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Home My WebLink About4507 FALMOUTH ROAD/RTE 28 - Health 4507 Falmouth Rd aka 4495 Falmouth Rd n74-nA-1 n74-044 C- t ;.t _ - No. �Cvo v Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for �Diqo.5AY *V.tem (fow6truction Permit Application for a Permit to Construct( ) Repair 0e) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No.�ly�'(S AA1LA kk 1 + 44 Owner's Name,Address,and Tel.No. t_c r t#2- Gp A,,_,v Assessor's Map/Parcel 69,t f —0Y 3,,// ''�� Installer's Name,Address,and Tel.No. ecJ�L�t L>��^SGS Designer's Name,Address and Tel.No. S 1 t�&0� $1AA (� ?- l3 a k ZC�3 Z Q�ft rq�n bla � Type of Building: � Dwelling No.of Bedrooms 1 Lot Size �$`J�a� sq. ft. Garbage Grinder ( ) Other Type of Building � 1.e_4r-v+y 7 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required 3 d gpd Design flow provided 3 -k 5 gpd Plan Date �T -2,h, Z,o cc;, Number of sheets Revision Date Title Size of Septic Tank l OO Type of S.A.S. Description of Soil Nature of Repairr Alterations(Answer when applicable) ,' ( p Q�l b /►,,/� N-2,o Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of H alth. Sign Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No._ 47 2� Date Issued -�O _ 7 No. �v f 4 I ,F: 4 Fee fa THE COMMONWrLTH A �OF MASSACHUSETTS Entered in computer:- PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ' 2pplication for Bi!5pO!5al *p$tem Cow9truction 'Permit Application for a Permit to Construct( ) Repair 4O Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. kAj0"1 .Owner's Name;Address,and Tel.No. 1.o T t+2 C,-)-�-v•%T Assessor's Map/Parcel 0,9�q —0z/_3 Installer's Name,Address,and Tel No. U J, ��"�� Designer's Name,Address and Tel.No. CI u W iY�Tu vk L�� vvx Type of Building: Dwelling No.of Bedrooms 3 Lot Size 8,i� a — sq. ft. Garbage Grinder ( ) Other Type of BuildinX,`j,b,4e. 4;1,, No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required).',` 3 _ gpd Design flow provided 3 gpd Plan Date W1 'ZIS- ZO/O ,v Number of sheets Revision Date Title yX 1 r y� Type of S.A.S. Size of Septic Tank I Description of Soil 3b t i Nature of Repairs Alterations(Answer when applicable) ��a lip q v7 (� `ly 1ti Date last inspected: 1 Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of- Compliance has been issued by this Board of Health. Signed Date Application Approved by Date �I J Application Disapproved by: Date for the following reasons Permit No. ,� 10—"" Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of-Compliance THIS IS TO CERTIFY,that the On-site ewage Disposal System Constructed ( ) Repaired (�) Upgraded ( ) Abandoned( )by e QC at b1 i-,�It�Q �,, 12QQ� has been constructed in accordance with the provisions of Title 5 a d the for Disposal System Construction Permit No. dated Installer L (;,_;6..- Designer t I #bedrooms Approved design flow q 3 0 gpd j The issuance of this ermit all not be construed as a guarantee that the system v� n as desi J ed. Date ( 11 l U Inspector K (77 of..I No. rI�` "` �lri r7 Fee. JI:.% —./�-� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION — BARNSTABLE, MASSACHUSETTS %igpo!9al *pkem Construction 30ermit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) System located at JiJ1 i4l�ihv kA— aaip"J �� t and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Construction rmust be completed within three years of the date of thi�it. Date �/ c'3�/(5 Approved bY�r _Cj Gk �J i (-- t )C.Gn r Town of Barnstable Regulatory Services ,JSl, Thomas F. Geiler,Director • BAWWA" • Public Health Division M SS 059. ►`� Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: / / Sewage Permit# ZO iO A`4 OL Assessor's Map/Parcel oa � Installer&Designer Certification.Form Designer:,r2o�� /�Lr S Installer: Address: ,(,�� Address: F0'60 VIA On 1 2-L, Zo t 0 C - 'd-e was issued a permit to install a (date) (installer) septic system at based on a design drawn by (address) i datea"zzr �d (design r) certify that the septic system referenced above was installed substantially according to the design, which may.include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if required) was inspected and the soils were found satisfactory. "O A190 WETS c�N taller's Si e R. a n y No.527 Q e igner's gnatur ) (Affix D VAL e) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DWI CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS_FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnsWesignercertification form doc Town of Barnstable P# 1 30 7s— ,�Y'' Department of Regulatory Servi � Date °� � o ces Public Health Division ��EDA1e� 200 Main Street;Hyannis MA 02601 Date Scheduled 19 1 �- a Time-�✓=t Fee Pd.� Soil Suitability Assessment for Sewage isposal Performed By:��T.