Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0245 OLD YARMOUTH ROAD - Health
245 OLD YARMOUTH RD., HYANNIS . I v i Date: % / //J TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Ek, HA-alk BUSINESS LOCATION: c�L/S O 1 • V, rYlb1Jik• 2b A wlu`jS Mid, INVENTORY MAILING ADDRESS: DO. 00C 1`01A . kv\Aw, ;i S NA9� 6n601 TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: ( � INFORMAT N/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 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) 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 n t listed which you feel Floor&furniture strippers may e t x' azardous (please list): Metal polishesIle,el 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 YOU WISH TO OPEN A BUSINESS? For Your Information, Business certificates (cost .. .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 tia operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the cornpleted form to the'Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Z Fill 'n please: r �- ��� aA APPLICANT'S YOUR NAME/S: k RE BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number z -6-- 4n s N. :NAME OF CORPORATION: TY)V)f�LU PI, rill,(_a' NAME OF NEW BUSINESS dZ� Y`n `-, ,uA, W C PE OF BUSINESS -IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINES U —t1iZm� �D wNN�5 � MAP/PARCEL NUMBER L5 J (Assessing) When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ER'S OFFIC This individu' I ha n ' l of ny ermit re uirements that pertain to this type of business. A`t orized Signature** COMMENTS: 2.. BOARD OF HEALTH This individual s een infqrKMe of th p mit Feq irements that pertain to this type of business. Authorized ignature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** f COMMENTS: ± TOWN OF BARNSTABLE LOCATION 2- �j j QG,) VA4WaW AD SEWAGE # &6 VILLAGE � ASSESSOR'S MAP & LOT ` INSTALLER'S NAME & PHONE NO. Jcr .?A W A2TS7- e65-,Q� I SEPTIC TANK CAPACITY /DD 0 e:�`)4� IN 2to LEACHING FACILITY:(type) � ` ��% �C&A.6)(size)�X!/ �L',r S?atc NO. OF BEDROOMS N�/� PRIVATE WELL O UBLIC WATER BUILDER OR OWNER AEctAx;cF Co y-�i��Quc�c�,� - �Sso�i A,,c& DATE PERMIT ISSUED: DATE .COMPLIANCE ISSUED: h VARIANCE GRANTED: Yes t No �s �� n`� �, .. a��r , � � , �' - �' r t N. ASSESSORS MAP 0: Ar .. s PARCEL NO.: : . THE COMMONWEALTH OF MASSACHUSETTS - AR® OF HEALTH 7...(���hv--- -------------OF............ ........_......-.._. Applirtatiou for Disposal Works Tonstrurtion Urrutit .. Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .............Z Y! tJL �9!�flf? 7�._e =�9 A t-1 14�vv�s 14P .... .. --• ---•----,��....X Location-Address or Lot No. l ._11f�`N,67 vP C M Nt �c�4 >c4S .4 Owner ddress aTa_.r . ................. 0 Installer Address �33,,� d Type of Building Size Lot____---•--_7.7.. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building No. of persons....l,l................... Showers ( ) — Cafeteria ( ) Otherfixtures .._ ..... J.J C--...�2-5," e-5.-•-----•------•-••---•-•-•--•---......--••-•---•---------•---------••----------•--------- aftd ail c�u W Design Flow-------------- -7 •�/�gallons per person per day. Total daily flow------•-----��-----•--•-•-•••• gallons. GY Septic Tank—Liquid capacity'--_{000.gallons Length---------------- Width---------------- Diameter................ Depth................ (e� Z _.Tv Disposal Trench— ?o. .................... Width�P -- --. S . tal Length.................... Total leaching area....................�sq.fit. Seepage Pit No---(P_4,V)------ Diameter........ ...... Depth below inlet.................... Total leaching area-_��:o( ... Z Other Distribution box ( ✓) Dosing tank ( ) - aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I..... _......minutes per inch Depth of Test Pit-----6.�........ Depth to ground water.... - .._.. 44 Test Pit No. 2.....2......minutes per inch Depth of Test Pit..../,N........... Depth to ground water-----AP4 c...... a --•------------•-----•--•-••-------------•-••-•--•-•--•--•••---•••-----......_.. .---........................................................ Description of Soil.................C,et4__ i�_l ........... v -----------------------------------•-••-•-•-•--•... •--•••----•-......-•-•- -- �6�4a991'4� 1I� R MUST 111 RmuNG......-•-•-•------• IJ Riy-'+3� W - ;ZTAi 1 w!0R,__AM .CERTIFY 1Td t" ..+4�,P.H w.L�*y = ............ .....' !t'_-A1A�__-_-----------•- U Nature of Repairs or.Alterations—Answer when applicable.;__�a�__ 4__.____°1'A�_INSTALL °""'� ,.... ,-, ,-0 FLAN. Agreement: The undersigned agrees-to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iTI E State Sanitary Code— The undersigned further agrees not to place the system in operation un a ti Compliance has been issued by the b d of health. = = / Date Ap Approved By-----------_--- ------ Date Application Disapproved for the following reasons---------------------------------••-----------................................................................. --------------•-----•----••------------•-•-------------------•-------------------------°------------...