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HomeMy WebLinkAbout0087 NAUTICAL ROAD - Health -UTICAL WAY , HYANNIS 87 & 89 NA ; A = 306 231 i t D A Y t o � 3 ,i I 0 YOU WISH TO OPEN BUSINESS?' _ 7 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 200Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI.,3 .Main St,aHyannis,MA,02601 Crown Hall)and get the Bus.iness Certificate that is required by law. DATE: t Fill iri'please: Ik `Tr APPLICANTS YOUR NAME/S t�ril i cI BUSINESS YOUR HOME ADDRESS: a r4 A- TELEPHONE # Home Telephone Number C-el sca�tcarra�u�a .. :.. NAME OF CORPORATION. - _ NAME OF NEW BUSINESS 1, TYPE OF BUSINESS n IS THIS A HOME OCCUPATION? V' YES NO _ y ADDRESS OF BUSINESS i. - t_ I f MAP/PARCEL NUMBER ` When starting anew business there are several things you must.do in order to be in compliance with the rules n o s ftlle�0 Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST. GO TO 2 in -(corner of Yarmo 11 Rd.&'Main Street).to make sure you have the appropriate permits and licenses required to legally operate your b ess in this town. 1. BUILDING-CO MIS 10 R'S OFFICE This indivi 1 1 a inf rme f a .p re iremen t p i t this type of business. d ' Autho i attire** r MME TS ►eLX 2. BOARD OF H ALTH <` MUST COMPLY WITH ALL This individual has been info rN rements that pertain to this type of bu i : .. RDOUS MATERIALS REOUI ATIONS . Authorized Signature COMMENTS: 3. CONSUMER"AFFAIRS(LICENSING AUTHORITY) w This individual has been.informed of the licensing'requirements that pertain to'this type of business.,L, Authorized Signature**-. COMMENTS . -' a •' . r TOWN OF BARNSTABLE Dater /20/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF'BUSINESS: N P, e r� BUSINESS LOCATION: 'a i ' NTORY MAILING ADDRESS: "A apw. TOT MOUNT: TELEPHONE NUMBER: b 19 "9O CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: �� � � 4 rl.� MSDS ON SITE? TYPE OF BUSINESS: 1 INFORMATION / RECOMMENDATIO . 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 requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) L Gasolin 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) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers dshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applica is Signature Staff's Initials loop No. ee THE COMMONWEALTH OF MASSACHUSETTS Entered incom*Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for M1sp08AY *pstrm Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon 96 ❑Complete System ❑Individual Components Location Address or Lot No.S 7 n A)4,vA Owner's Name,Address,anq Tel.No. Assessor's Map/Parcel 36401 919 1 �� �� � Installer's Name,Address,and Tel.No. �j 019-�/_ 9 1917 Designer's Name,Address,and Tel.No. ��lo-fh- &, iYc4Aba,) ys-=�u5�v&A ! "74A o a -1 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) 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 Environme o and not to place the system in operation until a Certificate of Compliance has been issued by this Board of He . Si ned Date J Application Approved by m Date Application Disapproved by Date for the following reasons Permit No. Date Issued ,.--.a=-v -+n..vr......... .-.n..�_.......owa+w^w.� ... ��,p.rx.,.-..»r.,. .wd�FfiCq.J�FeFpvw6-w'vw«w..�--'-c.w7..r.^+w.»..,...-.,w ,-... ... -_.,=.''-r.vcnr'i r•+��:/..w-. ...-.. _.-:... No. ! ee \ OMMONWEALTH OF MASSACHUSETTS Entered in com ter:\ PL-1(�C% 'dSION TOWN OF BARNSTABLE, MASSACHUSETTS Yes 21pplltation for bisp08al 6pstPm (Construction VPrmit Application for a Permit to Construct( ) Repair( -) Upgrade(' ) Abandon 06 ❑Complete System ❑Individual Components Location Address or Lot No.8?/ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 3C;, a�/ d Installer's Name,Address,and Tel.No. .-OS-/29/_ 9 3 47 Designer's Name,Address,and Tel.No. ��o�a� C.G/►�S'�-yvL..�-t'o�yS-�r�uS�v„1/'`'� 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 Ti le Y Size of Septic Tank Type of S.A.S. r Y Description of Soil Nature of Repairs or"Alterations(Answer when applicable) c Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental-Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health:-" i ed _ v-- Date /i Application Approved'by /�� d ll Date Application Disapproved by �� l V Date for the following reasons Permit No. '' Date Issued 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 l/�y�401n6`'r%<Jrt Y �{tl y1 at Q( 6/r , - / ,'S has been cons cted in acc,rge c- with the provisions of Title 5 and the for Disposal ystem Construction Permit No. id InstallerYjr 1,t-!�c Designer #bedrooms Approved design flow j IJ gp d The issuance of this permit shall/not em� be construed as a guarantee that the syst wil!1// ct'on as def sig �nelJ ? Date Inspector // f --------------- -� - - - - _ :._.._�_. 4N' Ni 5��­ Fee - - -- - �`I'HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS M1sposat *pstem Construction JCrmlt Permission is herebyanted to Construct " µ granted ( ) Repair(, +p) Upgrade( ) Abandon System located at q 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 plete within three years of the date of this permit. Date / Approved by / 1 i Commonwealth of Massachusetts W Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for Y rY every page. City/Town. State Zip Code Date of Inspection Inspection results must be submitted on this form: Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. important: A General Information When filling out I forms on the ��� • computer,use - 1. Inspector: only the tab key to move your David D. Coughanowr , cursor do not Name of Inspector use the return key. Eco-Tech,Environmental Company Name A .. ;., r� 43 Triangle Circle, Company Address p Sandwich ¢' MA 02563 'e"07 City/Town R State Zip Code -508 364 0894 1328 Telephone Number * License Number B. Certification 'I certi that l have ersonall inspected the sewage disposal system at this adds ss and th6fthe fY p Y P 9 P Y e - f ?information reported below is true, accurate and complete as of the time of the inspection. TlTe insp*ction was performed based on my training and experience in the proper function and n aintenan4of of ite sewage disposal systems. I am.a DEP approved system inspector pursuant-to�Sectionr .34Q,.gf Title 5 (310,CMR 15.000). The