02632-0066 775-3338 775-6412 Ul Commonwealth of Massachusetts Executive Office of EnAronmental Affairs Department of environmental Protection Trudy Cox* 6-j" Dayld u8..�_�osuu �ttr�hs V.� ^liy • �,.1f e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: John Cummiskey Addse" of Owner. 217 Greenwood Ave Data of inspection: 2/3/9 7 (If different) Box 503 Ne.meoftn,pector• Joseph P.Macomber Jr. Hyannisport,Mass . Company Name,Address and Telephone Number. 0264.7 J. P.Macomber & Son Inc. Box 66 Centerville ,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the"wage disposal system at this address and that the information reported below is true, aocumts and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sits"wage disposal systems. The sysum: _ Passea Conditionally Passes *eds Further Evaluation By the Local Approving Authority i ails Inapeetoes Signature: / Date: ''( _/ 7 The Sysum Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner.wd copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTEM PASSES: A,)P 1 have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CUR 15.303. Any failure criteria not evaluated are indicated below. B) SYSTEM CONDITIONALLY PASSES: One or more sysum eomponanti used to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Iodicaw yes, no, or not detarmind(Y,N,or ND). Describs basis of determination in all instances. If'not determined',explain why not) ,VO4LQ,.A The"ptic tank is metal,era:ked, structurally unsound, shows substantial infiltration or extiltration,.or tank failure is .mm+^•at. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by tLe Board of Health. (revised 11/03/95) 1 One Winter Street a Boston, Massachusetts 02106 * FAX(617) 556.1049 * Telephone (617)292.5500 V.� Premed on R"1W Paper ®. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oonUnued) PropertyAddreaw 212 Greenwood Ave Hyanni sport,Mass . Owner. John Cummiskey Date of Inspection:2/3/9 7 B)SYSTEM CONDITIONALLY PASSES(continued) N� Sewage backup or breakout or hP static water level observed in the r--distribitt- soa be-,at is dun to broken or obstructed pipe(s) • or duo to a broken,settled or uneven distribution box. The system will paas inspection if(with approval of the Board of Health: broken pipe(s)an replaced obstruction is removed distribution boa is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH:- A)b Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 60 feet of a surface water 29 Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. A0 The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. .jam The system has a septic tank and soil absorption system and is within 60 feet of a private water supply wall. �Q The system has a septic tank and soil absorption system and is Is"than 100 feet but 60 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or Iris than 6 ppm. 3) OTHER System has 2-61x8l block cesspools . One srrvices the gray water useage . One services the baths . (revised 11/03/95) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Addreaa:21 2 Greenwood Ave Hyannisport,Mass . Owner. John Cummiskey Date of Lwpeotion: 2/3/97 D) SYSTEM FAILS: _.. e I have determined that the system violates one or more of the following failure criteria as dafinad in 310 CMR 16.303. The basis for this determination is Idantiflad below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or dogged SAS or cesspool. Discharge or ponding of effluent to the surface a the Around or surface waters due to an overloaded or dogged SAS or cesspool. Static liquid level in the distrib� utio b iabove outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in eesspooi•is less than 6'below invert or available volume is less than L2 day flow. �J Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. �D Any portion of a cesspool or privy is within 100 feet of a nuface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 60 feet from a private water supply well with no acceptable water quality analysis. If the well bas boom analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E) LARGE SYSTEM FAILS: The following criteria apply to largo systems in addition to the criteria above: The systam wrvee a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a aigmi6eant threat to public hashb and safety and the environment because one or more of the following conditions rust: Wr the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface driakdng water supply f the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into!Wl compliance with the groundwater treatment program requirements of 314 CUR 6.00 and 6.00. Please consult the local regional office of the Department for Au-thar information.. l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST PropbrtyAddreas: 212 Greenwood Ave Hyannisport,Mass . owaert John Cummiskey Date of inspection: 2/3/9 7 ' Cbenk it the following have been done: ' ping information was requested of the owner,occupant,and Board of Health. None of the system compons4ts