HomeMy WebLinkAbout0588 OLD STRAWBERRY HILL ROAD - Health 588.OLD STRAWURRY HILL,HYANNIS
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YOU WISH TO OPEN A BUSINESS?
For Your Information: Business certificates (cost$40.000 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Cleric's Office,1"-FL., 367
Main Street, Hyannis, MA 02601 [Town Hall)
DATE: O�/,2 3 l a o l:) Fill in please:
APPLICANT'S YOUR NAME/S: ct�aw $olr Z
BUSINESS YOUR HOME ADDRESS: S8 8 � S � /YYa O�E 3 Z
i.41
ce.Ii;:rrSlr�� _
TELEPHONE # Home Telephone Number O 9 .360 S66 S
NAME OF CORPORATION: 55 toP bclN
NAME OF NEW BUSINESS TYPE OF BUSINESS —"
IS THIS.A HOME OCCUPATION? YES NO Of 0-2632-
ADDRESS OF BUSINESS MAP/PARCEL NUMBER �� (Assessing)
with the rules and regulations of.the Town of
are several thins you must do in order to be in compliance I h h
.When starting a new business therer g y P 9
Barnstable. This form is intended to assist you in obtaining the information you-may need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. & MainStreet) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COMMISSIONER' FFIC MUST COMPLY WITH HOME"OCCUPATION
This individual has been-'f rime/anypermit requirements that pertain to this a of busines
type P q P MULES AND,REGULATIONS. FAILURE TO
COMPLY�--
MAY FiE UI_� IN FIN€ .
A fiorized Si nature** //
COMMENTS: y
2. BOARD OF HEALTH
This individual h n infor a of the permit r quiremw ts that pertain to this type of b`MUgfftoMPLY WITH ALL
HAZARDOUS MATERIALS REGULATIONS:
Authorized ' n ure*
COMMENTS:
3. CONSUMER AFFAIRS [LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
ff
I
bate:04 12J /-J5
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM
(,,NAME OF BUSINESS: j�l�I i�/Ti ,r/�� � c_ MA
BUSINESS LOCATION: 5f.9 OLA 4571-Z4 x -l-I/lL X44 INVENTORY
MAILING ADDRESS: &4klAe-46t e )4iCL Roe- Jay4,1,;4.1- TOTALAMOUNT:
TELEPHONE NUMBER:
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUMBER: (Sod J60 3o ` q MSDS ON SITE?
TYPE OF BUSINESS: h-fI'A16
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use,
storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals(Developer)
lubricants, gear oil ❑ NEW ❑ USED -
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt&roofing tar PCB's
Paints, varnishes, `stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform,formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous(please list):
Metal polishes
i
Laundry soil &stain removers
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials
DATE: _ 7/15/96
PROPERTY ADDRESS: 5RR nld Strawberry Hill Road
- RE ED
02632 AUG. 1 1996
-- HEALTH DEPT.
TOWN OF BARNSTABLE
On the above date, 1 Inspected the septic system at the above address.
This system consists of the following:
1 . 1-1000 gallon septic tank. Center cover.
2. . 2-1000 gallon precast leaching pith. '
Based bn my Insoaction, I certify the following conditions:
1 . This is a title five septic system. ( 78 Code
2. The septic system. is in proper working
order at the present time.
SIGNATURE:
Name _J P Racomber Jr. _______
Company:_J. P.Macomber &_ Son-_Inc . ;
Address:_-Bs-,-bb-----= ---,--
Centerville , Mass__02632
P-hone:__,
1
THIS CERTIFICATI014 DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
,JOSEPH P. MACOMBER & SON, INC.
Tanks-Cestpoolt-Leschflelds
Pumped 4 In"116,d
Town Sewer Connectlons
P.O. Box 56' Centerville, MA 02632-0066
775-3338 775-6412
• a
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
William F.Weld Trudy Coxe 1
00wrnor 8--taq
Argoo Paul Celluoal David 13.Struhs
LL G tumor Can dazwrrr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
PropertyAddre.,: 588 Old Strawberry Hill Road Cent. AddressofOwner.. 10 Hiltz Ave
Date of Inspection: 7/15/9 6 (If different) Lak e v i l l a,Mass .
