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HomeMy WebLinkAbout0846 MAIN STREET (OST.) - Health (2) 846 MAIN STREET, OSTERVILI-A -H_ - - = _ - c l _ 1 ti ti. 1 r 7 9 fj i J TOWN OF BARNSTALBLE LOCATION FL16 MA IA 571057) SEWAGE# �I L(" 2-Z5 VILLAGE 0S tJ'I ffe ASSESSOR'S MAP&PARCEL 11 " INSTALLER'S NAME&PHONE NO. Z,1�aO SEPTIC TANK CAPACITY UO 7 d®® LEACHING FACILITY:(type) I (size) le) t NO.OF BEDROOMS L l 000 w1 Y 7 ,-,k OWNER i �Q.r��L•�S PERMIT DATE: 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 facIAVKa-_�_ N Feet FURNISHED BY �SZr��'l �?.rvrC�.s I—\e�,. wA.rz (3v�lcl �� CASE" �ujm i L-o4o DOCK G-T ppp /r Z-Z7 A- '�/s g z 3®6 A l/b g q-5Zb- eA r Matthew Eddy From: Dudley, Brian (DEP) [brian.dudley@state.ma.us] Sent: Wednesday, January 18, 2012 2:48 PM To: Matthew Eddy Subject: RE: Quick Title 5 Question Hi Matt, As long as there is no food prep and coffee and pastries are brought in, retail flow at 50 gpd/1000sf is OK. Thanks, Brian From: Matthew Eddy [meddy@baxter-nye.com] - Sent: Wednesday, January 18, 2012 2:10 PM To: Dudley, Brian (DEP) Subject: Quick Title 5 Question Hi Brian, I just left you a message. I'm meeting with Tom McKean and he wanted something bounced off of you. We have a new small retail store addition going in on a project in Osterville. The owner wants to include in the back of the shop a small area to sell takeout coffee and pastries. Nothing will be cooked on site and there will be no seating. I was asking Tom if he looks at that as straight retail from a flow standpoint and he wasn't sure. He was questioning the need for additional flow for"takeout", but there is no Design Flow criteria defined in Title 5 for takeout only (especially when it's incidental to the main retail use). Can you please lend your expertise and position on this? Thanks Matt Matthew Eddy, P.E. Managing Partner BAXTER NYE ENGINEERING & SURVEYING 78 North Street-3rd Floor•Hyannis,MA 02601 Ph:508-771-7502 x1 7 • Fax:508-771-7622 •email:meddy@baxter-nye.com •www.baxter-nve.com Please consider the environment before.printing this e-mail 1 _ , COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS NM NTAL. P ROTECTION . DEPARTMENT OF,EN VIRO E TITLE 5 OFFICIAL.INSPECTION.FORM-NOT FOR VOLUNTARY"ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM CERTIFICATION Property Address: 846 Main Street ✓ Osterville.`MA 02655 . Owner's Name:: RobertXioller Owner's Address: x r j. -. . . tz'. Date of.Ins.ection: August 29. 2608 Vj v Name of Inspector; (Please Print) James M.`Ford OR Company Name: . James M. Ford c.> .. dress: P.O:Box 49 O *7 Mailing Ad. _ g - . � Osterville.MA 02655-0049 Telephone Number:. (508)8624400 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 the inspection. The inspection was performed based on my- training and experience in the proper function.and maintenance of on site.sewage disposal systems ..1 am a DEP approved system inspectorpurgiantto Section 15.340 of Title.5(310 CMR 15.000). The system: .:Passes Conditionally Passes = Nee Further Evaluation by the Local Approving Authority .' 'Fail ' Inspector's Signature: .' Date: September 1, 2008 The system inspector shall sub rt a copy of this inspection report to.the Approving Authority(Board of Health or DEP),within 30 days.of.completing this inspection. If the system is,a shared syst'.in or has a.design flow,of 10,000: gpd or greater,,the inspector..and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be-sent to'the'system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that -ulp time. This.inspeW,on does not address how the system wilt.perform in the:future under the same or different. conditions of use. Title 5 Inspection Form 6/15/2000 page 1 L i Page 2 of 11- OFFICIAL INSPECTION FORM,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION.,(continued) Property Address: 846 Main Street Osterville,MA" Owner: Robert Kioller Date of Inspection: August 29, 2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of.Section D. A. System Passes: ✓ I have not found any information which_indicates that any of the failure criteria described in 310 CMR 15.301 or it!310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: . One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The,system,upon completion of the replacement or repair;as approved by the Board of Health;will pass: Answer yes,,no or not determined(Y,N,ND)in the for the following statements. If"not-determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or.not),.is structurally unsound,'exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection.if the existing tank is replaced with a complying:septic tank as approved by.the Board of Health: *A metal septic:tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance. indicating.that the tank is less than 20 years old is available: ND explain: Observation of sewage.backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a.broken,settledor.uneven distribution box. Systemwillpass inspection if (with approval of Board of Health)`. broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: :. The system required pumping more than.4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the.Board of Health): broken pipe(s)are replaced obstruction;is removed ND explain: 2 r Page 3 of l l OFFICIAL INSPECTION FORM,-NOT'FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE'DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION:(continued) Property Address: 846 Main Street Osterville. MA Owner: Robert Kioller Date of Inspection: August N 2008 C. Further Evaluation.'is Required by the Board of Health Conditions exist:which require further evaluation by the Board of Health in order to determine if the system. is failing to protect public health,safety.or the:environment: 1. System will pass unless Board of Health determines.in accordance with310 CMR 15.303(1)(b)that the system is not functioning in a manner which will.protect public health,safety and.the environment. Cesspool or privy is within 50 feet'of a surface water Cesspool or privy.is within 5.0 feet of a bordering,vegetated wetland or a salt marsh 2. System will fail'unless the Board of$ealth(and Public.Water Supplier,if any)determines that the. system is functioning in a manner that protects the public health,safety and environment:, _ The system has a septic tank an&soil absorption system(SAS)and.the SAS is.within 100 feet of a ' surface-water supply or tributary.to a surface'water supply.' The.system has aseptic tank and SAS and the SAS is within a Zone 1 of a public water supply: -:The system has aseptic tank.,and SAS and the SAS is within 50 feet.of a private water supply well. . The system.has aseptic tank and SAS and the SAS is less:than.100 feet but 50 feet or more from a private water supply well". Method used to determine distance **This system passes:if the well water analysis,performed at a DEP certified laboratory, for coliform` . ; bacteria and volatile'organic compounds indicates that the.well is free from pollution from that facility and the presence of.ammonia nitrogen and nitrate nitrogen is equal to or less.than 5 ppm,.provided,that no other failure criteria are triggered.: A copy.of the analysis must be attached:to this form.. 3. Other: 3. Page,4 of 11 OFFICIAL INSPECTION FORM-...NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM : . PART A CERTIFICATION (continued) Property-Address: 846 Main Street Osterville, MA Owner: Robert joller Date of Inspection: August 29, 2008 1). System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or'surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool . '...Liquid depth in cesspool is.less than 6"below invert or available volume is less than''/2 day:flow ✓ Required pumping more than 4 times in last year.NOT due to clogged:or obstructed pipe(s). Number of times pumped ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation, ✓ Any portion'of cesspool or privy is within 106 feet of a surface water supply or tributary to a surface water supply.. ✓ : Any portion of a cesspool or privy is within a Zone l of a public.well: _ ✓.. Any portiori of a cesspool or privy is within 50.feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100'feet but greater than 50 feet from a private water supply well.with no:acceptable water quality analysis..[This system passes if the well water analysis, performed at a DEP certified laboratory;forcoliform bacteria and volatile organic compounds' indicates that the well is free from.pollution from-that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of.the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR.15*303,therefore'the system fails. The system owner should contact the Board of Health to determine'what:will be necessary to correct the failure. E. Large System: To be considered a:large system the system must"serve a facility with a design flow of 10,000 gpd to 15,000 gPd• .You must indicate either"yes"or"no"to.each of the following: (The following criteria apply to large systems in'addition to the criteria above) Yes No _ the system is-within.400-feet of a surface,drinking_water'supply the system is`within 200 feet of a tributary to a:surface drinking.water supply the system isaocated in.a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone lI of a public water supply�vell If you have,answered"yes"to any question in Section E the system is considered a significant threat;or answered "yes in Section D above the large system has failed. The owner or operator of any large system considered a ` significant threat under Section E or,failed under Section.D shall upgrade the system in accordance With 310 CMR 15.304..:The system owner should contact the appropriate regional office of the Department. . . 4 Page 5 of 11 OFFICIAL INSPECTION:FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL:SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 846 Main Street OsterMle, MA Owner: Robert&oiler Date of Inspection:.. Auzust 29, 2008 Check.if the following have.been done: You must indicate"yes"or."no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,.or.Board of Health Were.any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? J v ume of water.been introduced to the s stem recently or as art of this inspection 7 - _ Have large of .s, y y p p ✓ Were as built.plan.s of the'system.obtained and examined?(If they were,not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up?., ✓ Was the site inspected for signs of break out? ✓ Were all system coinponents;.excluding the SAS,located on site ✓ Were.the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees;material of construction;dimensions,depth of liquid,depth of sludge and depth of scum? _ Was the facility owner(and occupants if different from owner)provided with infonnation on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of.:Health. ✓ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR.15.302(3)(b)].. - 5 IL Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENT_S : SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION C ON FORM PART C SYSTEM INFORMATION Property'Address: 846 Main Street Osterville; MA Owner: Robert Kioller" Date of Inspection: August 29, 2008 FLOW..CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESI.GN flow based on 310 CMR 15.203 (for example:'110 gpd x#of bedrooms): Number of current residents:' Does residence have a garbage.grinder(yes.or no):' Is laundry on a separate sewage system(yes or no) [if yes"separate inspection.required] . Laundry system inspected(yes or no): Seasonal use.(yes or no): Water meter readings,.if available(last 2 years usage(gpd)); Sump.Pump(yes or no): Last date of occupancy: COMMERCIALANDUSTRIAL Type of establishment: Retail Design flow(based on 310 CMR 15.203): 549 gpd Basis of design flow(seats/persons/sgft,etc.); Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) no Non-sanitary waste discharged to the Title 5 system.(yes or no): no Water,meter readings,if available: : Unavailable Last date of occupancy/use: Currently'occupied OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: 'Unavailable. Was system pumped as part.of the inspection(yes or no): If yes,volume pumped`. gallons--How,was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box;soil absorption system: ., Single cesspool Overflow cesspool Priry Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be ' obtained from system owner) Tight Tank Attach a copy of the DEP approval : Other(describe): Approximate age of all components,date installed(if known)and source of information: 'Date of installation.2124186.-as built Were sewage odors detected when.arriving at the site(yes or no): No 6 r Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS" SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 846 Main Street Osterville, MA Owner: 'Robert Kioller. Date of Inspection: AuQust29, 2008 BUILDING SEWER(locate on site plan) Depth-below grade: Materials of construction:" cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on-condition of joints,venting,evidence.of leakage,etc.); SEPTIC"TANK: ✓ .(locate on site plan)-" Depth below grade: See below Material of construction: . ✓ concrete _metal" fiberglass _polyethylene other(explain) If tank is metal list age! Is age confirmed by._a,Certificate.of Compliance(yes.or no): (attach a copy of certificate) . Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle:. Scum thickness:. : Distance from top of scum to top ofoutlet tee,or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet.tee or baffle condition,structural integrity; liquid levels .. as related to.outlet invert,evidence of leakage,etc.). The tank was under asphalt narking lot and unaccessible.The tank will.be.dug.up and covers will be installed to grade and the tank will be pumped. Work'will be done By 9112108 per owner GREASE TRAP: None (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 baffler Date of last pumping: Comments(on pumping recommendations,inlet and outlet"tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,"etc,); Page.8 of 11 OFFICIAL INSPECTION FOR_ M=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM' PA INSPECTION FORM RT C SYSTEM:INFORMATION(continued) Property Address: 846 Main Street . Osterville_. MA Owner Robert ob t K'oiler Date of Inspection: August 29,2008 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal fiberglass --polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day, Alarm.pre sent(yes or no): Alarm level: Alarm in working.order(yes or no): . Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX ✓.'(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids,carryover,any evidence of leakage into or out of box,etc.): The D-box was level. The cover was to trade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(Yes or no): Alarms in working order,(yes.Or.no) Comments(note condition of pump chamber,condition:of pumps and appurtenances,etc.): . 8 , is Page 9 of 11 4 _ OFFICIAL'INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART SYSTEM-INFORMATION(continued) Property Address:. .846 Main Street. Osterville. MA Owner: Robert Kioller Date of Inspection: August 29, 2008 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why.- Type ✓ leaching.pits,number: 1 =6'x 6'w/2'stone per as built card, leaching chambers,number: leaching galleries,number: leaching trenches,number;aength: leaching fields;number,dimensions: overflow cesspool. number: Innovative/alternative system ` Type/name of technology: Comments(note condition of soil,.signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.): The nit had 3.of water on the bottom. There did not annear to be any signs of failure The bottom to grade was 12' The cover was to grade.` CESSPOOLS: None'_(cesspool must be.pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid:to.inlet invert:. Depth of solids layer: Depth of scum layer: Dimensions.of cesspool:. Materials of construction: Indication of groundwater inflow(yes or no): Comments..(note condition of soil,signs.of hydraulic failure, level of ponding,condition of vegetation,etc.): . PRIVY: None (locate on site plan): Materials:of construction: Dimensions: Depth of.so'lids: - Comments(note condition.of soil.,signs of hydraulic failure,le ofponding;condition of vegetation;etc:): t 9 I Page.10 of 11 OFFICIAL INSPECTIONYORM-NOT;FOR.VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C - SYSTEM INFORMATION`(continued) Property Address: 846 Main Street Osterville:MA'._ Owner: Robert Kioller Date:of Inspection: AuWt 29; 2008: SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a:sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.'Locate.all wells.within.100 feet. Locate where public water supply enters the building, J uv e�' r� 10 f 40 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM 1NSPECTION-FORM PART C. SYSTEM INFORMATION (continued) Property.Address: V 6 Main Street Osterville: MA Owner: Robert Kioller Date of Inspection: August 29, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40+A :feet Please.indicate.(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record'-if checked,date of design,plan reviewed: Observed site(abutting.property/observation hole within 150 feet of SAS) ✓ Checked with local Boarc10 Health-explain: Topographic and water contours.maps` Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe.how you established the.high ground water elevation: Usinz Barnstable topogra&c and water contours,maps, the inaps were showing approximately 40'.+%to,ground water at this site This report has been prepared,only for,the septic system and components described herein: This septic.system has been. inspected and passed.as of the date of inspection..This report is not a warranty or guarantee that the system.will. . funetion.properly in the future. There have been no warranties;or guarantees; either expressed, written or implied, relbting to the-septic system,.the inspection, this report and/or any components of the septic`system which:have not been located and inspected. 11 i COMMONWEALTH OF MASSACHUSETTS EXECUTIVE.OFFICE OF ENVIRONMENTAL AFFAIRS :. DEPARTMENT OF:.ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION.FORM-:NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE:DISPOSAL`SYSTEM FORM PART A CERTIFICATION a t` JIlea m s ,�h Property Address:. 856&858 Main Street i Osterville:MA.02655 r E / €t . Owner's Name: Robert Kioller t r)•r;1 Owner's:Address: .. r l Date of Inspection: August 29. 200800 --� f = . Name of Inspector:.(Please Print)'James M.Ford M Company Name: James M.Ford Mailing Address:. P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862=9400 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 the.inspection: The inspection was.performed based on my training and experience in the proper�function and maintenance of on site sewage disposal systems: Iam a DEP approved system inspector..pursuant to Section 15.340 of Title 5(310 CMR 15A00). The:systeni:; Passes Conditionally Passes Ne ds Further Evaluation by the Local Approving Authority; F I Inspector's Signature: - Date: September 1.2008 f. The system inspector shall sub a copy of this inspection reportto the Approving.Authority(Board-of Health or DEP)within 30 days of completing this inspection..'If the system is a shared system.:or has a design flow of 10,000 gpd or greater,.the inspector and the system owner shall submit;the.report to.the appropriate.regional office of the DEP. The original should be.sent to the.system owner and copies sent.to the buyer,if applicable;and the approving authority: Notes:and Coniments This.report only describes conditions at the time of inspection'and under the conditions of use-at that co time: This inspection does not Address.how the system will perform in the future under the same or different'. conditions.of use Title 5.Inspection.Form ;. 