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0839 MAIN STREET (OST.) - Health
MAIN STREET, QSTERVILLE I II o d u 6 I' 1 0 y� OD� Miorandi Donna From: McKean, Thomas Sent: Friday, March 23, 2018 3:56 PM To: Miorandi, Donna Cc: Crocker, Sharon Subject: FW: Oggi's Hair Salon Donna, Please see e-mail below. § = �j }r° %I Sharon, please keep this on file. From: Elizabeth Lynch [mailto:easllaw@gmail.com] Sent: Friday, March 23, 2018 3:13 PM To: McKean, Thomas Subject: Oggi's Hair Salon Mr. McKean, I represent Sandra Aupperlee, owner of Oggi's Hair Salon. I represented her when she purchased the salon and have continued to represent her throughout her ownership. Sandra Aupperlee's ownership continues today. There has been no sale of the business. Although there were preliminary discussions, no sale occurred, nor is one pending. Any information which was posted on the internet was incorrect and done without Ms. Aupperlee's knowledge or consent. When she discovered the posting, she had it changed immediately. As we all know, anyone can post anything on the internet. If you have questions, please let me know. Elizabeth A. Lynch Attorney at Law 702 Putnam Avenue Cotuit,MA 02635 508-428-7560 telephone 508-420-5290 fax This e-mail message and any attachments are confidential and may be attorney-client privileged. If you are not the intended recipient please notify Elizabeth A. Lynch, Attorney at Law, immediately by telephone at 508-428-7650 or by e-mail to easllaw(d),gmail.com and destroy all copies of this message and any attachments. 1 H V, � • c oy • p O " E ...D ca Certified Mail Fee Ir $ Extra Services&Fees(check box,add fee as a ppropriate) rq ❑Retum Receipt(hardcopy) $ O ❑Return Receipt(electronic) $ POSfmark O ❑Certified Mall Restricted Delivery $ ® Hire O ❑Adult Signature Required $ !/ ❑Adult Signature Restricted Delivery$ j O Postage m171— $ _ Total Postage and Fees d�` Et. S t�q n. rq _��J l�G1I1 _. _. O Apt-171— o. 4r PO Bo1r City, :11 1 11 111•1 L m Complete itemg 1; and 3. A elute -O Agent U Print your name an ddress on the reverse G ❑Addressee so that we can refu the card to you. R ived by(Printed Name) ate o DeI ery n Attach this card to the back of the mailpiece, . /�- or on the front if space permits. D. 1. Article Addressed to: Is delivery address different from item 11 Ye n, �/ � If YES,enter delivery address below: [3 No !'l�5P 190Il'I f 11'v 00 Ml1CI1( II I�IIIII IIII I'I I II II II I I I III�I t II�I It III II ICI 3. Service Type ❑ ei Mail Express® ❑Adult Signature ❑Registered MailTl" ❑Adult Signature Restricted Delivery ❑Re $Istered Mail Restricted Certified Mail® Delivery 9590 9402 1933 6123 1784 46 Certified Mall Restricted Delivery `�Return Receipt for ❑Collect on Delivery l Merchandise ❑Collect on Delivery Restricted Delivery ❑Signature Confirmallon- 2. Arti ❑Signature Con cle Number(Transfer from service labeo Insured Mail Confirmation 7 015 1730 0 1 4987 6940 J Insured Mall Restricted Delivery Restricted Delivery (over$500 Domestic Return Receipt PS Form 3811,July 2015 PSN 7530-02-000-9053 Town of Barnstable Barnstable VErcyo Health Division �`CeCj swRrrsrn6>re, 200 Main Street, Hyannis MA 02601 II MASS. $ 2007 039. �m Arf��,lA Office: 508-8624644 FAX: 508-790-6304 Paul Canniff,D.M.D Junichi Sawayanagi Donald Guadagnoli,M.D. CERTIFIED LETTER: 7015 1730 0001 4987 6940 February 26, 2018 Ms. Sandra Aupperlee/Owner Oggi Hair Designs 845 Main Street Osterville, MA 02655 Dear Ms. Aupperlee/Owner of Oggi Hair Designs: In light of the disputes of ownership of Oggi Hair Designs and in order to close out the file on this business we are requesting official documentation, in the form of a notarized .affidavit. Sandra Aupperlee, former owner according to website (www.decoyrealty.com, came into the office on January 19, 2018 stating she was still the owner of the hair salon. Ms. Aupperlee also provided copies of her Commonwealth of Massachusetts licenses. Ms. Aupperlee's website previously stated that she in fact did sell the business. However, Ms. Aupperlee called again and stated she was still the owner of the business, known as Oggi Hair Designs, located at 845 Main Street, Osterville. She stated that someone else posted this on her website without her permission. Ms. Aupperlee has since changed her website to state that-she is the owner. At this time, therefore, the Health Division, is requesting that you submit to this office an affidavit which is NOTARIZED indicating that you are currently the present owner of Oggi Hair Designs, within 30 days from receipt of this letter. For assistance on this required affidavit it is advisable to use this free online form which is: https://www.Iawdepot.com/contracts/affidavit/#.WpBfsuRy7cs . QAOrder LettersBeauty Salons\Beauty Salon 3-Feb.23,2018-845 Main St.,Osterville.Doc ' r • r, r - r If you have questions regarding this matter please feel free to contact Health office at 508- 862- 4644. Sincerely, Q�Sql. Rdean., S. Director of Public Health Town of Barnstable QAOrder LetterskBeauty SalonsBeauty Salon 3-Feb.23,2018-845 Main St.,Osterville.Doc TOXIC AND HAZARDOUS MATERIAL REGISTRATION FORM NAME OF BUSINESS: O661 /7X4 4_S/61/V Mail To: BUSINESS LOCATION: f�.� *, itf S% OST�,�diLL�. MA Da2�. Board of Health MAILING ADDRESS: 15; r/gC Town of Barnstable /' P.O. Box 534 TELEPHONE NUMBER: (Car) Hyannis, MA 02601 CONTACT PERSON: &1 LL. O�-U EMERGENCY CONTACT TELEPHONE NUMBER: 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 V/ 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: Quantity/Case Quantity/Case Antifreeze (for gasoline or coolant systems) Drain cleaners Automatic transmission fluid Toilet cleaners Engine and radiator flushes Cesspool cleaners Hydraulic fluid (including brake fluid) Disinfectants Motor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel Refrigerants Diesel fuel, kerosene, #2 heating oil Pesticides (insecticides, herbicides, Other petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages 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) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business Cpmptete ItemI and 3. C Print your name and address on the reverse ure so that we can return the card to you. �1,(-�(� e o Attach this card to the back of the mailpiece, Addre Ise or on the front if space permits. B. Received by(printed Name) C. Da o I' 1. Article Addressed to: D. Is delivery address different from item 1? Yes �1 0 If YES,enter delivery address below: 000 3 Se Ice II flll'I IIII IlilIIIIII II IIIIIIICIIIIIIII IN ❑Adult dult Signaturee ❑Registered Mail EVrresse 9590 9402 1933 6123 1786 13 stsnature Resricted Dative e9 red Mail AitCertified all ry ❑Re IRIS, Mail Restricted ❑Certified Mail Restricted Deliveryeery AMinla Nltmher ITiansferfrom Service/abeq ❑Collect pt for on DeliveIlect on Iv ry ResMcted Delivery Merchandise CoinfirmationTM+ 7 15 1730 11001 Merchandise 4 9 8 7 7 Insured Mail ❑Signature Confirmation 6 8 3 7 Insured Mail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 iOV�$soD) Domestic Return Receipt m ►.CO O cO Certified Mail Fee Er $ Extra Services R Fees(check box,add ree as appropriate) r_1 ❑Return Receipt(hardcopy) $ O ❑Return Receipt(electronic) $ Postmark•' C3 ❑Certified Mail Restricted Delivery $ H ,�- O ❑Adult Signature Required $ .r ❑Adult Signature Restricted Delivery$ C3 Postage m $ Total Postage and Fees Sent T rq !