Loading...
HomeMy WebLinkAbout0045 MAIN STREET (COTUIT) - Health 45 MAIN`STREET, COTUIT �1 _ A= 00 a I ' I i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, I FL.,367 Main Street, Hyannis,MA 02601 (Town Hall) DATE:_ Fill in please: APPLICANT'S YOUR NAME: jl A Cft-21`EYL BUSINESS YOUR HOME ADDRESS: t145 kv►H!N S I �T.�U PSTAIP-S 569,uaD,a(ooa�35 TELEPHONE # Home Telephone Number 509,119"U 13R0 NAME OF NEW BUSINES 17A CONSUL N TYRE OF::SUSINESS �Hoiv N 1.77/V& IS THIS A HOME OCOUF►ATiON?' YES NC1�_, Have you been givon,approval from the buildin :division. YES NO�_ ADDRESS OF BUSINESS . ,, MAP/PARCEL:NUMBER O J O! When starting a new 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.--_(oorner 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 COMMISSIONER'S OFFICE This individual.has been informe f anyy permit requirements that pertain to this type of business. Authorized 'gnature* COMMENTS: Ur 2. BOARD OF HEALTH This individual hVL4ianW f the mit re u' ements that pertain to this type of business. Autature* COMMENTS: A� 3. CONSUMER AFFAIRS AUTHORITY) LICENSING ( H RITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE LOCATION 'Ar rrl i.0 ST SEWAGE # VILLAGE Co 71c 1 T ASSESSOR'S MAP& LOT 9 r6a INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Oy LEE E-5-0 ed cEs s Pooc (size) mar 7 t 6 x R' NO.OF BEDROOMS z 4- 't 19ov 0 RG-Ti4,c- BUILDER OR WNER 1 CA -T PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by SI-cP Vt�E3� - tt� s� ' ���� i � � �� �- .� f+ r�� . . f'� �i IU S'Y � o '-�-5 U�!�°'�JI� �,, 4 COMMONWEALTH OF MASSACHUSETTS z EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS A DEPARTMENT OF ENVIRONMENTAL PROTECTION_�� ONE WINTER STREET. BOSTON, MA 02108 617-292-5500qj i s a TRUDY CORE WILLIAM F.WELD Secretary Govemor DAVID B.STRUHS O,c ARGEO PAUL CELLUCCI RM 00 Commissioner Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTIO yF0 PART A CERTIFICATION �._AT Address of Owner: Cv// -q + Property Address: L'O%u r i (If different) `�,q25 To.cls�Ni c S Date of Inspection: ;Fl1,3 aC�' Name of Inspector: �#�2/��ti-- sy1 Lri �rl f .J. �, <'v7tf. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: </• �r/. 41�'cSo.ce_ .Ctss�c�, iCi �r 3G Mailing Address: Telephone Number: S O it ail•S G 3 CERTIFICATION STATEMENT performed based on my training and experience in the proper function and I certify that I have personally Inspected the sewag al system st m at this address and that the information reported below is true,accurate and complete as of the time of inspection. Tinspection maintenance of on-site sewage disposal systems. The system: Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails Date: Inspector's Signature: ----�� --= / � vin Auth ty within thirty (�O) days of om The System Inspector shall submit a copy of this inspection pd orggreate�rr the inspector and the c he system neeshall str6mit inspection. If the system is a shared system or has a design flow of 10,000 gp the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system own er and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, 8, C, Or D: A] SYSTEM PASSES: lates any of the failure criteria as defined in 310 CMR 15.303. I have not found any information which indicates that the system vio Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: vhe "Cohe.Board section pass. be replaced or repaired. The system, upoi One or more system components as described in of Health completion of the replacement or repair, as appro Y Indicate yes, no, or not determined (Y, N, or ND es wne ono ° o�eh p�o°Id in ed the systemsinspector determined", th a'copy of a explain Cert f why cate of _ The septic tank is metal ess the o Pe ears prior to the date of the inspection; a Compliance (attac indicatingthat the tank was installed within twenty shows y the septic to , whether or not metal, is cracked, structurally unsound?existing septic tank Isbeplatcaed�withaa'�onforming septic tank failur ' imminent. The system will pass inspection if the approved by the Board of Health. Page 1 of 10 (revised 04/25/97) DEP an the World Wide Web: http:ltwww.magnetstate.ma.usldep Z�J Printed on Recycied Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 5'r Owner: Date of Inspection: 61 SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in th istribution box is.due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. a system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is le ed or replaced The system required pumpin ore than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with appr of the Board of Health): oken pipe(s).are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further,evaluation by the Board of