have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Lame volumes of water have not been introduced into the system recentjy or as part of this inspection. "As built plans have been obtained and examined. Note if they are not available with NM. 2Tb.,facility or dwelling was inspected for signs of sewage back-up. Z71he system does not receive non4anitary or industrial waste flow 'he site was inspected for signs of breakout. ZA11.87gt4m components,-deluding the Soil Absorption System, have been located on the site. i fCLL The septic'tank were uncovers opened,and the interior of the septic tank was inspected for condition of be or Z7u, material-of construction, dimensions,depth of liquid,depth of sludge,depth of scum. size and location of the Soil Absorption System on the site has bean determined based on existing information or I/• prwdmatad by non-intrusive methods. Ths facility owner(and occupants, if different from owner)were provide wit h th information on the proper rnaiatenana of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAddreas: 212 greenwood Ave Hyannisport,Mass . Owner. John Cummiskey Date of Inspeotiow2/3/97 FLOW CONDITIONS RESIDENTIAL Design flow; W_p allons per^ 01A-/ e Number of bedrooms:; Number of current reaidants:,L Garbage grinder(yes or Laundry connected to system(yes or no)jses Seasonal use(yes or no)-" Water meter readings,if available: t Last date of occupancy: COMM ERC IAL n ND U S TRIAL- Type of establishment: tiff Design Dow:_A2&_gallons/day Grease trap present: (yes or no)" Industrial Waste Holding Tank present: (yea or no)AZ19 Non-saaitary waste discharged to the Title 5 system: (yea or no)AL-4 Water meter readings, if available: Alh AA Last date of occupancy: A>/4 OTHER(Describe)—�4A Last date of oocupaacy: GENERAL INFORMATION PUMPING RECORDS and source of' tion: System pumped as part of inspection: (yes or no)_&D If yes,volume pumped: ns Reason for pumping iU TYPE OF SYSTEM Septic tank/diatribution bo=/aoil absorption system Si4u cesspool6 Nb Overilow cesspool Al Q_ Privy Shared system(yes or no) (if yes, attach previous inspection records, if arty) Mt Other(explain) APPROXIMATE AGE of all components, date installed(if(mown)and source of information: 711 VG�i41^� Sewage odors detected when arriving at the site: (yes or no) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C• • SYSTEM INFORMATION (continued) Prop"Address: 212 Greenwood Ave Hyannisport ,Mass . Owner: John Cummiskey Date of Inspection: 2/3/9 7 SEPTIC TANK:,4,Xe— . (locate on site plan) Depth below grade:_4)—h Material of constructiorkilconcrete —metal —FRP —other(explain) Dimensions:_ Sludge depth:�;�_ Distance from top of sludge to bottom of outlet tee or baffle:!!kt Scum thickness: ,d2A Distance from top of scum to top of outlet tee or baffle: 41t� Distance from bottom of scum to bottom of outlet tee or baffle._ s_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffle,. depth of liquid level in relation to outlet invert, structural •rity, evidence of leakage, etc.) S6Dtictank is no present. GREASE TRAP. VOWL (locate on site plan) Depth below grade:.N�A Material of constrrlrtionNA :oncrete metal FRP other(explain) Dimensions; Scum thickness. Distance from top vr scum to top of outlet tee or baft'1e:1!//I Distance from bottom mi crom in bonnm of outlet tee or dahte _V*- Comments. (recommendation for pumping, concli—n of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etr.� Grease traD is no -present X. V (revised 1/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontiaued) Prop�styAddresa: 212 Greenwood Ave Hyanni sport,Mass . Owner. John Cummiskey Dale of Inspectlon:2/3/97 TIGHT OR HOLDING TANK NLuf�, 00MU oa site plea) e Depth below Material of _metal_FRP_otbartespLdn) Alh AJ Dimaasioas:_)h Capacity_ A)A gallons Design now as/day Alarm Ievel: Co—sw : (condition of inlet tee,ooaditioa of alarm and a"t switches,etc.) Tight or holing tank not present DISTRIBUTION BOX:j26A,-4Z_ (locate on site plea) Depth of liquid level above outlet invert:_ Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of lealca lato or out of b=,etc.) Distribution box not present PUMP CHAMBER: pe- (locate on site plan) Pumps in working order.(yes or no)-11?& CammaaL: (note oondition of pump chamber, oondition of pumps and appurUnaaoes,etc.) Pump Chamber not present. (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontlnued) prop+rtyAdd,ese 212 Greenwood Ave Hyannisport,Mass . Owner. John Cummiskey Dave of Inapeottcn:2/3/9 7 SOIL ABSORPTION SYSTEM(SASk2— Goeats on site p1&4 if posaibL;suavation not required,but my be approximated b7 am-intrusive mathods) e If not determined to be prewat,explain: Type: > number. leadfn chambers,number: leaching gallaries,number: lesehir, trenches,number,kagtb l.adin Salda,number,dime as: overflow cesspool,number: Comments: (now coalition of soil,signs of hydraulic failure,level of pondin&condition of vegetatioa,etc.) None of the above present. cpsaPooLs:�� (locate(a site Number and coaSgumdon: 'Depth-top of liquid to ia wA)P �. Ad) a �of� �l . c " Depth od==1,3 Dimensions of oaapool: Materials of construction: _ Indication of groundwater 4�A" _ inflow(cesspool must be pumped u part of inspection) W 44 5 .424 P �1111'J Comments:(note condition of soil,signs of hydraulic failurs,level of oondition of a,_etc) Medium sand: Yes there are si ns of ,yddraulic failure •No level of Vegetation is normal. Bo e at Do e s ooT-T'17T in faTlice- System must be upgraded to a title five sep ic .sys em. PRIVY: (locate on site Plan) Materials of coast„cti=. NA Dimaaskw: NA Depth of solids:,N.