Nameoflnspector.. Joseph P. MAcomber Jr. 02347
Company Nance,Address and Telephone Number.
J.P.MAcomber & Son Inc. Box 66 Centerville,Mass. 02632 508-775-3338
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sew disposal systems. The system:
�s
— Conditionally Passes
— Needs Further Evaluatio By the Local Approving Authority
— Fails r� � �
Inspector's signature: Date-
The
system Inspectors aubmit 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 wind copies sent to the buyer,if applicable and the approving authority.
INSPECTION SUMMARY:
Check A,B, C,or D:
A] SYSTEM PASSES:
�/I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
B] SYSTEM CONDITIONALLY PASSES:
_V One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes
inspection.
Indicate ye4,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not)
The septic tank is metal,cracked,structurally unsound,shows substantial infiltration or exfiltration,.or tank failure is
imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Street a Boston,Massachusetts 02108 a FAX(617)556-1049 a Telephone(617)292.5500
i�Printed on Recycled Pape
_`."''SUILr 10E SEWAGE DISPOSAL SYSTEM•INSPECTION
PART A s,
CERTIFICATION(continued)
588 Old Strawberry Hill Road Centerville,Mass.
Joseph Beneski
7/15/96
: r:.'SSFS (continued)
Srwabw backup or i reakout or high static water level observed in the
or due to a broken, settled or uneven distribution box. The system e distribution
��a box is due to broken or obstructed pipe(,)
Health): Pass inspection if(with approval of the Board of
broken pipe(s)are replaced
obstruction is removed
distribution box is levelled or replaced
The avStom -quir d pumping more than Tour timeg,8
with approval of th
year due to broken or obstructed pipe(,). The system will pass
inspection if( e Board of Health):
broken pipe(s)are replaced
Obstruction is removed
C) FURTHER EVALUATION IS REQUIRED BY THE BOA
RD OF HEALTH,
Conditions exist which require further evaluation by the Board of Health in order to determine if the system is
public health, Safety and the environment. failing to proms the
1) SYSTEM WILL P.19S 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 50 feet of a surface water
Co"Pool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh,
Z) SYSTEM WILL F.S:L UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,
DETERMINES THAT T11E SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HE
SAFETY AND THE ENVIRONMENT
TH AND
The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply surface water supply, PP y or tributary to a
4W The system has a septic tank and soil absorption system and is within a Zone I of a public water suPP�1'well.
dp The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well.
40 The system has a septic tank and soil absorption system and is less
supply well, unless a well water analysis for 'on sm bacteria and volatile o00 feet but 50 feet or more from a private water
from pc llutiou from that faciLty and the presence of ammonia nitrogen and cnitrate nitrogen is
that the well is free
equal to or less than 5 ppm s) OT'HEI{ I
--------------
(revised 11/03/95)
2
•� I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for
this determination is identified below. The Board of Health should be contacted to determine what will be neceaaa:y to correct the . CO failure. -
1
All Backup of sewage into facility or system component due to an overloaded or clo"-%),
ALP Discharge or ponding of effluent to,the surface of the ground or surface waters due w u.;.
cesspool. ;
j& Static liqui,d��l�ev��ell in khe distribution box above outlet invert due to an overloaded or clogtw SAS or cesspool.
ALJ Liquid depth +eesspeol is leas than 6"below invert or.available volume is less than 1/2 day flow.
yO R Zlui i i ven. .___..'due to clogged or obstruct p pe0j). 1
Number of times pumped _
1,[0 Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
�1D Any portion of a cesel ul u, 1::.:; •,itt::u l.::ne 1 ui a puuiic 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 unalv�i�. If the well has been analyzed to be acceptable, attach copy of well water analysis for
coliform bacteria, volatile orga:uc compounds, ammonia nitrogen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
The following criteria apply to large iyateiiuu in additi`on to the criteria above:
{
NO The system serves a facility with a design flow of 10,000 gpdi)br greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or moreof the following conditions exist:
Q/IO the system is within 400 feet of a surface drinking water supply
AO the system is within 200 fa:of a tributary to a surface drinking water supply
M the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mapped'Lone II of a public
water supply well)
The owner or operator of any such system alnail brine the sysuai and facility into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information.,
(revised 11103/95) 3
`1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Add, : 588 Old Strawberry Hill Road Centerville,Mass. 02632
owner. Joseph Behwdfki�'
Date of Inspoctim-7/1 5/96
Check if the following have boon done: - -
,Pumping information was requested of the owner, occupant, and Board of Health.