6/15/1000 page 1 /" Page 2 of 11 OFFICIAL INSPECTION FORM-.,NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: '856&858 Main Street . Osterville.MA Owner: Robert Kjoller Date of Inspection: AuQust.29, 2008 Inspection Summary: Check A,B,C,D.or E[ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in.310.CMR 15.303 or in•310 CMR 15.304_exist. Any failure'criteria not evaluated are indicated below. Comments f B. System Conditionally Passes:. One or more system components as described in the"Conditional Pass"section need to be replaced or repaired...The system;upon completion,of the replacement orrepair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N;ND).in.the for the following statements..If"not.determined",please explain. .The septic tank-is metal and over 20 years old* or the septic-tank.(whether metal or not)is structurally unsound,exhibits substantial infiltration'or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic-tank:as approved-by the Board.of Health. - *A metal.septic tank will pass.,inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank.is less than 20 years old is available. ND explain: Observation of sewage backup or break out or highstatic waterlevel in the distribution box due.to broken or- obstructed pipe(s)or due to abroken,settled or uneven distribution box. .System will:pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed . distribution box is leveled or replaced` ND explain: The system required pumping more.than 4 times.a year due to broken or obstructed pipe(s). The:system will pass inspection if(with approval of the Board of Health):.. broken pipe(s)are replaced obstruction is.removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM; PART A CERTIFICATION- (continued) Property Address: 856&858°Main Street ` Osterville.MA Owner: Robert Kioller: Date of Inspection: August 29, 2008 C. Further Evaluation is Required:by the Board of Health: Conditions exist which require further evaluation by the Board-of Health in order to determine if the system. is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CAM 15.303(1)(b)that the System is hot functioning in a,manner which will protect public health,safety.and the environment: Cesspool or privy is within 50 feet-ofa surface.water Cesspool or privy is within 50 feet of a bordering vegetated wetland:or a salt.marsh 2. System will fail.unless:the.Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety.and environment: ; The system has a septic tank'and soil absorption system(SAS)and the SAS is within 100 feet of a' surface water supply or tributary to a surface water'supply. The system has a.septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS_and the SAS is within 50 feet of a private water supply well.. - The system has.a septictank and SAS and,the.SAS is less than 100 feet but 50 feet.or:more from-a private water supplywell**. Method used to determine.distance "This system passes if the well water analysis,;performed at a DEP certified laboratory; for coliform. bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen.and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis.must lie attached to this,form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM:-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART A. CERTIFICATION (continued) Property Address: 856&858 Main Street OsterWIL MA Owner: Robert joller . Date of Inspection: Auzust 29, 2008 D. System Failure Criteria applicable to All systems: You must indicate either"yes"or"no"to each of the following for all inspections: . Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth:in cesspool is less than 6"below invert or available volume is less than-'h day flow ✓' Required pumping more than 4 times,in.the,last year NOT due to clogged or obstructed`pipe(s).:Number — of times pumped: ✓ Any portion of the SAS,cesspool or privy.is below high ground water elevation: ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply:. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool.or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than,100 feet but greater than 50 feet from a private water .. supply'well with no.acceptable water quality analysis.[This:system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is,free from pollution from that.facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A.copy of the analysis.must be attached to this form.] No (Yes/No)The system fails. Lhave determined that one or'more of the above failure.criteria exist as ` described in 310 CMR 15.3,03,therefore the system fails. The system owner should contact the Board'of Health to determine what.will`be necessary to correct the-failure.; E. Large System: To be considered a large system:the system must serve..a facility with a design flow of 10,000.gpd to-15,000 gpd• You must indicate.either"yes"or"no"to-each of the following: (The following criteria applyy to large'systems'in addition to the criteria above) . Yes'. No the system is within 400 feet of a surface drinking water.supply the system is within 200 feet of a tributary to a surface drinking water supply . the system.is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA).or A.mapped Zone.II of a public water supply well If you have'answered"yes"to any question in-Section E the system-is considered a significant threat,or answered "yes"in Section D above the large system has failed: The owner-or operator of any large system considered a M significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15:304. The system owner should contact the appropriate regional office of the Department. ` 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM'INSPECTION FORM PART B CHECKLIST Property Address: 856&858 Main Street Osterville, MA Owner: Robert Kioller Date of Inspection: August 29, 2008 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No 'Pumping information was.provided by the owner,occupant,or Board of Health ✓ Were any of.the system components pumped out in the previous two weeks ✓ Has the system received normal flows in the previous two week period Have large volumes of water been introduced to the system recently or as part of.this inspection ✓ Were as built plans of the system`obtained and examined?(If they were not available note.as-N/A) Was,the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs.of'break out? ✓ _ Were.all systein'components,excluding the SAS,,located:on site'? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank.inspected,for the condition of the baffles or tees,material of construction;dimensions,depth'of liquid,depth of sludge and depth of scum Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location:of.the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health: _ Determined in the field.(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)-[310 CMR.15.3 02(3)(b)]. 5 Page 6 of 11 ' OFFICIAL INSPECTION FORM.-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 856&858 Main Street . Osterville: MA Owner: Robert Kioller Date of Inspection: Auizust 29.2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): .- DESIGN flow based,on 310 CMR 15.203 (for example: 110 gpd x.#of bedrooms): Number.of current residents: Does residence have a garbage grinder_(yes,or•no): Is laundry on a separate sewage system(yes or.no):; [if yes separate inspection required]. Laundry system inspected(yes or no)t Seasonal use(yes or no): Water meter readings,if available(last 2 years usage_(gpd)): Sump Pump(yes or no): Last date of occupancy:: COMMERCIAL/INDUSTRIAL.. . Type of establishment: Retail Design flow(based on310 CMR.1"5.203): spd Basis of design flow(seats/persons/sgft,etc.): Grease trap present.(yes or no):.- Yes Industrial waste holding tank present(ye s or no) ..no Non-sanitary waste discharged to the Title 5.system(yes or no): no Water meter readings,if available: Unavailable Last date of occupancy/use: Currently occupied OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes.or_no): Yes. If yes,volume pumped:,, gallons--How was quantity pumped determined? Reason for pumping: Maintenance 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). Innovative/Alternative technology 'Attach;.a copy of the,current operation and maintenance contract(to be obtained from system owner), Tight Tank Attach a copy of the DEP approval p Other(describe). Approximate age of all components;date installed(if known)and source of information: Date of installation 917101 -as built Were sewage.odors detected when arriving at the site(yes or no): No 6 f } Page 7 of 11 OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 856&858 Main Street Osterville, MA Owner: Robert Kioller Date of Inspection: Aueust 29,_2008 BUILDING SEWER(locate"on site plan) Depth below grade: . Materials of construction: _cast iron 40 PVC other(explain): Distance from private water supply.well or suction line: Comments(on.condition of joints,venting,evidence of leakage,etc.): ` SEPTIC. TANK: (locate on site plan) • Depth below grade:, 3' Material of construction: . ✓ .concrete _metal _fiberglass:"_polyethylene _other(explain) . If tank is metal list age: Is age confirmed by a Certificate of Compliance,(yes or no): (attach a copy of certificate) Dimensions 1500 JzaL Sludge depth:`. 2„ Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum.thickness: 4" Distance from top of scum to top of outlet tee.or baffle: 6" Distance from bottom of scum to bottom of-outlet tee or baffle: 10" How were dimensions determined: . Measure stick Comments(on pumping recommendations,inlet Arid outlet tee or baffle condition,structural integrity,liquid-levels as related to outlet invert,;evidence of leakage'etc.)` The Tees were present. There was no.siQn ofleakaze. The cover was 10"below trade The tank was punsp"ed forrnaintenance GREASE TRAP; . Yes (locate on site plan) Depth below grade: 9„ . - Material of construction: ✓ : concrete _metal._fiberglass'._polyethylene._other. (explain): Dimensions: 1000.gal. . Scum thickness:` 4, 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: Unknown Comments(on pumping recommendations;inlet and outlet tee or baffle condition,structural integrity,.liquid levels . as related to..outlet.invert,evidence of leakage,etc.): . The liquid level was.nornial level. The grease tank was pumped for maintenance 7 S Page 8 of I ~ OFFICIAL INSPECTION FORM-NOT F OR V ,OLUNT AR - . Y ASSESS MENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION(continued) Property Address: 856&858 Main Street' Osterville, MA Owner: Robert Kioller Date of Inspection: . Aueust'29..2008 TIGHT or HOLDING TANK: .None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete ._metal _fiberglass _polyethylene._other(explain): Dimensions: Capacity: gallons. Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarin.and float switches,:etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Eren Comments(note if box is level and distribution to outlets equal,any,evidence of solids carryover,any evidence of` leakage into or out of box,etc.): The D-box was level. PUMP CHAMBER: None (locate on site plan) f Pumps in working order(yes or no): Alarms:in working order(yes or no)' Comments(note condition of pump,chamber,condition of pumps and appurtenances,etc.): - } _ 8 .. w Page 9 of.I I OFFICIAL INSPECTION FORM-NO T FOR,VOLUNTARY ASSESSMENTS : SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8S6&"858 Main StreeC Osterville. MA Owner: Robert Kioller. . Date of Inspection; Awast 29:M8 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation:not required) If SAS not located explain why: Type leaching pits,number:. leaching chambers,number: 2-500 Qal. drywells 12.5c3l5' Per as-built leaching galleries,number: leaching trenches,number,length:: leaching fields,number,dimensions: - overflow cesspool,number: Innovative/alternative system. Type/name.of technology: Comments(note condition of:soil,signs of hydraulic failure,level of ponding,damp soil;condition of vegetation,.etc.): The Drvwells were dry and clean: There did not appear io be anv,signs of failure The cover was 10"below CESSPOOLS: None .(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to.inlet invert: Depth of solids layer:. Depth of scum layer:. - Dimensions of cesspools Materials of construction. Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):, PRIVY: None (locate on site.plan) Materials.of construction: Dimensions: Depth.of solids: Continents(note:condition of soil,signs of hydraulic failure;level of,pondin&.condition of vegetation,etc.) f - Page 10 of•11 OFFICIAL:INSPECTION:FORM NOT FOR VOLUNTARY ASSESSMENTS, SUBSURFACE SEWAGE.DISPOSAL SYSTEM INSPECTION FORM: :PART.C SYSTEM INFORMATION(continued) Property Address: 856&858 Main Street Osterville MA Owner: Roben Kjoller Date of Inspection: 'A ygusr 29:2008' SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to:at least two permanent reference.1andmarks or benchmarks.. Locate all wells within 100 feet.'Locate where public,water supply enters the building.,. w �kf,�.Ja-e1 --- - -- - _�- -Q, , 3 O O a a5 30 y ay 33 b - 10 f Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION(continued) Property Address: .856&858 Main Street Osterville.MA Owner: Robert Kioller Date of Inspection:. August 29, 2008 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground Water. 40+/- feet Please indicate(check)all methods used to determine the`.high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting propertyiobservationhole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators,installers-(attach.documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, ihe.maps were:showing aptiroxitnately 40'+/=to ground water at this site. This report has been prepared only for the septic system and components described herein. This septic system has been inspected and passed as of`the date:of inspection. This report is not a.warranty or guarantee that the system will function properly in.the future: There have been no warranties or guarantees;either expressed, written or unplied,. relating to the septic system;the inspection,,this report and/or any components of the septic system which have not been located and inspected. 11 r `.TOWN f0Y BARNSTABLE" � Ordinance` or'Regulat o ' T WARNING NOTICE Name of Offender/Manage:r' A'V/ . . i dress of Of � , MV/MB Reg # Ad e laa:g e./e/S`tatZ t _ ., ;/ P- .' �' " 01 usiness Name a�a - siness Address igmature Enforcing Orffic 41 ill,ge/state/Zip j a AA Location of Offense 608 O orcingADept/ i isi,n 1� Offednse• a. i1 actsP� j6rc,�l A 07 �` � �� -9- 1 UAJ Dt,��/ed/ VD Tiis will serve-.only as a warning. At *th s. timea>no legal"action has been, taken'. t ' is 'the goal of Town agencies :to achieve' ,voluntary "compl' ance" ` of Town ,rdinances,,F Rules and Re:gulations;." Educat oln > -fforts `,and -warn n_g natice,s are i ttempts to gain voluntary compliance. S b' pier,t v latio l :. r s, 1't' n ppropr;iate legal action '.by TOWN .g s OF BARNrST>ABLEx g wy Ordi ce or ato a. e WARNING NOTICE - a . - �. r- 6 . Address of Offender MV/Mg ;Rey `# Business j IF A.Name # 4 d 4 t ;�;, air/P I p 20109. 3 i r a Business •Address` Signature .o -� n:forcng 'officer Village/State/slip- :Location of Offense2 t �� . , -, / ." { c forcing� De°pt/�D vision' 4 'gv Of f erase a• Ad . a Facts ; `i),Vi " 'Wr Auuwf/ This will,"serve only as a-warning: ,At this time .no legal action h s been 'taken. Its is� the goalhof Town agencies : to achieve ,voluntary compliance o.f Town Ord�.na-nces, Rules 'and ]: -egtlatio�ns. : 'Education efforts'.and warning notices ' are attempktsr to gain 'volusntary._ compliance. ubse g went ,v .olations •will result in .:..° .. apiprof-Dr e legal action by the Town r e . �^... �. z 4 WHITE OFFENDER CANARY=ORDlREG PROD PINK ENFORCING OFFICER 'GOLD ENF©RCING DEPT.: +@'. ". ". -i 3• `':, ,a .,+ - §a r.._,..' .-it�a ,... ,3i;'�,.aa :ez 3 t,.`'.w'3r £...ENF IN �L `< `y . .,f .I � 'L., ;� � ,J'��, ��-*."Cs"��,rY6, 1'1.� � ,. � `�. � -. °•, �� -.� �' � ,.�:a.'�°esaw: ' Wit... x � I I ,�� , , � -�, .. .. A � � � _ ���� _� w �' 1 � � � 1114I"ll 1� ,.;,� III �' I1� ! I, � i ..r_a �> - _ _ � .,.. ��� x yy r } ' d C's r :f� ���� � � � i � ' yiw4;Nz`' '#�a,��a;�f,.�arc7�.ry�.'+�a:'��c-- t:Le,,.0 n�� �'d,� tom, �� F. � \ \. i �� �\ ., �� �, �, � ��, � ,��� � � �,� � l {,_ �,-. � �� ��� � � ��� `�; � � '� y -_ • •: •, nly ATLANTIC / 1 WASTE SYSTEMS 0 008 - � � } � . . .y . . .. % \ \ \ \ } \ »� »y. a • , . : . . ?:r �» �.. a.. e ,:. .. . � . . , Holbrook R. Davis P.O Box 572 Osterville,MA 02655 July 30,2002 Town of Barnstable Ms. Donna Miovandi Health Inspector 367 Main Street Hyannis,MA 02601 Dear Ms. Miovandi: I no longer own this property. Kindly remove me from your mailing list. Yours truly, Holbrook R. Davis TOWN OF BARNSTABLE BAR-W 2981 7 Ordinance or Regulation WARNING NOTICE A /S 1 Name of Offender/ManagerA 11 Address of OjzzKP Reg.