� Comments:(note oaadWoa of soil,signs of hydraulic failure,I"of poading,condition of vegetatbn,its) Privy is not present (revised 11/03/95). g SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION .FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE L=SPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100 ' Hyannis eater Company 775-0063 ' O i o . G Re CA/ Wo OcZ AUe DEPTH TO GROUNDWATER depth to groundwater P,gthod of determinesion or /approximation: stall d - 0 ` a ion. 're.c l�a:ch— it .at. 217' Greenwoo ve ;,, No wa er encountered a �ti Y Sb►y1( 3��1 THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. Junc 8, 1995 Acting Director of the - ion of Water Pollution Control No.._/.3 Fics.....3�._: n....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH APPWWO TOWN OF BARNSTABLYZ &X=ZS0 R�rK lirtttioit for l n ul 'I i �xk Cn>agt�t 4fwmm ONO Application is hereby made tor a Permit to Construct ( ) or Repair �X) an Individual Sewage Disposal `:,ystem at:-40 - .... Loattion Address or Lot No. A,B.Condon .....................------.._.....---•--•-•- ---------------------------------•--------____-----------•-••-----_•-•-----------------__---•---•- W J.P.Ala e omb e r Jr. "'cr Address Installer Address UType of Building Size Lot............................Sq. feet t-, Dwelling-X No. of Bedrooms---------------3---------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures -------------------- --------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. a' Septic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter................ Depth................ 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........................................ 0-1 0-. Test Pit No. I................minutes per inch Depth of Test'Pit.................... Depth to ground water........................ Li, Test Pit No. 2................minutes per inch Depth of Test Pit-.................. Depth to ground water........................ 9 ----•-•-•-------------------------------------------------------•--•----------------•-••-....._..--•......................................................... O Description of soil_...---Sa-d--•&•-.QX.a.rel-------•--•-------------------------••----.x V -•.........................•-•-------...._..._..-----•-•-•-----...•-•••-•-----••---------•--•-------------•---------••-------------••-----------•••-----••---------•-._._........--••-----•---••------_. W --------- ---- ----------• --------••••• U Nature of Repairs or Alterations—Answer w, en applicable..Om7 .. C....Sp o O l s . I n s to 1..••-1--1 000 ----•-.. tank 1-distribution box 1-1000 hallo leach_pi_- --- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with '�r the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the x system in operation until a Certificate of Compliant has been is ed by the boa d o health. g -- 8/ /9.3 Signed ...... �....... .....:...... Dare Application Approved By ............�� ....... ..................... ................... �.... Dace Application Disapproved for the following reasons: ....................................... . . . ............. . .. . .-- .................................... ... ................. .. . ... . . ..................._....... ........................................ --...... ................................................. ........................................ q. Date PermitNo. .........L. ---t... ....Ll L. ------------------ Issued .................................................................... Date �„d>�.+......�... w va....�.,i;i.,...+.P� ...._:+..o'., y��w-w ..+ � ..+.L_...���d�S..:`+.' :�����'. - � ti-,�•..-r-'^f>w4 .-`+il�s a.-r,+c .����, A No-..!_:a- ` , � 10 Fxs.....3 ...01?........ .y THE COMMONWEALTH OF:MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliratinn for Diripniul Works Tontitrurtinn rami# Application is hereby made for a Permit to Construct ( ) or Repair �[X) an Individual Sewage Disposal System at: 17 b 5 3 moil= r ��' n 11e .......................-u.......-----a � --•---................... -.-•---------------------•--•-----•--------------- ---------.. Lc:-ition.Address v or Lot No. A.B.Condon r�► rM .� t-� �, �p. _ ...................... - ........ .-••----•--•--------..--•-------------•-•---------•---.......----..._........-----._.....--------- + O+rner W J.P.Macomber Jr. Address Installer \ Address UType of Building Size Lot............................Sq. feet .. Dwelling-X_ No. of Bedrooms..............2...........