None of the system components have been pumped for at least two weeks and the system has been receiving normal tlow rates
during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection.
_LXs built plans have been obtainod and examined. Note if they are not available with N/A.
_L The facility or dwelling was inspected for signs of sewage back-up.
JzThe system doer not receive non-sanitary or industrial waste flow
i:a :i; «as insptr:ted for signs of breakout.
`,,yy
All system components,%luding the Soil Absorption System, have been located on the site.
, The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or
material of construction, dimensions, depth of liquid, depth of sludge,depth of scum.
_Y_. 1 _size and location of the Soil Absorption System on the site has been determined based on existing information or
ap 7fulty'
ed by non-intrusive methods.Th owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/W95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
rirojx,rty ,;. - 588 Old Strawberry Hill Road Centerville,Mass.
Joseph Bebeski
Datc or l,: 7/15/96
FLOW CONDITIONS
RESIDENTIAL-
Design flow:,/—gallons 100-r'(%� y
Number of bodroonu:�6
Number of current reridents:_0
Garbage grinder(,yes or no):"
Laundry connected to system(ya or no).. .y �y
Seasonal use(yea or ao):11h q � � � � � �
Water meter readings, if available:
I �
Last date of occupancy:•Z�/VEI .
COM MERC IAI./I N'DUSTRIAL:
Type of establi,+hiuent: ISM
Design flow: A1LA gallons/day
Grease trup preseut: (yw or no)j
Industrial Waste Holding Tank present: (yes or no)oVA
Non-sanitary wasta dischnrgcd to the'title 5 system: (yea or no)Mfi
Water meter r•euduxp, if avui!;,tle:_
Last date of occupancy:_,•
OTIIER: (Descrit.e). ... �
Lust date or
GENERAL INFORMATION
PU!1iPING R ::. pNe cr infortuation:
e—
System purupcd ss part of inapoction: (yes or uo)
If yes,volume pumped: 100b gall9ni c ) f
Re.von
TYPE 0 SYST2.:.L
Septic tankldIAribucou box/soll absorption system
Single az-Vp;cb
jV-6 Ovnrilow c4"p,-A '
�1� Pritiy
Shar4! system (yea Cr no) (if yes, attacb previous inspection records, if any)
poneuts, date irist.
.VLUod (if known) and source of information:
Sewage odors d-Lo-tvd wt,en arriving at the ,:,,•: (yes or no /T/p
(revised 11/03/95) b
16k
JOSEPH R MACOMUR&SON,UI(Co
P.O.Box(Be
CI RVZLF,MA 026nom
Name: Josoph eenoski Customer Code:
Address: 508 Old Strawberry Hill Road jben
Town: Centerville state: Zip:
Mailing address:
10 Hiltz Ave Lakeville MA 02347
Notes: 812191 pump T&P 185.00 rec 8)13191
916191 system LP 1500.00 pump T 105.00 9113191
11194 letter
l
t r
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
- PART C. •
SYSTEM INFORMATION (continued) r
Property Address: 588 -01'd- Strawborry Hill Road Centerville,Mass.
Owner: Joseph Beneski
Date of Inspection:7/1 5/96
EPTIC TANK:_) WP1Z,9
locate on site plan)
epth below grade:-A/
aterial of construction: concrete _metal _FRP other(explain) -
imensions: 1 7e I
fudge depth:—, � `I
istance from top of sedge to bottom of outlet tee or baffle: ,1
cum thickness:—!a�_
istance from top of scum to top of outlet tee or baffle:`_
istance from bottom of scum to bottom of outlet tee or baffle._ l
omments:
ecommendation for pumping, condition of inlet and outlet tees or affl depth of liquid IPvel in relation to outlet rove s uct ral
.grity, evidence of leaka e, etc.) .Pump tank•�ever�y 2-j years; •Inlet tee and out��e v -vess
ate in lace;, n tn nil
tlet invert:- Se
no gians of KALE. und;
REASE TRAP.4104 e—
Cate on site plan)
epth below grade:,
aterial of conslri146r-W#:oncrete _metal _FRP _other(explain)
imensions; A�
um thickness: '�/5F
stance from top vt scum to top of outlet tee or baffle: N)9
stance from bottom nt arum i- honnm of outlet tee or baffe:. AJ( -
mments:
commendation for pumping, condit-rl of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural
e rity, vidence of leakage, et
+ised 8/15/95) 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oontinued)
Property Address: 588 Old Strawberry Hill Road Centerville,Maas.