---•----•-••-••--•-•-----•...... •-•---•-••-----••-------------••--•---------••-•-••-•-••--.•-- Date PermitNo....... ................................... IssuecL....................................................... ti.y. _ � y` 1. . d •its a [ Y -z•, .� F � t' THE COMMONWEALTH OF MASSACHUSETTS EOARD OF HEALTH ... .......- OF......... C N r, �r ........................... Applirtt#taatt for Bi-gVusttl Marks Tonstrulrtiaatt rruti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Z y� ova Location-Address or Lot No. LF._._LvPFS::_....---••---------•-------•................. ....(�.._C sa €T,� --Yq —_ Owner Adl�ress ..................n!_.A S._.� 4 4 ....... ._:.:::. Installer Address d Type of Building Size Lot....--.0 7__Ae_,44 yAtsF- aDwelling—No. of Bedrooms............................................Expansion Attic ( ). Garbage Grinder ( ) aOther—Type of Building C09# 't�/3t------ No. of persons.../r------------------ Showers ( ) — Cafeteria ( ) Other fixtures .----�?_,�Ce1 L' 40-514'UR4.........................-----'......................................---------------------- s l MOO Design Flow_____________ [t gallons per person per day. Total daily flow..:....... �,........................gallons. W 'T..- i�ha�--- 04 Septic Tank—Liquid capacit _lpt�n-_.gallons Length................ Width................ Diameter----------------- Depth................ x Disposal Trench—No. .................... Widt11�4 ZS1AoPfota1 Length.................... Total leaching area---------___-_•____sq. ft. Seepage Pit No.�. .)..._..__ Diameter.................... Depth below inlet.................... Total leaching area. .ra sQ ' Z Other Distribution box (✓ ) Dosing tank ( ) t aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1... ----------minutes per inch Depth of Test Pit... .......... Depth to ground water.. ,C;r........ f3, Test Pit No. 2---2 .........minutes per inch Depth of Test Pit.e3'....._..... Depth to ground water...,�,��.._.__... aP4 --•--------•.................••---•---=---•---------•----------------------.......--------•--•---•------:...-•---......--------................-- ••---- xDescription of Soil............... S la+z ..... =. Gtri-----------------------------------------------•--•------------- V ----•-------------------------••-----•----------•------------------_•--_•-__---__._-----__--__--•------____-.-_--.-------_--------__----------•-----------------•-----_---•-----------••-•--------•--.-- W -----•-•----•-- - ------------------------------------------------------------------ --•-••-------------•-•----•-•---------------...•------•-----------•••---•-•--------------------------•-------••---- UNature 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 1 I._ E 5 of the State Sanitary Code— The undersigned further agrees not to puce the system in operation until a Certificate of Compliance has been issued by the and of health. � l,...--fi _+C /.. ![i�i �G...._..Si neC �. /� `Date a r /j •. _. - ate Application Approved By.....,....=- f'. � ._..:_ 4� -- Application Disapproved for the following reasons:----.......................................................................................................... _ ......................................::............................................................................................. ................................................---•------------ r,. - Date i 7 Permit No. '_r.SS >..r_ ._...... Issued----•--•--------�= Date THE COMMONWEALTH OF MASSACHUSETTS r BOARD OF HEALTH ..OF. ,-2/1/ " .% C -.............. ......... . . f�rif irtt#r aaf f�a>x�t��ittttre THIS IS TO CERTIFY, That. fie'`.Individual Sewage Disposal System constructed ( ) or Repaired ( ) bY--------••-----y---------------------•-----------...... .:_....:.-------••-------•••--•---------- --------------•----._...-------------.......--•-----------•- -------•- Installer.- .-/ at. ---•-------------•-----•--•---. _.-. ,,.yam-t !== has been installed in accordance with�[11e provisions of T i T%E j oite tState Sanitary Code as described in the application for Disposal Works Construction Permit No'�:._. _r].._____ dated. f�. .-.- ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A G ARA TREE THAT YFIE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................... .............................. •••---------•--•---------- Inspector.................................................................................... THE COMMONWEALTH:;OF. MASSACHUSETTS r .-------- BOARD OF HEALTH _.................... •"..(/ ' O ........................................� ...OFkice..... ..!% � ....:.._.._...: :: �.................... t ///'''``` r F r e F .x...,3_..... Disposal k� 15 U_ It rrmi Permission is herebyranted---- •-- .