�`Q �7 r�p¢L ` Witnessed By: n Location Address LOCATION& GENERAL INFORMATION .i�t� �"1�� / 1lrY,J Mvu �� /2 .,2 1. Owner's Name 7 11 a T+� r ( , d Address Assessor's Map/Parcel Engineer's Name NEW CONSTRUCTION REPAIR Telephone# Land Use Slopes(40) /UJ' w /� —,--a—d Surface Stones t�^i Distances from: Open Water Body O� ft Possible Wet Area ft Drinking Water Well Drainage Way g Qo ft Property Line �ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands In Proximityto holes)) a � D l J lie � r� 3�� 1� �U T&2 U 76 t e-3 q�t N s s Parent material (geologic). / / Depth to Bedrock Depth to Groundwater. Standing Water in Hole:/✓anl6_ /C_ n/ / _ Weeping from Pit Face Estimated Seasonal High Groundwater Method Used: DETERMINATION FOR SEASONAL HIGH WATER TABLE Depth Observed standing in obs.hole: Depth to weeping from,side of obs.hole: in. Depth to Soll mottles: Reading Index Well# in, Groundwater Adjustment ng Date: Index Well level_,, �p Adl,factor ft. Adj,droundwnterlxvel,,,,o, Observation PERCOLATIONTEST-4- bgte Thne Hole# Time at 9" Depth of Perc 7 Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak r D /wTr.r Rate Min✓Inch �- Site Suitability Assessment: Site Passed Site Failed:. Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division'at least one (1) week prior to beginning.. Q:\SEPTIC\PERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistencv.%Gravel) /o 1,2 DEEP OBSERVATION HOLE LOG Hole#2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. . Consistencv.%Gravel) � J .ter DEEP OBSERVATION HOLE LOG Hole# R Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Cnitec Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil.Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) F LA.Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No Yes Witi:iil 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervigus material exist in all areas observed throughout the area proposed. for ti;e soil absorption.system? If not,what is the depth of naturally occurring pirvious material? Certificatio,i I certify that on 193 (date)I have passed the soil evaluator examination approved by the Department of Envi onmental Protection and that the above analysis was performed by me consistent with . the required trai ' ,e penis nd e p ' nce described in 310 CMR 15.017. Signatur Date Q:4SEPTIC0'ERCFORM.DOC TOWN OF BARNSTABLE - . BAR-W 1606 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager �Jl�,v„fJ�' • U �,bl/ �j��CKL�fX Address of Offender MV/MB Reg.# YL( 7 /T/'lf� Village/State/Zip Business Name Sew -A _'7"r-e2 Y am4 , on !1-21- 19Y Business Address &g y 'T jZ ,�/N„ Signature .of Enforcing Officer Village/State/zip V�%Cf ,µ . Location of Offense ^` Enforcing .Dept/Division Offense o46 ' Facts /Qy `}G d�. ( �In �v� ' ir�i2-� s�l"��'�J �C�X • � - • This will serve only. as a .warnidg. At this time no legal action has been taken. ;'It is the goal of Town agencies to ,achieve voluntary . compliance of Town °Ordinances, Rules and Regulations. Education efforts. and warning notices are `attempts to gain voluntary compliance. Subsequent violations will result in ,appropriate legal action by the' 'Town. TOWN OF BARNSTABLE-, BP R-W "i l sl Ordinance or Regulation WARNING NOTICE r,� i Name of Offender/Manager C.u... rCf � "�� tr S-� _bcr�- .diP , Address of Offender SZ?`i 1 �K� G+1 MV/MB Reg.# Village/State/Zip 64 1ki 4 X44 1 Business Name a- --r r,,R am , on 11�441 19, Business Address "� ( �,�., c ,..� ddt•� , Signature .of Enforcing Officer Village/State/Zip Cdy� I� /L Location of Offense f� �r6'ay GZ �f Enforcing Dept/Division Offense Facts (Gu-1 ��r This will serve only as a warnifrig. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town `Ordinances, Rules and Regulations.-. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town Health Complaints 24-Apr-98 Time: 9:30:00 AM Date: 4/24/98 Complaint Number: 1300 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: sav-a-tree Number: 4507 Street: falmouth road Village: COTUIT Assessors Map-Parcel: Complainant's Name: anaonymous Address: Telephone Number: Complaint Description: Complainant stated that there was a new 1000 gal tank with blue liquid stored outside. It is behind a fence so you can't see it from Route 28. Complainant will call back for a follow up on results of inspection Actions Taken/Results: Investigation Date: Investigation Time: �,O, I b— (�W d� I,vl� .1 Ste- C,9 �►;,� Sje-.,- 1 Health Complaints 27-Apr-98 Time: 9:30:00 AM Date: 4/24/98 Complaint Number: 1300 Referred To: GLEN HARRINGTON Taken By: GLEN HARRINGTON Complaint Type: ARTICLE XXXIX HAZARDOUS WASTE Article X Detail: Business Name: sav-a-tree Number: 4507 Street: falmouth road Village: COTUIT Assessors Map-Parcel: Complainant's Name: anaonymous Address: Telephone Number: Complaint Description: Complainant stated that there was anew 1000 gal tank with blue liquid stored outside. It is behind a fence so you can't see it from Route 28. Complainant will call back for a follow up on results of inspection. Actions Taken/Results: There was a 1100 gal plastic tank of lawn fertilizer sitting on the ground. I spoke with Michael Talbot. He said that the company was planning to move tanks water tank too), into a storage garage. He said tank would be empty at end of second application of season. I gave them a warning stating that they had to move tank within 30 days or provide secondary containment. Investigation Date: 4/24/98 Investigation Time: 4:30:00 PM 1 Date: 3/19/97 TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: Lujean Printing Co. , Inc. BUSINESS LOCATION: 4507 Route 28, Cotuit, MA 02635 MAILINGADDRESS: P.O. Box 571, Osterville, MA 02655 Mail To: TELEPHONE NUMBER: 508-428-8700 Board of Health Town of Barnstable CONTACTPERSON: Luke P. Lally P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 508-428-8228 Hyannis, MA 02601 TYPEOFBUSINESS: printing Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES x NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: 4507 Route 28, Cotuit, MA 02635 TELEPHONE: 508-428-8700 LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity o Antifreeze(for gasoline or coolant systems) 0 Drain cleaners NEW USED o Cesspool cleaners 0 Automatic transmission fluid 2 gal- Disinfectants 0 Engine and radiator flushes 50 lb. Road Salt (Halite) 2 gal. Hydraulic fluid (including brake fluid) 0 Refrigerants 0 Motor oils - 0 Pesticides NEW USED (insecticides, herbicides, rodenticides) 0 Gasoline, Jet Fuel 40 gal. Photochemicals (Fixers) 0 Diesel fuel, kerosene, #2 heating oil x NEW x USED 20 lb. Other petroleum products: grease, 60 gal. Photochemicals (Developer) lubricants, gear oil x NEW x USED 24 oz. Degreasers for engines and metal 3100 lb.Printing ink 0 Degreasers for driveways & garages 0 Wood preservatives (creosote) 2 gal. Battery acid (electrolyte) 0 Swimming pool chlorine 0 Rustproofers 0 Lye or caustic soda 0 Car wash detergents o Jewelry cleaners 0 Car waxes and polishes 0 Leather dyes 15 gal.Asphalt & roofing tar 0 Fertilizers 5 gal. Paints, varnishes, stains, dyes 0 PCB's 112 galLacquer thinners 8 oz. Other chlorinated hydrocarbons, x NEW USED (inc. carbon tetrachloride) o Paint & varnish removers, deglossers o Any other products with "poison" labels 0 Paint brush cleaners (including chloroform, formaldehyde, 0 Floor & furniture strippers hydrochloric acid, other acids) o Metal polishes 0 Laundry soil & stain removers 2 Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): 0 Spot removers & cleaning fluids 1. Subtractive plate developer (dry cleaners) 2. Subtractive plate finisher 15 gal-Other cleaning solvents 0 Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS o-- TOWNIOF'-BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory BOARD OF HEALTH 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY r (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Q.7 � Class: 3-- ?.Miscellaneous t* QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: xs & � -- CJ r - s's DISPOSALlRECLAMATION REMARKS: 1. Sanitary Sewage 2. Water Supply s L-P?_ O Town Sewer &Public i2r-on-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 NO ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product VL 1. 2. Person O Inte ewed Inspector Date ,✓ l; fOXIC=AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: LQ 4"13 Pr o 011 IJ G 1I3 Co Mail To: BUSINESS LOCATION: L4 S U1 RT Z_e� CATy'oT ryn A Board of Health MAILING ADDRESS: P� b S-tRV; (1-e Town of Barnstable MA P.O. Box 534 Barnstable TELEPHONE NUMBER: - ' `� ^ ;` �-E2 �'( 0 0 Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: L42 0 S1 (o`II Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities totalling, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES _ NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: °-1 C�"1 (��_ �., T U k Vn A TELEPHONE: Srs5h P e-l'2. 't o 0 LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid `Z CA05Toilet cleaners Engine and radiator flushes Cesspool cleaners �LHydraulic fluid (including brake fluid) �7 (.41) Disinfectants z GAS- Motor oils/waste oils SbLf_ Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, 1I7z cAs,t_ Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal ?O OLPhotochemicals (fixers and developers) Degreasers for driveways & garages 1cN®6 i--t'- Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine Car wash detergents Lye or caustic soda Car waxes and polishes Jewelry cleaners Asphalt & roofing tar Leather dyes Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) Paint & lacquer thinners PCB's Paint & varnish removers, deglossers Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) -LA (.ALOther cleaning solvents S/,ALk 0 D "Q-LItQ'e- - X Bug and tar removers fJRWe W A I SeR L,e R� Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business ti Al t2 �1 0 R VN m Q j O TOWN OF BARNSTABLE MPLIANCT a j z h� _ U BOARD OF HEALTH satisfactory �J o 0 n unsatisfactory- Z COMPANY,Z0Sb�.0►- ,Vre;a� : �a (see"Orders") z ADDRESS O3�07?5iZM0ztZk r4e Class: � -72,;:7_ QUANTITIES AND STOk MAJOR MATERIALS Case lots 1 , IN OUT IN OUT IN OUT #&gallons Age Test Fuels: I` line;�et Fuel-(�4}� B- Heavy Oils: w-waste-m'otor-oil-(G)-, new-motonoil-(,C)' - transmission/hydraul c Synthetic Organics: degreasers Aw f • Miscellaneous: CA;PL& DISPOSAUftECIAMATION REMARK7 1. Sanitary Sewage 2.Water Supply Iflo E 0 0 O Town Sewer Public 'Won-site OPrivate - t 3. Indoor Floor Drains YES NO Gam' O Holding tank: MDC I O Catch basin/Dry well y9__,f _ O On-site system 4. Outdoor Surface drains:YES NO O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product YES NO 2. Person (s) Interviewed Inspector Date , T6W' N0F*BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfacto 2.Printers BOARD OF HEALTH , 7 � 3.Auto Body Shops < b unsatisfactory 4.Manufacturers COMPANYi a n�r Jr i sra`f (see"Orders") 5.Retail Stores �✓ 6.Fuel Suppliers ZADDRESS •✓!i'/�"7 +'�rrr! L116.. CyIgSS; 7.Miscellaneous ' o`T- , T , m n QUANTITIES AND STORAGE (IN_= indoors; OUT=outdoors) MAJOR MATERIALSUnderground Tanks I IN OUT I IN I OUTI IN OUT #&gallons Age Test I Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) .l Dom,+.r, _.