Owner. Joseph Beneski
Date of Inspection:7 5 9 6
TIGHT OR HOLDING TANK AA1�bl°� '
(locate on site plea) •
Depth below grade:,d&
Material of construction:Qooncrets_metal_,FRP_other(uplaia)
Dimensions:QR
Capacity: mpt P11 no
Design&w•, j)t_galloas/day
Alarm level:,_
Comments:
(condition of inlet tee,condition of alarm and float switches,etc.)
Ala Cgv t 1?.wrS
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: A*
Comments:
note if level and distribution is ual,evidence of solids over,evidence of leakage into or out of box,etc.)
istribution box Is level•No evidence og solids cam over• o
leakage in or out or the distribution box.
PUMP CHAMBER 4A,441e,
(locate on site plan)
Pumps in working order:(yes or no)_d�2
Comments:
(note condi''oa of pump chamber;condition of pumps and appurtenances,etc.)
��.O,n•�P�lrs' .
,
(revised 11/03/95)
DISPOSAL,SYSTEM INSPECTION FOILM
FART C
_ . i N VOILMAT1ON (continued)
Property Addruue:
Owner.
Date of Ittspeotiolt: �
SOIL ABSORPTION SYSTEM (SAS):A—,kre'444V �� ��5 T �
(locate on site plan, if possible; excavation not r�:;ui;,-.:. ilk:. ::..y Le approximated by non-intrusive methods)
!f not determined to be present. explain:
Type:
leaching pits, number: e"F
leaching chambers, number:
leaching galleries, number:
leaching trenches, nuniber,ler_gth:�Q -
leaching fields, number, dimensions
.......... ..................
overflow ce .,: 1, n::ri.!_,,r:Q
Comments: (note condition of roil, of hydraulic fu:lurv, level of ponding, condition of vegetation,ete.)
MAdium sand to fine sand;No signs of hydraulic failure or podding
All yAp:etnti nn in normal- Bo h l Aachi ng pits arA dry.
CESSPOOM: �
(locate on silo
Number and confio.:ra:iorr_.. /V1 _,—_—•--- .. __
Depth top of liquid to inlet ur•:;-:: _F___...._..
Depth of solids layer: _._--
Depth of scum Inyer:__Dimensions of cesspool;__
Materials of construction:,--.
Indication of grou::dwcitor:____
inflow(cesspool court U numpod as part of irupcction) /UT6
Comments:h ote condi:;. . 4;ir'd. rigz, f hvdra:•lic fuil::n,, level of ponding, condition of vegetation, etc.)
PRIVY: jA14)Q
(locate on site plan)
Materials of construction:
Depth of solids: �-
Co nts:(r_r•,te condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
(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 Water Company
775-0063
.• .. �,,,,:+• ._ - ._.`;per. - ''' :"' . .
Aham• i,; � r
DEPTH TO GROUNDWATER---_._-..._.
.2 dePt
2
MRthod of determ'naatt ono p oximati, ,n
No wa-tet.,enctunber4eat F2 ien.near ie�c lin it was installed
.d. g .P
atom er o c.
THE- iM
CONONWEALTH -OF MASSACHUSETTS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT MOWN THAT
Joseph P. Macomber, Jr.
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
S 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.
June 8, 1995
Acting Director of the ion of Water Pollution Control
rnnnTroT—nrr�r•+•rrTrnrmnntra.s-nrtes.rrenrn�i+norr�+er�+nnTn•!w-�tTrs•oTaTias �,.�^,�r,��:i--..