�..... `- to C�stru ( ) or Re air ( ) an Individual Sevi,�ge Disposal System at \'O........ ._. ._.... .+ 3c�..<Y133V. ---__-- �--_--:`" ..........................A ............................. Z5treet � as shown on the-application.for Dispo al Works Construction Permit __4�"'�'�.__ D���-�_��-�........._.. Board of ealH £hh� DATE----............................................................................ \\/ - FORM, 1255. HOBBS & WARREN, INC., PUBLISHERS ^^ "'�`~""'"• -- NSTRUCTION RF. LiAncr: &COO CORPORATION 34 Mill Street P.O. Box 498 Assonet, MA 02702 _ (617) 644-2291 o q" of 1451(-74 2 y . A- . �. OF ERT � _TOWN OF BARNSTABLE LOCATION J Cf yy$4 40a SEWAGE # i VILLAG ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �Grr- T �DZS cw-l�7 SEPTIC TANK CAPACITY /DD Z7 Cv p L 14 ! T v a clTXTTT(_ R A(`TT TTV•(rvr,Pl . Ca:C/�` ,Oi/' 1 4A0qek,&)(size)6-Xi, .SIc'x NO. OF BE — PRIVATE WELL O UBLIC_WATER I BUILDER OR OWNER �u►4NGc Cb4;_S7QuCr"u0 - : I... DATE PERMIT ISSUED: 1 1 5 ' DATE . COMPLIANCE ISSUED: c P° VARIANCE GRANTED:. Yes No. — - - � Q /4�Z_1�Al-e _Z� I TOWN OF BARNSTABLE OMPI.IANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body shops O unsatisfactory- 4.Manufacturers COMPANY,672 V 91116-11- (see"Orders") 5.Retail Stores ,� 6.Fuel Suppliers ADDRESS 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSCase lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons 177 Test Fuels: Gasoline,deLFae-thy Diesel, Kerosene, #2 (B) Heavy Oils: waste motor.oil (C) new motor oil(C) Synthetic Organics: degreasers Miscella ous: / / � �D DISPOSAL/RE(;LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O own Sewer ublic On-site Private . Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N01Z ORDERS: O Holding tank:MDC k 117-1 cj O Catch basin/Dry well ZT O On-site system l 5.Waste Transp9 r4L �a4C14,. Name of Hauler Destination Waste Product YES N0 1. 2. P o (s) In a ed Inspector Date I_ (508)778-6888 FAX 790-1811 L & M .GLASS CO., INC. GLASS&ALUMINUM PRODUCTS a AVELINO S. LOPES 245 OLD YARMOUTH RD. President HYANNIS, MA 02601 1 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANY G tA"I 6-W3 � (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS 7�1d 2-,-1-i vv41t lam' Class: 7_- 1 7.Miscellaneous A44n=s QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS0 se lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test FXa"s('oxli4, j Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: (,/W5 &w' & �� z�iS Spa rC-7 p( DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Wate Supply41 �►-S% . O Town Sewer ublic (� �° v CV 0-On-site OPrivate S 3. Indoor Floor Drains YES NO LZ E02 f '4113 O Holding tank: MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination ,WasteProd ° YES NO 1. 4-v; 2. Person (s nt wv`iewed Inspec r at Complaint Release of hydraulic oil on road at 245 Old Yarmouth Road, Hyannis Patch of fresh hydraulic oil spill located in front of L & M Glass Corp. Blue building to right facing L&M. Catch basin in front of building at edge of road. Area is not paved. Spill heads up road for 100 - 150 ft. towards Barnstable Water Co. Large spot from hidden drive sign to spruce true where All Cape Hydro Wash is located. Donna Miorandi was on site at 3:45 p.m. on 10/22/91 to observe the above. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAI AFFAIRS John Graci DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 245 OLD YARMOUTH RD. HYANNIS -6`- 4 U 3 Name of Owner L&M GLASS Address of Owner: SAME Date of Inspection: 12117199 r D F C 2 8 1999 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) TOWN OF BARNSTABLE ci HEALTH DEPT. r Company Name: nla r C Mailing Address: nla r Telephone Number: nla I 1 CERTIFICATION STATEMENT I certify that 1 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 sewage disposal systems.The system: X Passes The Inpection is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Evapapon By the Local Approving Authority performing at the time of the Inspection.My inspection does Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of its components useful life. I Inspector's Signature: G1` Date:12/17199 The System Inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING THE SYSTEM NOW AND MAINTAINING EVERY TWO YEARS. revised 9/2/98 Page 1 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 245 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12/17/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection B. SYSTEM CONDITIONALLY PASSES: n& 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. nLa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)Indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,Is 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 complying septic tank as approved by the Board of Health. nla Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced n& 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 245 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12117199 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1j(b)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 surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 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 less than 5 ppm,Method used to determine distance n(a_(approximation not valid). 