# ffender D m If Village/State/Zip V ( 0A6L� i Business Name AngBusiness Address 9 ture - n ing Of is Village/State/Zip �j'� t Location of Offense 9 0--�/ © ® tWorcing Dep / i ision Offense Facts (V ADLl A rLA A I G v *Ti&swil:l serve only as a warning. At this time no legal action has been to en. It is the goal of Town agencies to achieve voluntary compliance of Town I Ordinances, Rules and Regulations. Education efforts. and warning notiselple am attempts to gain voluntary compliance. bse ue„}c t atio sP appropriate legal action by the Town. C.J AsBuilt Page 1 of 1 CcI TOWN OFBARNSTABLE . LOCATION O lG 11 mAr11 sr SEWAGE# VILLAGE 6STCrU,1� _ ASSESSOR'S MAP&•PARCEL II`7-015-001 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_ Y'rT (size) NO,OF BEDROOMS rr OWNER PERMIT DATE: 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�nSPu,7ian 1 ` kyG (3gc.k ` 3q� 410 - : • SyS3 4ttp:Hissgl2/intranet/propdata/prebuilt.aspx?mappar=l 17075001&seq=1 3/8/2012 y. 4 Ll��� OWN OF BARNSTABLE ATION �J �' �S� �/ �NAI SEWAGE# D001 ' VILLAGE D STexyj ASSESSOR'S MAP&PARCEL /1'1=D15' D03 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /Ob C,(LA S't, 1560 50ri(, LEACHING FACILITY:(type) �y l,vea(S (size) tax 33. NO,OF BEDROOMS OWNER ( 0 Lr PERMIT DATE: 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 260 feet of leaching facility) feet Edge of Wetland and L,aching Facility(if any.wetlands exist within 300 feet of leaching facility). feet FURNISHED BY S FQ 15�0 • + 4 00 00 1 MA In 00 0 i an a 3 0 e o a� a5 3 a� 30 j y ay 33 r h .ulCOMMONWEALTH OF MASSACHUSETTS / EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 846 Main Street Osterville, MA Owner's Name: Holbrook Davis Owner's Address: Date of Inspection: February 16, 2001 RECEIVED Name of Inspector:(Please Print) James M. Ford MAR,U 2 2001 Company Name: James M. Ford Mailing Address: P.O. Box 49 TOWN OF BARNSTABLE Osterville,MA 02655-0049 HEALTH DEPT. Telephone Number: (508) 862-9400 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 the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Inspector's Signature: Date: .February 21, 2001 The system inspector shall su it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I / I i Page 2 of 11 • OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16 2001 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 f Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16, 2001 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A-copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16 2001 D. System Failure Criteria applicable to all systems: You must indicate either`yes"or"no"to each of the following for all inspections: Yes No _ ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _ ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. _ ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone 1 of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP cer tified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: r _ To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 846 Main Street Osterville, AM Owner: Holbrook Davis Date of Inspection: February 16, 2001 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? a I ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ Were all system components,excluding the SAS,located on site? _ ✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ Determined.in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16, 2001 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no): ' Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use(yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump Pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: RetaiUDry Goods Store Design flow(based on 310 CMR 15.203): 149 gpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): No Industrial waste holding tank present(yes or no) No Non-sanitary waste discharged to the Title 5 system(yes or no): No Water meter readings,if available: Unavailable Last date of occupancy/use: Currently occupied OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: None on file-per treatment plant Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: 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) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Feb 24186-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of I 1 OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 846 Main Street Osterville, AM Owner: Holbrook Davis Date of Inspection: February 16, 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: See below Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tank was under an asphalt parking lot and unaccessible GREASE TRAP: None (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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 846 Main Street Osterville, M4 Owner: Holbrook Davis Date of Inspection: February 16 2001 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level There were no signs of leakage The cover was to grade PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I-6'x 6'W 2'stone-per as built card leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovativelalternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The pit had 1'ofwater on the bottom The scum line was 2'up from the bottom. There were no signs offailure. The cover was to grade The bottom to ade was 12' - CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.):. PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 9 Page 10 of 11 •FFICIAL INSPECTION FORM - NOT FOR VOLUNTAR Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16, 2001 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 109 feet. Locate where public water supply enters the building. lyw o S-r. covere'd WALKW A � Ovtr�.gc� I >So o F I Aa' (3a- C3- Llo, ASPW+ 3y - sy � Cti - 53� 3 10 O y V l r Page I 1 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 846 Main Street Osterville, MA Owner: Holbrook Davis Date of Inspection: February 16, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: i You must describe how you established the high ground water elevation: The bottom of the pit to grade was approximately 12' Using the Barnstable topographic map and the Cape Cod Commission water contours map the maps were showing approximately 40'+/-to groundwater at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a r have been no warranties or guarantees, warranty or guarantee that the system will function properly in the future. Thee gua either expressed,written or implied, relating to the system, the inspection and/or this report. I� 11 i No. \ �' � Fee ell i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS ZIpprication for JMigaar bpgtem.Conaruction Permit Application for a Permit to Construct( . )Repair( )Upgrade SX)Abandon( ) O Complete System El Individual Components Location Address or Lot No. 8?cj M4,/,Sk. O skery i l�P Owner's Name,Address and Tel.No. H�Ibroo�t �. Owv�S Assessor's Map/Parcel (17 —'7(o—ZP.O. lZAX 57 Z 0STG*%J%k—L1;,t�Y11� OZ(oS S Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Hic.4Ly 1p- Pe�er 5U.404Y. 1?e 3B Ro►sary CAA2 .Og4rin•s oZbol - W. !Sox (OS`1, 7P,\.ter ft& o5kerviIie, IY1k Type of Building: Dwelling No.of Bedrooms Lot Size G,`l l O 1 sq.ft. Garbage Grinder(11JO Other Type of Building !j No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow ZOO gallons per day. Calculated daily flow GCA gallons. Plan Date 1=cb Z8, Zo 01 Number of sheets Z Revision Date 91(.101 Title 51TG i?LkU SySTe 6i?6Rkbe—. Size of Septic Tank loon &-K. (E=,TUU61 Type of S.A.S. Description of Soil; Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agreesi.to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provis' Title 5 of the Enviro tal Code and not to place the system in operation until a Certifi- cate of Compliance has bee i ue s Bo Hea . Signed - ® W. Date 05 c O Application Approved by Date i Application Disapproved for the following reasons Permit No. Date Issued —.-- -- THE COMMONWEALTH OF'MASSACHUSETTS w s ,BARNSTABLE, MASSACHUSETTS -certificate-of Compliance.- �__ THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded ) Abandoned( )by at F �i�� \`::�. .� C�� �'>�''.v �\_ has been constructed in accordance `� \- �- _`dated (j with the pr yisions of Title 5 and'lhafor Disposal System Construction Permit No. )�`'> , Installer � o� ' �...._.�._.. �. o Designer The issuance of this permit shall not be construed as a guarantee that the system will function as desigped. Date 9 i r)I Inspector No. ���_-�.`.i� y�:{.. "�, --------------------------Fee �`-' THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ;0i6pooat *pztem Con0ruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade )Abandon. ) System located at ( c `=�\ ► l>`_,\,t-_ y and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: I I r l_� Approved by i #870 Design Flow Retail:gallons per square foot= 0.05 (50/1000) Office:gallons per square foot= 0.075 (75/1000) Finish Grade Retail space= 1370 sf 69 gpd Office Space= 0 sf 0 gp_d minimum allowable gallons per gpd day- 200 Filter - i� zFabric Compacted Fill Total 200.0 gpd { Septic Tank w w pea Slane j Sized @ 200%of design flow for retail= 400 gallons Reuse F,dsting 1000 gallon tank + Leaching Leach Field M Chamber 3/4"-1 1/2 Double Waded Required Area=GPD/0.74 270 sf Slone Field Size=1T Width x Length 4-Id' I Length= 21.0 if ( 9' Use 9'x21'field with 1 (one)50P gallon leaching dryweils I Area Provided= 309 sf CROSS SECTION OF CHAMBER All Components To Be H-20 NOT TO SCALF, 4'0 Sch.40 PVC Finished I From Septic Tank Grade �Q _ 6m,D.c •a•1 aS' A.s Conduit Thru Chamber :o For Power a Float G°I° a , Emergen Stcrage Cables. To D Box r cy r: Chain " Vol. ZG C.At. ° c? Min.2 Cover < � Alarm , j on EI. 37 2"0 Sch.40 PVC PumpcnEl.3b_5' Mercury Float p Threaded Pipe : Switchs-3Req'd Pumpoff El 3S.5 Check Valve Secure Pi p eat To & f� Bottom of Chamber— I� Bottom El 34.5� 6"Washed 1 Stone Min. 0 i •E �' • a SECTION T_ MIN 14 tip YVMv PUMP CHAMBER DETAIL TO95A4PRa+eb I 24"0 Opening Above For M.H. Not to Scale Ft 8Y EN`u/E o t Support Pipe For Frame a Cover. Float Sup °e • �� s': Pump Power a Float Control To D-Box Cables Installed in Accordance, With Local Bldg.6 Elec.Codes. - NOTE:Engineer to Field Confirm Elevations -� i At Time of Installation. a 4"O From.Septic Precast Pump Tank.Sch.40 PVC Chamber p% q 0 - o�•J. _ °.tea:oa°c :.°o F Z� PLAN M1N f «.3 •e Ivoo 1000 GAL- 1000 GAL 'oR6A3E I I � E�. TRA7 SEPfVL pvr1� c 39.t'o yf rA?IK caA+rt3E1t sL 38.y _l.3 . EL3 M,N - DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale � i� .;2 AD4j�e� OWN OF BARNSTABLE tATION �' O S� MIA ST SEWAGE# D 00 1 VILLAGE O ST"e..rV+ll� / ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY lob G/l,A•!'L SGO so <G LEACHING FACILITY:(type) OtY(NJS (size) rax 33• NO.OF BEDROOMS OWNER 0 Lr PERMIT DATE: 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 L.aching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY Do 3 a� 30 P f. y ay 33 y G TOWN OF BAIZNST'ABLE LOCATION MAGI) Sr SEWAGE# VII;LAGE 09-FEryAR ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) UI iT (size) NO.OF BEDROOMS OWNER PERMIT DATE: 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 L'aching Facility(if any wetlands exist within 300 feet of leaching facility). r ) feet FURNISHEDBY� GGTI J rOIC Q �yG (3Ac-k � Q � a 3C� yo sy s3 O a- 1 � �� •�"vs. _ Aw � k OWN OF BARNSTABLE LOCATION Sy G FrS6 8 S$ 'oZ u�1 SEWAGE # —GO VILLAGE Men, Sa' OSfev v + ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �4-e-V-4 00,,-i"— SEPTIC TANK CAPACITY I.Ja0 S.I LEACHING FACILITY: (type) /02 3 Y2 1 (size) -5W N S BUILDER OWNE do., C-\,4 t t e. 4,i1 -'J1, . PERMITDATE: C) COMPLIANCE DATE: / Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ZFeet 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 l chicility) Feet Furnished by �'` ; . �.t� 1 "�l�-\rl S� �, � ,� �� a � �.``��., �. �. �� � �, � , r' �\ ��o, d �. f Q �� ���7� Q� �� ��� � 33 ' b k ��_ � � �' ��° No.7i�� ' �. Fee SV►-- .. THE COMMONWEALTH AF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for Mi!6pooar *pftem Couttructiou Perron Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.� � J� n fie 2 t Owner's Name,Address and Tel.No. 6,5 4 e-#- )We 1fU/6ro0/�_ /e• �Q�I S Assessor's Map/Parcel m /� n r� O�5� /0 Q ,�OX Job �lSfc%rY %��, m iq od l�J� Installer's Name,Address,and Tel.No. /� Designer's Name,Address and Tel.No. j 0df-LlcA if 33 11q A C_b, Co 4 s� I°efer Sv11/rain /6Pa r�,r ,2.� . �' /� 0Box �s7 7 6s rvIlle mn Type of Building:Dwelling No.of Bedrooms Lot Size 3 Z,1 Db sq.ft. Garbage Grinder(A Other Type of Building 2 tt L No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow �b,lbboS(` �-' S78 gallons per day. Calculated daily flow gallons. Plan Date r Ert>'� 'z-00 i Number of sheets 1 Revision Date KL©)v 0 Title /D►i� �n umo ,Ve-bPc-E D SEPi1 C_Sys ZVd A UPGt2A Qs S Size of Septic Tank 2 0C)Q (-AzLo iA S Type of S.A.S. 13 K (�,7 escription of Soil Nature of Rep V or Alteration (Answer when ap ica le) h�'wE.?4L IL INSslpre, I.D`lA Date last inspected: iC 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 Certifi- cate of Compliance has been issuedt this Boird of Health. Signed Date 2.a d Application Approved by c Date 3 i 0 Application Disapproved for the following rea ns Permit No. �0QI-131S Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by at has b en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. '—I-) dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector �,,t ��,/_rY :. •. ` Fee No: J v !l� Cam+v THE COMMONWEALTH�QPMASSACHUSETTS -' Entered in computer: Yes w - - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS /=11pplicatton for Mi5poar *pztem Congtructiori Verna Application for a Permit to Construct( )Repaii( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components t/ Location Address or Lot No. f�t!s /� �� Sf/� e r Owner's Name,Address and Tel.No. Gs &,-v, )'1/E 11V1brook >/C- �a vl Assessor's Map/Parcel /) // r&LL 0 7500 fJ o i3 p Y ,�_2c,7, 0s4Grb;/1[', Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. SQlf- 3 41L/ /0�ter SLq/J,fa19 iA u fax G.5� / - Y/Z>� 6 sic rv,/Pe- r2 14 0?4,47S Type of Building: Dwelling No.of Bedrooms Lot Size 3?41 sq. ft. Garbage Grinder(�0 Other Type of Building f2 c_— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 5(VION)S� c �U76 gallons per day. Calculated daily flow a I gallons. Plan Date r`Lr'5?$ ZbU t Number of sheets 1 Revision Date KI a!v is Title -S+it FLAry ,�'eoQg,ED SQ71 LcSj�; VP6i2-A' aES ' Size of Septic Tank 2oCU0 6A`LC)k ,5 Type of S.A.S. 13 K (.7 Description of Soil 1 Nature of Repairs or Alterations(Answer when ap icje) � ; �E.>c ►� w► .�-!o y7 ram_ _ Pje r' UV1-re t o , A / � aid Date last inspected: 1� `�d��(:' �y� — i VMh{ l�r" ,J; :Q�1/ Agreement: MIA"^ The undersigned agrees to ensure the construction and maintenance of the afore described on-site wage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued" this Board of Health. Signed Date 3 27 G Application Approved by Date - /i, 0 Application Disapproved for the following reas ns Permit No. Date Issued --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compitance ! THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired ( )Upgraded( ) Abandoned( )by at _�W/t c' rat e c�� { -c i�2 e has b en constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.2� dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date Inspector = _ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS xioogal *potem Construction Verna Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this ,permit. Date: /cg,32 c Approved by �t�t J t f�7 �� ; PH ,t Centerville-Osterville-Marston Mills Fire District Water Department P.O. BOX 369 - 1138 MAIN STREET OSTERVHIE, MASSACHUSETTS 02655 ,CJ,�`sr�'Ac OFFICE of _ WATER M BOARD OF WATER COMMISSIONERS �+yRDEPT. WATER SUPERUfMDENT a1bNs September 21, 1988 Osterville House & Garden Main Street Osterville, MA 02655 Re: Centerville-Osterville-Marstons Mills Water Dept. Cross Connection Control-PWS ID#4020002 Attn. Mr. Holbrook Davis: - On Tuesday, September 20, 1988, a cross connection survey was con- ducted at Osterville House & Garden by Donald F. Rugg of the C-O-M Water Department and -Richard O. Wiles of the Department of Environmental Quality Engineering, Commonwealth of Massachusettes. This survey was conducted in accordance with the Drinking Water Regulations of Mass- achusetts, 310 CMR 22.22. Mr. Carl Souza was present throughout the survey. As a result of this survey, unprotected cross connections were found to exist. I have attached a list of cross connection violations that were found on the premises. These cross connections are in direct viola- tion of section 22 of the Drinking Water Regulations of Massachusetts and plans must be submitted to the Department of Environmental Quality Engineering detailing correction of these violations. The plans must be submitted within 30 days to the D.E.Q.E. Regional Office. i The Centerville-Osterville-Marstons Mills Water Department is re- sponsible for the quality of the potable water supply system, and as such, failure to submit plans for corrections of these illegal cross connections may result in the termination of the water service to the premises as provided for in 310 CMR 22.22. (2) (b). If you have any questions regarding the survey or the violations, please contact me at 428-6691. Very truly yours, Donald F. Rugg Superintendent DFR/jw enc cc: Comm. of Mass. D.E.Q.E. Town of Barnstable Board of Health Town of Barnstable Plumbing Inspector `{ f NOTICE OF NONCCMPL LANCE NONCOMPLIANCE SLMMARY - NAME OF ENTITY IN NONCCMPLLANCE: Osterville House & Garden LOCATION WERE NONCOMPLIANCE OCCURED OR WAS OBSERVED: Main Street, Osterville, MA DATE WHEN NONCOMPLIANCE OCCURED OR WAS OBSERVED: September 20, . 1988- DESCRIPTION OF NONCCMPLLANCE: 1. Cold water line feeding a fire sprinkler system which is equipped with siamese connection. DESCRIPTION OF THE REQUIRRAWr (S) NOT COMPLIED WITH: 310 CMR 22.22 section 2 (a) states that no person shall maintain upon premises; that they own or occupy, a physical cross connection between the-distribution system of a public water supply and the distribution system of an un- approved water supply unless the installation has been reviewed and approved by the appropriate reviewing authority. ACTION TO BE TAKEN, AND THE DEADLINE FOR TAKING SUCH ACTION: The Department r�_-quiyes that an approved type double check valve assembly be installed on the fire sprinkler service. Plans for the necessary corrective action must be sub- mitted to the D.E.Q.E. Regional Office in Lakeville, MA for approval within 30 days after receipt of this communication. If you have any questions, please contact Mr. Richard 0. Wiles (D.E.Q.E. ) at 947-1231, ext. 680 or myself at 428-6691. DATE: September 21, 1988 BY: Donald F. Rugg e Water.Superintendent 7 TOWN OF BARNSTABLE v LOCATION �y� /�f�;� �S� SEWAGE VILLAGE (�5��Y y �I N ASSESSOR'S MAP & LOT/)- , -o7,— f INSTALLER'S NAME PHONE NO.,-� f="W - _ Zf�.� 410 SEPTIC TANK CAPACITY /oo l' r LEACHING FACILITY:(type) ���t� ���y _ (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �/ r1 84k a � AD } a r-pGY� A, 1 S� I r ,7,-1 It l No.. THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Di I. .........OF.....5ftP -40t-Plq_ .......................... Apptiratiun for Disposal IV fxslb Tonutrurtiun rrmit VGMRPe Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... .................................................. r#.Qt ... F►�V,.) saw Location-Address or Lot No. = •-O E)���/..1.�„1- ....- .A------------------------ ................................................................................................. Owner Address W Installer Address /� d Type of Building Size Lot.Y!T4- G.Sq. feet V Dwelling—No. of Bedrooms................................ Expansion Attic ( ) Garbage Grinder ( ) �-+ -------- p`�, Other—Type of BuildingDRVOOQVS. No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtZoais.gallons ............... rJ�Q ------..---------------------------------------------------•----------------•------•------------------- Design Flow...5.7G �► per-�-P mit-g� �� Total d�it flow.... .. .....................Olopn)., WSeptic Tank—Liquid capacity�r�7._gallons Length10...... Width; b!,.. Diameter................ Depth�-:�Q.... x Disposal Trench—No..................... Width.................... Total Length........... Total leaching area....................sq. ft. Seepage Pit No........2-w....... Diameter.._.�.f0_.._..._. Depth below inlet.- .... Total leaching ar . .......sq. ft. Z Other Distribution box ( ) Dosing tank ( ) V � �- Percolation Test Results Performed by._ .�t?f ` � ._.. ._ ............. Date.101/.6/877.............. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2.......A ipru�t`es peer inch Depth of Test Pit----0!....... Depth to ground water-_�40.0 '�.. a •--_4--------------------------.......