TOWN OF Barnstable . WARD:OF HEALTH
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D - CERTIFICATION
^•TMt^T•: .:T—T.117i^.T.TTIin}.T19f.'1RI T{TP7041f7171t19'''^M1'IT"{tTR70R170r^7'ATIR.f7� itifl/{ iTV`rT'7T"11+r•
-TYPE OR PAINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS _ 5RR n1 d St,.Auberry Hill Rog-d Centerville.Mass.
ASSESSORS MAP, BLOCK AND PARCEL #
OWNER' s NAME Joseph Beheski
PART D - CERTIFICATION
NAME OF INSPECTOR Josenh P_ Mannmhar Jr_ .
a
COMPANY NAME J.P.Macomber & Son Inc.
COMPANY ADDRESS Box 66_' Centerville,Mass . 02632.
Street Town or City State EiP
COMPANY TELEPHONE ( 508 1 775 - 3338 FAX (508 790 - 1578
CERTIFICATION STATEMENT
I .certify that I have personally inspected the sewage disposal system at
this address and that tlr'e information reported is true, accurate, and,
complete as of the time of. inspection.. The inspection was performed . and any
recommendations regardilig upgrade , maintenance , and repair are consistent
with my training and experience in the proper function and maintenance of 'on- '
site sewage disposal systems .
Check one: •,
.XXXXXXXXXXX System PASSED t
The inspection which I have conducted has not found any information
which indicates that. the system fails to adequately protect public
health or, the environment as defined in 310 CMR 15. 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED* .
The inspection whicji I have conducted has found that the system fails to
Protect the public health and the environment in accordance with Title
5 , 310 CMR 15 . 303, .and. as specifically noted on PART C - FAILURE
CRITERIA of this inspection form . .
Inspector Signature Date '
One copy of this ertification must be` provided 'to the ..QWNER, the. BUYER
( where applicable) and the. -DQARV OF HZALTII.'
• �:A ;npy,99G$Pn �L40, th-e owner os� operator ehal�, upgtlgde 'the vy8tem.
within °o'n9' year or 'tl�e.:du;Ce of the inspection, unless":;allowed or required_
otherwise as provded`�.in 310 Ch1R 16 .306 : ' 1
HAIt�S�.
�` �M CERTIFICATE OF ANALYSIS Wage: 1
Barnstable County Health Laboratory
Report Dated: 11/10/2004
Report Prepared For:
SAP, 73 Order No.: G0428598
Pablo Motta PARCM 101
588 Old Strawberry Hill Rd. LOT e
Eetil•1p,, MA 02630 - -----
Laboratory ID#: 0428598-01 Description: Water-Drinking Water
Sample#: 2859811 Sampling Location 588 Old Strawberry Hill Road Collected: 11/9/2004
Collected by: PM Received: 11/9/2004
Test Parameters
ITEM RESULT UNITS RL MCL Method# Tested
LAB: Inorganics
Alkalinity 13 mg/L as CaCO 1.0 EPA 310.1 11/9/2004
Approved By:_
( Director)
t
c� Aa
< w
cn
RL = Reporting Limit
MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
TOWN OF BARNSTABI:E
ti
LOCATION 04
,5 r4w� t Rd SEWAGE # � -
.
VILLAGE #YWXAekSS- F—SSOR'S MAP & LOT
n —
!NSTALLER'S NAME & PHONE NO. `.���� 'I�CGM br,
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) py � _(size) (70�
NO. OF BEDROOMS PRIVATE WELL O PUBLIC WA',''EEC
BUILDER OR OWNER
»ATE PERMIT ISSUED:
DATE COLlPL1ANCE ISSUED: �---- ---- --___.-._—_.
VARIANCE GRANTED: Yes _ No
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APPROVED Fss.....$...30 -09
No.. ._.....
Barnstable Conservation Commission
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Signed Date TOWN OF BARNSTABLE
. pphra#iun for 14upuual Vorks Tonstrudion Vrrmit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
588--Ol�d_.S�rawberry H 11 _Road 5e-gv �e �
•- --...- -._...-• --------- #--------------•-....................................................
Location-Address or Lot No.
rtteneskil
...................... --------........------•---......._......--•-••----------------.------ .........._................................................................................_.....
Owner Address
W J.P:Macomber Jr.
,• •.............................•------•-----------------------._.........----------------....------ .......-•----------------.....------------....---------..._------..............------------------.