✓ � .f new motor oil (C) f� transmission/hydraulic Synthetic Organics: degreasers Miscellaneous:Ole Ix 1 64 IPX,WP DISPOSALIRECLAMATION REMARKS: ,, 1. Sanitary Sewage 2.Water Supply fl�`,�"'1'''fl�,"44 ^`� �`��1,�` �l"I ?s�hi�'�/�7 O Town Sewer ®Public �54� ��h I .O On-site OPrivate 3. Indoor Floor Drains YES NO fj� ,gig O Holding tank: MDC "` , ' O Catch basin/Dry well O On-site system ✓ 4. Outdoor Surface drains:YES NO 1/ ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter �? Name of Hauler Destination Waste Product�.-� YES NO 2. . , Person (s)`Interviewed �-"' " `✓Inspector- ! Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH 'K satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY Lv^r�,►ti �r�+►�`°'► O (see"Orders") 5.Retail Stores y 7 / 01 6.Fuel Suppliers ADDRESS ,SQ �,� LrISSS: 7.Miscellaneous Ca QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) F e'e4) 0 r I —IQ 6_e 3 sg new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: j 1J5' ➢� Ft G-- t s I a cd�..o DISPOSAL/REt;LAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply i,& 4 j-S� ;3 xltiU ®i S E Set( Co O Town Sewer Apublic �s �., Gd� - QCC4,01 ,9-0n-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 N0—,& ORDERS- 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler uct Licensed?, Destination/ � � I AZ Ltr(�S�Q Gin lC) 7 NO Person (s)'IriterviAved Inspe or Date c - TOWN OF BARNSTABLE COMPLIANCE: GLASS: 1.Marine,Gas Stations,Repair satisfactory �'"2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4. an COMPANY f1c /f/ ?`/W��''J°� O (see"Orders") 5.Retail Stores ,yam 6.Fuel Suppliersaneo ADDRESS .5�f� ' �_ Class: 7.Miscellus 1t f_V i 7'QUANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS IN OUT IN OUT IN OUT #&gallons 777 Test Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: -' DISPOSALIRECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply ^®✓1' ` O Town Sewer Public P(On-site OPrivate 3. Indoor Floor Drains YES NO C� O Holding tank: MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: 0 Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Narne of Hauler Destination � � • � YES NO 2. �~ Ile Perso nterviewed Inspector Date .MICHAEL:LALLY 4507 Route 28 Cotuit, MA 02635 P.O. Box 571 Osterville, MA 02655 508.428.8700 Fax 508.428.8524 cod net email: IujeanQcape • • Stations, ' ,. 3.Auto Body Shops (see"Orders") 5.Retail Stores Fuel Suppliers Miscellaneous A 1 • ' klemwere • 1 •11 Case lots Drums "Above Tanks Undem-round Tanks ib 1 • •1 / ONE ' MINNOW !L:mmig' .60'. 41 '! m awar-Am. - o Pow,ww' A'0 re-00" ME I.,N V-M, 7 /1 i Name of Hauler Destination Waste Product i.icensed? THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH °�yn---....OF......PA? rPS.table t ...................... . ............................................................... Appliration for Di-opuiitt1 Workii Tonstrnrtion rrmit Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: .Rt_.28 Santuit Lineans..print .!g-•QQA...Rt...28...S:antau.t ....:. .._...................... ............................................. Location-Address or Lot No. ----•--•--...L...... La11e...........................................•--.. ...Rt. 28 Santg. ....•----••-•----•---...........---•------............ ---- - Owner Address W A & B Canco 350 Main..St�-w...Yax z $7..... ............ •.................................•--•----•-----•-------•---............•-----........-•-•----•-• Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms....."_.P...............................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building ..._..__.... No. of ersons........................... Showers p'�,,, yp g -•-- ----- - ( )-— Cafeteria ( ) 04 Other fixtures �c aanc ..- txH.a O ------- --------- ----------------•... •-----.. W Design Flow............................................gallons per person per day. Total daily flow.._...........__............................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ W h—No..................... Width....._.._.._........ Total Length Total leaching area..______.__.._._....s ft. x Disposal Trench g g q. 3 Seepage Pit No-----_------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq..ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ 0.4 Test Pit No. l................minutes per inch Depth of Test Pit.................... Depth to ground water......._............._.. Test Pit No. 2................minutes per inch Depth of Test Pit---------------..... Depth to ground water........................ W 0 Description of Soil-------------------•-------•--..........-----------••---.......--•-•-------•------•-•--------•--------.._.........------------------•---------------•---•......•--.---•- x _ _ U - x -------•----•- --------------------- --------------••---•----------------••---------•-•---------------------------------•....emu `tG ......................... ------------------------------------------- Nature of Repairs or Alterations—Answer w�gn a licablea_000... on U P ��""`�" PP ��- � gt�.r__S s�:n-----II-Bax-------•---. .............and._t000..galioaa..heavvy..sty--Uae-h-ng.-pi-t-----------------------------------•-..•----�......-•--•--•-••----•-•------...------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A ITLE 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed... __. �" 84- Date Application Approved By..