_ �� ? l 0 � r _ :/1 1 11 11.1 T. k_. �VKWE tp� Barnstable Town of Barnstable � ♦ r AFAmadcaC ty IA MAS BL& Board of Health1639. Arlo+�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED LETTER: 7015 1730 0001 4987 6803 January 30, 2018 Oggi Hair Designs 845 Main Street Osterville, MA 02655 Dear Oggi Hair Designs: The State Environmental Code, Title 5, 310 CMR 15.000, prohibits the discharge of salon/barber shop industrial waste into an onsite sewage disposal system and requires that this waste be discharged into a holding tank. The policy applies in the event of a change in ownership. It has come to our attention that there has been a change in ownership at Oggi Hair Designs. Therefore, you are required to connect to an approved holding tank. Sandra Aupperlee, former owner, came into the office on January 19, 2018 stating she was still the owner of the hair salon. Ms. Aupperlee also provided copies of her Commonwealth of Massachusetts licenses. Since January 19, 2018 it has come to light that she has sold the business (please see attached document). You have ninety days (90) from the receipt of this letter in which to comply with this regulation. Enclosed is a copy of the policy, procedures, and guidelines to assist you in obtaining compliance with this regulation. If you have questions regarding this matter please feel free to contact this office at 508-862- 4644. Q:\Order letters\Beauty Salons\beauty salon 11845 Main St.,Osterville.doc Sandra Aupperlee,Agent I Decoy Realty Page 1 of 3 508-888-6545 (te1:508-888-6545) 1 LOCATION (http://www.decoyreatty.com/contact-form/) O (https://twitter.com/RealtyDecoy) 9 (https://www.facebook.com/decoyrealty/) (https://www.instagram.com/decoyrealty/). (https://www.linkedin.com/in/decoy-realty-388b2Ol4a/) Deco >t Realty, Ltd. (http://www.decoyrealty.com/) Sandra Aupperlee, Agent 508-888-6545 508-833-1545 fax ' sneckhairaaol.com(mailto:sneckhair@a aol.com) _ i 356 Route 6A East Sandwich MA, 02537 Receive Email Alerts from Me Sign Up Sandra is a lifelong Cape Codder. She grew up in North Dennis and currently lives in Cotuit with her husband who is a builder. Sandra has owned and operated small businesses for 25 years and understands the importance of open communication and client service. he recently sold her successful Osterville hair salon and is focusing on bringing her business expertise into her http://www.decoyrealty.com/agent-detail/Sandra-Applebee/141058/ 1/29/2018 I Sandra Aupperlee,Agent I Decoy Realty Page 2 of 3 i y Creal estate practice. Sandra has a passion for gardening and interior design and enjoys`traveling, spending time with her family and driving her 1973 VW convertible. She is a member of the Cape Cod and Islands Board of Realtors. CONTACT Decoy Realty, Ltd. 356 Route 6A East Sandwich, MA 02537 Phone: 508-888-6545 (tet:508-888-6545) Email: decoyrealtyeverizon.net (mailto:decoyrealtyeverizon.net) Property Search LOCATION 6 View larger map G e Decoy Realty Ltd Dennis" _ o' .° Chatham.,.,, Barnstable ° y Drt Gojagle Map data©2018 Google, F'ht s://www.linkedin.com/in/decoy- (ht r a - nc6l �lty/; http://www.decoyrealty.com/agent-detail/Sandra-Applebee/141058/ 1/29/2018 Sandra Aupperlee,Agent I Decoy Realty Page 3 of 3 Copyright ©2017 Decoy Realty, Ltd. All Rights Reserved. Site Produced by Coastal Mountain Creative (http://coastalmountaincreative.com/). Terms of Use (http://www.decoyrealty.com/terms/) I Privacy Policy (htt[?://www.decoyrealty.com/privacy/) I Sitemap (http://www.deco, ry ealty.com/sitemap/) htt ://www.deco real .com/a ent-detaiUSandra-A lebee/141058/ 1/29/2018 P Y h' g PP r - Op THE r�, Barnstable Town of Barnstable a"RNSMBLF� ' Board of Health I AT fD �a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Public and Environmental Health Program Policies,Procedures, and Guidelines Tanks at Beau Salons and Barber Shops No. 2010-06 Tight ty p Updated 9/2U17(added last paragraph on page2) [The State Environmental Code, Title 5, 310 CMR 15.000, prohibits the discharge of beauty salon/barber shop industrial waste into an onsite sewage disposal system and requires that this waste be discharged into a holding tank. This policy only applies to beauty salons and barber shops which are connected to onsite sewage disposal systems.] On June 8, 2010 the Board of Health voted to issue the following policy relating to hair salons and barber shops: 1) Every owner of: • any new hair salon or barber shop, or • any existing hair salon or barber shop which is seeking approval to install additional seats, or • any salon or barber shop where the onsite sewage disposal system fails a sanitary inspection, of • any salon or barber shop that has a change in ownership, or • any salon or barber shop operation that has a change in licensure. and which is connected to an onsite sewage disposal system shall submit plans for an industrial waste holding tank. The plans shall be submitted prior to opening for business, installing additional seats, or upon discovery of a failed onsite sewage disposal system, change in ownership, or change in licensure. The plans shall be prepared by a professional engineer, designed in accordance with 314 CMR 18.00, and shall be submitted.to the Department of Environmental Protection and to the Public Health Division Office, at 200 Main Street Hyannis Massachusetts. 2) All hair salon and barber shop holding tanks shall be installed in accordance with the approved plans prior to opening for business, prior to installing any additional seats, or upon Q:Policies\TightTanksatBeautySalonsand Barbershops Revised 6/12/2010 l I discovery of a failed onsite sewage disposal system, change in ownership or change in licensure. 