9q Installer Address
Type of Build' 2 Size Lot............................Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
P4 Other—Type of Building ............................ No. of persons-----------------_.......... Showers ( ) — Cafeteria ( )
Ga Other fixtures ------------------------------- .
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid*capacity......--....gallons Length------_-------- Width................ Diameter---------------- Depth................
x
Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No---_--------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date---------------------------------------
� Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..---.-----------.-----.
GZ4 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................
P4 ----•-•-•-----------------•-------•-----------------------------------------•----------------•------.........................................................
0 Description of Soil-... .. _
x -Sind---g�---��'�:�r�I----•....................•-------------------------------------------------------------------•----•-------._.........---•-----
U .............
W ------------------------------------•-•----•--•-•--••------------------------------------•----------------------------------------••---•------------•-------------•••-------•---------------------------
V Nature of Repairs or Alterations-Answei mtnJ .nli
9TIltan----Ieac Yh p-i:t------------•------------------------------------------------
--------------------------------•-•-------------------------------------------•--...........---•-----•--------------------------------------------------------••--•------------••---•--•-•.....
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 Compliant has bee ifed b the boa d of he h.
Signed �✓ ------ .. ....................
} Dace
Application Approved By .............
--------- U <.a w� ., ... -_ �' � ...
Dace
Application Disapproved for the following reasons: --- ------------------------------------------------------------ --- ------------ ----------.....--------
- - -
Permit No. ..........7----------3
7/------------------ ---- Issued -----------------------------------------------------------`e----
Due
J
No......................... Fss.....$....3�..
\ THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
Appliratinn for Dispniittl Works Tonstru r#iun liermi#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: , / }
588 Old Strawberry H'. 11 Road Gent-ervt-1-1e
........................._.._......- - :. .....----------------------............... ........................
........ - - .........
- -•----
Be ne s ki Location-Address ,p6 � or Lot No.
•...............•......._.-•---••-----------.........--•------------------------------•-••------- ................................=.................................................................
W
J.P.Ma e omb e r Jr. Owner Address
Installer Address
Type of Building Size Lot................. ......Sq' feet
Dwelling No. of Bedrooms...._._._..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No`.'.of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ----------------------------------------•----
W Design Flow............................................gallons per person per'day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area-___-_-------_---_sq. ft.
Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit....................•Depth to ground water........................
(s, Test Pit No. 2.:..............minutes per inch Depth of Test Pit.................... Depth to ground water........................
r
0 Description of Soil...
__;..................
-----------------.......------------------------------------------- -------------------------••-•----------------._-----
x ......-__._Cana t� Urave 1
-------------------------------------------------------------------------------------•-----------------------------------------------------------.......----------------------------------------------
U Nature of Repairs or Alter,,ations—Answl then;appl �ble�.Ci...._,ticti---pi'i;"......----••......-----'••---•..............•---......---
---------------•-----------------•--•-----------•-•------------------•--....---------------------------------••---•-----------------•--•-------------......-•-------...---......._..............._..----
-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 Compliant has ben issued by the bo d of h a th.
I. N - _
Signed 9.. 4../41..�'g
/ - Dare
Application Approved By ............ -- ..,.... - �L t
Application Disapproved for the following reasons:
............................... ..
,. - . Dare
Permit,No. 7 ....... .o�/........................... \ ` Issued ........... �e
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH A�
TOWN OF BARNSTABLE
CIlelrtifira e o Count tiance
f � �
THIS IS TO CERTIFY, That the Individual_Sewage Disposal System constructed ( ) or Repaired (XXX)
ay ..-�Tx-P.>-M c.nmb.Pr.--Jr.------------------------------------------------------------------ --------------------------------------------------------------------�-------------------- ----- ........---..
iInsra ler
i!I at �8---St-rawberry...Hill
....Road
.-----.. ....Old.......---Centerville..........
........................
..........
...........................--------
{� has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in
I the application for Disposal Works Construction Permit No. ........�1/-... ........ dated ................................................
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
•# R A I �t �y r L tr r Y /k
DATE.. - -------------------Y---------------------- Inspector ..... .� . ? ,
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
FEE............Jo....
t.