Health in order to deter ne if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT TH STEM 15 NOT FUNCTIONING IN A MANNER WHICH'WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND TH VIRONMENT: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering v tated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALT (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER AT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank d soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface wat supply. _ The system has a se ' tank and.soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a ptic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system h a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private w r supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the w is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or le than 5 ppm. Method used to determine distance (approximation not valid). 3) O i (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 445— �fAi.t! si, Oo i k s 7- Owner: ss�.a2 ��.4ti H.� r�ci•z/ Date of Inspection: D] SYSTEM FAILS: You must indicate eit ,er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 31 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine wh will be necessary to carted the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clog d SAS or cesspool. _ Discharge or onding of effluent to the surface of the ground or surface waters ue to an overloaded or clogged SAS or _ g p cesspool. _ utlet invert due to an erloaded or clogged SAS or cesspool. Static liquid level in the distribution box above o _ Liquid depth in cesspool is less than 6" below invert or available v ume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT du to clogged or obstructed pipe(s). Number of times pumped _ Any portion of the Soil Absorption System, cesspool or ivy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 fe of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a ne I of a public well. Any portion of a cesspool or privy is withi 50 feet of a private water supply well. . _ Any portion of a cesspool or privy is 1 ss than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. I he well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organi ompounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" as t each of the following: The following criteria apply to I ge systems in addition to the criteria above: d greater (Large System) and the system is a significant threat to The system serves a facility ith a design flow of 10,000 gp or public health and safety d the environment because one or more of the following conditions exist: Yes No the sy m is within 400 feet of a surface drinking water supply th 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 own or operator of any such s6500. Plelasering the system consult the localnegionlaly into officefull compliance of the Departmenttforhfurther information.tment program require ents of 314 CMR 5.00 a I Page 3 of 10 (revised 04/25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addresses: 49' ,A1AiRI Tic i T Owner: Y �r1aGc ,tfi�.+�3ci•t/ Date of Inspection: 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. 2r+1sr��c�= S _ 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. As built plans have been obtained and examined. Note if they are not available w th N/A. The facility or dwelling was inspected for signs of sewage back-up. V.,� The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. /O��c rou�tr _ All system components, excluding the Soil Absorption System, have been located on the site. ySrLOSs A—_ _ The se� mannoles 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: _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Z( Existing information. Ex. 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) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 44s Owner: ""4e- /-/W'W Date of Inspection: 1-0011 FLOW CONDITIONS RESIDENTIAL: Design flow: 71'49 ;.p.d./bedroom for S.A.S. Number of bedrooms: a Number of current residents: - Garbage grinder (yes or no): 41'e Laundry connected to system (yes or no):_A/O Seasonal use (yes or no): 4e Water meter readings, if available (last two (2) year usage (gpd): )� Sump Pump (yes or no): 4/0 J ,n Last date of occupancy: COMMERCIAUINDUSTRIAL: l Type of establishment: )e(f_rf c. Design flow: ivv gallons/day ci9a�� — FcoeeJ rr--9c<<�.� crr�� tS jl% Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) :j0,fVC 46Ve'f✓e /moo crc o Non-sanitary waste discharged to the Title 5 system: (yes or no) /lv Water meter readings, if available: Sc c= /i=aov Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) �� If yes, volume pumped: F}V 42 gallons Reason for pumping: c sumac— ,[/o s tl .