-•-•-----•-••---•--•-•--..... .............................................7.................................... Descri tion of Soil �.. Z'----.... ��... .ss -s�Q.� � .�..�" -.....GL' f.J xc---�---$....u.D-------------------------------------------------------------------------------------------------------------------- w ....-------•-•-----------------•----••------------------•-------------------------------------•--...------------•---------------------------•---•--......-•---------•------------•----•----.._......... UNature of Re airs or Alterations—Answer when a plicablej_*-j CX.f,.F`SS._..S_ L J_�.. 0.&. L-...AcM..-LQ00..G.F.01 ... RCL ...PIT. A Agreement: l o 0 o G Pr L LS RC H P 1 `r i 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 o place the system in operation until a Certificate of Compliance has been issue y o - ,- ..Signed-------- ..... . _ 2 .. . "Date _ Application Approved By----------- 't-� � ................ ........��r..l_!:9.:--'rl.. Date Application Disapproved for the following reasons---------------•--------•--------------------•---------•-----------------------------------------------•••-•--- r . ....................•-------...-•---•---....-•-----•-•--........-----.....---------------...---------------••-•---...-----------------------------------------------------------------......--------••-- pp.. Date PermitNo.......d�_.2. --kZ2..--•-----------•--. Issued....................................•---•---••......••-- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G T"ow- ..................... ....--- ....-.OF.... ..:1� 9'#� AppWation for Disposal n Frrutit. Application is-hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Systesn t ................ .._........ .................•--....•••••-•--•-••----•-•-...._............-•-•---- N.....U S�._...L.................i1 .1,-J -- --�•--- ---- v S i 1 ti Addr or Lot No. V i tfaeg . A ...... - ....---•-- ...... ........................ . --• .._...............__.._....................---- Owner Address W .......-•---...-•-•.......................•••........................ -•------.....----•-...----•••--•--.....................•••.....................................- Installer Address Type of Building Size Lot. .....................Sq. feet Dwelling—No. of Bedroo S.-..,,..... ......... ........Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building R ��ID o... o. f persons............................ Showers ( ) — Cafeteria ( ) cis Q ,er fixtur s --------I........................................................................... Sc�3 I 1 Gtil� S 1- j" W Design Flow -------•..... allons p on`e da`�, Total daily.,flow galloi i WSeptic Tank—Liquid capacity-� -• allons Length. ___�. Width.�7._..` ._ Diameter................ Depth..... ... x Disposal Trench—No----------------•--•- Width.................... Total Length.......;.... Total leaching area....____-._......sq. ft. Seepage Pit No......... -..... Diameter...... d._..... Depth below inlet... Total leaching area sq. ft. Other Distribution box ( ) Dosing tank ( ) 1 -7 `Percolation Test Results Performed by...... _....�) ..... .....•...... Date... f. .................. aTest Pit No. 1................minutes per inch Depth of Test Pit.............. Depth to ground water-----_. _ . ~ 1 I�..l C� c- (>~ Test Pit No. 2------•--...minutes per inch Depth of Test Pit.................... Depth to ground water........................ A 315 U pv,E.•157 --------•---------------------------------••-••--••--•-•-----•-••.. -(--)------C......L....-�•--:- ---.�---•---- .D Description of Soil ......... S xc= -------------------------------------------------------------------------------------------------------------------------------------------------------•••••. V W -•••-•-•••-•--------•-•--•---•--••••--••••••----•--...•-••------•---••--•-•-----------•----•-•••--•----•-------•---------------------•••----•-•••-••••-•-•••-•-•..--•-• ••..... UNature of Repairs or Alterations—Answer when applicable...1.1�.C_r-i F=.S __...�'E.`'r?`f.. ...`T��``. 3T ..G- 1.�,..._1.�1�.F?.G -3:. ' �'Zy..-Z....S-�-orv)'. 'f- F.;,C1S't)r.sC� Agreement: 10 b J_ 1_?= P)G Y) n T S i S T Fs-NN 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 Compliance has bee ss y t b -Signed........ . .... — ._�:..r Date Application Approved By........ ....................... :-\..............•.. :---- ...... �.. Date Application Disapproved for the following reasons---------------•---------.....------------------------------------------.................---•••--•---........... ----•-•-----•-•-----•---------------•-----.........----...............--•--•-----•--...................•........--------...------•-•-------------••---------------•-----•------••------••--••............ Permit No.......0................. .................. Date 7 7 - Issued--------............----...._..........1_ Date i !� THE COMMONWEALTH OF MASSACHUSETTS 1 BOARD OF HEALTH i L ........ oF...... ''7'...............................:.......... TntifirFatr of ToutpliFanrr F THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by-------------- -------••-•------.-----------.-----.---.-----•-•-----.-----...-----.-------•-•--------••-•-------------.--------------------------.---•----•----------------------•---••_..... I staller at........ ........ `: 5 •-------------�'-1 =''``•=x( .P---•------...........------•----.............---•-------....--...j...------•--..... has been installed in accordance with the provisions of T I of The State Sanitary Code as descrit ed in the application for Disposal Works Construction Permit No._.....................................- dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. 11----�� DATE...........................Lj.:::.-�-----. .............-.............. Inspector................... .............................................. THE COMMONWEALTH OF MASSACHUSETTSa BOARD OF HEALTH ......................... ... OF.. / �a z. ..�{.'........�................................... FEE. .. rj^ 4. .... No.....--•...............• :................ .. Disposal Works T11nstrndion rrntit Permission is hereby granted...................................... t to Construct ) r Repair � ) an I d' ual Sewage Disposal System `"" at No.--•-•-•..... �G•--•-• •...... r--•-......... . .... Street --� as'§nown on the application for Disposal Works Construction Permit: ._. DATE C � \ Board of Health • -•••------••-���:.� ................................•... ' FORM 12S;5 HOBBS & WARREN, INC., PUBLISHk �14� T ION ;- ': SEWAGE ,PERMIT NO. . 1 � /y VILLAGE I N S T A LLER'S NAME & ADDRESS B U I L D E R OR OWNER DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED �LJ SL ..r Y L0iCATION SEWAGE PERMIT NO. VILLA-GE INST`EAy,ILL R'S I NAME ADDRESS )22ali,�1&14,)k&1- 0R OWNER 7 DATE PERMIT ISSUED DATE COMPLIANCE ISSUED � (�� _..�� i �� `� 1 �.�� aI 3 I :ate �� .t P� .��� a J� r _�� -t7 i �� .v� . L 1 No.._.. ?....? Fss .I�S ....................... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..................OF...... �Ca . . . �. ........... ApVtira#inn for Disps al Works Tonstrnr#inn rJermit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............ - -4 -----....- - -•-• - ----- n Lo ation-Address or Lot�NnP .. {,� ...................... - ,A1 .-kl eh �.0.. ................................ caner Add s w %. � e ......................................... -------------� - ;. ...................................... a p� Installer Address UType of Building Size Lot............................Sq. feet 4 N Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures -----------------------------------•-----------.....-----••-------------------------------. ............ W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid'capacity.jt�o®.gallons Length................ Width................ Diameter__.__________.-- Depth............... x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft.' Seepage Pit No.-/............... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by........................... .............................................. Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, .Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •---•-----------------------------------------------•-----•.....-----------..............-•......---.......................................................... 0 Description of Soil........................................................................................................................................................................ x x :.. _ U Nature of epair�s o�A terations—1 �swer w en applicable... J1 ___ .--.- -_ _. -... __.. .4?� .............: Agreer�fent. vW D,t;(Z 1Gh-R�'-- G The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Com 1phnas n issued b he board of h p py t ealth. .•-- -•-���- 4-- ------...-•-•---•---•----•--•----••--•- ----- 36- le APPlication. Approved BY----•-••----------- -- - -....-- ---- �---•------ -...---•--1- --�--3-- -�4------- Application Disapproved for the follo :-----•---------•--------•---•--•-----------------------------•-------------....-----------_.... .....--••-- --......---•---------•-----•---------------------------------•-•-•--.......--- Date PermitNo.......................................................- Issued........................................................ Date No......................... .......................... THE COMMONWEALTH OF MASSACHUSETTS k k j BOARD OF HEALTH 5.....�.......... ....................OF..--.-'a"?-...S `. ......>-4'............................................. } .-- hration for Dispotial Works Tnnitrnrtiun thrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ` ri .......... .. .....�+nc,�`-- .c-5: . ..._.__.. st-vl1��L .. OvS ... ........................ `� �� Le ;d�dr�ess � �•or•Loop.S .._...... ._..__.............. caner ._.._._..__....._._......._........... ...-----.._..�u�...._...._._.. ........__ ..................................... Q �.. � r' _._.._�'?_..�"�...---'-�°--- �s....................................... 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 Otherfixtures ----------•--------_-•___-----•------•-----••-••.......... . �{ 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. €t. l Seepage Pit No.._.___•___-____.__. Diameter____________________ Depth below inlet.................... Total leaching area..................sq. ft. " I Z Other Distribution box (N ) Dosing tank ( ) a, Percolation Test Results Performed by.......................................................................... Date..................................=---- a a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ G4 Test Pit No. 2................minutes per inch Depth of Test Pit............._....... Depth to ground water........................ 9 ••••---•--••------------------•-------•------••------------•---...••---------•--•-------•----_---•-•.......................:_................................ DDescription of Soil...........................................................................................................................................x x ------ =•---- V Nature of epairs.os Alterations— saver w en appli le.__ � $]� ,�, �} cep ...--- "' j :ash �-'-°`�_-_____-- 1�--- ------------------ Agreement: W D£ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 7ITiZ 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has ben issued by the board of health. Igned--•----•••- •----------- ................................ 1 e i ApplicationApproved By................... ••-•••----•--) . .-•-------------•-,--------------{.-- ...........-•--------• -•-----•- J6 Application Disapproved for the f ollo g reasons----------------------------------------•------•-••----•-----•••-------•--•-••----•------•-----••._......_...._ .........................:........•---•-----•-----------......-----------------...------------------------•-••-•-----••---•----•••••---•••---•-•--•---•---••-•--••----------••••---------------'•..--•--- Date PermitNo--------=--------------------------------------------- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH - .....................".....................OF............................ • .................................................... Trrtifiratr ,af T utpfiattrr THIS IS TO CERTIFY, t the In` id e ge Disposal System constructed ( ) or Repaired 04 by............ ..__ . •-•-------••-•-•---------------- � ..._......... _........ .... ..-'CO .- 1 at C ...........................................11j _�IT+ller (0 C -T G._O t/► 1 1 6 , --1---... ------ . ...... ------------------------ _ has been installed in' accordance with the provisions of TIT TPC� Th tate Sanitary Code as described itirthe application for Disposal Works Construction Permit No------- - �+�4I._.... __._. dated----------.`.--- --�------_----•••-. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT �1 -�_`- 014$fk DED AS A GUARANTEE THA THE SYSTEM W_-• = --S1i 4TliFACTORY. ,7UP V V1 ..,rDATE..----.... .--••-_--... . r .........................•-----...---•---- ` Inspector__ ......-•----..... --------------•---......-------------------••-- P THE COMMONWEALTH OF MASSACHUSETTS �j BOARD OF HEALTH ................OF...................... .........._..... ......... , j aC No......................... FEE ...................... Disposa nr�� C a�a�r ion motif Permission is hereby granted -------------------••-•----•--•------------------------•---•••---------••_-------•--•-••_____-_-•------- to Construct ( ) or Repair ( )� a�Individual Se as e`,Pibspjy ystem atNo................ .....----•---`v .'..`_..----......----...._�-._.-��.....-----------------11--ff-�-----------•--...-----•---•--------•--•----•--•--------•--•-----•--...-----.... Street as shown on the plication for Disposal Works Construction Permit No.rz�.....~°.._.{`..... Dated..__._.. f. 3....n� .......... ------------------------------ .1._..---------._ ealth Gl/ oard 5V I r 7 DATE.. --------------------•--•----- FORM 1255 WOBBS & WARREN, INC.. PUBLISHERS \ p Fr �V e � 77 tMa4t4 l etc w f a i l L O CAT IAN SEWAGE PERMIT NO. VIL (AGE INS ILER'S NA i ADDRESS OR OWNER DATE PERMIT ISSN"E D DATE COMPLIANCE ISSUED -�-� I/ ;:_ � ��,,;. ;,� ,�^ f .�.J-ass exa.�- c�� .^ '� �) i :� ® CJ� �� �� �? �7 f - �� - Fps-`fo N .......l.f/ .... - .................:......... THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALT ....... .............OF........... ..... .. :..................... Appliration for Mipoiial Morkii Tondrnrtiun ramit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: r. .....�.y6._.. ............U....... LocatioA-Address or t N ! 1; v-uj---------------------------------------------- ----5�...................................� , ........................................... Owner Address d.._...:.1 .[1. ---------------------------------------------- -----------------------------------•------• ------------.............-----------....... Installer Address Type of Building Size Lot............................Sq. feet U ,..., Dwelling�No. of Bedroom� �..,�._-�� _ ---•----------------Expansion Attic ( ) Garbage Grinder (119 aOther Type of Building VE!!---_-........... No. of persons_-/�_.............. Showers VY6) — Cafeteria (/Y0 Otherfixtures --------------------------------------------------------------------------------------- -------------------------------------------------•-•--------- W Design Flow... ............... . ..._._. gallons per person per day. Total daily flow--------- `' ..._....._.--------gallons. 9, Septic Tank .Liquid capacity Ilons Length................ Width---------------- Diameter................ Depth----------...... x Disposal Trench—No..................... Width_._..`__.._......... Total Length...... Total leaching area............ sq. ft. Seepage Pit No._. .._---_____ Diameter......... Depth below i let._ __. ...... Total leaching area_ sq. ft. Z Other Distribution box ( ) Dosing to ( / , - le a Percolation Test Results Performed by..._-__ -.; :...ed���'................................. Date_.._�t'Q._.-.�..�.._�..��..�.- a Test Pit No. 1................minutes per inch Deptl of Test Pit-------------------- Depth to ground water........................ GT., Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground waste r--._•--_-__----•-__-__-. a ------------------- .....•-- - ---••--le--••-••-•••---•-• l-•�------- .. O ! ------- ` Descriptionoo ------- -_-._ ----------------- W UNature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------------------------•--__-__---__. ------------------------------------•-----------------------------••--••--.--..•--••-••••-••-•••-••-•-•••-••----•--•------------•••-•-•••-••--•-•-----•------------•-•---•-••-•---•-•......----•----••- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'TTLI p ' '° 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. Application Approved By...... /� L t== Date Application Disapproved for the following reasons:------•------------------------•----------------....----------•-----------------•---------...............---•--. ...........-•-•--------------•---•-•--------•-------------------••-------••------•--------------------------•-••---••--••••-••••••••-----•••-----------------•-••••..........................-......... j -2 Date PermitNo................................................=........ Issued..... ......................... - ......... Date i N97-1-1 THE COMMONWEALTH OF MASSACHUSETTS wx BOARD O HEALT ' ... .. .....OF...... .. Appliration for Diipnmal Workfi Tongtrurtiun ramit Application is hereby made'for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: n,. ...! -- 6.... .. ------------------- -••-•-•--•-•....-- -----...._..•-•-- ---••---•-----•------•---........._-•-•-- ...... .._.:` LoAc4atixoit -Address ' ! r od .............------------------.............----------- ... ----- ------ ........ - Owner Address ,.a --• . .......... ` G( = ----------F--------------------•----------... ------------------=---.----=-------------------....._._....----------------------..._........-•---- Installer Address Type of Building,,�-- Size Lot............................Sq. feet U Dwelling No. of Bedroom .___ __.-.----------- _Expansi n Attic.( ) Garbage Grinder pa, Other Type of Building 42(- ----------- No. of persons-----d__'_''_'________-__- Showers Wc.)) — Cafeteria Q' Other fixtures -------------------------------- - --:. ------- W Design Flow__ ________________ _ _____ gallons per person per day. Total daily flow----_. _ "`_______:._.___.__..gallons. ' .x WSeptic Tank Liquid capa'city..gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No_ ___________________ Width ..___.____._._._ Total Length.............. Total leaching area.........._,,_*__.. sq. ft. Seepage Pit No....; ..--___-___ Diameter.........,--- Depth below et_____ ..._. Total leaching area_2.6 sq. ft. Z Other Distribution box ( ) Dosing to ( '� Percolation Test Results Performed by.... Date___:/I1___-.e�__ `_.'_ ._ 1:. a -Test Pit No. 1................minutes per inch Dept of Test Pit__________.__.______ Depth to ground water_.