--.....---..----Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons--------.-----_---.-..---- Showers ( ) — Cafeteria ( ) d Other fixtures .. ;1Z--------------------- --------------------------------------------------------------------------•-------•------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. fx Septic Tank—Liquid capacity............gallons Length---------------- Width---.------------ Diameter.-.-..-------... Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 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.--..................... Gi, Test Pit No. 2................minutes per inch Depth of Test Pit--.................. Depth to ground water........................ Al --••--------------------------------------------•----------•--------------------............._•-•---......................................................... 0 Description of Soil......Sa'gd---&- GravTel---•--------------------------••....--------•-•-•--•-•-•-•------------- V .--------------------------------------------•--....-•--•------••--......--•---•••---------•-------------•----•--•---•-----------••-•---•-----••-------.... W --•------------------------•------•-------------------------------------------......-----------------------•----------------------------------...----------------•-•--.........-•----......-•----..... U Nature of Repairs or Alterations—Answer when applicable-Om7 t cessPOOls . Install 1-1000 tank 1-dis --ribut o , box -1-1J00 Prallo leach- Di `-- .................................• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board o health. Signed ------- ��/{�j� /:".! 1� ! ....... /5/93.....:------ Dace Application Approved By ------------ � ... ...... .c -....._,-, .................. ........................� �.-.3•....-.�P...'� ................. Dace Application Disapproved for the following reason . .............................................................................. ........................................... ............................................................................. ------ ........ ....................................................................... Dare Permit No. ....... .--�j..-.... - `` Issued- ............... Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE ;)L)7 Certificate of (fomplizince THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired XXX) by ......J...P.Mai 0Mb e r Jr --- m,--- ----.. ....................... .-------.............. .... ... has been installed in accordance wruh«te ptovlslo s of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ....... .......... ....: dated ._...-.-.._...- PP P .3' .y�....._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.... - ...!. ._`.._� .. ................_. Inspector ............................................. .......... .......__.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE FEE 30 0o No...l...3.r y.:....1 ............. 1 t to FYI Drkv Tons#r uan rrntit o Permission is hereby gr nted -.J P,_Ma�.o.m P r-:Tr ------------------------------------------------•--- ....•..... to Cons ;Yr .,f ) or P r X-��4 {:. irl,i�1:- ��zge Disposal System as shown on the application for Disposal Works Construction Permit No,�-��\.�___ Dated------- 'y3f.r_9�J._._...._. J DATE........... �� Board of Health 2 FORM 36508 HOBBS&WARREN.INC..PUBLISHERS Mr. &Mrs. I F. Cummiskey nZ�191M P. O. Box 303 217 Greenwood Ave.Hyannis Port,Ma. 02647 Town of Barnstable Department of Health, Safety, &Environmental Svcs. 367 Main Street Hyannis, MA 02601 i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA i Mr a Mrs'1. .Cummiskev P.O.Box 503 ` 217 Greenwood Ave. Hyannis Port,MA 02647 Fax 508 778-4235 March 28, 1997 Town of Barnstable Department of Health, Safety, & Environmental Services 367 Main Street Hyannis, MA 02601 Gentlemen: tnctosed fs our Application for a Bed & Breakfast at 212 Greenwood Ave. As you requested, below is a sketch showing the location of the sink. As you know, the Title V septic system is being completed today.. Please contact,us if there is anything further you require. Sincerely, John F. and Carol A. Cummiskey Encl. 1 Px �1Vf Parcel No. R288,174 Key No. 192749 t Town of Barnstable • Department of Health, Safety, and Environmental Services r �B"MAW Public Health Division .s6�9 � 639 N 367 Main Street, Hyannis MA 02601 Thomas A.McKean Office: 508-790-6265 Director of Public Health FAX: 508-775-3344 SEATING ANNUAL SEASONAL ASSESSORS MAP AND PARCEL NO. DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT NAME OF FOOD ESTABLISHMENT t ADDRESS OF FOOD ESTABLISHMENT off. G'i 66IJ W06 L) 14-V6 TELEPHONE NUMBER -7 7J5-'Oe?0 TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD X BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES SOLE OWNER: YES NO IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: G°1+40 L A S�e IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK ads ,, SIG R'V- NA UR �F APPLICANT RESTRICTIONS: HOME ADDRESS All D A 50 3 HOME TELEPHONE