__._. :. - -•-•------- ........ G-----. T Date Application Disapproved for the following reasons:.........................................................:...................................................._ ..........•..................................•----•----------••--•-........••••-••--........_........•••-----------------••-•---•--•------•--•....•-----------------------•-•---•--- -----•--•-•-`- Date PermitNo...........................-1• .................. Issued.................... ................................ Date J $15 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................:.....T.OW.n........OF......Barnstable Appliratinn for Diopnottl Works Tono#rurtion rrrmu Application is hereby made for a Permit to Construct ( ) or Repair (x) an Individual Sewage Disposal System at: .............Rt-28_Santuit ....._...... -• -•-•-•--......_._... .........Lujeans.-grintin� C°!--Rt•_28 Santtlit Location-Address or Lot No. ..... -Lug La11e.Y......................................................... .....Rt. 28 Santuit Owner Address W A & B Canco _350 Main St. W. Yarmouth a ............................ - .......... ..._...... ............---........ .......................q:....... M Installer Address ^QSi Type of Building Size Lot............................S feet U DwellingNo. of Bedrooms......................... .....Ex Expansion Attic — .-•---•-••---- P ( ) Garbage Grinder aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .... ..D t'!?! 1 .4.-eY-9�eC... tiMa4 Design Flow.......................... 1 W gn ------------------gallons per person per day. 'fotal daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Dept h................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area...................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area.................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ M Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fZ' Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 9 .............................................................................................................................................................. Description of Soil--•---•-----...--•-•.......................•------.........---------•--..............------.................----......-----.....---•----•--........I...........-----_.... V ---------------------.......-••••--•-......_...-----...............-----•----•• ..............�.. -- . - U Nature of Repairs or Alterations—Answer when applicable. Q Q__9aj.; p't�c_-6vate Til....p 13oX..... .............Md.. �--1� Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System.in accordance with the provisions of TITI.i 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed............. ............. ......-•-•------ ..._.... — � Date Application Approved By....-•--<_ ===:_��:::.... _. .f,.:°-_•-==°-`-="— ----------------------- .........I........a...... ::'.-?..... Date Application Disapproved for the following reasons:.......................................................................................................... ----...---•..............•---••-•---------•---; •`•......-----.........---------•----....-•---...._.........----------....-•---............................-----............--• ........ Date PermitNo............ t_..._•----... Issued.................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .....................Town OF............Barnstalbe ................................................................. Trr#ifiratr of Tampitanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by......A & B Canco 350. Main St. W...YarmQM.t.=•----•--•--... ..__ ... --••----•-•......-- •.....-•- -_... --•--•••-. ....................................._.._...._ • Installer at.........Lejeans_Printinc_Service.-•------Rta.-.28..S,antui.t..ft.-•...................eke Lally has been installed in accordance with the provisions of TITLE _5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ;- _::.1. ....... dated......... ,::�....._f ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........... ]3 ................... Inspector........ - ............................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Lujeans Printing Y® � 1 Town...oF......Barnstable.................................................. 15 00 No... ...... .5.. Fn......s......-'........ Rovasal Works Tono#rurfion nt Erra Permission is hereby granted---- ,C_ .: : .... 31 h ?n..............•---------••---..................................................--- to Construct ( ) or Repair -( �.}^�ri ndividual Sewage Disposal.-System IV Street <-- as shown on the application for Disposal Works Construction Permit No.�'__;�Z. ... ..�,�ted....._.................................... ..........` . :�.....f S }� Board of Health DATE................. ..:: ... ~ ..................................... FORM 1255 A. M. SULKIN, INC., BOSTON Date: TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: ef:�A,4 A wwo n � BUSINESS LOCATION: Lf�� -61c LI ITR K ^� , C n enj �� e), 3 MAILING ADDRESS: 58ft e 1f f_AD Q0A0�2�°r: ,Q0s D(�t i Mail To: TELEPHONE NUMBER: l u0 oaRio,pc1 ,Board of Health Town of Barnstable CONTACT PERSON: °� (��L^ 2 P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: sAdAt Hyannis, MA 02601 TYPEOFBUSINESS: I-OLL.)tJ M a ( �J i Ebf4-mr_ Does your firm store an of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils i0064—Pesticides / NEW USED (insecticides, herbicides, rodenticides) roc.