-_______--_______-_--. Test Pit No. '2.................minutes per inch Depth of Test Pit-------------------- Depth to gr and , water_:._._-___________-_--. / f �o Description of ." --il � . W -_'1.. -1 rr x -----•-•--•--------------------••-•-----•..--------_-••••------------------- ------------------•---•-------••------•-" ............................................---•-•--•----•----•--------•---.._. U Nature of Repairs or Alterations—Answer when applicable----------------------------------------------_.................................................... a Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i i:'i p 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. Sig --•--•----------------•-•------••-••---•-_••-• ................................7 Date Application Approved By........ - � ''!"jC�,'` / •` Date Application Disapproved for the following reasons:..................-------------------------------------------------------------------------- -----------------_ -•----•---------•-----------•----•----------•----------------•--•-------------------------•------------------------------------------- ---------------------------------------._...-•••••-•-•--•-•-•_.._ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD Of7HEALTH OF.......... t ............................................ `� �rr��firtt#r ,af �nm��li�anr.� TH S - 0 I hat the Individual Sewage Disposal System constructed ( ' ) or Repaired ( ) •- . . ..--- .. ...-------- + V er stal , at......"'- Tt. K.- - has been installed in accordance with the provisions of THY1 5 of The State Sanitary Code as d scribed�rin the application for Disposal Works Construction Permit No ,,,-� ____:`__P1.1f.......... dated__...--1 ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST ® AS A G NTEE THAT THE SYSTEM WILL FUNCTION SATISF CTORY.; DATE. ---._. Inspector...:... ___:_ " THE COMMONWEALTH OF MASSACHUSETTS BOARD OFAHEALTH JI� .�,�,�,� ..... ... Y..1...........OF.............-- .. .,........--•-----•---........_..... .... . /' <..�.a..✓ No.. ... FEE...,-.5............... �t m ml k n tan rrmtit to ConstPermission uc i( ) o ebY granted� dived ----- ----- ,. . .......... ........................................................ �2 ew Disposal st . at No._'. = � y treet as shown on the application for Disposal Works Construction P No _ '' - ---='_; -,-' Dated �- ------�-�-'-:_.._. r/X' ..... .. . . � r--•------•_•-----•--••- Board of Health DATE / ..: FORM 1255 HOBBS & WARREN, INC., PUBLISHERS4, - 46 How F�cwn4-Tt�* r I � � �Ad.Ny Nt. JoFl� '� r•h ' � st'tt�4 � L���W tr.�•c �N6tt � �� ���E'er D •,• M , • - tAv•0 \40-. Fr:-6Q: 'l ,� 14 s� 110 .y' �. < ter. vton �' �2 � .� •} ✓3.' ©- �"rvN:.•+��� � ,� old , '. G-,&fr*GtT`! = Irv. to Y,4 x • r ��� �. 3 9 3 .n►L. L Efl 1� •rc tNr i en•rt�s,t r,-H- k,cbPr-- 'T177,5 5 f4 Z� Pr4' T1rOAS �1 fi t ►v.o� 2 b�" � a . of SA n LLL !'i� �1► Q,G�ta•►=, 'SFO 4.rl'17 2 8+ ,o k top r ► .! i irM►7Dsa. : AddPOEX t� No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstetn Construction Vertnit I I ,6 -1s-om Application for a Permit to Construct 0() Repair( ) Upgrade( ) Abandon( ) ❑Complete System Xindividual Components Location Address or Lot No.�'�b iMA-n 87 C0 S7-041 'l ) Owner's Name,Address,and Tel.No. /�1cP�sfanr� .4ifoc- Assessor'sMap/Parcel /gx INcrce-s-7e. r'7 NA-7,ucAfA 6/-7b0 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 13Aii-+ems-tNt/t ouc S ez3"b3 7�I_7n2 Type of Building: Dwelling No.of Bedrooms Lot Size2 .$' sq.ft. Garbage Grinder( ) Other Type of Building d0AjA,§�, CA r L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date s-Z Z.-14 4Q,,7 -*-+Y Number of sheets Z Revision Date Vl.o-A- Title Size of Septic Tank ek cA,,, Type of S.A.S. x c 97i N� Description of Soil NIA Nature of Repairs or Alterations(Answer when applicable) _T0rS4A-(.( /;CeJo 4A!(wv J�K,- O ', Date last inspected: I 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 Date Application Disapproved by Date for the following reasons Permit No. 14 -'.2 25 Date Issued � 3 I a Na?C7 y"22 rJ _ Fee - THE COMMON EAL�k `OF.,MASSAC.HUSETTS Entered in computer: w , k �� ' :: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yicat on for Disposal b. psteru Construction,hermit I i-t -c) 7s -ooj t Application for a Permit to Construct QO Repair( )''Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No.p q b Y"1 A,r\ S7 (0 S7-1 ry a!LR_) Owner's Name,Address,and Tel.No. M,le,it-owc <4SfoL -. Assessor's Map/Parcel D �O /S;, (Mo rcQ 392 r7 -t 3 N /1A 6/7 6 0 Installer's Name Address and Tel.No. Designer's Name Address and Tel.No. ire4 C-�1(,) 13.4Xi•e- dlvy4_1 Ci S Oo3 s 77t - 7Tv2 Type of Building: . Dwelling No.of Bedrooms 0 Lot Size 3Z IS fl sq.ft. Garbage Grinder( ) +t Other Type of BuildingdU,,,.-O.c,c_.(- No.of Persons Showers( �) Cafeteria( Other Fixtures Design Flow(min.required) gpd Design flow"provided gpd r=� Plan Date .S- 2 2 _ 4 ed 7_9-r U Number of sheets Z Revision Date N o N R Title # Pxi�7eAj ,. Size of Septic Tank�°k�sf•„„� Type of S.A.S. -'Description of Soil NjA Nature of Repairs or Alterations(Answer when applicable) _T wS A i( 1 o v o 4A(l u.v 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 He th a , �y���~S-i�gn�ed � Date Lf Application Approved b Date t Application Disapproved by Date for the following reasons Permit No. w2 n 141 Date Issued A-7' V .t r -_.-- -- -_---- - _ - - -_ -: --------- -------------------- THE COMMONWEALTH OF MASSACHUSETTS 4 U`- BARNSTABLE,MASSACHUSETTS 00 (Certificate of Compliance _ THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed)( ) Repaired( ) Upgraded( ) Abandoned( )by'&,.-� C at_ t/1� i'�'+A 1/1 f l l eC-7 T Q S7Cw+fie.. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. � 2 2� dated :Z 3//S/ Installer p�C 7y ��� S Designer (�E� f-� A'ti #bedrooms- U Approved design- ow N gpd The-issuance of this it sha not by construed as a guarantee that the system will hcti n esigned. d C Date (�J Inspector r/ 0 - ------- ` --- No,2ni L/ --2Z�g Feed THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposar 6psteut Construction 3permit Permission is hereby granted to Construct(Y Repair( ) Upgrade( _) Abandon( ) System located at i to MAbn J 7;--w 7 0 S 7f vvl 14a— S-e ltvd and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date Z Approved by ti ���` y�. s_4� tf '�•'~ram:.. _ �" � .'� ...•.��y � +-0 r -_ - t,,�_p.-yam' ..t ,meµ•. _�!`iC�; � y� '"�'��� ,�..,,,,,+c --�` � �' I ��� r�� �( "r � lilt` •c;4- ,�. ?�`! �F�„�..r- '",� i` � �. �l �,_ �x2c « +7e'r•• � _oy r � .� ��,�, r .yam•^� �..�i1y .'k.�,J� yr �,�. --z.". �F'• �. :{ .r � <�• �'i� '� �. .�` ✓ ; y. ':4. !_ gpi'.F'.. y _L }. J' - .�r�1' •ems- �:� in— AOkt - d. Pi PW 44 d rt i '7 -.�„-x,. .o. i �� LFF'^.afdt,,�C'iW„',{�dp 1'�+ T4 y_r� - x • j,,,�,'Y�+ � �� ",5y �_.ta�s K 4 �'}ay.„� ',j;�¢ yam+!- 4 d ,f�1"��� •q y M. PM .NY�R I .Ml ..y�ppJ✓ t^ti, rt�.X '� � - •y�.. 1t0;1' ' tw w� s°^�«.,5�:.� S+s.- fit.`'.,� Y+++ru�.k �,,Y.,. ��S"",-- �3„u, '`�:",�. vq� ..e _ �'ram•.,- �U .� 'J+jr�ylj�j _ � w�' 4i:���, � �i`� v �(.�. f" . vc. 0. -i f _ �%l�� ^ r � �. . ��6 !�✓� � ��� a . _ .. _v . . � . t . �-�-.n. ry., T. t ..u!y..0�. C Y� � I xcw.yay.:a..:a...:�.��.. .. '�'� =.s"+:,a*se '�>'�.�s...�....m..«�w..,�,.,,.,_....e.,.�, �__........_. __._._....,__y_.,.5 __._......__. ..._..,_ ��._. _,a.> ,. s....... .. 0-7S--00 `°FiME Tp�� Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMTR!% . A • 200 Main Street• Hyannis, MA 02601 9�A 6M O`0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rFD MPy ]] j' Business Name: t MA Date: Location/Mailing Address: q /kd Contact Name/Phone: ( Inventory Total Amount: <9)0 MSDS:- -6AJJ-he License#: 1 Tier II : No Labeling: 01P 9. Spill Plan: LA Oil/WaterSeparator: A © Floor Drains: iW5 Emergency Numbers: J`" Storage Areas/Tanks: 9 Emergency/Containment Equipm ntnt:- SIM Waste Generator ID: Waste Product: Date&Amount of Last Shipment/Frequency: Licensed Waste Hauler&Destination: Other Waste Disposal Methods: LIST OF TOXIC AND HAZARDOUS MATERIALS no C 1 � 1� � NOTE: Under the provisions of Ch. 111, Section 31, of the en�, ral L(1aws fi1of A, h ardous 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 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) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: Inspector: Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS IKE ropes Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARMs�Ls.� 200 Main Street• Hyannis, MA 02601 039. �p'FOMA+ TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT Business Name: PI) Date: 06 �f aoao Location/Mailing Address: 63 Contact Name/Phone: Inventory Total Amount: a SD IN it *"License#. Tier II : Labeling: 1 Spill Plan:Oil/WaterSeparator: Floor Drains: Emergency iwh Numbers: Storage Areas/Tanks: Emer enc /Containment E ui ment: 1 dpi Waste Generator ID: Waste Product: 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) v/ Windshield wash Motor oils - V 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: �auIk/Grout insectici es, 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 1504 Paints, varnishes, stains, dyes Lye or caustic soda Lacquer thinners V Miscellaneous Combustible Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables V Fertilizers Floor&furniture strippers PCB's Metal polishes Other chlorinated hydrocarbons Laundry soil &stain removers (including carbon tetrachloride) (including bleach) Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: i 1l— li, l- 1 fl INFORMATION/RECOMMENDATIONS: e i ' Inspector:JAI Facility Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY-BUSINESS `°FIB rokti Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • BARM��e.� 200 Main Street• Hyannis, MA 02601 i639 TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT RFD MP ( i Business Name: i t C d n Date: Cl � /14 Location/Mailing Address: G. Contact Name/Phone: Inventory Total Amount SDS: CV)14Q, License#: Tier II : N 6 Labeling: r6iull 1, Spill Plan: Oil/WaterSeparator: AIIA Floor Drains: Emergency Numbers: Storage Areas/Tanks: Emergency/Containment Equipment: i Waste Generator ID: Waste Product: 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 an isposal of 111 gallons or more requires a license from the Public Health Division. Antifreeze Other cleaning fluids �utomatic transmission fluid Other cleaning solvents&spot removers �,ff ngine and radiator flushes ug and tar removers ydraulic fluid (including brake fluid) Windshield wash '70 Motor oils to Miscellaneous Corrosives `X0'fS d Gasoline,jet fuel, aviation gas Cesspool cleaners Diesel fuel, kerosene, #2 heating oil 10 'Disinfectants q b Miscellaneous petroleum products: Road salts grease, lubricants, gear oil frigerants Degreasers for engines&garages Pesticides* VCaulk/Grout X insecticides, herbicides, rodenticides 04 1 to Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals(Developer) ar wash detergents Printing ink Car waxes and polishes Wood preservatives (creosote) Asphalt&roofing tar �-p Swimming pool chlorine �aints, varnishes, stains, dyes Lye or caustic soda acquer thinners 1� Miscellaneous Combustible J Paint&varnish removers, deglossers ZO Leather dyes iscellaneous Flammables V Fertilizers aQ loor&furniture strippers t PCB's Metal polishes `-ro Other chlorinated hydrocarbons Laundry soil &stain removers v (including carbon tetrachloride) (including bleach) O 3d0 Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMEN TION5: c Inspector: / Facility Representative: < �— WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS SME TOk,4• Town of Barnstable Office:508-862-4644 Public Health Division Fax:508-790-6304 • RAR .kq E. MASS • 200 Main Street• Hyannis, MA 02601 . u t659. MPy,.0� TOXIC AND HAZARDOUS MATERIALS INSPECTION REPORT rF0 Business Name: �95 erv,l te— Noy5e- ; Date: D 16 Location/Mailing Address: 8�6 ✓V/R t°t :S4 , 6542'ry 11 Contact Name/Phone: 1►^atk 04,11z1, ass �� � Colo-ow►�c- �0�3- Y28-(ci 1 t �..- Inventory Total Amount: r"21�t)qw�4, 000016 SIDS: License#: 3) C,4 3 Tier II : Labeling: c J ® k Spill Plan: pro Do6f Oil/WaterSeparator: Floor Drains: 0 o Emergency Numbers: k Storage Areas/Tank O* 5kKlt,�0-11ek caw iw�� -✓Lk- -fie fs��,h,�o Qo� Emergency/Containment E ui ment: a k Ivtb�w o of k-cL, n s Waste Generator ID: --7 4"0 i k e 1 Waste Product: &I,, - Date&Amount of Last Shipment/Frequen y: 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. qO Antifreeze 304'19 Dry cleaning fluids t Automatic transmission fluid Other cleaning solvents&spot removers Engine and radiator flushes Bug and tar removers - Hydraulic fluid (including brake fluid) 7- Windshield wash tZ g p Motor oils 2.1D Miscellaneous Corrosives Gasoline,jet fuel, aviation gas <s Cesspool cleaners t��pnCF C�1r c�k.t1S. i15 el fuel, kerosene, #2 heating oily`o Vn Disinfectants to «,{ ^u Miscellaneous petroleum products:$ 000 I Road salts 4,1 '500a s grease, lubricants, gear oil Refrigerants Y Degreasers for engines&garages Pesticides: $p 4-24' -Its Caulk/Grout yl, apt�,��y,.,e y S aS,� gp insecticides, herbicides, rodenticides Battery acid (electrolyte)/batteries Photochemicals(Fixers) Rustproofers Photochemicals (Developer) 3 Car wash detergents '' t� Printing ink v Car waxes and polishes 1� �S ��oX 6x Wood preservatives(creosote) Asphalt&roofing tar r,y�0. -{�� s -10 ,�0X } Swimming pool chlorine 00 k poo Paints, varnishes, stains, dyes So 4 i°yuo° Lye or caustic soda Lacquer thinners taco{e,�rt�y�,ticwQ S$ Miscellaneous Combustible 2, S Paint&varnish removers, deglossers Leather dyes Miscellaneous Flammables W&04- �� Fertilizers- -.ca.5c—k 2 Floor&furniture strippers �pOgabq PCB's t Metal polishes t '� Yy �+1 011 Other chlorinated hydrocarbons Laundry soil &stain removers es- (including carbon tetrachloride) (including bleach) -k Any other products with "poison labels" (including chloroform, formaldehyde, hydrochloric acid, other acids) VIOLATIONS: ORDERS: INFORMATION/RECOMMENDATIONS: t, #- 3 Ct 0,< S 'S C-e \S Q,C . k ceav o , 1 Oays c` y.V rt �9 c�S 5 o��v« Inspector: \Zi �` ��g�°`��� • ���- I\I- '0 "A. -,Fsa&ity Representative: WHITE COPY- HEALTH DEPARTMENT/CANARY COPY- BUSINESS TOWN OF BARNSTABLE _,COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair nters BOARD OF HEALTH satisfactory 2.Auto Body Shops 0' 4 O unsatisfactory- 4.Manufacturers COMPANY (see Orders ) 5.Retail Stores 6.Fuel Suppliers ADDRESS .? / Class: - 7.Miscellaneous ANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel(A) . es9�, T'eroseire, #2 (B) Heavy Oils: waste motor oil (C) new motor oil(C) transmission/hydraulic Synthetic Organics: degreasers Miseell e�ous: � q i Vr� DISPOSALIR.ECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer Public '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 71 NO ORD O Holding tank:MDC _ O Catch basin/Dry well O On-site system J 5. Waste Transporter Name of Hauler Destination Waste Product YES NO 1. 2. (<'l JA A I ',. Person( ) terviewed Inspector V Date 8/15/2016 Osterulle House And Garden-Google Maps GO► )gle Maps Osterville House And Garden ?OmbwvMm Ha um Ana WrdM F;>Axrt Paul€+rcwle-, f��in4,r'Ga»at. Y.rp/s,a!tfa0� Fi•C U34-,t mt c Crisp Fis".xLead Cater�i le`uilbge uf:r�n tl 0uT Levy of th 83-k of C3pe Ga1 O%mumptica G 5 5 �'r�4S05(Y.rk r, Go 9le Map data @2016 Google 200 ft, Osterville House And Garden 1 review Hardware Store https://www.googIe.com/maps/place/Oster\iIIe+House+And+Garden/@41.6272997,-70.387505,17z/data=!4m5!3m4!1s0)09fb3280d189ab2d:0>O9adOa576b352cb... 112 Number Fee 1292 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health .This is to Certify that Osterville House and Garden \ ~ 846 Main Street, Osterville, MA Is Hereby Granted. a License. For: Storing or Handling 500 gallons or more of Hazardous Materials. ---------------------------------------------------------------------------------- -------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2017 unless sooner suspended or revoked. ---------------------------------------- WAYNE MILLER,M.D.,CHAIRMAN PAUL J.CANNIFF,D.M.D. 07/01/201.6 JUNICHI SAWAYANAGI THOMAS A.MCKEAN, R.S.,CHO Director of Public Health �s 4 i h Town of Barnstable • THE► Regulatory Services MAI Richard V. Scali, Director MAS& _ BAMSTAB ,b � Public Health Division M�-camwuz mwu�-cowW� Thomas McKean,Director 1657 14 - Sag 200 Main Street, Hyanmis,MA 02601 Office: 508-862-4644 Fax: 508-790- 3Q4 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS-JU-ifY 1st-=JUNE 30th): - - - - - - APPLICATION FEES CATEGORY 1 PERMIT 26- 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 -499 Gallons: $125.00 El CATEGORY 3 PERMIT 500 or more Gallons: $150.00L ' -A late charge of$10.00 will be assessed if payment is not received by 1st. ` ASSESSORS MAP AND PARCEL NO. DATE FULL NAME OF APPLICANT: NAME OF ESTABLISHMENT: �' - ¢o�ll€ �Cftt%a_ c4j acz►�,u � ADDRESS OF ESTABLISHMENT: ��(o M+� i ". (`'}S-l�e,�rll� �I A OU55- MAILING ADDRESS(IF DIFFERENT): TELEPHONE NUMBER OF ESTABLISHMENT: SCE `I Q Z J EMAIL ADDRESS: �w►�sC �c�& Ccc,451 • ��i SOLE OWNER: YES NO' IF NO,NAME OF PARTNER: FULL NAME,HOME ADDRESS,AND TELEPHONE# OF: CORPORATION NAME wnj G-A2:a Cott PRESIDENT J Ass G,fz TREASURER ;:4 A.�� CLERK IF PREPARED BY OUTSIDE PARTY: SIGNATURE LICANT Name: Company Address Telephone#: Email: Q:\Application Forms\HAZZAPP Revl6.docx Page 1 of 2 Number Fee L's 1292 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health This is to Certify that Osterville House and Garden .-------------------------------------------------------------------------------------------------------------------------------- 846 Main Street, Unit D, Osterville, MA .----------------------------- --------------------------------------------------------------------------------------------------------------------------------------- Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. Restrictions: -------------------------------------------------------------------------------------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and expires 06/30/2021 unless sooner suspended or revoked. --------------------------------------- JOHNNORMAN DONALD A.GUADAGNOLI,M.D. 07/01/2020 PAUL J.CANNIFF,D.M.D. THOMAS A.MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable Inspectional Services BARNSTABLE NJIISUKE-CSM R IU-CMU-FYA1k15 Public Health Division� Wt3Slai34L5.OSEEVRL•�`51 B.VLYSi48LE _ 1639-2014 •ARNgrABUL : Thomas McKean;,Director �E. fir_s 4 039. 