3) OTHER nLa a revised 912/98 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 245 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12/17/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described 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 necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day Flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n1a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X 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.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: 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: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply " X 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 upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the B@partm@nt for NOW inform@10, revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 245 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12117/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) 11 5.302(3)(b)) X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. a . revised 912/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 246 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12117199 FLOW CONDITIONS RESIDENTIAL: Design flow:-n/a g.p.d./bedroom Number of bedrooms(design): n1a Number of bedrooms(actual):n/A Total DESIGN flow: n1a Number of current residents:n& Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JM Seasonal use(yes or no):JM Water meter readings,if available(last two year's usage(gpd): n/a Sump Pump(yes or no): NQ Last date of occupancy: n1a COMM:RCIAIJINDUSTRIAIL Type of establishment: �Oh".h�ERGIAL BUSINESS "IITH 3 EMPLOYEES Design flow: n1a gpd(Based on 15.203) Basis of design flow: n& Grease trap present:(yes or no):�LQ Industrial Waste Holding Tank present:(yes or no): NQ Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:n& Last date of occupancy: n1a OTHER: (Describe) n1a Last date of occupancy: n& GENERAL GENERAL INFORMATION PUMPING RECORDS and source of information: da System pumped as part of inspection:(yes or no):N If yes,volume pumped nLa- gallons Reason for pumping: DIA TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: Wa APPROXIMATE AGE of all components,date installed(if known)and source of information: . 1985. Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 245 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12/17199 BUILDING SEWER: (Locate on site plan) Depth below grade: E Material of construction:X cast iron _ 40 PVC _ other(explain) Distance from private water supply well or suction line: TOWN Diameter: n1a Comments: (condition of joints,venting,evidence of leakage,etc.) nLa SEPTIC TANK: X (locate on site plan) Depth below grade: LEVEL Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) nLa If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): DLO n& Dimensions: L 8'6"H 5'7"W 4'10"H 20 Sludge depth: $_ Distance from top of sludge to bottom of outlet tee or baffle: 2C Scum thickness: V Distance from top of scum to top of outlet tee or baffle:3 Distance from bottom of scum to bottom of outlet tee or baffle: K How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition.of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING NOW AND THEN MAINTAINED EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) D& Dimensions: n(a Scum thickness: n& Distance from top of scum to top of outlet tee or baffle:inIaa Distance from bottom of scum to bottom of outlet tee or baffle n!a Date of last pumping: n(a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nla revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 246 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12/17/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: jVa Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) Dimensions: n1a Capacity: WA gallons Design flow: Wa gallons/day Alarm present: NQ Alarm level:i3la- Alarm in working order:Yes_No_ MO Date of previous pumping: n& Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n(a DISTRIBUTION BOX: _ (locate on site plan) Depth of liquid level above outlet invert:WA Comments: (note if level and distribution Is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) nLa PUMP CHAMBER: MO (locate on site plan) Pumps in working order:(Yes or No): MQ Alarms in working order(Yes or No): NO Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nla y revised 9/2/98 Page 8 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 246 