✓ Gasoline, Jet Fuel CSf' `raj*s) Photochemicals (Fixers) 36 Diesel fuel, kerosene, #2 heating oil(jam&Mj NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar e2090 /65Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS G _ Date: V TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: -AY A BUSINESS LOCATION: J!Y6 IFbV00 71 4)> 5J 1 10 MAILING ADDRESS: a S'", v/d , �(1 Mail To: Board of Health TELEPHONE NUMBER: b!8 ' lq Town of Barnstable CONTACTPERSON: M t L4 IdC P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: 45#Nu f- Hyannis, MA 02601 TYPEOFBUSINESS: 0A J*U'Q_41juCE_ Does your firm store py of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils 00 &aL Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) ew Diesel fuel, kerosene, #2 heating oil� T �+h� NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repai BOARD OF HEALTH (Y Satisfactory 2.Printers 3.Auto Body Shops O unsatisfactory- 4.Manufacturers COMPANYf}f1.1 -�' (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS .�.C � Class: �°�•Miscellaneous QUANTITIES AND STORAGE (IN-indoors;OUT-outdoors) MAJOR MATERIALS Case lots Drums �-UndergroundTa,nks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: 40- Gasoline Jamie A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) f' new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 71 , " DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply C nL7—/ � - .. w O Town Sewer Public 10-1 ,�,� ��s 7 �oe On-site Q Private r " V, 3. Indoor Floor Drains YES N0 // i O Holding tank:MDC_ O Catch basin/Dry well + O On-site system 4. Outdoor Surface drains:YES NO Y O ERS: Q Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destina ion I aste,,P � � • � YES NO 2. r F.9 Person(s) Interviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair BOARD OF HEALTH X satisfactory 2.Printers 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY Clry -� ' �� O (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS -1 Q_ Class: s7 7.Miscellaneous /r QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALSUnderground IN OUT IN OUTI gallons Age Test F j�2ti � fGasolind,Jet Fuel (A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil (C) new motor oil (C) S� transmissio drauli Synthetic Organics: degreasers Miscellaneous: x 1l�� 0 A U_r ate. r'o ,Gc W'0 Cepti 17•-1 5 �c To 4V,, CGS pt �C, DISPOSALIRECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply Lc�JSC. l O Town Sewer Oublic A"o Q i• , �P f; fi�,_On-site OPrivate � a I b4 3. Indoor Floor Drains YES NO_X__ O Holding tank:MDC_ O Catch basin/Dry well (' .1-9-j@ ra K 4T VA 2 OL-f�QV+Ji O On-site system lae !tit vwW 4. Outdoor Surface drains:YES N0X— ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter � � Li YES NO 2. .5® Person(s) Interviewed Inspector Date TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores ZI 6.Fuel Suppliers ADDRESSADDRESS �-7.Miscellaneous IES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATERIALS ,. IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers til' of �- TIT— Miscellaneous: 1/. lA4 `7 � A10 A U DISPOSAUREC TION REMARXS: 1. Sanitary Sewage 2..Nyater Supply O Town Sewer VPublic ' ' On-site OPrivate 3. Indoor Floor Drains YES N.0 O Holding tank:MDC_ O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO O ERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Product YES NO 1. 2. erson(s) Inte ewed Inspector Date Date: a TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM ' NAMEOFBUSINESS: SAV4TeC6' BUSINESS LOCATION: Sd MAILINGADDRESS: Mail To: TELEPHONE NUMBER: y Z-0F ` / 9- Board of Health CONTACT PERSON: se—I(-rs Town of Barnstable P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Q14C -66 3 Hyannis, 3 02601 TYPEOFBUSINESS: %fie— �'°� Does your firm sto a any of the toxic or hazardous materials listed below, either for sale or for you own use? YES V NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) IT- Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides — f NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda T Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS px, 3e-- TOWN OF BARNSTABLEOMPI.�ANCE: CLASS: 1.Marine,Gas Stations,Repair atisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops OF, nsatisfactory- 4.Manufacturers COMPANY 3-a'�� see"Orders") 5.Retail Stores 7'�07 Fa-vrk.yt�"k '1-76.Fuel Suppliers ADDRESS C18SS: 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors; OUT-outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) new motor oil (C) x �ronemico;n ---'raulic Synthetic Organics: degreasers h� al v_ mac/LLB v od S M seellaneo s:- l� - DISPOSAURE(;LAMATION REMARKS: /J A 1. Sanitary Sewage 2.W ter Supply Q� 0 ' 1� C�OF`/' 1 �< O Town Sewer gublic v P�bn-site OPrivate n L 3. Indoor Floor Drains YES�`�NO�C AtIke O Holding tank: MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0—>< ORDERS: O Holding tank: MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. rson nterview d Inspect r Date Fly 7P LOCATION '1 _ SEWAGE PERMIT 0. as -- o�� VILLAGE _ e� Q - — OS--� •PPu A & B CESSPOOL SERVICE 128 BISHOPS TERRACE, HYANNIS, MA 02601 ' BUILDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED J W A� ` LOCA„ ION � SEWAGE .PERMIT pMQ. 166125 VILLAGE I'NSTALLER'S NAME i ADDRESS e U I L D E R OR OWNER DATE PERMIT ISSUED Vi DATE COMPLIANCE ISSUED3_ -( t, . i ! ?j U y, L FIMB.