200,Main'Street, Hyannis,-MA 02601 , i f Office: 508-862-4644 '''':� d Fax ;508 Z90✓6304 APPLICATION FOR PERMIT TO-STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES AREAEQUIRED,TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st-JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ —T CATEGORY 2 PERMIT 111 —499 Gallons _$125.00_ _ '❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 V&� *A late charie of$10 00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? YES_NO. IF YES,SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS.STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: C�Sv�II �etiu A, P GzN �rP �fam > Co`�"C' 5. NAME OF ESTABLISHMENT: i- >Zydilc 41-SC A+- GW2De . cltP 6. ADDRESS OF ESTABLISHMENT: Ajo% k �? � 7. MAILING ADDRESS(IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: y�S 9. EMAIL ADDRESS: �l MdZ5 Bs-izazll- )�AQtr>wnpz-. ca,M 10. SOLEOWNER:_>�_YES_NO IF NO;NAME OF PARTNER: Y 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME C)S PRESIDEN mr kA TREASURER - CLERK •12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE77 Q:Vlpplication Forms\Haz Mat Appli Draft Jan20l9.docx bS+��S�i� Mai bZ.lcs� � 1 l �JAbLa- 1 Number Fee 1292 THE COMMONWEALTH OF MASSACHUSETTS $,5o.00 Town of Barnstable Board of Health This is to Certify that Osterville.House and Garden 846 Main Street, Osterville,-MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. ----- ---- --- ------ - --- - ---- ----- ----- -- --- ' ------- ----- --:- ------ - -- -- ----------------------------- This license is granted in conformity with the Statutes and ordinances relating there to, and . and expires 06/30/2020 unless sooner suspended or revoked. ---------------------------------- --- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI, M.D. 07/01/2019 JUNICHI SAWAYANAGI THOMAS A. MCKEAN, R.S.,CHO Director of Public Health Town of Barnstable W y Inspectional Services BARNS LE V`tHE —STOM8u US<C.49Public Health Division l:-:L2LL0 E1'.40a'U:R<dNaxaA}FIk%l_F E BARNSTABLE, • Thomas McKean,.Director ; MASS. $ en59.+a 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 -o APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE '` HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE,CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1st-J[TNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26= 110 Gallons: $ 50.00 El CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 0 GI1 CATEGORY 3 PERMIT 500 or more Gallons: $150.00 �V87r f0; *A late charge of$10.00 will be assessed if payment is not received by July 1st. :�>7J 1. ASSESSOR'S MAP AND PARCEL NO. 34C, PA10 )- )4 c32G.S� 2. IS THIS A PERMIT RENEWAL? X YES_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. -n 4. FULL NAME OF APPLICANT: �}�tZy;i ►, 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: S 14. 5+ 0S-(-0.p1 c kA 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: q�pe 9. EMAIL ADDRESS: �4gmcs 10. SOLEOWNER: _X_YES_NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME OStpuollr- 4.tsL aj C^ gbmg► CoRj> PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE 11 I c) Q:\Application Forms\Haz Mat App Revised 09-10-1 . ocx r iµ Number Fee 1292 THE COMMONWEALTH OF MASSACHUSETTS $150.00 Town of Barnstable Board of Health f This is to Certify that Osterville House and Garden 846 Main Street, Osterville, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. This license is granted in conformity with the Statutes and ordinances relating there to, and and expires 06/30/2019 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.O. _ 07/01/2018 JUNICHI SAWAYANAGI THOMAS A.MCKEAN,R.S.,CHO Director of Public Health `* Voengatoryof B4rnsxable Services Richard V. Scah,Director "o Public Health Division BAMSTABLE {AFNSLMLE.fEtRE1MlIF•CDf11R•4YM:N15 ��� Thomas McKean,Director "°�°�""�;�"-4"� 5T""� MAS&9`l'PIFo 200 Main Street, Hyannis,MA 02601 �D5 Office: 508-862-4644 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT 500 or more Gallons: $150.00 N VIS *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2. IS THIS A PERMIT RENEWAL? A YES—NO. IF YES,SHIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES(25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: , 5. NAME OF ESTABLISHMENT: � 2v 6. ADDRESS OF ESTABLISHMENT:�, G�'11'W ►� �j�" ®StLv;I� !� c� ��s� 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE: 8. TELEPHONE NUMBER OF ESTABLISHMENT: 9. EMAIL ADDRESS: 10. SOLEOWNER: YES NO IF NO,NAME OF PARTNER: t — 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME C -tv r ll� 1 I�� A, ('�,� ►, r A PRESIDENT.►^,,,,,�, TREASURER ?� � CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: • COMPANY ADDRESS EMAIL: SIGNATURE OF APPLICANT DATE j 1 Q:\Application FormsUiAZMAT APP 2017 REVISED cx Number Fee 1292 THE COMMONWEALTH OF MASSACHUSETTS $15o.00 Town of Barnstable Board of Health - r This is to Certify that Osterville House and Garden 846 Main Street, Osterville, MA Is Hereby Granted a License For: Storing or Handling 500 gallons or more of Hazardous Materials. -------------------------------------------------- --------------------------------------------------------------------------------------- This license is granted in conformity with the Statutes and ordinances relating thereto,and and expires .06/30/2018 unless sooner suspended or revoked. ---------------------------------------- PAUL J.CANNIFF,D.M.D,CHAIRMAN DONALD A.GUADAGNOLI,M.D. 07/01/2017 JUNICHI SAWAYANAGI t THOMAS A.MCKEAN, R.S.,CHO Director of Public Health i fr. . Tower of B nstable / O ���� Regulatory ery Richard V. Scali, Director # 'WE rqi, o Public Health Division BARNSTABLE mawscnie...ur:pue.court•xrm.cis �q BARNSTAB . • Thomas McKean,Director 1639'- 9 MAC. � 1639.2014 �+ 200 Main Street, Hyannis,MA 02601 �Ig 0 n hti� Office: 508-862-4644 q�!/ —p2 C>!/6 Fax: 508-790-6304 APPLICATION FOR PERMIT TO STORE AND/OR UTILIZE HAZARDOUS MATERIALS IN ACCORDANCE WITH THE TOWN OF BARNSTABLE GENERAL ORDINANCE, CHAPTER 108, HAZARDOUS MATERIALS,ALL BUSINESSES THAT HANDLE OR STORE HAZARDOUS MATERIALS GREATER THAN HOUSEHOLD QUANTITIES ARE REQUIRED TO OBTAIN AN ANNUAL PERMIT(RUNS JULY 1 st—JUNE 30th). APPLICATION FEES r - CATEGORY 1 PERMIT 26— 110 Gallons: $ 50.00 ❑ CATEGORY 2 PERMIT 111 —499 Gallons: $125.00 ❑ CATEGORY 3 PERMIT. 500 or more Gallons: $150.00 9 V.S. *A late charge of$10.00 will be assessed if payment is not received by July 1st. 1. ASSESSOR'S MAP AND PARCEL NO. 2: IS THIS A PERMIT RENEWAL?—�--' YES,_NO. IF YES, SKIP QUESTION 3. 3. FOR ALL NEW PERMIT APPLICATIONS,INDICATE WHETHER BUSINESS HAS ZONING/BUILDING APPROVAL FOR HAZARDOUS MATERIALS STORAGE/USE OF • GREATER THAN HOUSEHOLD QUANTITIES (25 GALLONS)? YES NO. 4. FULL NAME OF APPLICANT: 1E Vqw; - tto<<�2 �r,�. .G-R 'DL� C_,c 5. NAME OF ESTABLISHMENT: 6. ADDRESS OF ESTABLISHMENT: Z;fi 0StaQ\)',1( kiQ Oaf 7. MAILING ADDRESS (IF DIFFERENT FROM ABOVE- S. TELEPHONE NUMBER OF ESTABLISHMENT: S6�5 9. EMAIL ADDRESS: y►1 N A.A G tZ 10. SOLEOWNER:&YES NO IF NO,NAME OF PARTNER: 11. FULL NAME,HOME ADDRESS,AND TELEPHONE#OF: CORPORATION NAME OateeuMC gpiw�,c cyeg �2Aa►:� �oS'� . PRESIDENT TREASURER CLERK 12. IF PREPARED BY OUTSIDE PARTY: NAME: TELEPHONE#: COMPANY ADDRESS EMAIL: 0 SIGNATURE OF APPLICANT DATE " )'g� Q Upplication Forms\HAZMAT APP 2017 REVISED. -cu � .....•.-.. ,-r...-........:....•,..�rr4^ti-^",.�:--.,,,r„�•^^*`."R.`�".^�v.a�!''^`-.'.`"'v'`'w"!..'-bwa"",°°"-.'..`s`-'crrr-Tr- ,-F�. .. ,..1,r... �•...r.+,.`. TOWN OF BARNSTABLE BAR-W 5174 Ordinance or Regulation `WARNING NOTICE Name of Offender/Manager 4 Wes �-�' ��� T Address of Offender MV/MB Reg.# Village/State/Zip Business Name 054-CrVd1,e_ 400y 6-'"4YA►4 �'r�L> /pm, on { y�� 20 Business Address Mr i fJ Signature of" Enforcing Officer Village/State/Zip f_ J37CY'V t lk- , IVA 02(5r Location of Offense Enforcing /Dept/Division Offense V1 �n �r, G'Yj` a• > �i I ./t�� ' 4 �l� ? .�4f" Yt / art 5 Facts t�'2: .v {a� y ! 1 C Y"t �� i� t,.i��t �t.�t �t V' r Pf This will serve only as a warning. 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. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. ... - -...' ,..-.-.-. �-..-....-... ..v-�,•1.Lr""l..e�+..ry..r`r.�f::.-.�..A`.....---•-.r +..w..r-r...r '.--ti:,,,r.*.v..,w.....•s. ..�Td.y�y..-. „r.,..^tiW..r-r+'+rw....Y« ,. - "--- - TOWN OF BARNSTABLE BAR-W 54 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager -Ulvl- : ' t -. Address of Offender MV/MB Reg.# Village/State/Zip Business Name ", t /, - [''t I'rr am/pm, on i f, 20 Business Address Signature of-' Enforcing Officer Village/State/Zip `yf { 14— "Y/ Location of Offense • _, ��, i}lam ��F,� ,.,�. _> -;�.�k.�t_ Enforcing Dept/Division Offense is ' S t �i Tk. ., j 4 i l4 p i t w t' wi�Fa i✓Z rj "e! !1 l�f .. a` Facts I__' 'i' � .�' +.i 3 •�� 1 + 1 i t.Jx' a„2 P{'r. (' C� f1'# �vr �d`.f i-��_n ��'i _a d.f�," ''d!•''"" tl *�' This will serve only as a warning. ,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. `"` WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. TOWN OF BARNSTABLE UNDERGROUND FUEL `AND CHEMICAL STORAGE SYSTEMS ASSESSORS MAP NO. PARCEL NO. ADDRESS ® VILLAGE Ill 1dAME CONTACT PERSON O �0 PHONE NUMBER LOCA TION OF TANKS: - CAPACITY: TYPE OF FUEL- AGE: JTYPE:. LEAK OR CHEMICAL: DETECTION SYSTEM! DAT& OF PURCHASE OF. EACH: 1. 2. 3. 4. 5. DATE` O`F° FIRE DEPARTMENT. PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT- PASS PLEASE PROVIDE A SKETCH. SHOWING THE LOCATION OF TANKS ON THE BACK OF THIS CARD. 4 'filu• ij`gg, '/ 'v /7 40�L t`i S E' ;CENTERVI' LE-OSTERVILLE�` � Q e � � APPLICATION FOR�PERMIT � , �•; , FIRE DEPARTMENT PTO INSTALL•ALTER FUEL OIL 13URNING EQUIPMENT! Date c 19 f h x 16 the Head ofthe FIre.Department k ' y z�K t lk.+, t iar e: rdy saw.q,�#w; : cs° x: H "' " " f s Application is herebyrr►ade In accordance with the rovisions or Chap14t3 G:L d Regina' z ` tIons made;urider,authority'thereof by the'undersigned for permit to install-alter',for '. > son or personjsQand•at the.location named herein,certain equipment for the keeping;storage '- ,or use'offuel qU hgr�la14ble liquid roducts used for fuel as described betow NAME LEE— NAME- U ` "His, (Owner or,Occupant) � ' J �'2'/T/3`1�"� . s n x. � .. '> zADDRESS �t'uI7!✓ / �S?'�t. ' � ° .Descdiptlon Nam a: ADDRESS q1y �..x„ r Manufactu A a"��."1 'd .b "° il ►', 3d5{ ' g. Burner , Type „ s Model or size A s , r Location "M ro ass.Appved No ti .Storage Tank• Type 5.<l�.t/�q-�1!- �- t `�,_Capa Ity, 71 '_gals(or)Size " 'trt'� 9LOC8tIOM �� /�IJ'TS�r cam ` F� kld74 � ti �q`Y f Amount of fuel required for test) e" + �° � 17iis appit atlon is made"vitn,full knowledge ofjt �geeyulre�me^ts of there ul�ttO�n - �goveming such installation;which will be made In com fiance therewith. g p f i Note•If this application involves alterations to existln equipment describe ful�� IY on reverse aide �., t'1"g� rvr-r 3 CEP`F � y«•r; ' vet � _ �, t� �-' �'ti' � � `r' ,b $� `vim" A �K � �. �, Y+n t• 'Z"3��{ 4 • q'xa Signature of A II ant < k � By V 'aL�k-t-T,= ra t Aadrese 'SS! 0�tc,�C a :/oi, t i ; Certificate of Competency No. t V Telephone No$P 11 , 7s ��i s _ fLF® �� � �"`g � ��t��-4��•� `�', '1"� v�>err ?�Ptt 'a � �.���,� �1�' � t �# t y Dept 0 lot' S }- -f.� iAt " f Y 1 C�� ..��f'� ..r ' � �f. '� 1 tt"i� �yJj/�,�/ � �• , d CL 14 Wli& l LI 06-cv I ae� S M E vc­lNr, v/11I op(_Am'-�- No_ 1033-4 2_153L MAOF IN IJSA CF.T npr_,ANIZED AT SMEe�.�M/ #846 . Design Flow Retain'gallons per square foot= 0.05 (50/1000) OfficA gallons per square foot= 0.075 (75/1000) Retail space= 10020 sf 501 gpd Office Space= 630 sf AZ gg_d hilnimum allowable gallons per day= 200 gpd Total 548.3 gpd Septic Tank �VP Sized @ 200%of design flow for retail= 1097 gallons Existing 1500 gallon tank Leach Pit Existing 1000 Gallon Leach Pit eXe with 2'Crushed Stone Sidewall Area= 188 SF Capacity= 470 gpd Bottom Area= 79 SF Capacity= 79 gpd Total= 267 SF 549 gpd All Components To Be H-20 �` S �ALt1.lM6 0 by' .`� O J t t�ese�io F 1� o -oa \ y� o PRopos�t000 fit . 40' 42 O 24 ' ! - O SLAB 1 ,F 4' U a o a-t E i_ AP Fl K1M L CAT t 'OF SEPTIC'TANK a, 000 •, 1=X1S'T•4NG'SE4TIC SYSZSM-Co B� 'x � R�MOvEp A MOXIMA7P I-0c AT 7 OF SEE 1l� ' �tY r,.. :0 0 SLAB 1` , ` HYD 44 `' 1C 42r F1EQ) AUNSTED AROUND WATER LINE r . M - r-A SCALE: •11' = 30' For property line information see Plan of Land in Barnstable,MA Prepared for Holbrook Davis dated August 4,2000 By Canal Land Surveying in Plan Book 561 Page 68. r enrsn wove 'This Lot is Municipal Water J . ies Sbgwn oKD- is Plan Are Approc Filter ' ` w urs Prior to Any Excavation l=orThia -_� Fabric Compacted Fill ' .?,• tractor Shall Make The Required - a LocusN •, KC )i9 Safe(I-888-344-7233) 1/8=Ve �>J is Required to Secure Appropriate pea Stall own Agencies For Construction Plan. Required to Within 12°of t Leaching o '. .} ,��N •.�� a Chamber luried Four Feet or More or Subject Double Wastrel R,3• affic to be H-20 Loading. Slone '. 4-10 - o be Installed in Accordance With ,� .41 !moo )Latest Revision And The Townof _ 13-0 ' d of Health Regulations --- 3ch.40 PVC. d LOCUS PLAN CROSS SECTION OF CHAMBERS Scale: 1:12,000 Assessors Map 117 NOT TO SCALD Parcel 075-1 &0' #862 - ZONING-GROUNDWATER PROTECTIOI "a Y OVERLAY DISTRICT iare foot= 0.05 (50/1000) � � .. _ _ FG.,Ai"_ rare foot= 0.075 (75/1000) ft , 0 sf 0 gpd III r 2468 sf L ' ble gallons per day= 200 gpd 40 1500 Gallon Top El. 'i0 Total 200.0 gpd t 39.8 Septic Tank 39.E ' i ••r;: BoLEI. 37 gn flow for retail= 400 gallons, Bedding as Use 1500 gallon tank Per Title 5` r N 0.74 270 sf DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM x Length If - Not to Scale 1 (one)500 gallon leaching drywalls ' w 273 sf Field adjust inverts as required to meet min. pitch requirements. `'a Be H 20 Per Town of Barnstable Groundwater Map groundwater elevation is approximately 5.0 Therefore there is approximately.35.to 39 feet to groundwater from existing grade. VENT SYSTEM IF REQUME . VENT TO BE LOCATED So, CREATE'A VISUAL IMPAIR' #856 &858 FG. q2 auare foot.= o.05 (50/1000) quaWfoot 0.075 (75/1000) ,�000 G�►, . y 6000 sf 300 gpd �(� c�Re►SE �. ° 900 sf 6a ggd f rable:�allons per day= gpd Total 367.5 gM -R •.. 0 uail4a -- 3B.� Septic Tank F3. — ml _ w; Bol,El .F g - :ter.- ;. , •: . �si n A�w for retail= ,. . 735 gallons ' Use 1500 gallon tank xi Bedding at Per Title S D/0:74. 497 sf DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Ih x Length Nol t0 Scalt 0 if n 2(two)500 gallon leaching drywens Field adjust,inverts asrequired to meet min. pitch requirements. 511 sf Per Town of Barnstable Groundwater Ma oundwater elevation is approximately 5.0 • To Be H-2o � ,: • .r P groundwater PP Y Therefore there is approximately 35 to 39 feet to groundwater from existing grade. #832 square foot= 0.05 (50/1000) ` square foot= 0.075 (75/1000) G•y ' = = 655?sf 328 gpd e= 3528 sf 265 gpg Total' 592:2 gpd 43 1500 Gallons Top El. y3' design flow for retail= 1184 gallons 42'B Septic Tank Use 1500 gallon tank " y 2. 42 2` cY\: Bot.El. �10' Bedding as 3PD/0.74 800 sf; Per Title 5• /idth x Length 5F" `' DELVELOPED PROFILE OF PROPOSED SEPTIC.SYSTEM Fj , with 5(five)500 gallon leaching drywells r �a 810 sf Not to Scale— Its To Be H-20 `Field adjust inverts as required to meet mina pitch requirements. Per Town of Barnstable Groundwater Map.groundwater elevation is a roximatel _5.0 PP Y Therefore there is approximately 35 to 39 feet to_ PP Y groundwater from existing grade.., d° b x sY O ti SITE DEAN. Proposed Septic System Upurades - 8329 8469 8569'858, & 862 MAIN ST Ilan is°for the repair/upgrade of the existing septic systems to - OSTERVILLE, MA 1um feasible compliance. There is no proposed increase in flow or'a FOR sed change in use. �rkmanship and materials not specifically,mentioned on this plan_ shall MR: HOLBROOK'DAVIS y with the provisions and specifications contained within - BY �IR15.00 latest addition _ - ' '- ---- _ SULLIVAN ENGINEERING Relocated Septic System for 856&858 Main Date. 09/06/01, OSTERVILLE,MA St&Added Upgrade for 870 Main St. DATE: FEBRUARY-28,`2001 Revision Modifications to System Based on Additional Date:03/22/01 ° As Built Information ��_ Sttcr I/r nvres I.Water Supply ForThis Lot is Municipal Water' 2 Location of Utilities Shown on This Plan Are Approx. Filter c,ti a Compacted Fill ' At Least 72 Hours Prior to Any Excavation ForThis Project The ControctorSholl Make The Required 24 Notification to Dig Safe(1-888-344-7233) I/8=h jgpd 3 The Contracter is Required to Secure Appropriate Pea Stc Permits From Town Agencies For Construction ' 9Pd Defined byThi:s Plan. 1pPd, 4. Install Risers rs Required to Within 12!'of a Leaching Finished Grade. a Chamber 5.All Structures Buried Four Feet or More or Double Y ' Stone gallons to Vehicular Traffic tobe H-20 Loading. 6. Septic SystemtobelnstalledinAccordance With �— 4-10 310 CMR 15.00 Latest Revision And The Townof 13- 1 Barnstable Bourd of Health Regulations 7. All Piping to bai Sch.40 PVC. v CROSS SECTION OF CHAMBERS Capacity= 470 gpd HOT TO SCALE Capacity= 79 gpd 549 gpd #862 Design Flow , IF.G.9I F1 Retail:gallons per square foot_ 0.05 (50/1000) Office:gallons per sluare foot.=, 0.075 (75/1000) ' Retail space= 0 sf 0 gpd 7 r Office Space-� 2468 sf ,]85 Mg yQ' CV minimum allovrable gallons per day= 200 gpd 1500 Gallon , Total 200.0 gpd 39- Septic Tank 39. , Septic Tank 5' 3 9.4', 39.z Sized 0 200%of design flow for retail= 400 gallons. Bedding as Use.1500 gallon tank Per Title 5 i z h f Leach Field Required Area=GPO/0.74 270sf DELVELOPED PROFILE OF PROPOSED SEPTIC SYS' Field Size=13'Width x Length Not t0 Stok a Length= 13.0 If use 13'x13'field with 1 (one)Soo gallon 73 wing drywalls . . Field adjust inverts as required to meet min. pitch requirements. Area Provided= Ail Components To Be H-20 Per Town of Barnstable Groundwater Map groundwater elevation i tra�os� t000�� . w►+tp Cl1N3 +� -- -- -- _ Therefore there is approximately 35 to 39 feet to groundwater from 40 #856 8 858 r` Design Flow3 F.G.42 yZ Retell:gallons per square foot= 0.05 (50/1000) , ' Office:gallNis per sauar>:foot= 0.075 (75/1000) i000 GA►: t t 1' Retail space= 8000 sf 300 gpd �� 1 Office;Space- 960 sf 88 y� Tx r minirElum allowable...tallons per day p gpd •,,« �- :Total 367.5 gpd Septic'Tank 38.( t3. - - Septic Tank -- —� --- -- Sized 200%of c esign'f oVi for retail- w x -735 gallons - - •: - —- -2' - - _ r; r Us0'1500-gallon tank z Bedding as ,ya Per THIe 5 Leach Field Required Area=GPD/0.74; x q ' r' a97'sf OELVELOPED PROFILE OF PROPOSED SE Field Size=13'Wirfth x Lengths .� -, , k Length= 271.0 Scale Not 10 Use 13'x2T field w th 2(two`)500 gallon leaching drywells / 'Field adjust invertsfas required to meet min. pitch requirements. Area Provided All Componenrs'To Be H:2o' Per Town of Barnstable Groundwater Map groundwater elevatic '� a<M Therefore there is approximately 35 to 39 feet to groundwater frI EPT IC c Design Flow Retail:gallons pfr square foot— ¢0.05`t r(50/1000) y r . yy Office:gallons prr square foot o, #�0 T7 1 1(75/1000),+ati-_ f G.y Retail space= Rr855� ' 328Cg , t 1 Office Space f.� f3528''sf � - 1 a a •»: 4T< , Total. r* 592.2+s 9 y 3 � ? 1500 Gallon Septic Tank , , 8� IIYo , , sizepd Z00%�.fdeslgn flforret�all , i1aaan ns ' ``5 42 Septic Tank `I2•� Y Use 1s00 all n tank cYtt� I V �� � t y 2.y'. 42. L �' � k"� �..�-° `c rs,:: ►► + --4 x Leach Field ; �� $ Bedding as Required Area �GPD/ " Per Title 5 Field Size=10,Width x Length�-c Length Use e)501 e Ilon'I`achlnpdywe�is DELVELOPED PROFILE ,OF PROPOSED SEPTIC F1E1-D.AD3USTEp. Area Provided 3Not to Scale _ e; AROUNO WATER LANE All Co pononts T€�J�e H-20' K ` Field;adjust inverts as required to meet min. pitch requirements. t. _ . r x b Per Town`.of Barnstable Groundwater Map groundwater elevat K Therefore there is approximately 35 to 39 feet to groundwater f At r �v a� Props $ it t7b` yF_ # , 832 1. This�lan is or the reEaic�hftdde ofzttie eaist>tnglsephes ystems'to' maamiumwf"�'" ,,,t y. ,,�, �.,.