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12117/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: n/a Type: leaching pits,number: 6'X6'LEACH PIT leaching chambers,number: jVa leaching galleries,number: _nLa leaching trenches,number,length: nLa leaching fields,number,dimensions: n/a overflow cesspool,number: n1a Alternative system: n& Name of Technology: jVa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY.THE PIT HAD 2' OF LEACHING LEFT AT THE TIME OF THE INSPECTION. CESSPOOLS: _ (locate on site plan) Number and configuration: nfa Depth-top of liquid to inlet invert: n/a Depth of solids layer: n& Depth of scum layer. n& Dimensions of cesspool: n& Materials of construction: WA Indication of groundwater: n[a inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) WA PRIVY: _ (locate on site plan) Materials of construction:nla Dimensions:nIA Depth of solids: Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& z , X revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 246 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12117/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a �o LxG�e revised 9/2/98 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 246 OLD YARMOUTH RD.HYANNIS Owner: L&M GLASS Date of Inspection:12/17/99 NRCS Report name: D& Soil Type: n& Typical depth to groundwater: n& USGS Date website visited: nla Observation Wells checked: MQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM- _ Slope _ Surface water _ Check Cellar Shallow wells Estimated Depth to Groundwater 10 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions Checked with local Board of health _ Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) GROUNDWATER IS AT 10+FEET revised 9/2/98 Page 11 of 11 :a CO.m,.%101-'%,zALTH OF MASSACHUSETTS EhECU TIVE OFFICE OF EN VIRO\ME\TAL AFF.AIP. DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE R IN STREET. BOSTON hLA 0210E (61') 292-55Uv �cgc , TRUDY CORE Secretan ARGEO PAUL CELLUCCI DAVID B STR''FS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 245 Old Yarmouth Rd . Nameofowrier Avelino Lopes Hyannis MA Address of Owner: — (j Date of Inspection: /3--- Name of Inspector:(Please Prinq Wm. E . Robinson Sr. I am a DEP approved systenl inspector rsuant to Section 15.340 of Title 5(310 CMR 15.000) Canrpar1yName: Wm. E . Robinson Septic Service Mailing Address: PO BOX 0 9. Centerville . MA Telephone Number: 7 7 5— 7 0 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 a disposal systems. The system: _ asses Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Inspector's Signature: w L Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)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 tfre system owner and copies sent to the buyer, it applicable, and the approving authority. NOTES AND COMMENTS 4 � revised 9/2/98 Page Iof11 %J �.•rted on Recycled Pane, - IL a. r. t: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A r CERTIFICATION (continued) 'rop"Address245 Old. Yarmouth Rd.. , Hyannis Jwrw: Date of InsAWlaino Lopes INSPECTION SUMMARY: Check O B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. ` CO MENTS: B. SYS EM CONDITIONALLY.PASSES: ne or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon c mpletion of the replacement or.repair, as approved by the Board of Health, will pass. Indicate ye , 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection: or the septic tank, whether or not metal, is 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 complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). broken pipe(s) are replaced obstruction is removed distribution box 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 revised e ised 9 2 9 8 / / Page 2 of I I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Icontinued) Prop"Address: 245 Old. Yarmouth Rd.. , Hyannis Owner: Avelino Lopes Date of Inspection: -3- 0 C. RTHER 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 the ublic health, safety and the environment. I YSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES Iff ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within.a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 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 less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revise, 9/2/98 Page 3orii ` 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 245 Old. Yarmouth Rd.. , Hyannis Owner: Avelino Lopes Date of Inspection: D. SYSTEM FAILS: You mus indicate either"Yes" or "No" to each of the following: I eve determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this d termination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or-clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 160 feet of a surface 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 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LA GE SYSTEM FAILS: You mu t indicate either "Yes" or "No" to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Y S 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) The o ner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office f the Department for further information. V re ised 9 2 98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART B CHECKLIST Prop"Address: 245 old. Yarmouth Rd.. , Hyannis Owner: Avelion Lopes Date of Inspection: 1_3 —l� Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No Pumping information was provided by the owner, occupant, or Board of Health. _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. s _ As built plans have been obtained and examined. Note if they are not available with NIA. _ The facility or dwelling was inspected for signs of sewage back-up. _ The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding 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 tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: L _ Existing information. For example, Plan at B.O.H. / _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) 115.302(3)(b)) _ The facility owner (and occupants,if different from owner) were provided with information on the proper.maintanaac"f SubSurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION rrop"Address: 245 Old. Yarmouth Rd . , Hyannis owner: Avelino Lopes Date of Inspection:--3 FLOW CONDITIONS RESIDENTIAL- Design flow: g.p.d./bedroom. Number of bedroo s(design):_ Number of bedrooms (actual):_ Total DESIGN flow Number of current residents:_ Garbage grinder 1 es or no):_ Laundry(separat system) (yes or no):_; If yes, separate inspection required Laundry system inspected (yes or no) Seasonal use I es or no):_ Water meter eadings, if available (last two year's usage (gpd): avaragps22 , 000 gal • per year Sump Pu (yes or no):_ Last dat of occupancy: COMMERCIAUINDUSTRIAL: // Type of establishment: kf�5 5 of a YO Design flow: 31�A gpd ( Based on 1,5120 )_n Basis of design flows Y3 6 Grease trap present: (yes r no) /L® Industrial Waste Holding Tank present: (Yes or no)L v Non-sanitary waste discharged to the Title 5 system: (yes or no)A d Water meter readings, if available:y,es Last date of occupancy:7 �(;�(j OTHER: (Describe) Last date of occupancy: /�� g—" GENERAL INFORMATION PUMPING RECORDS and source of information: A, System pumped as part of inspection: (yes or no)_.,d,, 40 If yes, volume pumped: gallons Reason for pumping: TYPE OF YSTEM 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other �J APPROXIMATE AGE of all components, date installed lif known)and source of information: S JJ (0 f Sewage odors detected when arriving at the site: (yes or no) d revised 9/2/9.c Page 6of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'rop"Address245 Old. Yarmouth Rd.. , Hyannis owner: Avelino Lopes Dste of Inspection: e 3 _ Cr-0 BUILDING SI ER: (Locate on si a plan) Depth bek(condition Material :_cast irons 40 PVC_ other(explain) Distance ater supply well or suction line Diameter Commenof joints, venting, evidence of leakage,-etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: vEoncrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal, list age_ ls.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: �j "� /, J Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:�� " Scum thickness: /';L , r Distance from top of scum to top of outlet tee or baffler i I Distance from bottom-of scum to bottom of outlet to or baffle: How dimensions were determined: �'�r• .d K comments: (recommendation for pumping, condition of inlet and outlet tees or ba les, depth of 1• id level in relation to outlet invert, structural integrit ✓ evidence of leakage, etc.) l G O —� �( t� 6 A C4G C 12- G EASE TRAP: (loc to on site plan) Depth below grade:_ Materi I of construction:_concrete_metal Fiberglass _Polyethylene_other(explain) Dimen ions: Scum ickness: Distan a from top of scum to top of outlet tee or baffle: Dista a from bottom of scum to bottom of outlet tee or baffle: Date f last pumping: Co ants: (reco mendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evide ce of leakage, etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART C SYSTEM INFORMATION(continued) +ropertyAddress: 245 Old. Yarmouth Rd.. , Hyannis Owr*r: Avelino Lopes Date of Inspection: `—j TIGH R HOLDING TANK: (Tank must be pumped prior to, or at time of, inspection) (locate o site plan) Depth bel w grade:_ Material of onstruction:_concrete_metal_Fiberglass_Polyethylene—other(explain) Dimensions Capacity: gallons Design flow: gallons/day Alarm pres nt Alarm leve. Alarm in working order: Yes_ No_ Date of pr vious pumping: Commen s: (conditi n of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:" (locate on-site plan) Depth of liquid level above outlet invert: v Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHA BER:_ (locate on si a plan) Pumps in orking order: (Yes or No) Alarms in orking order(Yes or No) Comme