$.1.5...00........ No....................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .......................OF........................................................................................ Appliration for Dhipoiial Works Tonstrurtion "nutit V 0/7 Application is hereby made for a Permit to Construct or Repair ( X) an Individual Sewage Disposal System t imouth Rd. Cotuit, Ma. 4 1', ......................................................... .......... ADn---------------------- ..... -----------"............... Luke P. LallyLocation-Address t I Falmouth Rd. CoVfJ,0'M2 ................................................................................................. . .................................................................................................. Address A & B Cesspool Service 128 Bishops Terrace Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder ( ) 14 44 Other—Type of Building ............................ No. of persons._-..--.----_-------.------- Showers Cafeteria ( ) 0.4 Other fixtures ...................................................................................................................................................... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid*capacity........--..gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.....--.....---..... Total Length..................._ Total leaching area..--................sq. ft. Seepage Pit No....----_-_-------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. f t. Z Other Distribution box Dosing tank (,.- ) Percolation Test Results Performed by........................................................................... Date........................................ 1.4 Test Pit No. I................minutes per inch Depth of Test Pit..........._........ Depth to ground water....................._... Test Pit No. 2................minutes per inch Depth of Test Pit................._.. Depth to ground water..------.............--. .............................................................................................................................................................. 0 Description of Soil...................................................... ------------------------------------------------------------------------------------------------ ;%�....................................................................................................................... -----------*---------------*----------------*---------------------- ................................................................................................................F-U-1---in...old---cesispo61------lnsta-14.......new...1000 U W&JIblif Repairs or Alterations—Answer when applicable............................................................................................... ................... tank._wAth..D—B ox..a.nd...100'U...gal...Leach...Pit ..........................................I.................................... .. .......... ......... ............ ...... ......... ...... ........... ------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T I'�IE 5 of the State Sanitary Code.. The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued b e boar he ASigned.. . .. . ......... . ... ...................... .............. I................ Date Application Approved By........... . ...... ....... ........................................ ........................................ SigneS e been issued b _5e boar he Date d ......... ................. ..................... .................. Application Disapproved for th f 11owing reasons:.............................................................................................................. ......................................................... .............................................................................................................................................. Date PermitNo......................................................... Issued....................................................... Date ---------- —-------------------------------- $15.00 No....................... Fl?+$......... ._._ .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable ...................................--......OF.......................................... Appliratiun for Disposal Works Tonstrurtiun Prruti# Application is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal System?almouth Rd. Cotuit Ma. .......... - ... i -• .................• --•-- .... .............»......»..»......Luke P. LallAo�atonAddress C ot&tNFalmouth Rd. o.Ma. -••-•--•..............»».....--------•---------...---....---....-------••-----•---....._•----•-• ..................................................... _».•-•--............... .»»......»........ W A & B Cesspool Service 128 Bishops TerritflEss Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria O. ( ) 04 Other fixtures ------------------------------------••-•-•-•-•----..._....-----...:.