3) Any sink, which is connected to the the approved holding tank, shall be designated as a hazardous materials/chemical discharge sink. Clearly visible, permanent signs shall be posted at the designated sinks indicating that any and all potentially hazardous materials and chemicals shall be disposed of into this sink Signage at other sinks, at the same facility, shall also be posted clearly indicating that no employee(s) shall discharge any potentially hazardous materials or chemicals into "these sinks. Each sink shall be posted separately. Here is the link to the DEP certification form and instructions (BRP WP 56): http://www.mass.gov/eea/agencies/massdep/service/approvals/industrial-wastewater- holding-tank-certification.html Q:Policies\TightTanksatBeautySalonsand Barbershops Revised 6/12/2010 o Complete items 1 2 _ '�o Print your name and address on the reverse so that we can return the card to you. � � A errt o Attach this card to the back of the mailpiece, Addressee or on the front if space permits. R eived by(Printed Name) C. D of elive I. Article Addressed to: ® 0 D. Is delivery address different from item 1? Yes Q� 0 M/g-D If YES,enter delivery address below. ❑No Mir II I�III�I Ifll III I II II II I I I IIIII I II I II I I'I I I�II •Adult StRegistered Mail jress® ❑ S Signature Restricted Delivery ry ❑ main9590 9402 1933 6123 1788 04 A ifled Maile ❑Registered Mail Restricted ❑Certified Mall Restricted DeliveryDelivery 2. Article Number(Transfer frnm.zomir.(nhcn ❑Collect on Delivery 1ORMerchan etum Receipt for ❑Collect on Delive Restricted Delivery ❑Sig aturedtse ConflrmationTM 7 015 17 3 0 0001 4 9 8 7 6773 ❑insured Mail ❑Signature Confirmation ❑insured Mail Restricted Delivery Restricted Delivery PS Form 3811,July 2015 PSN 7530-02-000-9053 over$s00 Domestic Return Receipt t t f` LI�13 � .M1D • • cO Er Mail Mail Fee ) i tea,r Extra Services$ _ ❑Return Fees(check box 'Receipt(hardcopy) adtlfee as appropi ��I 'I J ", 0 ❑Return Receipt(electronic) $ t� �Adutsd Mail Restnoted Delivery 9nature❑A k' Required 3 o $ f dult Si $ w 0 Signature Restricted Postage Delive y$ M1 t ��'of Total Postage and Fees $ r-3 Sent T �l.$1 Slreetan1 bb / j( -V-- !(J ___ r -- �tMt Barnstable Town of Barnstable AlAnWINCHI ' PAACM"BM ' Board of Health 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED LETTER: 7015 1730 0001 4987 6773 January 12, 2018 Oggi Hair Designs 845 Main Street Osterville, MA 02655 Dear Oggi Hair Designs: The State Environmental Code, Title 5, 310 CMR 15.000, prohibits the discharge of salon/barber shop industrial waste into an onsite sewage disposal system and requires that this waste be discharged into a holding tank. The policy applies in the event of a change in ownership. It has come to our attention that there has been a change in ownership at Oggi Hair Designs. Therefore, you are required to connect to an approved holding tank. You have ninety days (90) from the receipt of this letter in which to comply with this regulation. Enclosed is a copy of the policy, procedures, and guidelines to assist you in obtaining compliance with this regulation. If you have questions regarding this matter please feel free to contact this office at 508-862- 4644. Sincerely, s A. McKean, R.S. Director of Public Health Town of Barnstable Enclosures Q:\Order letters\Beauty Salons\beauty salon.doc IK*E jl�`" Town of Barnstable Bar r 1 PJ'tCaC i + .ARNSI'AHLE, : Board of Health MASH 9ej t6;Q. � prfo �A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi Public and Environmental Health Program Policies,Procedures, and Guidelines. Tight Tanks at Beauty Salons and Barber Shops No. 2010-06 Updated 9/21/17(added last paragraph on page2) [The State Environmental Code, Title 5, 310 CMR 15.000, prohibits the discharge of beauty salon/barber shop industrial waste into an onsite sewage disposal system and requires that this waste be discharged into a holding tank. This policy only applies to beauty salons and barber shops which are connected to onsite sewage disposal systems.] On June 8, 2010 the Board of Health voted to issue the following policy relating to hair salons and barber shops: 1) Every owner of: • any new hair salon or barber shop, or • any existing hair salon or barber shop which is seeking approval to install additional seats, or • any salon or barber shop where the onsite sewage disposal system fails a sanitary inspection, or • any salon or barber shop that has a change in ownership, or • any salon or barber shop operation that has a change in licensure. and which is connected to an onsite sewage disposal system shall submit plans for an industrial waste holding tank. The plans shall be submitted prior to opening for business, installing additional seats, or upon discovery of a failed onsite sewage disposal system, change in ownership, or change in licensure. The plans shall be prepared by a professional engineer, designed in accordance with 314 CMR 18.00, and shall be submitted.to the Department of Environmental Protection and to the Public Health Division Office, at 200 Main Street Hyannis Massachusetts. 2) All hair salon and barber shop holding tanks shall be installed in accordance with the approved plans prior to opening for business, prior to installing any additional seats, or upon Q:Pol i ci es\TightTanksatBeautySalons and Barbershops Revised 6/12/2010 discovery of a failed onsite sewage disposal system, change in ownership or change in licensure. 3) Any sink, which is connected to the approved holding tank, shall be designated as a hazardous materials/chemical discharge sink. Clearly visible, permanent signs shall be posted at the designated sinks indicating that any and all potentially hazardous materials and chemicals shall be disposed of into this sink Signage at other sinks, at the same facility, shall also be posted clearly indicating that no employee(s) shall discharge any potentially hazardous materials or chemicals into these sinks. Each sink shall be posted separately. Here is the link to the DEP certification form and instructions (BRP WP 56): http://www.mass.gov/eea/agencies/massdep/service/approvals/industrial-wastewater- holding-tank-certification.html Q:Policies\TiglhtTanksatBeautySalonsand Barbershops Revised 6/12/2010 DATE: ., 5/1 /96 PROPERTY ADDRESS:-Main Street ell ( w Osterville ,Mass ,� MAY 'T 1g96 02655 On the above date, I Inspected the septic system at the above address. t 9 This system consists of the following: 1 . 2-1000 'gallon septic tanks . 2. 2-Distribution boxes w 3 . 3781x121 cesspools . 2- recast 121 leaching its packed in stone. H2O Wheel load pits . aAlbn my Ins:�ction, I cerptlfy the following conditions: 1 .This is a title five septic system. - ( 78 Code ) 2.The septic system is in proper working order • at the present time. . 