�.._., .. ' . easible compLanoe.There isrn_ olproposedlincrease In 11 1flowfor propfosed change m ase. ,�� 2. All w,orkmaa it aad at�nals U, �� z IV pecafi aUy,mentionii4thisplan{shall ; r aced for Holbrook comply with the,pro�nsionl! nd specification c tamedtwitbin '' b ` 61'Page 68. 310CM .15:�1a'test nuumo of /x =� SeptiSystem for 856&"858 Main Date 09/06/ r k= St&A dad U de for 870"Ma>Ia Sf:F ti... r x �ttmeatotak llodd>tt,ra u`tosystem9Ba ea'onrAaa�aonal#y Date o3Rvo1 zd x Ai- "Bm7t,Woimation _. u ._ .' ` f 175 GRADING AND DRAINAGE NOTES: , 1. DEBRIS, EXCESS, AND UNSUITABLE MATERIALS FROM THE BAXTER NYE EXCAVATION & DEMOLITION OPERATIONS SHALL BE REMOVED FROM THE SITE AND DISPOSED OF IN A LEGAL MANNER BY THE ENGINEERING V� CONTRACTOR Q 2. DIS11312BED AREAS SHALL BE PROTECTED AT ALL TIMES TO SURVEYING CONTROL' SEDIMENT TRANSPORT BEYOND THE LIMIT OF WORK. ;: 3. THE SITE SUBCONTRACTOR SHALL PROVIDE ALL EXCAVATION. BACKFILL. AND COMPACTION NECESSARY TO ACHIEVE THE FINISH Registered Professional Engineers GRADES SHOWN ON THE PLANS AND FOR INSTALLATION OF PAVING, and Land Surveyors AND ALL. UTILITIES. 4. ALL DISTURBED AREAS NOT OTHERWISE TREATED SHALL BE 78 North Street - 3rd Floor STABILIZED WITH 4 LOAM, SEED, do MULCH. THE CONTRACTOR H nnis, Massachusetts 02601 ' SHALL ESE RESPONSIBLE FOR AREAS UNTIL VEGETATION HAS BEEN PERMANENTLY ESTABLISHED. • 5. ALL STRUCTURES AND PIPING SHALL BE DESIGNED AND Phone - (508) 771-7502 INSTALLED FOR H-20 LOADING. FOX - (508) 771-7622 come baxter-ny . 6. ALL GRADING WORK SHALL BE DONE IN A WORKMANLIKE MANNER www. : ACCOMPLISHED TO CREATE POSITIVE DRAINAGE AND ELIMINATE ANY PUDDLING OR PONDING. THE CONTRACTOR SHALL NOTIFY THE ENGINEER WITH ANY GRADE ISSUED OR QUESTIONS PRIOR TO STAMP STAMP PERFORMING THE FINISH GRADING WORK. �_IVA OF Q4 . �� qc MATTHEW yG� EXCAVATION FILL NOTES. '77W CIVILe,4 EDDY 1. SIDE SLOPES OF TRENCH EXCAVATIONS DEEPER THAN 4 FEET SHOULD No.43183 BE FLATTENED (AS REQUIRED BY SITE CONDITIONS) TO AT LEAST 1H:1V OR ciSTEa�o�w�� ".., �;s a. ( .. � � I � �`��"",..,,;� � ww.. "..,., / � rs'•, SUPPORIT:D WITH TRENCH BOX OR SIMILAR DEVICE. ALL WORK SHALL AL �APPROXIMATE -"� BE PERFORMED SAFELY AND IN ACCORDANCE WITH OSHA AND MOSHA f� P I" X I I� A 1 E L�,1.4".s � f`� � � � REQUIREMENTS. CONTRACTOR SHALL OBTAIN NCH PERMIT AS R J Q MINTS C NTRACT •, ..•. ff} -r :• "",•' BT THE REQUIRED. ,r I ,, - ,",,-; "" r_ 2. AFTER REMOVAL OF TOPSOIL AND INADEQUATE MATERIALS, GENERAL FILL . (": r 4:' " " 1 ` "'€""' I r," '" 1 z"" SUBGRAD ' SHOULD BE PROOF-ROVED WITH A LOADED 10-WHEEL C O N S U L T A N T µ wx ' "" r".:€ TANDEM-AXLE DUMP TRUCK. THE PROOF-ROLLING SHOULD BE PERFORMED ,K. ` , f s., .£ AND PROPOSED c r"° 'f �' ' ss , "� a w w . ,, :..fit 1!A r CHNICAL: .ENGINEER. NO FILL SHOULD BE PLACED "..._"." t , " ^" - # """ 40.8>�r. 1 f UNTIL RTHt SUBGRADEE S APPROVED BY A GEOTECHNICAL ENGINEER. ?) X . ' c"' ... '{:s �r`r P .....A F '> R MORE ,y^� �, ° BORROW MATERIALS FOR FILL OPERATIONS FOR GENERAL SITE GRADING J / j t 1 ,fd z ! j " t, "' , C' y r r € ' t r'"~r" ' :'" GRANULAf AND BE APPROVED BY A GEOTECHNICAL ENGINEER ALL FILLS �� �} pU, R�.:•',..s R ,.I,.,f , ✓ S I- 4,.... . r g ;� t J # F ld# �f t s - - f" SHOULD €EET AASHTO DESIGNATION A 2 4 CLASS III 0 , r' : �.: , ,w # "" LIE CONSTRUCTED IN 8" LOOSE LIFTS AND COMPACTED AS CONSULTANT E. w; ;.. :) :�t jJ I P f 14 � 4 �^ p� '`� � - P I `,F I U�.1�1#f..�. ,�f.,�� r� � � SHOULD } •�. 3)p}\€ j��• EE .,`FE 4 ' '�...'" ' � "- ,. , ' r , ,.,., r., f~ y"" 4•...�"" f f .. , i...... FOLLOWS,!UNLESS OTHERWISE NOTED IN PROJECT SPECIFICATIONS: L.. IA% '3:1 ^�f.".,i 4 4 1: R�..�/ �./'ti.J ! 5 L I..... ,f J ...,,,. " .'""+...................... .... BRUARY : v .. :,,: 3 s f -fir~ f 1 16 t".� I �P�,S ".._ .. TITLE V CONSTRUCTION NOTES: - FILLS SUPPORTING FOUNDATIONS AND FLOOR SLABS, 95X OF ASTM j €, _ _. ._.................... _..9.._j......,.. •f ^HIV EXISTING LEACH PIT (PER BAXTER D-155724;MSHTO T-180) f "" /y .� 1. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE WITH I INCHES OF ROADWAY SUBGRADE AND SUBBASE 95X OF ASTM R "..�t. 9/ U .r ,� ~ ~ " _ f' � & NYE INC. SEPTIC SYSTEM TITLE V OF THE STATE SANITARY CODE DATED APRIL 21 2006 AS D-1557 ('AASHTO T-180) f UPGRADE PLAN, DATED 10-06-87) 1 :z "t AMENDED THROUGH THE DATE OF THIS PLAN, do ANY LOCAL RULES & - RETAINNG WALLS AND FILLS WITHIN ROADWAY (BELOW TOP 24 INCHES "' s t s} E J REGULATIONS APPLICABLE. ) ( ) OF SUBGRADE AND SUBBASE). 92X OF ASTM D-1557 AASHTO T-180 / 3 f � PREPARED FOR : t � "�'-""`.�..,,, M• `�.. � .,. '� ," � ,..: FILLS IN GREEN SPACE, 90X OF ASTM D-1557 (AASHTO T-180) r,f4 ".,.,,., .•,,, ,, n # ., ."-�t "-t," I 2. ANY CHANGE TO THIS PLAN MUST BE APPROVED IN WRITING BY THE - FILLS FOR PIPE EMBEDMENT (BEDDING HAUNCHING AND INITIAL BACK r r , r ENGINEER. ELEVATION INFORMATION MUST NOT BE CHANGED WITHOUT ' ��.,._ FILL), 952 OF ASTM D-1557 (AASHTO T-180) WRITTEN PRIOR APPROVAL BY THE ENGINEER. r --�; `t>x... , `� ;, ,., ff ABBREVIATIONS MI�at01'1� A8��C18tE'S R€M=4L1.� _ s 1 TO BACKFl em somm of �2 �� NOTIFY . m4 1 } - ,,y ;; «� eaEwIc Cester Street ," f f� ., < r t J ti." .____ . "........}"_� , "t'" I ` -' } THE BOARD HEALTH AGENT AND ENGINEER FOR INSPECTION. e0S 1�OTIOII OF SLM HP HIAOWH POW _ " • ^, " 'y "",.".�" ~' ��� t j / y f! f 3 f i ✓ ; LP W" " cf Ati _ M �,, '', NBt�ck, MA Oi760 2252 ~k>d� t ., f , ' , ) i ` SANITARY DISPOSAL e0wmTOM OF WALL PaINT '" ."^ ✓ N " ,� 1 t ' ` € #� " _ "f ` , J �} �. j f UN ALL SANIT NOTED HEREIN. PIPING TO FF TO TOP O� t 4 1 L, .,, BE 4 SCHEDULE 40 PVC. FED FLOOR ELFVAIION LESS OTHERWISE M01LL 0 # 9 - ,, '~ 1 € s 5. INSULATE ALL PIPES AGAINST FREEZING AS REQUIRED WHEN LESS THAN M `"-• .w......" ,...,"..., '" 4l ��� �. }�� l , � > t r} ! - s ,A M `� it 3' OF COVER. _ j � UTILITY NOTES: ,1 ��^ �7�� �,� ✓ • � . f r�41 itT€��`11 I... .. PIP, 1 ~ F~ ` � ; d41 r �'>€a w' / ` f 1. 1: THE CO AT •' OR CONTACT DIG SAFE - - 0 ".� ''' 1 888 DI--SAFE) ANND UTILITY COMPANIES TO LOCATE ALL EXISTING "S U! €��==3 < ��` "~�"� �� � �"��w� � �\ jy.. �' � �...........�f........ UTILITIES, AT LEAST 72 HOURS PRIOR TO TIME START OF CONSTRUCTION. w THE CONT" HALL DETERMINE THE EXACT LOCATION BOTH ` , > =° I f" 4.f ) ' ::; y; I r.. _ FACTOR S / f s� � > I'"� O 1 � ..� :`=: )"," ' ,. I / k IRIM=41.60 RIZONTs�LLY AND VERTICALLY. f ," CALLY OF ALL EXISTING UTILIITE� BEFORE THE k .~ ^,, f ".., r �.,... ... rr j S.", w % . START OF ANY WORK. THE LOCATIO ,�t ? r 0, PROPOSED ; ,..>= r I. 4..r, _f...., " r�4 E, ES, ARE SHOWN S, f f } .... f� ,,"�f #J L- • I UNN SYSTEM INV. IN=36.28 .. .. E Jos, N OF EXISTING UNDERGROUND INFRASTRGCTUR UTILITIES, CONDUITS AND LINES j ^te f F fp, APPROXIMATE WAY ONLY, MAY NOT BE LIMITED TO THOSE SHOWN.. HEREIN r;...4„, � M1"'�"""" •a",,,,,.,�^ ::``may £,``-..,, "^�„-" � '"•F`"`' �' E r� �` ., - £',f`; f�';.,,. ':r � � , / � � to r ".r r"#, F ,.r ; , ` " , I r "'"•• ,, 'NV - r r r, """.....__........................." ...................,. .f �jf} " .. ,""• ` Y� }/} t 1, •f € t # ,") i. l.€ :,...."/ f, "..:?..v................... .............................i N` AND HAVE NOT,BEEN INDEPENDENTLY VERIFIED BY THE OWNER, THE ' "� "^. .../ti,..J ENGINEEFI. TOR AGR a' OR ITS REPRESEI�TA l ",,,, ."... " TIVE. THE CONTRACT AGREES TO BE ',.., l APPROXIMATE LOCATIONOFFULLY RE""�ONSIIBLE FOR ANY AND !� , y r " , 1 `- r " ,,,.. �. � � ".". ...,�.- ..~..�•.... 4., ,� } n+ ,"-`� r E;- S WHICH C3E 1 • ",. " "- f `"": '••�-.. r- -r ,. OCCASIONFO BY THE ONTRAC-10R SFAILURMEATO ',A)CATY aTEV_q •a.... "^.. ""•y'"^^"-..'^•• ,� ,.„•f ``".'•".�.,, ""Y...,,"""L.. `• t z 4,< .✓' r '{E.:,3` .�} i t °f"` i.,. y a. " t SCH. 40 PVC ( �1 G: � INFRASTR. TUBE AND UTILCnES EXACTLY. IF ELEVATION INS '••„ w .. f I JI i/ SYSTEM1=vrtMAII�OFi CB _ � ....�... � _ DIFFERS FROM PLAN INFO � HAS NOTIFY THE } - �} � � ~_-, 4" , ` " " `• , ? •,t j� tic . t `"4 ( , - 1 f S 7X t ..,; ,} } ", !, `:.y/ ;t4 j� ENGINEER IMMEDIATELY FOR POSSIBLE REDESIGN.N AT UTILITY CROSSINGS "`", v, ."`.-•^„ i"'"�.". ..,,,. r"•-,t,� `.� ~","•-.S„ �"'• t c:+l;",... c o,+,/ f -r .". ,f **�'. % 's „� .f w.3 .....F ,.�/ .. .... ..` E •..1.... ..3's�# � . „ r J - VERIFY IN FIELD THE LOCATION AND INVERTS OF WATER, ELECTRIC. GAS, , " �J. t * � � ,£ „'' ~` ,J € r C :. .: .i"1 TELEPHONE ac RELOCATE IF CONFLICTING D / DATA/COMM AND R CTING WITH PROPOSE _ 1 f '" r ` ..�, ,,�, INVERTS PER THE ENGINEERS DIRECTION. THE CONTRACTOR SHALL �� `..--IV AN' E I� C3 I N E I::."R I N:.;t, PRESERVE ALL UNDERGROUND SYSTEMS, INFRASTRUCTURE AND UTILITIES AS PROPOSES r r rr r r 1... � ' ' � REQUIRED. CLEAN OUT f ,I .1� £....I �!I I....I.....�.'.., ��A. , I� � ..�.I"' `•' r RY REVISED 2. 12" MINIMUM VERTICAL CLEARANCE SHALL BE MAINTAINED BETWEEN ALL elk -. �M , "~ 40.8f ::<��._"€ r �`" �� � � , 4 UTILITY CROSSINGS. } } �.,,'"'^,.,„y,,,"`'`i••,,,1 "-. ,`"^".,,, ' f 1 1 ^S`~'"J••,.. s .4.,'lij'^ `'••., ��,. " t ',..f } '.r,' 3. A MINIMUM 10' HORIZONTAL SEPARATION SHALL BE MAINTAINED BETWEEN WATER AND SEWER LINES. WHERE WATER LINES CROSS SEWER `, LINES, THE. SEWER LINE SHALL BE LOCATED WITH A MINIMUM VERTICAL vvl_ i. """" . ` ~;- } ,� "F CLEARANCE OF 18 BELOW THE WATER LINE. THE SEWER LINE JOINTS �• C. f -�., ^ 1 SHALL BE LOCATED EQUIDISTANT AND AS FAR AWAY FROM THE WATER LINE • ""� """� �! " "" -; AS POSSIBLE. WHEN IT IS IMPOSSIBLE TO ACHIEVE HORIZONTAL AND/OR W VERTICAL SEPARATION AS STIPULATED ABOVE, BOTH THE WATER LINE AND -' SEWER UI'4E AT THE CROSSING LOCATION SHALL BE CONSTRUCTED OF MECHANICAL JOINT CEMENT-LINED DUCTILE IRON PIPE FOR ONE FULL 20' r `�, � PIPE LENGTH OR ANOTHER EQUIVALENT THAT IS WATERTIGHT AND STRUCTURALLY SOUND. THE JOINTS FOR BOTH PI GJ PIPES SHAD. BE LOCATED V AS FAR ANAY FROM THE CROSSING AS POSSIBLE. BOTH PIPES SHOULD BE PRESSURE'; TESTED TO 150 PSI TO ENSURE THAT THEY ARE WATERTIGHT. w � " "✓" �"" � ,........_. """„ """" f€ r ,,J N ,- l 4. SEWER'. BUILDING CONNECTIONS SHALL BE 4" MIN. SCHEDULE 40 PVC, O L 0 AI' A SLOPE OF IX MINIMUM FROM MAINLINE TO BUILDING UNIT a ✓ - j .., r -", r WITH A C.EAN OUT SET AT A DISTANCE OF 10' (U.O.N.) OFF EACH UNIT " = ;"' , ~ -� - t , f FOUNDAIII N. - ,._ "- r `, i 5. THE GREASE TRAP SHALL BE CONSTRUCTED. IN ACCORDANCE WITH 310 PROPOSED H2G - 1,000 GAL. GREASE TRAP �, "" � "'- CMR € t - �` - I r ;` '4 3 15.0-STATE ENVIRONMENTAL CODE TITLE V. I I r INV. IN 37.33 l� ""j" 0-11 a " •" �a 1" INV. OUT = 37.08 ,h-. :. € •, > jy w.• '� 6. ALL UTILITY CUTS THROUGH EXISTING CONCRETE OR BITUMINOUS ,. �, ^,, �% ;•,w G,� ~"" `' i CONCRETT. PAVED SURFACES SHAI,..I..,.. BE SAW CUT. C 1 � ;....., ,... . ,. ti, £ 1 ,.... "- ,, !? r 7. SITE C�:)NTRACTOR TO OWN ALL EXCAVATION TRENCHING �•. ,�..�'�. �"M '"-�.�..," , •, :� s. I�� � . E ...."f f f 4 ..."; f � do BACK � LOT 12B �' f ..... ,� 3 I f �t } f r SCOPE « v % Gj ,�` I f 1 FILLING FOR ALL UTILITIES AND MISCELLANEOUS WORK INCIDENTAL TO THE. 9 6 " `•r ,:�:; THE PROJECT AND CONTRACT DOCUMENTS. s � / s ,�`....� �,s , 7 J :.,.)i �.�.../. F it � • s PLAN BOOK 561 PAGE �' r� r I i °68 � } r ... `.r L., w,.: f` L S s SITE , LAYOUT T NOTE: � 32,198 S FM. �'f f{ A„ �2 � " " "" ,, F }} % r f R IESXI 0 FOG PAVING SHALL BE SAW CUT TO CREATE A CLEAN EDGE WHERE w 0.74 ACRES D R A I '�A('7``•••/1 R'k/)O1 R U N O ' �r/ ,.� � �� ^..,, } E TIED INTO NEW PAVING. OR WHERE ASPHALT IS REMOVED Q ADJACENT TO ASPHALT WHICH IS TO REMAIN. BROKEN OR UNSTABLE PAVEMEN?' SHALL BE REMOVED AND SUBBASE REPLACED WITH SUITABLE 1 COMPACTED MATERIAL PER PAVEMENT SECTION DETAIL HEREIN. m .6 - ,," " i 2. DIMENSIONS SHOWN ARE TO OUTSIDE FACE OF FOUNDATION OR FACE OF CURB WHERE APPLICABLE. Q Z T } GENERAL NOTES SHEET TITLE G.F.E. w 42.`: -I 1 ' ~ "w-�... !: t 1. EXISTING SITE DETAILS SHOWN OF THIS PLAN TAKEN FROM PLAN Grease Trap Design Plan f f ENTITLED "EXISTING CONDITIONS AT 846 MAIN STREET. ' r l OSTERViLLE, MA", PREPARED BY CANAL LAND SURVEYING & PROPOSED 4" PVC ry" PERMIT:`LNG INC.. DATED OCTOBER 14, 2010. a INV. OUT 39.20 2. EXISTING SEPTIC COMPONENTS SHOWN ON THIS PLAN WERE TAKEN FROM SHEET NO ' =` A PLAN ENTITLED "SITE PLAN, PROPOSED SEPTIC SYSTEM UPGRADES, PROPOSED 3" PVC VENT. PREPAIIED BY SULLIVAN ENGINEERING, OSTERVILLE, MA, DATED FEBRUARY N RUN INTO BUILDING VENTING SYSTEM PER i t 28, 2L�01 WITH A REVISION DATE OF 09/06/01". COMPONENTS WEREC100 �j PLUMBING AND BUILDING CODE. SCALED FROM THE PLAN AND SHOULD BE CONSIDERED APPROXIMATE. }} rr i ALTHOUGH OLD SEPTIC SYSTEM IS LABELED '•TO BE REMOVED", THERE IS �j { A POSSIBILITY THAT COMPONENTS WERE ABANDONED IN PLACE AND FILLED Im .I�" .I�.,., 4�. .�� -�� � # � � WITH `2AND. DATE : 5 22 2014 J�r 10 U 0 20 G 42. 72 f � s t" J "� " f i SCALE : DRAWN/DESIGN BY: j14�YAp F` HELf4ED 8Y: MWE JOB NO: 2010-050:02 OADD FILE : 2010-0=ff. 0 BAXTER NYE ENGINEERING & SURVEYING BITUMINOUS — FINISH SURFACE Registered Professional Engineers GRADE� / e" 24COURSE 8" and Land Surveyors N07ESs SEE 1. WATERTIGHT MANHOLE FRAME AND 78 North Street - 3rd Floor H `-" NOTES NUMINOUS COVERS TO MEET H-20 LOADING Hyannis, Massachusetts 02601 BASE REQUIREMENTS. BE MARKED 'SEWER", COURSE AND SHALL MEET STATE ° SPECIFICATIONS. EAST JORDAN IRON WORKS 158OZ FR 4-1/2. 1588VH 6 Phone — (508) 771-7502 HL sw SET OR EQUAL Fax — (508) 771—7622 4" Minimum ° 2. STANDARD SEWER MANHOLE FRAME pk ; • AND COVER SHALL BE SET N FULL www.boxter-nye.com MORTAR BED. ADJUST TO GRADE WITH Concrete collar CLAY CRICK AND MORTAR (2 BNCK 2' X 2' X 8» COURSES TYPICALLY, 5 BRICK i; See Note. ::a ... COURSES MAXIMUM) STAMP STAMP SURFACE MANHOLE RISER AND-COVER HCF44 11 TREATMENT REAT ENTSEE PLAN) 4" URUN P TAW V T IND NE Y go� MATTHEW cyGN 24 COVER & FT?AAIE, REF EDDY B BUILDING TO ROOF IN p W. N U) 1 BUILDING AC W{TH PLUMBING ANQ TO MANHOLE RISER AND CIVIL oo g0 DEPTH REFER M PPCOVER LAN FORELAEV. ,o No. 43183 c c . VARIES BUI DING °�'��G I S T sA � 00 ' Job• **FINAL FINISH GRADE • o BACKFlLL - REFER GRADE PLAN NOTEDWARNNG TAPE FOR c• o ti ORDINARY BORROW (M.1.01.0) PLAN FOR SURFACE U��, E .0 24"O rim . 24'0 _ WITH C N S LTA T 0. 0 " MIN. I�IR GAP LINE SEWER BRICK WITH �v CUT T� r 3/4 CEMENT MORTAR .�::• a WATERPROOFING OUTSIDE 1 "'i"►° a`u HAND TAMPED Concrete to be used only► when �'' ° r:'ti� P: �••- INITIAL BACKFILL cleanout is subject to vehicular Cieanout set flush " " = 4" SCH 40 PVC TEE d a� = » `•:# ' 'HAND TAMPED loading, i.e. driveways. parking with finish grade 4 INV. N I LEVEL 9 MIN d ---°�•► s lots, eta. SCH40 PVC, ARouEXTEND TEE 7 HAUNCHING rtPDE'PIPE � °� TDo�TMHtD� CONSULTANT iB Y � B�mDIING� _ 4" FT�PENETRATIONS TIONS TANK UQ. L UID EL LEVEL 4�LMIN. ST. STEEL CLAMP & EXP. COMPACTED SUBGRADE/ MUST BE 4" PVC TEE BOLT ON INSIDE OF TANK A STABLE FOUNDATION. 4» - 1/8 Bend 40 Minimum ANCHOR TEE TO TYP. ALL TEES UNSUITABLE FOUNDATIONS MUST WALL12" BE UNDERCUT AND REPLACE IMTN » 4» A SUITABLE BEDDING MATERIAL ♦ Wye PRECAST TANK-H-2 ••,•f 4" � LOALXNG SET ON 6" LEVEL CRUSHED STONE BASE --flow PREPARED FOR : • COMPACT TO 95x MODIFIED PROCTOR (MIN.) IN 6" LIFTS (MAX.) ���� UNDISTURBED EARTH COMPACT Tn 95x MODIFIED PROCTOR CNN.) N 6" LIFTS (MAX.) Milestone Associates ONLY IF UNDER PAVED, CONCRETE OR H SURFACE �„•_ (AREAS SUBJECT TO vt7H& EMBANKMENT AND/OR PEDESTRIAN TRAFFIC). �-'"� 1. GREASE TRAP WILL BE SET ON A LEVEL STABLE BASE. 192 Worcester Street FINAL BACKFlLL N GENERAL EMBANKMENT AREAS MUST 8E COMPACTED TO 85% MODIFIED PROCTOR (MN.) N 12' LIFTS (MAX.) SECTION B- 2. GREASE TRAP WILL CONFORM TO H-20 LOADING SPECIFICATIONS. ***FOR SANITARY SEWER MANS, 6" BEDDING SHALL BE BACKFILLED 3. ACCESS COVERS SHALL CONSTRUCTED TO GRADE OVER INLET, BAFFLE AND OUTLET PIPES AS SHOWN. 3 WITH 3/8"-3/4" NON-ANGULAR STONE IN UEU OF GRAVEL. PROFIL BORROW COMPACT TO JIM MOD D PROCTOR. 4. TYPICAL SEAL CONSTRUCTION JOINS WITH BUM RUBBER OR AS 07HERWM APPROVED BY MA14UFUMRER ON ALL PRECAST Natick a SIRUCiURLS, TYP. ALL EXTERIOR SURFACES OF THE GREASE TRAP SHALL BE COATED WITH TWO M c COATS BITUMINOUS WATERPROOFING , MA 01760- 2252 MATERW. TO BE WATERTIGHT. CONTRACTOR TO PERFORM 24 HOUR WATERTIGHT TEST. c- UTLITY TRENCH N.T.S. C_ Septic Late CWanW N.T.S. c 000 GALLON GREASE TRAP N.T.S. DMIrAIL. D►�TAIL k a � Co m � 1" BITUMINOUS SURFACE COURSE/10P COURSE PER MHD M3.11.03 TABLE A CLEAN EXISTING PAVED AREAS Mk APPLY TACK COAT PRIOR TO OVERLAY t. b.p p p p• 'o.s o o: y Q•p Q 2" BITUMINOUS BASE COURSE/ BNDL]2 PER MHD M&II.03 TABLE A EXCAVATE POTHOLES & FAILING PAVED AREAS. v _ �a a. 1Y GRAVEL BORROW M1.03 o.TYPE B.0 OR D, REPLACE WITH GRAVEL BASE & 2 BIT. CONC. p0- ° NEW 1" BIT. CONC. SURFACE COURSE PATCH PRIOR TO PLACEMENT OF 1-112" OVERLAY 1" x 12" KEYWAY CUT UJ J NEW 1" TYPE 1-1 cc 4• .4L.°':. ... o..A a OR PROCESSED GRAVEL BORROW M1.03.1 OR (SEE NOTE) INTO EXISTING PAVEMENT -� �" to b';o RECLAIMED PAVEMENT BORROW M1:09.0. BIT. CONK. OVERLAY o cy :.'•. o, o-• A: :o . FOR ALL SPECS, AT LEAST 70%SHALL PASS 0Im N va THE 3/4 " SIEVE TO ALLOW FOR PROCTOR NEW 2" BIT. CONC. BINDER COURSE MATCH EXISTING PAVEMENT DENSITYCOMPACTION TL�iMIG. o. a c0 O o STANDARD DUTY FLEIIIIN E PAVEMENT COMPACTED SUBGRADE z COMPOSITION AND COMPAC71ON ACCEPTANCE TESTS O 1. OBTAIN SAMPLES FROM PLANT TO MCATE CONFORMANCE MATH M3.11.09 2 PEWOR6M PAVEMENT DENSITY TESTING AS OUTLINED N M3.11.09 NIC 3. ALL SAMPLES TO BE TAKEN N ACCORDANCE WITH THE MOOT SPECIFICATIONS. N w 4. MATERIALS SHALL MEET OR ACCIGD THE REQUIREMENTS SPECIFIEDINSECTION M3.11.00 DIVISION III . EXISTING BIT. CONCRETE p MATERIALS AND THE FOLL.OWNG SUBSECTIONS NEW 12" GRAVEL BASE SEE PLAN EXISTING& PAVEMENT E FFOR LIMITS EXISTING GRAVEL BASE MINERAL AGGREGATE :M3.11.04 BITUMINOUS MATERIALS :M3.11.06 MINERAL FILLER :M3.11.05 COMPOSITION OF BASE COURSE :M3.11.02 w F- 5. THE BITUMINOUS CONCRETE BASE COURSE SHALL BE CONSTRUCTED N ACCORDANCE WITH RELEVANT UMEL a SECTIONS/PROVISIONS OF SECTION 460 FOR CLASS I BITUMINOUS CONCRETE PAVEMENT, TYPE 1-1 WHERE 1-�1/220 OVERLAY MEETS NEW FULL DEPTH PAVEMENT O 6. CLASS I BITUMINOUS PAVEMENT .TYPE 1-1 REQUIRED PER SECTION 46M TESTING FOR BASE CONSTRUCTION. THE TOP COURSE SHALL MATCH THE OVERLAY >_ COURSES AND TOP COURSES SHALL HAVE A MINIMUM COMPACTION OF 95x PROCTOR DENSITY. AND SHALL BE PLACED IN THE SAME APPLICATION. ap TESTING TO BE COLLETED BY METHODS OUTLINED IN M3.11.00 O z 1:— BITUMRKWS CONCRETE PAVEMENT SECTIONS N.T.S. SHEET TITLE o�TAll_ Details c- PAVEMENT OVERLAY DETAL N.T.S. SHEET NO DATE : 5 22 2014 S C A L E : NOT TO SCALE DRAWN/DESIGN BY: MTM CHECKED BY: MWE JOB NO: 2010-050.02 C A D D FILE : 2()10-050GD.dWq r' SEPTIC SYSTEM DEOGN FLOWS ZONING TABLE pK �� AS 18' R/GyT EXISTING CONDITIONS PROPOSED COMMONS ZONING DISTRICT: BA (BUSINESS) S� SE, syo /N of WAY OMCE: 1,657 S.F. X 0.075 GPD/SF=124.3 GPD ASSESSORS MAP 117 PARCEL 75-001 s � O .. EXI TING r2., 483 PLAN RETAIL: 18.238 SF X 0.050 GPD/SF=911.9 GPD RETAIL- 19,338 SF X 0.050 GPD/SF=966.9 GPD OVERLAY DISTRICTS: �� \p PAGE 6pok GROUNDWATER PROTECTION (GP) r c� 70.50' \ ROE 63 STATE DESIGNATED ZONE 11 a \ \ TOTAL EXISTING DESIGN FLOW = 1,036.2 GPD TOTAL PROPOSED DESIGN FLOW = 966.9 GPD SALTWATER ESTUARY PROTECTION \ sus . e / THEREFORE REDUCTION )N DESIGN FLOW, ALLOWED USE: RETAIL & WHOLESALE 1, A 78. R�\, s8 p qiN/N�� NO CHANGE TO EX/ST. SEPTIC SY571:MS STORE/SALESROOM l / s Syo Cyr of �\ PK N REWIRED EXIST USE: OFFICE/RETAIL r s29 wN /N wq Y SE Tq/� EXIST. BUILDING FLOOR AREA: PROP. BUILDING FLOOR AREA: SET PACT '\ o DEfD / BASEMENT: 4.595 S.F. BASEMENT: 4.595 S.F. f 17,3 k I \ FIRST FLOOR (RETAIL): 18,238 S.F. FIRST FLOOR (RETAIL) epp GENERAL NOTES : SECOND FLOOR (OFFICO 1.657 S.F. (WITH 1,100'SF ADDITION) 19,338 S.F i t 4 24, \ GROSS FLOOR AREA 24,490 S.F. SECOND FLOOR (INCIDENTAL STORAGE) N \ GROSS FLOOR AREA 23,903 S.F. 0 09 W f \ �o 1 pK 1. EXISTING SITE DETAILS SHOWN OF THIS PLAN TAKEN FROM PLAN EXIST. BUILDING FOOTPRINT - 18,238 SF PROP. BUILDING FOOTPRINT - 19,338 S.F \® FpUNdIC ENTITLED 'EXISTING CONDITIONS AT 846 MAIN STREET, OSTERVILLE, MA". / PREPARED BY CANAL LAND SURVEYING do PERMITTING INC.. DATED TOTAL PARCEL AREA: 58,518 * S.F. SET X1�G LOT 10B OCTOBER 14, 2010. LOT 12B O P.B. 561 PG. 68 - 3ZI98 S.F. DUMpS . �2 ,,� PLAN BOOK 522 PAGE 89 LOT 108 O P.B. 522 PG. 89 - 26,320 S.F. TER ` �@Fj'fPLAN2 EXISTING SEPTIC COMPONENTS SHOWN ON THIS PLAN WERE TAKEN FROM 26.320 S.F.f . 