s: (note c ndition of pump chamber, condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8 of 11 I` J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 'ropertyAddress245 Old. Yarmouth Rd . , Hyannis ° owner: Avelino Lopes Date of Inspection: /_3- 0 c / SOIL ABSORPTION SYSTEM(SAS): l/ (locate on site plan, if possible;excavation not required,location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers,number:_ leaching galleries, number:_ leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool, number:_ Alternative system: Name of Technology: Comments: Inote condition of soil, signs of hydraulic failure, level ponding, damp soil, condition ogetation, etc. 16--0 iJ A U i CESSPOOLS:_ (Iota on site plan) Numbe and configuration: . Depth-t of liquid to inlet invert: Depth of olids layer: )epth of cum layer: Dimensio s of cesspool: Materials f construction: Indication f groundwater: i flow (cesspool must be pumped as part of inspection) Comm/cndition s: (note of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY•_ (locate on site plan) Materi Is of construction: Dimensions: Depth of solids: Com ants: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revises 9/2/78 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ''roperty Address: 245 Old. Yarmouth Rd.. , Hyannis lwner: Avelino Lopes Jete of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) r R t � 6 p 6 z` g � i revised 9/2/98 Page 10of11 J SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ropertyAddress24.5 Old. Yarmouth Rd.. , Hyannis Owner: Avelino Lo es Date of Inspection: �--�j 6 NRCS Report name Soil Type_ Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells. Estimated Depth to Groundwater a/J Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record i/ Observed Site (Abutting property, observation hole, basement sump etc.) DD termined from local conditions t/ Checked with local Board of health ' Checked FEMA Maps Checked pumping records Checked local excavators, installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) ,revised 9/2/98 Page ttof11 (508)778-6888 +, FAX 790-1811 L & M GLASS CO., INC. GLASS&ALUMINUM PRODUCTS AVELINO S. LOPES 245 OLD YARMOUTH RD. President HYANNIS, MA 02601 TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair . satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY �' -f O (see"Orders") 5.Retail Stores '® ��� 6.Fuel Suppliers ADDRESS- �L s ' 7.Miscellaneous OUT=outdoors)d" QUANTITIES AND STORAGE (IN= indoors;Q , MAJOR MA14�ERIALS IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) jheael, � , #2 (B) Heavy Oils: f� waste motor oil (C) 11 new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: c VC� 2� DISPOSAUREC:LAMATION REMARKS: l 1. Sanitary Sewage 2.Water Supply ? r �41 d`� O Town Sewer public �i0n-site OPrivate 3. Indoor Floor Drains YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES_j/NO OMIQ ( ` O Holding tank:-MDC O Catch basin/Dry well O On-site system c1��A''�; 5.Waste Transporter De 9 Name of Hauler sti nation Waste Product YES I NO 2. V _ C/A I-e r d ��Z. Person(s) nt ewed nspector Date a 1. .Jll-•� � i ,� a °• f, c t __ lot, vt aq.- < -- - - --_ t r,rF 4-Ai ; F l 1 1 C� k+ C>&_ V ART_1 E.` _ _. 4 e'ay PvC - _ _._ 3iPr j t t . _I If , S- `t v r7 h JJ .r,._ Cr F O X Q r •. �. �4 " I \n A S r; ra I G S \� DV ti t GPJ ? rti L d x too All \54- E 1>T r...._ '� 00 U l ' `` _..-•,.mec'raeaiwtraswrara .in•;•.:; tw _ ._.. '.,' • }Mp _y• v w' 1 Pr- I T•. t 0 bat _. _ — _ - -S� F'T 1C - ST F T t U �rT A 10114. 1 1Yra A-; It Erb, r' ea• i' . a W_. f' r ��-�.� .• � 6-Gw iy;,.. � Z`,'ice/'J •, / J \ � � / � ^� \ `! Rn �,-� /,\ x Vol> A 41 1p 4- ' .-.. ' `` �►` �'fi �fad ! ' x z �F It+i"":! .P L:IU rjJ` t_►�.f�. � c,rj. �!` c- _ 43Jtr100 5F 7' ( `-� s v a / r I , x s �Ttl»y v¢ �c. 1 J�• C. i C E ,� jyA! c ^, 1 / © � J /� sk +Q" �,.,,, 1. �--.� t, \ ,! 'i,• �rat c. r.�•�r� y ,����.r,.;�'�,;.dt+ts:A.':'r" � � �, �, � ...... � ./ ,,r s •qf,A ._ � O J+'p.. �''�?!1. �.�.L:. i 1.,.• ae'M* to'+.. �— T9 -- - -- C 1-4 0 IZV1C� ___ _ ...-------- !`_ � • E- � �_�.. '�. .�.�c"'` �� sa .i�..._k.is z. •„� firma � r ,a ,'' / 3� Ic• e 7': ,�} p ' _ , � .'�. -_... .S �•�, 1 � i I�- 7 + � � �.?4.i l�i., � �j-�, ..t::fa:.�..,v�l��Y l,�t:.+.�..I•w .%.+t�i..�:, ti•,r \ i ! ^f 4Sfl-IM(A "' �✓ l 1 .`"`f �l C'U.� "' La - r .� - .. _ Z G R,''`..� 'J Y-1 _,,,•- '�'lf..t(` °.t t t .^h•-� "l- t D t-a•::.i�.'.l� S._2.� +,�V - F � L - __—._---__��_._..._. ._.._ ____._.__ —__-__-_...__.-...__—_. _ ___------__ ._._-. _ _. ... _, __.. _. _ _ _ .:__. -s x ._.. ....�'.��• _,, / . �a�+l... f�,._rtf:.Jl J,��,f�?. �It,.� i _-- ----- �. -+ -_ I F __ __• �,( ;. _ O p Y' A R M U U ' �, -� p� tot, ► L . - _- _. _ f:, y i 'I"qci (07 _ _ _ _ - ,:z _ _ _ x b /J '��` !'C� / -i �99.Bt142.0 ' .-.•, %g6.82 " o? x 99.`� �i� K g9.R2. � � �.E r'!'�l^��:/JJ ���T__.�`•(1.. "TI.'`"fAC,._T�'M.#-'C..C..