3.The Beauty Parlor,� has moved location. The only repair that is needed is a separate ho ng tank for the parlor. This will only handle the wash and rinse sinks . The tank must have h20 loading metal covers to grade. The tank must be wired with a light & alarm floats to blink .anq sound when t e tank is at set capacity. SIGNATURE: G� Name:—J_P _M_acomber Jr_._____ __ i Company: J. P_Maco�ber & Son- ,Inc . Address:-.B,...-,6 ,------I------ CentervilLe . Mass__02.632 Phone:—__SQB—_Z.7--'5,-3338------- THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY R wlarvmm L�EP. MACOMBER & SON, INC. nks-Ceupoola-LeachfleldsPumped & Instilledown Sewer Connections 6� Centerville, MA 02632-0066 775-3338 775-5412 . U Commonwealth of Massachusetts ExecutNe Office of EnWonmental Affairs Department of • Environmental Protection William F.Weld Trudy Cox* ooVOna s—"Y Arg" Paul Celluccl David B.Struhs LL Gmrw C.omno"Wiwt • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION PropertyAddres&: 847 Main Street Osterville,Mass Address of Owner. High Point Trust Company Data of Inspection: 5/16/96 (If different) 1 International Place Name of Inspector. Joseph P. Macomber Jr. Suite # 4404 Boston,Mass Company Name,Address and Telephone Number. 02110 J.P.Macomber & . Son Inc. Box 66 Centerville,Mass . 02632 508-775-3338 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site&swage disposal systems. The system: Passes conditionally Passes _ Needs Further Evaluat'on By the Local Ap�roving Authority _ Fails Inspector's Signature: ` Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system Is a shared system or has a design now 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. INSPECTION SUMMARY: Check A,B,C,or D: Al SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below, B) SYSTEM CONDITIONALLY PASSES: _41-one or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, ,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined*,explain why not) . The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,-or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Winter Street • Boston,Massachusetts 02108 a FAX(617)556-1049 • Telephone(617)292.5500 4L Printed on Recycled Paper • T�nvs'ii• _ $ x.,a.} �"��`y���r ^�x*vf �z''s ijt'4�i"+.E Kk! �yi�SA• �� �H!��}�6..�6tS ��' f�£, e -.t•' «' � r + 5•s�`��� ,�r't.f�- r r ^}" MS��' sy�t a ?R� ��f''��, � #�i t � i'.K'�' t 'k' aft. � L �✓.' 's7`''F' a`�.{�.°'d .�4k '{`y'f tsa{�� lr���.}^� T i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE LION FORM PAJkT.A CERTIFICATION(oontinued) ProportyAddresa: 847 Main Street Osterville ,Mass . 0.2655 Owner. High Point Trust Company . ri f4 4 Date of Inspection:5/ /96 y B) SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or hVh static water level observed in the distribution box is due to broken or obstructed pipes) 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): .Tb.6 system will pass` inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed CJ FURTHER EVALUATI4S REQUIRED BY'THE BOARD HEALTH: 3 ,+ e t 4 �"� kA 9eW'1 Conditions exist wi,A,-t.`r•equire further evaluation by the Board of Health in order tio,dgteriiune if the system is failing to protect the public health,safety and m the environment.. . 1) SYSTEM WILL.;PAS9 UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN:A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: �^ Cecs 1 or privy is within 50 feet of a surface water : o 's'C`spool or:privy is within 50 feet of a bordering vegetated wetland or a salt marsh. a. +, 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE.ENVIRONMENT: �O The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply." ti 6 The system has a septic tank and soil absorption system and u.within a Zone I bf a pub,c water supply well. The system has a septic tank and soil absorption system and is within 60 feet of a pnvate we supply well. The system has a septic tank and soil absorption system and is 1eswl 4 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 jt 4?from pouutiou.from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. 9) OTHER Hair dr'es's,er must have. hold er tank for�wash ik-rin:se.. sinks. Tank must wired with light alarm floats Tank must be tested and then hopefully. hauled to the sewage treament plant in Hyannis ,Mass . Light & 'alrm will sound when the septic tank reaches itc capacity. Plan must drawn by a design engineer. •. .•.:(�revised•tr11/0+3%95>� =�~ ? {' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (oontlnuod) PropbrtyAddrosu 847 Main Street Osterville ,Mass. 02655 owner. High Point Trust Company Data orinsp,00tlow 5/1/96 ; DJ SYSTEM FA1LSr ' I have datwmdaad that the system violates one or more of the following Wura criteria as dallaad in 310 CUR 15.303. Tha basis for this determination is idantified baloW. The Board of Health should be contacted to datornibu what will be aocaasary to correct the failure. Backup of"wage late facility or system component duo to an overloadod or clogged SAS or ooupooL J�D Discharge or ponding of oPluent to the surface of the ground or surface waters duo to an ovorloadod or clogged SAS or ceupooL .P Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cosspooL 6Q Liquid dopth in ccuepool is less than 6"below invert or available volume is lass than W day flow. N) Raquirod pumping more tl:a-n 4 times in the Jut year NOT due to clogged or,obstructed pipo(s). Number of times pumpod _ Any portion of the Soil Absorption Syst.ern, cesspool or privy is below the high groundwater elevation. Any portion of a coupool or privy is within 100 foot of a surface water supply or tributary to a surface water supply. l Any portion of a ceupool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 foet of a private water supply well. Any portion of a Coupool or privy is loss than 100 foet but gmater than 60 foot from a private water supply well with no acceptabla water quality analysis. if the well has boon analyzed to be acceptable,attach copy of wall water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LAROE SYSTEM FAILS: The following criteria apply to largv systems in addition to the criteria above: The ryrtem servos a facility with a da'ign flo-w of 10,000 gpd or y-eator(Large System) and the system is a signlff=t throat to public health and safety and ths-envimament bo:ausa one or more of the following conditions exist: L9 the system is within 400 foot of a sw'face drinking water supply 6W the system is within 200 lset of a tributary w a surfaca drinking water supply AV the ryetom is located in a nitrogen sensitive area (Interim Wellhead Protection Area(IWPA)or a mappod Zone II of a public water supply wall) The owner or oparWr of any such rpum sha.l bring the system and facility into full oompUnu with the voundwatar tmatwnt pmV= roqulrvments of 314 CMR 6.00 and 6,00. Plow:9 consult the local regional office of the Department for further information.. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST: PropertyAddr.as: 847 Main Street Osterville ,-Mass : 02655 Owner. High Point Trust Company Date of Inspection:5/1 /9 6 • Check if the following have been done: ,Pumping information was requested of the owner,occupant,and Board of Health. Y 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. 2built plans have been obtained and examined. Note if they are not available with N/A s 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. ZA11 system components,�cluding 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. ZThe size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. ZThe facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub. Surface Disposal System. YES= Hair Dressers wash sinks are being introduced to the Septic system. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner. Date of Inspootion: FLOW CONDITIONS RESIDENTIAL: Design flow: e Number of bedrooms:_ Number of current residents:' Garbage grinder(yes or n0led Laundry connected to system or no)4A us Seasonal e(yes or no): /lff) Water meter readings, if available: Last date of occupancy:.Pre6e n)T'ry COMMERCIAL NDUSTRIAL: ,, /� ��1l nn ) rjmrdr2 Type of estab' hm l 03 t�tC lY4�L. �V� / ,l! �1s✓�$ Design flow.& g ons/dsy ` Grease trap present: (yes or no)d Industrial Waste Holding Tank present: (yes or no) � Non-sanitary waste discharged to the T•t spy/e (yes�or no) , Water meter readings, if available: j duct ,t7 Last date of occupancy: y OTHER (Describe) X Last date of occupancy: GENERAL INFORMATION PUhSING RECO S au source of info iati n -6r1` •.'�J '' 7 Flo System pumped as part of ins ion: (yes or no) 04t7 If yes,volume pumped: �/vV o > J Reason for pumping: aK�' ��1GL TYPE O SYSTEM Septic tank/diatribution boa/soil absorption system single cesspool Overflow cesspool Privy r rds SystemShared (yip or no) (if ttach revious ins�ectio reco , if --!�— AP RO)aMATE AGE of all o pon �(ifD � �t° � �ioa: 1 40 N&a> 5 �,v ST,¢d 9�- oC iP Sewage odors detected when arriving at the site: (,yes or no)44 +Og s nno���^ I—I,, r (revised 11/03/95) 6 No, THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEAL H r' 1........OF............. ............. i i A.V;Airntiou for MoVosal Yorks Tono#rarfion Hari# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal $tom at: ........���........ ..lion. ..ss.................................. .................... ...�... ...... ..�..... ... ................................. ........ •t•No� w .. ... ...... . nv......................................... ..... Q.�... . ..N•Add....................... . • --• ./ .......... er Address ........ ... ..... e of Building Size Lot. .Sq. feet U Dwelling=No. of— Bedrooms.;:.. — ......................Expansion Attic ( Garbage Grinder aOther Type of Building" r ....`No. of pe sons......Z..O............ Showers ( ) — Cafeteria ( ) Otherfixtures .......... ...y. / ............................................/.................................... ..... Design Flow..��_. . ,W.h. Mons er rson per day. Total daily flow..g � -�� --...-g� P P Y• y ...---.lt....7..ts....-.................gallons. Scptic Tank—Liquid cap city/-4P.0.galIons Length................ Width................ Diameter......... Depth................ 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 ( ) Percolation Test Results Performed by.......................................................................... Date....................................... 1.4 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ w Test Pit No. 2................minutes per inch Depth of JTest Pit.................... Depth to ground water........................ . O Descri 'o of Soi �16�•...._. s.....s •--. ••Cs,ss ..........................................•---................................ --__-__ ---� �..... x ....... :.. #��+ Vw ............................ — Nature of Repairs or Alterati s—Answer whle...-' 4 • .................................... ............................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'LIT LE 5 of the State Sanitary Code— The and igned further agrees not to place the system in operation until a Certificate of Compliance has en i ed by b r o lth. /01, Sign .. r1... Date Application Approved By...-_.._.. - ( .. !11 .. ,... .-1.f�-..7.�..... Date Application Disapproved for the following reasons:................................•__-_...............................-_-_........................_......_.... ........................................................................................................•............................... ....(../.............. ...... �....D .._..._ Permit No.... ......................... Issued.._..CS\....^lr�.�!�.^ p�".......:......... • Date l THE COMMONWEALTH OF MASSACHUSETTS BOARD O?f HEALTH /` �........OF........ .................................................... Ap.pliratinn for 11ispnsal Works Tons#rur#inn thrmi# U./ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal fS , at ..... .................................... ...»._ ».._ .. . iocatlon-Address................................... ...................•..._................... Lot-Na.... .. .... W ...... d-/1 �-. F!. •Address ....»» (�_ Ineta li er ....................................... ........---••Address........................... ....... Type of Building Size Lot......»»».»..-.- Sq. feet Dwelling—No. of Bedrooms�r ..........Expansion Attic ( ) Garbage Grinder p, Other-=Type of Building :`Yf r Y n, No. of persons....................... Showers ( ) Cafeteria ( ) a' Other fixtures Design Flow../ --...................3. --.........-}gallons per person per day. Total daily flow....:......I._Ye.._.............gallons. Septic Tank_` Liquid capacity/44&.g Ilons Length................ Width................ Diameter................ Depth................ 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 ( ) ~' Percolation Test Results Performed by................. ............................-.-..................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit..--................ Depth to ground water........................ G�. Test Pit No. 2................minutes per inch depth Test Pit.....- Depth to ground water........................ ............... I ......... Description of Soil- .............................................. U ............ ---..-. ........ ...... .---.........---........--...` ........-..........-.........�- :-~---............-----.. Uw ...............................- ---....-...-....--------------......