�C'oi3cc�t TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool _ Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 6eXI1CZI o��/ t=•¢ Sewage odors detected when arriving at the site: (yes or no)�t10 (revised 04/35/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: rn,q f+/GILc , tgnc3c�.c/ Date of Inspection: �/i3/Oct BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC �Y other (explain) ✓r S!iCCCs�-3•i' fl - TO �S-F /'/Tf/c!� s�D Distance from private water supply well or suction line ��— Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) yo �,tJ iC!-1 tiT e© L SEPTIC TANK:= (locate on site plan) Depth below grade: Material of construction: _concrete metal _,Fiberglass _,Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance �Le (Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: .t�Z Distance from top of scum to top of outlet tee or baffle: ±/2 Distance from bottom of scum to bottom of outlet tee or baffle: How dimensions were determined: 141SIO Comments: ondition of inlet and outlet tees or baffles, depth of liquid level in relation to out (recommendation for pumping, c let invert,structural integrity, evidence of leakage, etc.) f GREASE TRAP: ±gr Gi (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (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.) Page 6 of 10 (revised 04/25/97) SUBSURFACE SEWAG E DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ) Owner: Date of Inspection: /j310e TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of' spection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass •_Polye ylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in workin order _Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condit of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level abo ve outlet invert: Comments: (note if level and distribution is equal, evi ce of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER:_, (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Comments:. appurtenances, etc.) (note condition of pump chamber, ition of pumps and Saga 7 of 10 (revised 04/25/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: e .g,f/'V Date of Inspecti6n: /ice/po SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, 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 Technclo Comments: (note condition of soil, siZofhydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: co GJ9 (locate on site plan) Number and configuration: / Depth-top of liquid to inlet invert: z ' Depth of solids layer: AOK!s- 4 " Depth of scum layer: A10A1 c Dimensions.of cesspool: Y S Materials of construction: e07-10 Indication of groundwater: /Vd inflow (cesspool must be pumped as part of inspection) C&-3s F'o� s Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) 2dp�' &.bow" Su.3siD�VC�'� PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic ure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page 5 of 10 / Q� r•1 a ' G l w C A»fone H;.(�2obello,e}uxx. , a?4'22'E - 0Ln o cv " u a0 � o L1 14, z ; 1700 {' U7 co w N W1111am O.HarlOwehI- w a t N SSEF:• 7q.01!.._. to �o' Ro ...... c P� s+►_ 585'15 illGG1N P , PLAVW OF- LAND _ TLY OF DEEDS SA/vTUlrrT M. LI NW©OD FFPLASER. - Sc9�e: l i� 7tn�r Se{ 19, 950. B arse e: Kit�cqq i v,i I rtq i veers: +�'2095 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) G Property Address: Owner. � Date of Inspection: Depth to Groundwater fz- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local co nditions ditions Check with local Board of health Check FEMA Maps Check pumping recor ds s Check local excavators, installers X Use USGS Data Describe in your.own words how you established the High Groundwater Elevation. (Must be completed) I Page 10 of 10 (revised 04/25/97) x gi : Date Work Done Contracyrtor Septic systems are individual wastewater treatment systems that use the soil to treat small waste- - water flows,usually from individual homes. They are typically used in rural or large lot settings where centralized wastewater treatment is impractical. YOUK There are many types of septic systems in use today. While all septic systems are individually designed for each site,most septic systems are based on the same principles. SEPTIC x A ConventionalVr Septic System� Y M , .r= t s.ifv` •sue 5 ?y. /� i ifi 5k r o aw�S $�" aro x y —_--_==,j��%/� z - ._, � at `a.5).sum:::9r..«���'-.�;¢�_,.au��.�ul'. ff- =_= ` t A videotape version of this brochure,also entitled "tour septic System:A Guide for Homeowners,"is available through the EPA KTISmall Flows Clearinghouse.Call 1 800-624 8301. 