Disposal Worke Tonstr inn "prrmii
J P Macomber Jr
Permission is hereby granted '....................... ............................. .....
to Construct ( ) or RepairX(X ) an Individual Sewage Disposal System
at No..AK.....5P?E.R?:d...St8.Xb.9 rv•-Ha.11...Road...Centerville..........:.... =..... =
Street q
as shown on the application for Disposal Works Construction Permit .. Dated..........................................
--------------------------------------------------------
a d of Health
DATE...........
FORM 36508 HOBBS&WARREN.INC..PUBLISHERS
�Lo 6� vool�
LOCATIO 5 ,Wo,Cj ERMIT UO.
*V-Waw
IWSTQ ER U ME 4c, ADDRESS
BUILD _ R 5 Q, -E P, ADDRESS .
DATE PER"VT ISSUED =—
D ATE COMPLI &MCE ISSUED : AO
l
O
t
j
�� '� ihl f/• '
No...... ...... Fna....../d.. ..._
THE COMMONWEALTH OF MASSACHUSETTS
BOARD O HEA T,
_...... .. . _......... OF......:.. ... ... .. ... _ _r:............................
Appliratiun -for 43hipood Worko Tiat arurtion Vane t
Application is hereby made for a Permit to Construct ( "�'Or Repair ( ) an Individual Sewage Disposal
Syst.e7 at
a In-
.......... s or o. r
17 ..11�1P�.._._ . `.- �
A..................... __ .yYrr� 5S_ l�
F Installer Address
G�
d Type of Building Size Lot-. .. _&...._...Sq. feet
Dwelling Building...
of Bedrooms............... !---.---.---..------.Expansion Attic D�') Garbage Grinder ( )
aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures -------------------------------- -
g � g< P P P Y y gallons.
W Design Flow.... ........... . ... Mons per erson per day. Total daily flow..............................
WSeptic Tank-Liquid capacity/gallons Length---------------- Width-.......__.... Diameter----- .......... Depth................
x Disposal Trench—No. .................... Width-------------------- Total Length..-.--..-..--..----- Total leaching area--------------------sq. ft.
Seepage Pit No-----------/------- Diameter----100d--- Depth below inlet--------------------- Total leachi g a t------------------sq. it.
z Other Distribution box ( ) Dosing tank ( ) ake S��'.� AO P1)
aPercolation Test Results Performed bY-----------............................................................... Date----•-----------------------------
a Test Pit No. 1................minutes per inch Depth of "lest Pit.................... Depth to ground water_----....---. --.._...
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................-.-.----
� Ze �......
? -------
� 1 P. .
O Description of So- -- -- -- �-------
W /
U Nature of Repairs or Alterations—Answer when applicable....-...........................................................................................
---- -•------------------------------------------------------------------------------------•--•....----------------------------------------•-------.-...-...-..--•----•-•----•------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersi fu agrees not to ce the system in
operation until a Certificate of Compliance has bee tss d by the bo of 01^�Ai"76
... �..Sig ed -s��-=
Date
Application Approved BY--- f - jo - --•-- -- --•-•-----•�_=,2-y 7p..y.. '.7L
Date
Application Disapproved for the following reasons------------------ --------------------------------------------------------------------------------------------
...................•-•--••-•--------•-•--•-------•-----------••--••-----------•-•-----------•---------------------------•--•----......-•-•-•-------••--•-------------------------•----------.......-----
Date
Permit No.......Z2
......................................... Issued.
Date
------------------------------------ -------------.--- _--.-----__.-----------A---------------- -_-- - -' -- - - _
Fiziic ... h......
THE COMMONWEALTH OF MASSACHUSETTS
--y-� BOARD OF HEALTH
-.1/..rf. '.%,..- OF...........X.-!.s[.'S...;1�I/�'L. s ...............