------------------------------------"*"**"",•-••-•-••-- Nature of Repairs or Al ations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to` install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL..E 5 of the State Sanitary Code— T ndersigned further agrees not to place the system in operation until a Certificate of Compliance h en ' ue&et oar f li Sig ...... . ....... ate ApplicationApproved By.................:..... .................-........................... .. ..... .-..........................»».... Date Application Disapproved for the following reasons:...0.......................................................................... .......... ..........................................................................•----.......----.............--.-----.......-----........................._--............................ ....._..»..»» Permit No............................•-•-•---•-- } ----.......» Issued.:-:.. .:�1. ..:7(7' D ..... Date THE COMMONWEALTH.,OF MASSACHUSETTS BOARD OF HEALTH..,:.:..'°' ...........� ,,......OF........ ..Q.t,/ ..........................: .....:........ (Irrtif irtttr of Toutphatt r TH 1 TO CE Y,7haL106 Individual Sewage Disposal System constructed ( ) or Repaired (� by...`.' �.....)}.. .�..In................................................ ...... ....................._...�� ....... ............._ ........ i at..... F. :.......1�% `'' ... ......................... has been instal ed in accordance with th provisions of 5 0j The State Sanitary Q�99de as described in the application for Disposal Works Construction Permit NO._ _.S... ............... dated.... ................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WI FUNCTION SATISFACTORY, DATE......... 2 —. .. ... Inspector..... THE COMMONWEALTH OF MASSACHUSETTS y�-- BOARD OF EALTH 79. .1.� ..........i�..... ......OF.......... IGJ!? ..:.................................. Fs$. .�,i�.... No...... .. ......... 'I Permission ' ereby granted.r...... :.(J':..... ...... (1 ..........•........................................................... .. :. to Con (: �ai ( ) dividual Sr age Dispo st� _ f at No, ._e. ��s,�t....... _ -.........� p = ......_. ,i. � - Street as shown on the application for Disposal:Works Construction jil./No ... . ...... .. Dated....F �, '. .�x...:..... o eaH iW DATE.. .................. ,1 t..................... ....................... FORM 1255 HOBBS & WARREN, INC.. PUB4ISHERS THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH:...;,. ....OF............ �...�.,..................................... f�rdifiratr of Toutplittttrr IS I.S TP-OF TI1' t the Individual Sewage Disposal System constructed'`( or Repaired �,/t�/j��� /�///yyy��,��y/f�Q'/'y�ataller at............. ......�i!.. ..A... ... . ...... ... .7....::.1...�/.....�....... � •. ................................... has been installed In accordance with the provisions of FAf he State Sanitary Code as described in the application for Disposal Works Construction Permit h �/� y T -•0............. dated.....7.n....1 �.:-7y� ........... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................................I..........'. •-•--......... Inspector.................................•-•----............................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH ��ii ................ Z7OF............ + wr Fzz........................ Permission is hereby granted...... . . ..... .... ___ __ _ to Construc� (�) or Rep r ( I01vidual a gage Disp U .., f�.......................__.. creel as shown on the application for Disposal Works Construction Permit ►iZ� •7 AGE PERMIt M � ;< : l0 C A:1: 10N S E .. . , V I L L A:6''.E NST.: LIER'S ME' ,ADDRESS R 0R 01N d U f DATE''. PERMIT ISSUED ZS I S S U E D D A T COMPLIANCE a \' tt:•. ham• ,... '}:��;:J�: i 1 Ry SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddress: 847 Main Street Osterville ,Mass . 02655 Owner. High Point Trust Compnay Date of Inspeotlon:5/ /9 6 SEPTIQ TAN&Z'096 y'A A, (locate on site plan) Depth below grade: ar�Ff�"� �s1vi'•^S Material of construction:�ncrete metal FRP_other(ezplain) ' 1 rzb Dimensions:SWV depth:- Distance from top of sludge to bottom of outlet tee or baffle:_ Scum thiclmess: b _ Distance from top of scum to top of outlet tee or baffle: D Distance from bottom of scum to bottom of outlet tee or bafle: Comments: (recommendation for pump' ,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leafage,etc.) /•r� s; �- Oc/9".C&T T�,e y 1 i e 6 GREASE TRAP (locate on site plan) Depth below grade: Material of construction:Awncrete_metal_jRP other(ezplain) A)# Dimensions: A)A Scum thiclmess: A)h_ Distance from top of scum to top of outlet tee or baflle: 09_ Distance from bottom of scum to bottom of outlet tee or baffle: 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 leafage,etc.) 0 �x9evl/1'1 EN�� • (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) prop,rtYpddr,,,. 847 Main Street Osterville,Mass . 02655 Owner. High Point Trust Company Date of Inspection: 5/1 /96 TIGHT OR HOLDINGTAHI-40, Tight tank must be installed for the Hair Dressers (locate on site plan) wash &• rinse sinks. Depth below grade:,,A)# Material of consttuction:NAconcrete_metal_FRP_other(e:plain) AIR Dimensions: At4 Capacity: us Design flow: ons/day Alarm level: 11) Comments: (condition of inlet tee,condition of alarm and float switches, etc.) {V A CAN+WWT DISTRIBUTION BOX:A (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level d ti a ual, dance of soli ovRr a de of a�age into or out of box,etc.) D i s I'1 bu t 10 n is ri 0 t equal. Speed" le�refers must e e 1 s`ta�l.ecL• No evidence of solids, carry over; �In Pvidence of leakage in or out of the didtribution box. No of i repairs are neadert at this time PUMP CHAMBER&hy<, (locate on site plan) Pumps in working order:(yes or no)k,4 Comments: (nota co tion of pump chamber,condition of pimps and appurtenances,etc.) w►v1i1 t'.nJ7�i (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) PropertyAddreas: 847 Main Street Osterville,Mass . 02655 Owner. Highpoint Trust Company Date of Inspection: 5/1 /9 6 SOIL ABSORPTION SYSTEM (SAS):Z/ (locate on she plan, if possible;excavation not required, but may be approximated by non-intrusive methods) • If not determined to be present, explain: �J r Type` c f'�TS leaching Pita, number:�'j.2 leaching chambers, number leachin galleries, number: leaching trenches, number,length: d leaching fields, number, dime ions: (, overflow cesspool, number: s §8l�egts: (�UD3 1r�IfIl j sie of hSan` ` f'O �irief s&rid ceadition of vegetation,etcJ No signs of y rau is Failure; N signs of ponding; No vege a ion. Asphalt parking lot. CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: 7— Depth of solids layer. Depth of scum layer: Dimensions of cesspool: 1 Materials of construction: TGAN/L°l - Indication of groundwater: .UD.GYIJ -- inflow(cesspool must be pumped as part of inspection) ft(' sy 44d AS 424 'Z D� //x/t/�'�-71 at, Co ats: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) dame as move PRIVY:dAo '`� (locate on site plan). Materials of construction: Dimensions: IVA Depth of solids:' Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) • ,i)A �Jn C�.n��..c>rs i (revised 11/03/95) 8 ^ C�SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(oontinued) ProperVAddresa: 847 Main Street Osterville,Mass . 