---------••-- Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 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......................... GPI Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a ................•---••-•-•------..................-•--•--•••--------•................----•--..........-•--•-•-•--------•--•••-••------...---•-•--•-•------•-- ODescription of Soil.............•----------•-----...---...--•-•--••-•-------.............................................................................................................. VW ------------------- ----------•--•----•------- ...•--•--•-•-••----•-----•----••...----.......-----••--......---F111•--in---old..cesapncal....Jnsstall.._...new..1000 lbt•Itl®tgf Repairs or Alterations—Answer h licabbl .._.____ -----------------•-•---•-•--••• septic tank with D-Eox.and T0f galeheach'tit-------•-•------------- �. -•-------------------------•-----..........--•-------•-•--•--------...--------.._..----•--------...----._......----------------•-----•---........------....------------.................-----.......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of C pliance has been issued by the board o ea l4. Signed.. 6�- ned.. -__-•-. -.•- •--•---- -- �------_-•--• -•-•--••---•................... Date ApplicationApproved By............ . ....... ....... . ........................................................ ........................................ Date Application Disapproved for th f llowing reasons:-------•------•-------------------------••-----.....---•-------------------•----•-•------...•-----•---•...»»» ------•--•--•-•---.....--•---•---...--•...•-•---------------------•-------•----••-•••--•--•-•-----•............._...._......_.................__....•-•--•-----•--.......----_.... _•---......_..- Date PermitNo...................................................»»» Issued..----•--............._.._.......-•----................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town i Barnstable 1 ..........................................OF. ............................................................................... Tntif irtt#r of Tuutpliatur THJS IS TO CERTIFY, That th i iaaual Se a Dis S t constructed ( ) or Repaired ( x) & B Cesspool Sertce >�2 ishaps e�racp 11yya,018 Ala. y....................:........ z . •- --....... -• •-----............_..........._.....----...._.__.... FalrnouthdRd. C ottu ;•-eta • Installer at.................................................................................................................. -... has been installed in accordance with the provisions of TITI.F 5 of The State Sanitary Code as described in the %% application for Disposal Works Construction Permit No...... _S_�_ a ¢.._.__._.. dated....._�' .�7 _ .............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.................9-__^__t!_.5........ d�................................... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town of "Barnstable No... ..........»Q }. ...........................................OF.................................................................................... . Fim.................. Diu u � sttt rku ��tu� #�a��rrtnt� Permission is hereby grante ...---••--••--•................................••-••---•-........_....._......_. F to Construct ( ) or Repair ( ) an i idu Sew ge D SDosal Sys at No..---•-•--._.......-•.............•--.....-•=-•-----•--•---' �?`.�.!.... �-----r-�� 7 ......................................... ,. Street ��" a''� Y"�) R as shown on the application for Disposal Works Construction Permit No... ...... ...... ated.... ........ _.__............... ...... r _ .............................. Board of Health DATE..............-.................................................................. V FORM 1255 A. M. SULKIN, INC., BOSTON ' � 8 `r 28 ............ ROUTE ....... 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(ONLY) - � �AIN_ LEACHING TRENCH (/)REQ. %• P.Vc.PIPE MIN. , PfiCH 1/4"PMYr I PIPE-Mi. 1 1/8"-- P/2" YVf�Fr{m .SPVC 3S� PIT Cm 114"P�.r c. r GAS BAI•rLE--►� v ��t•F / 1 �� •V lYr�'• JE ! 1C TANK 3..� �r M� R/ //��) ��```—�"-- �-: 1 ....��"�.. GAL.. 1NV='i }� �-� �� •�'$�..3ln' s" BOX C/ ' CRUSHED srcme �y � . . /a - i� �3Q7-S' PROF)LE G�i 0,1� a�; a L �- i SEWAGE DISPOSAL SYSTEM ,A3 G SOIL LOG . A TIME ho s..al 'I ES HOLZ I TEST HOLE 2 - �Scil�� • -SF �0�� 4/ zp/6 .. '. .. =v. o� :.. , DESIGN DATA : - . ... �Rr ,✓ayy� ....... ,,,.c�� /0��3!'J'SsEs OF =tea.=.Doha 76-" /Z �\ /-0,9,W%71 /� ,CA/I'��y 'TGIAL :s+IA:«,i=a PLOW GALLONS/DAY y�7 3l, By~OM LEACHING AREA �fr�" �,��.s`4 �,/G• d L'� 29 i'R�"�/�K `p L i S1D� LEI aREa' '��--.!1�??- 3Q.:j%/—.,.Et4CH -�, d . Sys ,r SITE PLAN 4495 POUTEP. 8 COTUIT MA 7� - o��.��, . �� GaR�AG� DiS?osaL :. �!¢...(5o�a AREA 1NCrZ'..ASa) 9 G• GvA E - LOAi1U'E ,u.AL LZACKiNG AREA • ' �?T /o. z-u r PERCOLATION P..".i��. .. . .. � PEA.1N CY• FOR 16 yz ' i�Aettluc An:_.4 P�� PERCOLATION P.:u`•� '�/ /oyR6 y f�1so.r 1 . =� ..�- /yy` E'L• .2 �yy' - F�L- 3 APPROVED . . . . . . .. .... BOA? L UKE P LAL LY .. . a of 1; AL�:t ..... .K�aTER ENCOU r..IED ..- Cap:•...... ..... . . .... ... . .. . . . . �'IN OF MAs , ',G:iKT OR WITNESSED �BY •• ��r1.f7.':.5 �.1�.:✓. . :�lY.. BOARD OF HEALTH . . . . _ . . . . . . . . . . . . . . . . � ♦.• • • Y'i ••• • • l • • EE • • • . • • • . . . • 5 7 0 aREDsa� . - • . . . . . �/ EVAI