system, a 1 C3"A E Passes ❑ Conditionally Passes ❑ Fails a ❑,,Needs Further Evaluation by.the Local Approving Authority '' t _ February 13, 2010 ,. Inspector's Signature Date The system inspector shall submit a copy,of this inspection report to the Approving Authority(Board ' of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the,buyer' if applicable, and the approving authority. ****This report only describes conditions'at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of,use. ,, ,. ^Page 1 of 17 it. t5ins•09/OS Title 5 Official Inspection Form:Subsurface Sewage Disposal System Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 requited for y ry every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or-E./always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Inspector's Note==>" A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed on the'day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing determination. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,,will pass. Check the box for"yes", "no"or"not determined (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection.if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 _ f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) } B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced, ❑ Y ❑ N ❑ ND (Explain below): t '❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ - distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): El 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: . 5 ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a+bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every 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 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 .El ® 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 Y2 day flow t5ins-09/08 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 85-87 Nautical Way Property Address Alex Colella Y Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every page. City/Town 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. 0 ® 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•09/08 : Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form =Not for Voluntary Assessments °M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 Februa 13, 2010 required for y rY every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done:You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? = ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location.of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ e Existing information. For example, a plan at the Board of Health. Z, ❑ 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): n/a. Number of bedrooms(actual): 6 (assr) DESIGN flow based on 310 CMR 15.203 (for example-.110 gpd x#of bedrooms): n/a- no plan t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 • t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 3+ Does residence have a garbage grinder? '" ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? a ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 398 gpd Detail: 2008-2009 Sump pump? ❑ Yes ® No Last date of occupancy: current 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13 2010 required for Y rY , every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: t Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box,`soil absorption system ❑ Single.cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) Innovative/Alternative technology: Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP'approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y rY every 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: Age: 10+ years. Certificate of compliance issued 1/18/2000 (Board of Health permit#2000-19) Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 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.): No evidence of leakage or backup into dwelling was observed. Septic Tank(locate on site plan): Depth below grade: 2.5 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: 8.5ftx6ftx5ft(1000 gallon) . Sludge depth: 10 in t5ins•09f08 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 °M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13 2010 required for Y ry , every 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 24 in Scum thickness 2 in Distance from to of scum to to of outlet tee r 9 In P p e o baffle Distance from bottom of scum to bottom of outlet tee or baffle 13 in How were dimensions determined? As built card Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence-of leakage, etc.): Pumping is recommended at this time and maintenance pumping is recommended every two years. Outlet tee not observed check for condition at time of pumping. No evidence of leakage in or out was observed. Grease Trap(locate on site plan): Depth below grade: feet E Material of construction: '❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: i 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•09/08 Title 5 Official Inspection Forth: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 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for _Y rY every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 li Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for Y _ rY every page. City/Town 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 at outlet invert 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 appears level with no evidence of leakage in or out. Some solids in sump.A bucket of water was poured into the distribution box and was observed to pass through in a rapid and unobstructed manner, and could be heard splashing down into the leaching gallery. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/06 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 85-87 Nautical Way Property Address F , Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 1 ❑ 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.): Soils above leaching gallery appeared unsaturated. No evidence of surface ponding, breakout, lush vegetation, or other evidence of hydraulic failure was observed. An observation hole was dug into :leaching gallery stone and no standing effluent or effluent contact staining was observed in the stone or overlying soils. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool' Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 Februa 13, 2010 required for y rY every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t �M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for Y rY every page. City/Town 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 i 42f{ l3 �t 2 So it ? �t � 20 R300 WNY • d3 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 1 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: Barnstable GIS Department records You must describe how you established the high ground water elevation: Town of Barnstable GIS Department records indicate that the property is over 12 feet above groundwater table. , Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ` ° f R Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 85-87 Nautical Way Property Address Alex Colella Owner Owner's Name information is Hyannis MA 02601 February 13, 2010 required for y ry every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ®; Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE LOCATION r �. E �A Y' SEWAGE # VILLAGE. IV S AS ESSOR'S MAP & LOT INSTALLER'S NAME&'PHONE NO. SEPTIC TANK CAPACITY /O O y LEACHING FACILITY: (ty _ /�t/ �,%�/t' Tr�� (size) NO.OF BEDROOMS BUILDER OR OWNER . PERMITDATE: COMPLIANCE DATE: © 9 AqV 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 n or,within 200 feet of leaching facility) Feet o site g ty) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ti <A � w ! , 1 { et rr a No. C / Fee E` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: L Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIpprfcation for Mi.5pool *potem (Com5truction Vermtt Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. Q —j //�,�UT1 C�C- Owner's Name,Address and Tel.No. Assessor's Map/Parcel �0( Y Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. M l O—G1)'p -�`Yr-fl<L -57 cJY ST 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 J gallons per day. Calculated daily flow 5.lc— U gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank STj= PACOo7/� s'°'� Type of S.A.S. -141,4wea cicb7 (� Description of Soil �rz�l1�.s�tn Nature of Repairs or Alterations(Answer when applicable) i i fC, 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 Enviroftmeti a and not to place the system in operation until a Certifi- cate of Compliance h en issued by th' Health. // Signed Date [9 `moo Application Approved by Date Application Disapproved for the following reasons Permit No. 00—�� Date Issued 12 4— 7-- 2r" S No. 60 0 / ,..»,...-:-� Fee y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes , PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pplicatton for 33iopogar *potemY Congtructton Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System Individual Components Location Address or Lot No. B 7-- j�r vT+cc,L Owner's Name,Address and Tel.No. Assessor's Map/Parcel 3 0(o �Y �"S C Q '-et l C�,_ 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 gallons per day. Calculated daily flow ` - � gallons. Plan Date Number of sheets Revision Date a title Size of Septic Tank k.r 5 i I !�,d v Type of S.A.S. 4J �i C ,, /94,6 1-7 Description of Soil; Nature of Repairs or Alterations(Answer when applicable) /.. '.�e ' 7-An I/ T)r- /�/a r! r r'`t t t �e� C T"jam.✓ r. /r, t-L% a'Nt 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 hhaas-been'tssued by th y o Health. `_ - Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. 0_01 1 g Date Issued Zf" ----------- —'-------------------------- THE COMMONWEALTH OF MASSACHUSETTS 3 06_ Z 3 / BARNSTABLE, MASSACHUSETTS Certificate of Comphance 6 i THIS IS TO CERTIFY,that the On-site Sewage Dis osal'S stem-Constructed Repaired Upgraded g P�� Y �-- ( ) P ( ) ((� Abandoned( )by j'�11.7 -��/�L' S'� �E— - at '?�"� S �'��T i�_�t va., �'�.�� .c u� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit I CJ 0- dated /- 7- Z&O-d . Installer Designer Q The issuance of this VAe t, all not be construed as a guarantee that the s e ill ffu c ion s d�e gne / Date Inspectors No. 0 0 0 / Fee t THE COMMONWEALTH OF MASSACHUSETTS 3 06- Z 31 PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS 1wigo5ar *pgtem Congtructton Permit Permission is hereby granted to Construct( )Repair( )Upgrade(L-- bandon( ) System located at U 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 date of this ermit. ,r Date: Approved by. � `aC7 Ori;end M Recycled Qpper 1!6l99 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AYD APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (W=OUT DESIGNED PLANS) I, hereby cermy that the application for disposal works construction permit signed by me dated —�9 `�(� concerning the property located at �'� ��Cc U Lit + Cc, L fig- sty meets all of the following criteria: The failed system is conner ed 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 Pert of the proposed septic system / There are no private wells within 1:0 feet of the proposed septic system There is`no increase in flow and/or change in use proposed There are no variances requesed or needed. fi/ The bottom of the proposed leaching facility will not be located less than five feet above the ma..-dtnum adjusted groundwater table elevation. [Adjust the g.*otmdwater table using the Frimptor method when applicable] If the S.A.S. will be located with'_j0 feet of any vegetated wetlands, the bottom of the proposed leaching facility will not be located less than founern(14) fee, above the maximum adjusted groundwater table elevation. Please complete the following: d' A) Top of Ground Surface Elevation(using GIS inf6rmadon) �' r B) G.W. Elevation the m,�-(. High G.W. Adjustment . 4� = 3, DIF E-REvCG BETWEEN+A and 3 - 620'-t— IS v SIGNED : D�i E (Sketch proposed plan of systern on back]. q:health,older.c-t ~ J �� . .��I C e� TOWN OF BARNSTABLE s LOCATION111,ZV7'J- 6" L SEWAGE # VII.LAGE i A -S AS ESSOR'S MAP & LOT 4 INSTALLER'S NAME&PHONE NO. 7,2Q_t✓�rS' SEPTIC TANK CAPACITY /n tJ J LEACHING FACILITY: (ty /.L/ /l�V,4 Tc42 < (size)NO.OF BEDROOMS 1 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: O c�O 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 6( . � i c t �f