Appliration -for 4%ipoottl Works Tonotrnrtion Vrrni t
Application is hereby made for a Permit to Construct ( -,,"Or Repair ( ) an Individual Sewage Disposal
System at"'
--=----- ------ r r
�� Lo anon- ddrss `` or Lot No. j e
-------------------------- --------------------------•-- -- ,
wne Addr ss
a �J� f, .� == --• •---•-••------------------••-•-••-••••---••--•--•----•------------•......----•-----........-----
..... ------•--•----
Installer Address
QType of Building h Size Lot.._;�.I......:.t��:__..___Sq. feet
Dwelling—''o. of Bedrooms............... -'_.'........_._..___._._Expansion Attic (?S") Garbage Grinder ( )
aq Other—Type of Building ----------- ----••__-_-___- No. of persons..-.____--________-_--_--._- Showers ( ) — Cafeteria ( )
a' Other fixtures --------------------------------- -
W Design Flow...j_.._.______`�l!...................gallons per person per day. Total daily flow..........................------------------gallons.
WSeptic T;Ink—Liquid capacity-/ gallons Length________________ Width................ Diameter---------.------ Depth..-.-----..-----
x Disposal Trench—No_ ____________________ Width.................... Total Length-------------------- Total leaching area-------.------------sq. ft.
Seepage Pit No------------/....... Diameter.....� �'l4$-- Depth below inlet-------------------- Total leaching area------------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) (j/'. ``a '.2 /^ - y11 .
W Percolation Test Results Performed by-------------------------------------------------------------------:...... Date----------------------------------------
Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water------------------------
;14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water_-.-.--.__---__--_-----.
W --------- r - - ---'--'--------------•-•-----.••••�-••••••.......--•---;-i....----• .-•---•......-•----------•-----....._.._........••----.
O Description of Soil s ' YVq n, l �� �f - (� ��r LA_._..._._r� �.._ T r••r- � �/_r (�_.._rAm_.�.rp
(xj r"'` "f �3---------- •------ .--( -rJ_ ..... ..:4-�� �'� ,j_?..t 1` - �1 /
W
V Nature of Repairs or Alterations—Answer when applicable.----------------------------------------------------------------------------..._---.--._--..-..
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code.— The undersigiied,further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
... ---- ----....'Signed
f---��/•/ !�;� �('Va:f"�_____L �.__'%U�'/�'_� .�� Date
Application Approved B r. _ _ .... ' / t
PP PP Y -`-d, ��� c •••. r - ,/' Date
Application Disapproved for the following reasons:................./_......_____..____._.--_......_.._._.._.._..._......._._______________._....__._.__._....._.
---•----•.................................•--------------------------•-------•---•--•-------•-------............----•----------- ---------•--..-.•---.--.------------------------------.-•--------•--•---
Date.
PermitNo........ .................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALT�H�r P
............... ...............
�prtifiratr of 10.11,11ntlinnrr
THIS IS TO CERTIFY, That the Indivi ual Sewage Disposal System constructed (✓)nor Repaired
` ( )
by-------•....--•---...._••_._..... .....•-• ,C(!P_�, .� ..:+ r
,� in�
l C------------- t all r �f
has been installed in accordance with the provisions of Article XI of The State .Sanitary Code as described in the
application for Disposal Works Construction Permit No--- 7f 1____ G__ ......... dated------------------1
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. / /
DATE-------- ------..... -`-- /I . /r.•..:'• --, �. I I. 11 , .
Inspector ------ ---------------------------------------------------•--•-------•----
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
"76 i ............- 1.�.--.-.�.-
......OF....... ✓2•:� r_T/ fc r .
......................................
N . ..
FEE------`--•-•---•- --
Dtspotittl orkii Qlongtrnrtion Vprmit
�`V_Permission is hereby granted------------- ------- r'!.s..... .
.�
t c .,___�_______. �_:_ r -:!.= 'c._n, _ ividual/Sewage Disposal System
f r J .,i/_ /+t
at Construct vor ----- an Ind--------------------------------------- Ire" , .../-------•-------
c�t�- Repair r )
Street 1 �
as shown on the application for Disposal Works Construction P r-pit N _7""-)�2 el-..�'_-Dated......_ _:_ _s�: 7 G_.......
oa d of Health /
DATE ------------------------- .................................................. (f/,
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS
il
14�m LOW
el4.`�4
1_
1N QF M
r
p� WILUAM yGJ
v �
No 19334
7-71A T iN E- -,Aj pA i7o 4j
tJA J OAJ 77//J -4 AJ �C A J A5 X '5
�' '77i7711V tip. . 7—/—/G Nt l\S =Z YA1 A ,