•"�MI��: '� r•., /� f �,�',�")Ji�� , I 1 t44"3't �*�i•NCE `� � Lk..1�'1 , .,,,,, !✓ J a ,••--- �-YL\ / �' j1,� � ,. --_-_..•-_.___���'�-;,5_�f��TL�'.!�!L�_ :f'•= Fa>+� J-��2. .(�a�•fi4C. LC7L�Kl�v�i l�C� 1 i x y\ _ 7 S .5 cam-,�}._,S i f C 1 y r_ .c ,,.► f-+ tit.. rf, ! � �--+-. -� ._x:�.2n�v.7G-_:.^x'..•�-._ xm'lturs+:ssx-xxrrr „n , .'t±"'"iCJ�/It/L!l v r tao.06 E$►T k+o a~ i° ►+ 2 �'>r •�r*34\F� ,t.L.- .^,,�C,, - q X r -,« "` _.:;5 1�.- �S�.F_:�: Z.`'t'S'f� �: �� L .�.: =-- � �"+ 't4' } .� i T C. p L ac• �s �'=z�'-o" �` T 0Qsr� �. V - ---- . ( P r� _ j 4 TO C% S u6-.,,,,.. S•SNa) `T1D`!' �:�;;-:2 I r-•-ti= Li ' _..._ _. F7 t=_R C T c.S T t� , �.,:E-tisC �`•!t;, S.'r+a L.� ._ ::•..'�;a, -- -�I +�. �•AL..C,, UCJ E;,F R.t V E r C ?' �3 t'1 ft hid 1 r sir. f' .� GttA V tr CaQAv L $tliv.� L�Qtw, '`' �. ► y NSTALLATION AND CERTIFY IN WRITING \ �:nvirst, SIGNING ENGINEER MUST SUPErVI;�I= THE SYSTEM WAS INSTALLED IN STRICT ACCORDANCE TO PLAN. i �. � 13' •?:,'t p\�•. _ G , .; � NO 4.1�U F N�O is nl'1`E.Fe•`.; '� f �• -- - ; 11-Y �®®�� t:U T S CD � `t :q _ i AJt' � r L n c - TEST GL. DTI-`\ �"AK � N -�-_._. •-._ CONSTRUCTION a & ENGINEERING RA 'a. � . 4Sy VNC S ICt �k �.�v/IJspn., �°t • C CORPORAION IAI T,A ONE MA ------------- r ( N _ L ct�tcK .a�► cba _ �i �r.Lri-� ����ct► of,�gs� a p ROBERT CyG t cf) T - - _s 3 W DAVIDSON500 W �. x 1.._ Y A.N N I% la 6 F _ 0. 4U=�k N0. 245 OLD YAFZMO'vl i �o�s T EG��� DRAWN BY F a DATE JOB NO. y pn Z CHECKED BY ALE H T NO. 1 :1 --Q� I 2a-Olt �3 ?-CrJA ' j ^ CSvRrF.c. I ' r pfz -5 x _..-•-_..--- i ,�� _ � N LU ,� �-,Q°�� _ WAGGNI Ate \ � � 1� tp _'� `7 - I If — t 14- �xa + * / \ �� Hr/ +yg s�+c st'�c c.►g a !R,.G "d R, G .0 A 4- Y r , { . -- , , SWAGE N,E...T i "JA1 pa�a�:- i _I — 10 - - _ � a tt-` 'V' �,�-�_-_•_._ � VD ti� 1 I r. r f r ^ rn + J y � y t) � t�T- N :-yF1 c�c;ht._ .tit,L� r. �`� *-• + (' , 4 F L.—p PLAN � � t '• fad �� - ,�.M�s ►���z,. O yt { I ' f � ) ��-••- i '"" - i . r �'• \ , t •� y` i H . _ ,��"cup aT m Yz E XF'.'..JT,, Ak Y i _ f . ` • ` t .., �,., v- � ., ! �` .. w, �, 154. <<, :_cr,r�*���r E.,�, � p,,�fi,.. ti. � L.__ -.. .__ .«._ _... ... � *-" --••t .._- - _________..._._ _ -. _..______ ._.._-___--_ - ..,___....._ ( - - - -'Ja I { '9 f .,>A y...4r •y._ _..._.-.___. .,_.._.. _ ���#� ,yam � a � _,._ ._ ._...._ _ , TNT , F ? i a r tp , ! f ; �, :+J--K, A4 y C^+`";^^•.- `_ ",•.,-..�� t4>,r:��`+ �' �t� _ � � ,a;`�E � - ti..i' ``t_ t _,_ ___-..._„<_ t .... _ _�._.,_,_...............__u. _-_...._._ ..__....__-_.» ..__. .._ ... I ._--___..__.__ ________ .,� _r _ _.�._--..._.._.�...--_•.-.._._......-.._._ ��i r 1 RE,'T L �_C,nt1 w rr!A !o („ 1lo ._•...,,,,..,,� --. � �ti_7 � W!._LLL> rs I r r _ ! { - . TE.�' r + L L i "t_L T ►AG��."� -rr- T_ .00, +,_ "� ,. - 1 s , A _ - , E { � .,i t1t x't 9*dG _ t t C`cs - I e r --� t � 5 l P A t.. � '4Lb C�G ,300 `1 1PA.0 ti � / � 1 � � 1� •� E V `. .I. _ _ 4 .. � c�L,ll 't,:� ]41,. x � \ ,, - r H w r+y at 1. 4 43~Q ,2 a 'KCAL'- I tp° Lc� -G \ PF.RL �'*.`ST 5 92 r 4 � ♦V7f, �-UA,R^r. � - - w CaiS.AJb••L- .T � fl.0 N F4 I� 0Rnlrti�aF /W , O C U ` _ IVY c, StoJam\ \\ rl1ti / ,N1c+-i Q � AT, Tf , 6iGU E_ NO, � 4� :1 �} �(��t"�U1p3'r 1 4cD. �':►� "'� �G TA Ali p .Su NE, Ey-ie ,Fi ,,4i 4 1 1'1 '�. b �2r r c> V,F.. t` lw t 1 r, . ", q 4 6,e V t_x, C( 9 k f' _,2 'CO HA Mv.',t�+#t i J CF' i14_.lu,Tl{ rLM Mcrt E , tzA VI: 4"ll T.14 �P �f ! � p �o$ ROBERr 9ry\�D ' tu M. DAVIDSON •i .. ti,.iw '`d A,i7RL, - 4� za o A. f e KJW - �� , k __ ._.ram_ _...-....._ .._.-,--•--+-..•.«-^.v,••-,�_,.._,..-..„...,.«:-....--._»,_..,.,.-..-.-..-..«„-_.,......_.,.w..,...«. ... - . s' ,- �n, � -5r. ,a`�4., ,� ,,, ,, ..wd` .^. R .,e•. ,f. _... l+�x , {'�,r�" .. .�.^"fa'F4Y:�.�,:-^•h�x�� .rr ��. 'Cy, '?' � r� '. .. z .. ate, , ... �v �. < .. „ a<.... ..:..,,.<..5e.. yy ,.at ...... 'Y __.._�.,.•«..,a.w..._., .,8s....x�+.y.ca�.u..at,�Wa,cti+a.�,..>zU ., -. Jer +uw._..... .... �. _...,....a.1�.a.s:4►.,,..«,al+.-.evr.�, .:,a�..•�. .uikrr� .roJ..,,., ,t� +n „e.._.�.,,,..JY�.:. .•... •�S:erFi9�..%�}•r-a. .aet:.. .:.a.. ....c.-. ...#.'�i 'l'•P'y.. ..vwa.�+w32.�.r+ rF .rF,.L,G � C T 't FIN C.VTtl so 1,11 64 IT; GAM t A c T. 4" PVC pvc left so 4rl p T c_ V, LIL&C- J N(- c_rlz c_ Z :,L0-T TO-'rA-L BU I LID III 'NlF:.V. It" 50 'A 11?_' V F I C.EL 4 V2 IL o' NET C)F, D L\( R L Q U L_ \0 c- m R I b.C.4 'T s c' 1 00 (:,At.l 7 C.AL:`; T o'T A A L'a, VA`I L\e A L L 0 Ai- z)li-:-Va A-,.:, Z.5 4 K. R ii-P-1v E_ 18 C>AU-S/r>ok� 5) 4- L M U-1 A 5 4 IL_ C,0 EA Z CC -r-AlI 0_5 L_ w rr" z 0 Q, A L~L P__TT_ �' 4-)s Y J 1 Cr A+ .. t.'ool A,IZ IP-4k -rt-R 5,141- I o 79 TO-r,'&,L Z)'LS IC.,K1 CaAL' t> P, F__W_'\4 'C_ " 5 5 o Z!) 14 C.A L_t> A-1 c I: c- T t4 li -r c>iIII ---------- Ir k4i m a Pm -7- 461 jT 1 • ie yy ID ! 4 !Z,.- JA, QJ4.q L) tl T L C-) N L \/ A - IN AS 0 A 7 wool" ss+�A�40 o ROBERT o M. cc D IDSQN o 4�) RAW NIT ATE 2 N /0 HECKED CA LE HEET NO VtNiZ"