0 o For more information about maintenance or inspection of your septic system,contact your local board of health or the Department t of Environmental Protection: y - Central Regional Office: w (508)792-7650 3 Northeast Regional Office: A septic system consists of a septic After the partially treated wastewater (617)932 7600 tank, a distribution box and a drainfield, all leaves the tank, it flows into a distribution Southeast Regional Office connected by pipes,called conveyance lines. box, which separates this flow evenly into a (508)946-2700 network of dralntield trenches. Drainage Yoursepticsystemtreatsyourhousehold holes at the bottomofeachlineallowthewas- Western Regional Office: wastewaterbytemporarilyho/dingitintheseptic tewaterto drain into gravel trenches for tempo- tank where heavy solids and lighter scum are nary storage. This effluent then slowly seeps Boston Office: �e allowed to separate from the wastewater. This into the subsurface soil where it is further (617)292-5673 separation process is known as primary treat- treated and purified(secondary treatment). ment. The solids stored in the tank are decom- p y Published n with by the Northern Virginia Planning District A property functioning septic system does not Commission with assistance from Virginia Water Control Board posedbybacteria and later removed,along with pollute the groundwater. National Small Flows Clearinghouse,and the Northern Virginia 0 the lighter scum,by a professional septic tank Health Departments. Reprinted 1994 by the Division of Wafer Pollution Control of the Massachusetts Department of Environ- pumper. menial Protection. P.infm on A—y-d P.— - . The accumulated solids in the bottom of be very expensive to repair, Do have your tank pumped out and DON'T allow anyone to drive or park the septic tank should be pumped outevery and,put thousands of water supply users system inspected every 3 to 5 years by over any part of the system. The area three to five years to prolong the life of your at risk if you live in a public water supply a licensed septic contractor(listed in the over the drainfield should be left undis- system. Septic systems must be main- watershed and fail to maintain your sys- yellow pages). turbed with only a mowed grass cover. tained regularly to stay working. tem. Roots from nearby trees or shrubs may .clog and damage your drain lines. Neglect or abuse of your septic system Be alert to these warning signs of a failing D®keep a record of pumping,inspec- can cause it to fail. Failing septic systems system: tions,and other maintenance. Use the DON'T make or allow repairs to your can sewage surfacing over the drainfield back page of this brochure to record septic system without obtaining the re- caus e after storms), maintenance dates. • cause a serious health threat to your quired health department permit. Use family and neighbors, sewage back-ups in the house, professional licensed septic contractors • D®practice water conservation. Re- when needed. degrade the environment, especially lush,green growth over the drainfield, pair dripping faucets and leaking toilets, lakes,streams and groundwater, slow draining toilets or drains, run washing machines and dishwashers only when full avoid long showers,and DON'T use commercial septic tank , reduce the value of your property, sewage odors. additives.These products usually do not use water-saving features in faucets, help and some may hurt your system in shower heads and toilets. the long run. • DO learn the location of your septic system and drainfield. Keep a sketch of DON'T use your toilet as a trash can it handy for service visits. If your system by dumping nondegradables down your has a flow diversion valve,learn its loca tic s toilet or drains. Also,don't poison your Inspddlla (PO pUugP n > se stem and the groundwater tion and turn it once a year. Flow P y g y \ / di rerters can add many years to the life pouring harmful chemicals down the Tee of your system. drain. They can kill the beneficial bacte k ria that treat your wastewater. Keep The following materials out of your septic r 5.m.: ou0el:Treated WasleWele Inlat:sews^_c .�sn�o coee,o uslrlb.,lon ems: �� . DO divert roof drains and surfacFyJater system: Enters Irani House �� and Drain Fleld from driveways and hillsides away from the septic system. Keep sump pumps wa'ewa)er �^ and house footing drains away from the to —�— septic system as well. se,disposab ;:w 1jr sl�d4a ;; f yf f • d( lastics,etc. j �T %Si;» i -✓�ifi .i DO take leftover hazardous household chemicals to your approved hazardous P waste collection center for disposal. Use gasoline,oi, bleach,disinfectants,and drain and toi- t thinner.pes let bowl cleaners sparingly and in accor- dance with product labels.