02655 Owner. Highpoint Trust Company Date of Inspection: 5/1 /9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM: • include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' Centerville Osterville Marstons Mills Water Company 428-6691 70 .V ` b DEPTH TO GROUNDWATER Depth to water. '+ feet method of determination or approximation: Installed 8X 121 leaching pit. _Nn water encountered ate-47),-7 1 (revised 11/03/95) 9 . .At��-. S jCr z ASS l��C' i THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION ` BE IT KNOWN THAT Joseph P. Macomber, Jr. - Has satisfied the Department's qualifications as required and. is hereby_. authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter -21lA of the General Laws. Issued by The Department of Environmental Protection. 3 June 8, 1995 Acting Director of the ion of Water Pollution Control 'iT:'tTIT-r t•f��-n-T:'!r�_T:�TI-�"'�7".�T.T.::•T Tr>•:.. .T•..•... .. TOWN OF Barnstable BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION ��. �...�..T�T"-:'T-�.Tt��•�T TT.'TI•r:TTt�T.�:1f.T.Y'1'T1:T.•.•T�t.:TT�STTSr'Z'�TR'C•TrT>Z iClliR'TiiTTT.7S24•'tTTTTTRT.•.�t•i'T-'T•"t••_••� -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 847 Main Street Osterville,Mass._02655 ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME High Point' Trust Company PART D - CERTII%ICATION NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inc. COMPANY ADDRESS Box 66 Centerville,Mass . 02632 Street Town or City state LIP COMPANY TELEPHONE ( 1 508 '��_�.338 FAX ( 508 790 1578 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time of ;inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check one: Systeui PASSED Conditionally The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15 . 303 , Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* , The inspection ,which I have conducted. has found that the system fails to protect the ptibli,c health and the environment in accordance with Title 5 , 310 CMR 15 , 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 5/1-6/96 One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the BOARD OF HEALTH. * It -the inspection FAILED, the owner or operator shall upgrade ' the system within one year of the date of the inspection, unless allowed or required otherwise as provided in. 310 CMR 15 , 305 . `°FtMero►,� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARARr, E. MA55. • 200 Main Street• Hyannis, MA 02601 a �prED M01% TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: i '44 i rAlp- w 5 Date: Location/Mailing Ad ress: y 6 A4 k,x S O s h--ry i !he— Contact Name/Phone: Sa ti Av nAef I te- 529e— 7 3`7 2.o Z G Inventory Total Amount:a SDS: License#: Tier II : o Labeling: « "w` Spill Plan: Oil/WaterSeparator: IVIA �Floor Drains: Emergency Numbers: Storage Areas/Tanks: Co je.ey t in. b*lc -5hU aAl— Emergency/Containment Equipment: -F"(�Waste Generator ID:_]/IA' Waste Product f)Jk Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS 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 requires a license from the Public Health Division. Antifreeze Dry cleaning fluids Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers Hydraulic fluid (including brake fluid) Windshield wash Motor oils Miscellaneous Corrosives Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene,#2 heating oil / Disinfectants Miscellaneous petroleum products: Road salts grease, lubricants, gear oil Refrigerants Degreasers for engines&garages Pesticides: Caulk/Grout insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals (Fixers) Rustproofers Photochemicals(Developer) Car wash detergents Printing ink Car waxes and polishes Wood preservatives(creosote) Asphalt&roofing tar Swimming pool chlorine Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners 3 Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) 3 Any other products with "poison labels" (including chloroform,formaldehyde, hy.�ovhSO�IGuv��acid, aother acids) VIOLATIONS: ORDERS: INFORMATION RECOMMENDATIONS: O �i�vu vy/y� �� �►� w ►s ,rk Q� o D bv,zt,— 4-a o e�e. Inspector: L e-- Facility Representative: b WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- BUSINESS 0-pi,Hair Designs in Osterville,MA-(508)428-8115 Page 1 of 2 Contact Information Business Description Oggi Hair Designs Oggi Hair Designs is located in Osterville, 845 Main St Massachusetts.This organization primarily Osterville,MA 02655 operates in the Beauty Shops business/ industry within the Personal Services sector. Contact: Sandra Aupperlee This organization has been operating for Title: Owner i approximately 38 years Oggi Hair Designs is Phone: (508)428-8115 estimated to generate$45,582 in annual website: revenues, and employs approximately 1 people at this single locatiorf. There are 6 Companies located at 845 Main St, Osterville,MA 02655 Sector: Personal Services Category: Beauty Shops Map Industry: Beauty Shops SIC Code: 7231 41°3T42.1"N 7... Soft.. View larger map Name: Oggi Hair Designs _ Year Founded: 1979 Engaged In: a ❑Manufacturing ❑Importing [71Exporting a� c gaySt`- s- ,. . � e. Maln:St Location Type: Single aRevenue: $45,582 Employees Here: 1' Osterville' Facility Size: 600 sgft" Revenue&Employees are estimates _,a Rs off, Demographics for Zipcode 02655 Goog el Map data©2017 Google i v View larger map http://www.buzzfile.com/business/Oggi-Hair-Designs-508-428-8115 11/8/2017 Oggi Hair Designs in Osterville,MA-(508)428-8115 Page 2 Q£-2, r- http://www.buzzfile.com/business/Oggi-Hair-Designs-508-428-8115 11/8/2017 AsBuilt Page 1 of 1 LOCATION SSE W AGE PERMIT NO. 3Izz �7- VILLAGE NST L fR'S. ME ADDRESS B U I L 0 F R OR OW R LF G DATE.` PERMIT ISSUED DATE COMPLIANCE ! SSUED ' /- ry s I http://issgl2/intranet/propdata/prebuilt.aspx?mappar-117103&seq=1 12/14/2017 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION SEWAGE N M /1 N fT- VILLAGE Gs•�di'��� ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. �J /.� /VlaCo•-,/s✓ SEPTIC TANK CAPACITY 1.EACHING.FIICILITY:(type) Pi/ (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER f W,2. "P,t / V DATE PERMIT ISSUED: 7 DATE COMPLIANCE ISSUED_ �- VARIANCE GRANTED: Yes No o � http://issg12/intranet/propdata/prebuilt.aspx?mappar=117103&seq=2 12/14/2017 ------------- /�3 Ps No... s .... Flms.../A............... Cg THE COMMONWEALTH OF MASSACHUSETTS ` BOAR® OF HEALTH akA�3 14. . .... . ............................................ ................---- App iration for Disposal Works Tonstrur#tun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (. ) an Individual Sewage Disposal System at .... -� _ .......... --•-:•------...-••-•-•----•--.....----•-•-- ••..........................••--•--•--- .• Location.Address or Lot No. . '1 ----- ------------------------- •----------------- ---------- ----•--•-•----- = - � O ner � ................................Address a ---- 10' . !��<. t. .. ® 'e.---------- ------------ ....--------•--------- Installer Address PQ Q Type of Building Size Lot............................Sq. feet U Dwelling-V No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures .._.. ----- ---- - W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 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-__________•____---_____ - ------------ ---•--------------•---------------------.-------------------•------•--•---------- ODescription of-Soil-----••. ® ............. ...--------------------------------------•-•------•------------------------......--•-•-•--- x W ----••----------------------•-------------•-•-•---•------•-•--•-•--•---••••••--•--••------------••---------•----••---•---•----•-----••--- =-----------•-------- --------------- - ------ VNature of Repairs or Alterations—Answer when applicable.-.__.e�"14w __ ________________.......-vP'_-..__..:__..._............ ----------------------------•---...--•------•---•--•--------------------------------•-•--..........-----------------------------------------•--•--------------------------------------------•---------•- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with'' the provisions of iITi U 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 the oard f health. Signed. ._ :. :.. � �`� ,� = Date Application Approved By.,... - •--•----•-----------���I��"' w'___'t----•--------------------•-••-•------- ....•--._.�.- �,----•-�---- Date Application Disapproved for th following reasons:.......................................................................................... ' --------•-•---•--•--•-----•-••---•----------•-----------------------••--•--•---------------•----........:.--------•------------------------------•----------------------------------------------._....... Date Permit No...... .. -5 - Issued I Date ..._...--- -•--••------- ,. •••- •• ••••-•+• •.••.•�! • •• •�. .• '• •• { ............................................. x •^: .' I? ...:.......................... }rorr^ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH a -mac - y a, ptiration for-R-spinal Works C onl3 union permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) 'an Individual Sewage. Disposal System ate r ) Location-Address or Lot No. s. t Owner { Address J r� .. .. Installer Address U Type of Buildi . Size Lot............................Sq. feet Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—Type e of Building ............................ No. of ersons...._..:_.__...._..:p., yp g p __...... Showers ( ) — Cafeteria ( ) a Other fixtures - ------------------------------------------------ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length•___-_-•-__.-__• Width................ Diameter................ Depth................ . x... Disposal Trench—No..................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-.................... Diameter..........•......... Depth below inlet.................... Total leaching area..................sq. ft. Z . Other.Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.......................................................................... Date......................................I_ . Test Pit No. 1___-__-__-_-_`minutes per inch Depth of Test Pit.................... Depth to ground water---------_................ ' , Gal Test Pit No. 2..............:.minutes per inch Depth of Test Pit.................... Depth to ground water........................ tx ` f. O Description.of Soil......... - `.......................... - ;'. ----------------- ------ V ------------------•-------- ---....:--•--------------------------------------•--...-------------•----------------•--------•------------------------ --------- ..................................... W --------.-------------•------------------------•------------------------------...-------:...•--•-----•-•----•--•--•- �. U Nature of Repairs or Alterations—Answer when applicable:.__ __rg".- <. ...................................................................................................................................-.............................................._................... ._. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with. the provisions of TITL* 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 the,:oard.of health. � ,�� � � o !�Ef�� Signed- ?/ IZ ,.�A . ....... .' y'' i "s .r Date Application Approved By.......... .............. --- ....... . - ... ... . .�---- Application Disapproved.for the following reasons-................ ........................................................... ----•-------•.......... ................... ••-•-•-•----••----•-----••-•------•--•-•---•-•----••- �S ...��__:ewkte Date Permit No. •----•-..... Issued .. THE COMMONWEALTH OF MASSACHUSETTS r �/ , BOARD OF HEALTH j Tyrrtif iratr of Tompliaurr TZU&1 T� ERTIFY, That the Ind voual Sewage Disposal System constructed ( ) or Repaired (�•�-_ I �� ,Y! ' �r �7� � l / Installers.. .-.l. a----.....a ,. has been installed in accordance with the provisions of TIT 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..... dated........... ....,11511495............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...............................•-----•------------..............--•--.....-•---- Inspector................................ / THE COMMONWEALTH OF MASSACHUSETTS 4. BOARD ,OF HEAL,ITH/ OF f F. No.......................... C... 3 FEE... ................... in1 nrk C>zntrnrtUan,' rrmit7 <:s`+;.d y✓ d Permission > hereby granted .�..�....'.. ........ .__.... to Constr r. i < ' a ividual Sewage Disp sal S st U V-atN �Street as shown on the application for Disposal Works Construction Permit NoRs:__ �3 Dated.?,.__1. __,.. ...._........ ................................... oa eP aF DATE................... FORM 1255 'A. M. 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