4 gRfq 0.60 ACRES* A PLAN ENTITLED 'SITE PLAN. PROPOSED SEPTIC SYSTEM UPGRADES, REQUIRED ALLOWED EXISTING/PROVIOED PREPARED BY SULLIVAN ENGINEERING, OSTERVILLE. MA, DATED LOT AREA: 0 SF 58,518 SF m S6$ ,, �RfTq/N/ Nkl3TlNC FfN FEBRUARY 28, 2001 WITH A RE ASION DATE OF 09/06/01". ' l O l / _NC LINf AT 0 R �OPfRTY CONSIDERED BERE APPROXIMATE. THERE IS ALTHOUGH OLD SEPTIBILITY THAT SYSTEM COMPONENTS Y BUILDINGSETBACKS:COMPONENTS WERE SCALED FROM THE PLAN AND SHOULD BE FRONTAGE. 20 FT 210.81 FT CORNER ABANDONED IN PLACE AND FILLED WITH SAND. ``� / 4 S T N 85'28'32" E FRONT SETBACK 20 FT 4.2 FT • BIr CURB SET _ .33' ooNpy SIDE AR SETBACK 0 FT 2.55 FT(NEWADDITION 20.1 / / C$/p a PARKING SETBACK 10 FT 0 FT m TOTAL PI %51�*T,, *Wo D �{ MAx. BLOC. HEIGHT: 2 STORIES OR 30 FT 2 STORIES 4 58,524 Wq r P A o � w ® 1.34 ACKS9 (z P D f fo 60ok ` PER ASSESSORS qC f ` I MAX. LOT COVERAGE (STRUCTURES): 35% 33% (19,338 S.F.) <u i- ? Q 113 cb J z Q EXISTING p l o ` o CO PARKING TABLE QWNG PROVIDED l l BCD p R l LL OFFICE: 1 PS/300 SF) 52.5 SPACES REMOVING 1,657 SF �, PK NA 4' lT. juB 0 K/Nc or `, RETAIL 1 PS/200SF) PLUS STREET & OFFICE SPACE - 5.5 PS; z SET - / 7 PLUS 1 PS/UNIT PUBLIC PARKING S/T ADDING 1.100 SF �Xf r,, S / o �./� / / ® RETAIL = 5.5 PS; I/ w o o ;, c� N 76 08 703'• TWO EXISTING FIRST N o �.J `Bi� CUR o FLOOR UNITS BEING APPROXIMATE LOCATION OF aj q cv N `� 2 3 S,� ,` \ EXPANDED - UPGRADED SEPTIC SYSTEM j �� a SET TTOREMAIN IN (SEE GENERAL NOTES) Q CadEXPANSION AREA NO CHANGE IN UNIT DRILL '--_.__ ;'� cp COUNT S/T OUND� CONCR f THEREFORE EQUIVALENT HOLE IfT S 83'29'28" E I RL°CK © NUMBER OF SPACES w �'"'�---..�I REQUIRED WqCl APPROXIMATE LOCATION OF 50.06' I S/T • GRNDFATHERED N PRE-EXISTING NON-CONFORMING UPGRADED SEPTIC SYSTEM IET (SEE GENERAL NOTES) a0 Pk Nqlk 107 6' F oN© N 81.10'27.. W tx~ VENT CLEAN OUTS ��0 h O do �� Pk N S/T co �� a / SET IZ SET cA 0 /00 II 0 Z pK 9 m a, FpUN L�C ORI 42 0 1 o SET �E 42. 72 / : . 83 f EXISTING \ EDGE OF STONE :.; BRICK APPROXIMATE LOCATION OF UPGRADED SEPTIC SYSTEM v O� 3�13�+ s3 242 p WALK I_ '��S s�j9Q (SEE GENERAL NOTES) : ' ... .. :. .. ... APPROXIMATE LOCATION �<v , 1�t•{`�Nr��. c� 22.5�. / �6 ~` OF SEPTIC SYSTEM 4 �,C �� `� ��\ k :.!'.'. . .': �y- 832 LABELED "TO BE C ��11 f'l3. 09 REMOVED" (POSSIBLY o NQ `� `/ COBBLE WALK TO ABANDONED AND FILLED ^Q �Q �� `� �- 2. 8 WITH SAND) �^� G\���R Q �P`�0 �� ( BE REMOVED '::' : .':: :: :: N 0 AND REWORKED \�.'.'.'.. PK �2� QNCz APPROXIMATE LOCATION OF J ° FOR NEW %.. . F': : : : SEPTIC SYSTEM LABELED 'TO / rn G N/�� i �� BE REMOVED" (POSSIBLY it ENTRANCES ...... ... '.'.'. SMITE/LOCATION: �. / ABANDONED AND FILLED WITH / O it 846 Main Street SAND). �; oo � Q � Nq / F. F. E. 43. 0 ':�':': :...:.u:AaEa ' Ostervlie MA 02655 FOUND . .... .'.. . ._. . ..... PREPARED FOR Milestone Associates LOT 12B . 2:5. :: 192 Worcester Street #3 i PLAN BOOK 561 PAGE 68 10" 2p 32.19$ S.F.* p" a :'. R' 2. . ' 0.74 ACRES* I N D O W WELLS :89:': . . .'4 : .-: : : ':::':.: Natick, MA 0176062252 F.F.E. = 43.0-� � . .. . . . .. . . . . .... ... . . Fps `� �� ROOF . .:.. :..::....:.:.:...::::. 4 2 Tw GB DRAIN 41. 6 'S. INV. ': ::::::::::::::::::::::::::4. :::4. 5 site Plan EL.=40.14 4:.'.'.'.'.. .. .. . . . . .. .'.'.'.'.'.'.'. .' .' 2. 4 2. 9 6 EDGE OF STONE : ::::::::: x �c....::::: . ::..:::::::... . BAXTER NYE ENGINEERING & SURVEYING CID 41.6 . .. . 4 2. 6 6 Registered Professional Engineers and Land Surveyors Q 41 . 6 R o 1 78 North Street-3rd Floor,Hyannis,Massachusetts 02601 N ? a A V� - IRRIGATION CONTROL B O X Phone - (508) 771-7502 Fax - (508) 771-7622 . oLn _ _ _ _ _ _ F.F.E. = 43.0 :...:. _ ` /i O \\ ,a-2- ai . 47 `t o 6'X4' LEACHING BASIN WITH 1mmomw0 0 10 20 4tN OF PEAS ti 0 ? WINDOW WELLS :: '.Zg`3' "� SI Gf �: _ =� �% - 1 ' STONE AROUND PERIMETER SCALE IN FEET o� M� E rA 8 2 � C0 RIM V.=41 . SCALE: 1 = 20' W. ~ � o , p C 4 4 g R ELE 50 s U T C� SEE DETAIL #140-A 4t18 0 �� s 619 41 . �T A=10 . 51 F 1; G PER 561 /6 8 ANAL AW b ... IRRIGATION CONTROL BOX RELOCATE OVERHEAD _ a�E S WIRE SERVICE AS D E: 09130 11 I ST �IG ® o UP/LP 155 8 \� F y0L p E COORDINATED WITH LINE BEARING -DISTANCE ANCE J p\ ,\ � I p L1 N 53'54_19„ E 29.33' p�C�\ CONC MAILBOX GR�N>< O�NI NT L2 N59*50'10" E 37.69' TF p RAT A=10.51 ' s S CU UTILITY COMPANIES c L3 N 08'39'13" E 9.0?' pR� `a /PER 561/68 , /4� �` / -�, NO. BY DATE REMARKS o L4 r1 14'S3'46" E 12.50' DR ,.IEDCE OF p� L6 N 1 3.51'48" E 30.00' MAILBOX RgNrT `�E PAVEMENT SI,G-& FE MARKING DRAWN BY: DM DESIGNEDHE BY: MINE DRAWW NUMBER L7 S ;1'33'01" E 14.73' cvRe BLOWUP VIEW ( UNDEPGROUND ELECTRIC") `J L8 S 13'18'23" W 2 :20' L9 N �,7 02'1 " w 23. 0' SCALE: 1"= 10' OS \ 0: 2010 2010-050 Civil lot 2010-050-DM.dw a ww 2010-050 0 0 N i 0 30.6' 18.6' 10.5' OFFICE KITCHEN STAIRS DWN a r7 Wft OFFICE < v w NOTE: 10.3' lY o) L- °p 1 STAIRS LEAD TO UNOCCUPIED ATTIC SPACE Z APPROXIMATELY 31' x 26 1/2' O M OFFICE 7.2' [ru-j BATH 8.0' 10.3 "6 Main Street, Osterville LLC Osterville, MA STORAGE STORAGE oPRPMO FOR Milestone Associates 13.5' 192 Worcester Road .4, - Natick, MA 01760 11 CLOSET C »n� STORAGE o.6' Second Floor Plan '+ CV N CLOSET STORAGE Ln 10.0' 9.4' BAXTER NYE ENGINEERING & SURVEYING g 28.2' ( Registered Professional Engineers and Land Surveyors 78 North Street- 3rd Floor, Hyannis, Massachusetts 02601 Phone- (508) 771-7502 Fax - (508) 771-7622 ���-�"°F M MAIN STREET EW. N 10 0 10 20 ,o .4 8 0 �� .c /STCD ERN SCALE IN FEET Fss/ONAL�aG\ APPROXIMATE TOTAL FOOTPRINT AREA: SCALER"=10' DATE: 9/30/11 1,65 7f SQ. FT. Ln REV. DATE: REMARKS a O TOTAL OFFICE AREA USE TO BE REMOVED C2 ■ Y AND SPACE SHALL BE USED FOR 3 INCIDENTAL STORAGE ONLY MWING NUMM 0: 10 10-050 surve worksht 10-050ws—rental In 2010-050 „a 0 N Q 4 .w.wa"vataeewxro.o:zxu¢.n,o axlWx,..,. .�.a„+•�,.. ,+ :.;,m;:Mr,yn+:Rntaw.n•..�... .t..ev y-.,w,�:g��reeye�n:,re,asxsv.. ,....,..... .......,. ... NQTES Finish Grade ! , I.Water Supply ForThis Lot is Municipal Water Filter • ;,, �'. �2 Location of Utilities Shown on This Plan Are Approx. I* Fabric 'Compacted F1111 At Least 72 Flours Prior to Any Excavation For This FOCUS i Project The C,mtractorShall Make The Required �- Notification tr Dig Safe(I-888-344-7233) 3 The Contractor is Required to Secure Appropriate Pea Stone � Permits From Town Agencies For Construction ' - - Nast 8 QLc► Defined by This Plan. .. c 7(d� '4 Install Risers as Requiredto Within 12°of a Leaching s } ,p�• ° Finished Grade. N 3/4"�I I/2=' ' •l+ +- 5.All Chamber , - .•. ,as,c Structures 8u�ied Four Feet or More or Subject Double Mfoshed •:' Stone to Vehicular•traffic tobe H-20 Loading. - •' M Cx Septic System to be Installed in Accordance With ( , aG • ; 310 CMR 15.00 Latest Revision And The Town of 13- Barnstable Board of Health Regulations LOCUS PLAN 7. All Piping tobaSch.40 PVC. CROSS SECTION OF CHAMBER: Scale: 1:12,000 Assessors Map 117 NOT TO SCALE Parcel 075-1 &077 ZONING-GROUNDWATER PROTECTION ;it$62 OVERLAY DISTRICT Design Mow F.G.A F•G.�Ir, Retail*ga„ons per sc aare foot= 1.05 (50/1000) Offide:gallons per u uare foot= 0.075 (75/1000) Retail space= 0 sf 0 gpd , /f Office Space= 2468 sf 1§5 9W Lid 3 � minimum allow-Able gahons per day= 200 gpd 1500 GOIIOn Top_EI. y0- `\ e+:•'a: NQN At-xQ/ tat"c„ ►RW-QLA.C.0 Total 200.0gPd 39.8' Septic Tank 39 .;;: Bot.El. 37� - Septic Tank 39.4'. -5 CI -L n Sized @ 200%of de,,In flow for retail= 400 gallons Bedding as v; `. Use 1500 gallon tank Per Title 5 Leach Field Required Area=GPD0.74 270sf DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Field Size=13'Width x Length T—Y WITH CLEAN007 Length- 13.01f Not 10SCole SET F\uSH -10 F b• Use 13'xl3'field with► (one)500 gallon leaching drywells EXISTI 6 K i lL E;'10 vt Area Provided= Field adjust inverts as required to meet min. itch requirements. ,l r� �,� i�e r��v c;•U t.lp 273 sf J q p q '! ,.,:.• ; All Components To Be H-20 Per Town of Barnstable Groundwater Map groundwater elevation is approximately 5.0 Therefore there is approximately 35 to 39 feet to groundwater from existing grade. #846, 856, &858 u« 13 Design Flow 42 Retail gallons pe •square foot= 0.05 (50/1000) F.G. 4f Z FG.Retail spat = 17550 sf 878 gpd Z minimum alowable gallons per day= 200 gpd �42 V A \ Total 878 gpd 2000 Gallon '��� ,._� p Tn Fl. 4I' I Septic Tank -' Septic Tank .C4. Bot.El. 3$' �\ \ Sized @ 200%of design flow for retail= 1755 gallons - \ Use 2000 gallon tank Bedding as SLAB F. \ \ \ \ ► Per Title 5 E7ECTOt� \ Leach Field l�:FNr ku 1 \ Required Area=GPD/0.74 1186 sf��;,� DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM EX1, IN Field Size=13 N idth x Length , Not to Scale APPROK►MATE LOL'J' M•, -- Length= f7.0 If OF SEPTIC LANK 1 Uoo /' REYLACEq LY 2000&AL.• Use 13'x87'field with 6(six)500 gallon leaching drywells -�" sEvr�c.ZnNK,o-�,ox Area Provided= 1191 sf Field adjust inverts as required to meet min. pitch requirements. AND Lx:�t1 V-CLr, Per Town of Barnstable Groundwater Ma groundwater elevation is approximately 5.0 i� �• All Components To Be H-20 P gT PP Y DASH Therefore there is approximately 35 to 39 feet to groundwater from existing grade. i#832 - - ---- - - r--X\ST\NG SEPT It - �' Design Flow Retail:gallons per square foot= 0.05 (50/1000) Office:gallons per square foot= 0.075 (75/1000) F.G.Retail space= 6552 sf 328 gpd 144 FG.yy, APPRoxtMATE LOCATION "" AePRox►MATF Office Space= 3528 sf gp� OF Zet, kL'TANK r'"(0 O �:-``` - ��LOCA'SIoN OF Total N2.2 gpd _.Y �� Septic an 4 3 • „s• � oo, , M�„ � �� \ \ � 1500 Gallon Top El. 43_ --- \ \ Sized C 200%of design flow for retail= 1184 gallons y2.$ Septic Tank `i2 -•' SLAB \��\ \ A-10 Use1500gallontank c4r:;: Bot.El._ HOB q y Required Area Leach Field Bedding a5 �.� r•:.:: ,�•�:: Rired A =GPD/0.74 800 sf v �,� /+ � Field Size=13'Width x Length Per Title 5 N \ \ Ler th= 41.0 If , OF Use 13'x44'field with 4(four)500 gallon leaching drywells DELVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM �,,, i r S�'�` - �.�• Area Provided= 800 sf Not to Scale PETER y� �32 ` • ,, „: FiELt) AUIU TED Ali Components To Be H-24� SULLIVAN w AROUWD WATER LINE NO,29733 yy' 1 Field adjust inverts as required to meet min. pitch requirements. CIVIL Per Town of Barnstable Groundwater Map groundwater elevation is approximately 5.0 '$ kO r Therefore there is approxiniatciy 35 to 39 feet to groundwater from existing grade. EO r • 3 I Z/ •ZoO ~ SITE PLAN. SCALE. 1 V, _ 30 Proposed Septic System Upgrades - 8329 8469 8569 8589 & 862 MAIN ST 1. This plan is for the repair/upgrade of the existing septic systems to OSTERVILLE, MA maximum feasible compliance. There is no proposed increase in or a FOR proposed change in use. MR. HOLBROOK DAVIS 2. All workmanship and materials not specifically mentioned on this plan shall BY For property line information see Plan of Land in Barnstable, MA Prepared for Holbrook comply with the provisions and specifications contained within SULLIVAN ENGINEERING Davis dated August 4,2000 By Canal Land Surveying in Plan Book 561 Page 68. 310CMR15.00 latest addition. OSTERVILLE, MA DATE: FEBRUARY 28,2001 WMKxti.'xM�MVW�'Ylp.l,1MV]I•LWY •.. .:"rve..mM..w:'rp,yy�,ywWw�.r+•wr.�.MWU'. 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THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH APPROVED ,TOWN OF B A R N STA B L E ©ermOble Conservation Department Appliration for Diripmml Works Tat t,. .�',.,,�,� Data Application is hereby made for a Permit to Construct ( ) or Repair (X ) an Individual Sewage Disposal System at: .--$5F l }r� •©ste v -------------------------•-----------•--•- -Tale--F1sI--Ee------------------------------------•-------------•------------------ Location-Address or Lot No. L:...S $cQ.&...H....Davis-•-•--------•-•----•---•--•----•----------------- •---....----•-------------------------......---------........-•----...----•-•-•--........-----..._ Owner Address W W.E. Robinson_Septic-_Service____________________________ P,Q..Box__j.Qa9__Certte y llc__MA_•__•____________-_:-_•___.•___• Installer Address Type of Building Size Lot............................Sq. feet ,., Dwelling— No. of Bedrooms...............................-------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------- ----- No. of persons....----------------------------- Showers ( ) — Cafeteria ( ) 04 Other fixtures ............................... . . W Design Flow............................................gallons per person per day. 'Total daily flow............................................gallons. 9 Septic Tank—Liquid capacit W Disposal Trench--:fro. .................... Width.................... Total Lengt,y.......--.-.gallons Length------------- idth.-.--.-......... Diameter-----.--.-.---.. Depth................ x �h..........:......... 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........................................ 0 Test Pit No. I................rninutes per inch Depth of Test Pit...--............... Depth to ground water........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0+' ---•---•--•---•-------------•••••-••............•--•----••-••--•.......••---•------•----------............................................................... xDescription of Soil...........gravel--•-•-----------•--•---•------•-•----•-----•---• -............................... U ........................•-------------•-•-•----•-•--•----------•---•--••-----•----•-----------------------•-----------------------------•--------------------......-------••---.................-----••. W --••-----------------------------------------------------------------------------••••-•--•-•--•--------•-----•---•-•---------•-----••-......•-•--••. ................................................. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ installi?1g...a...,QQQ..gal..greases--�aF------------------- •---------•-................. Agreement: The undersigned agrees to install the aforedescribed`Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,bee issued bry oar f health. Signed ..... ....................... .. .... J Dare Application Approved By ............. �.. ....G.�Jrvt.17� Dace Application Disapproved for the following reafons: ...i.................................................................................... r Dace PermitNo. c 3 - .. ............... Issued ...............................-...................................... Dare .................................. r _ 0 -7 No... ........... THE COMMONWEALTH OF MASSACHUSETf S BOARD OF HEALTH/ ,TOWN OF BARNSTABL 7 . t a Appliration for Diripiniul Works (notuAr rat ernttt y- )3 Application is hereby made for a Permit to Construct ( ) or Rep.lir ( ) an Individual Sewage Disposal System at: t..bv2..� TT v 7�..Location-Address or Lot No. iam. .14._.A.:2mis................................................. •-•------•--------------•-----.......................................................••'-•^..... Owner Address aWAR. Rota nson•S� ti S ?L!m---•-----------------•----- - - - = tPn.l l .NIA_.... Installer Address UType of Building Size Lot............................Sq. feet .� Dwelling— No. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons....t•-..-_-__. ------- Showers ( ) — Cafeteria ( ) al Other fixtures ------------------------------------------------------------ .< ------------------- ----------------------------------•------------.------------- Wg g� per P Y , I'daily flow--------------------------------------------gallons. W DSeptic T an —Liquid capacity____.:.__. -gallons Length-- Per day. ,iota ................ 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. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZo Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ------------------------ ........................................•........................................................................................... 0 Description of Soil...........axaypl ----------------•--•-•-•-•----_---• V ........................................................................................................................................................................................................ W - UNature of Repairs or Alterations—Answer when applicable----------------------------------------------------------------------------------------------• i nstallr�q- -1. OOQ ail a � s�._tra........ Agreement: The undersigned agrees to install the aforedescribedrf Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental ode—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by oar f health. _ Signed .....:: ...::.......: ...:..............�.. ..... -. ----------------------- -��/ `'��. Dace Application Approved B PP PP Y - ..... ..................... .............' I f...._.. .-...s.. . - ------......................... Dace Application Disapproved for the following reasons: ... ................................ . ................... ......... ...................................................... ........................................................................................................ . . -----------------..-............------------------............................... ........................................ PermitNo. ..........C/... . ..1... 1. ..�................. Issued .................................-......................�fe...... Dace THE COMMONWE LTH OF MASSACHUSETTS BOAR OF HEALTH TOWN OF ARNSTABLE (�Ex#tftctt#e �om�ItttrtcE THIS IS TO CERTIFY, That the Individual Sewa e Disposal System constructed ( ) or Repaired ( X ) by .M.E....�-bi_nson---Sept:. -v�ee................ - ........... .. ..... ......................................................._........ In.railer 856 Main St Osterville -------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of T TI.E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit o. ..-.,���._-... ..... dated ..._................. THE ISSUANCE OF THIS CERTIFICATE SHALL N T BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. 4-----./.--1... .... _, ....... -------..... . .... Spector .................\,. . ' .... ................. ...... .. . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H ALTH g TOWN OF BARN TABLE No.... .........?`-1' FEEA'?Q-.Qd....... MsVasnl WorhD Tent udion "rrntit Permission is hereby ranted..._ .t..r... _, ---------------------------------------------------------•••.......... . Y g vv. Y�COiT1S dxY' ,' 71ce to Construct ( ) or Repair (X ) an Individual Sewage Dispos System atNo.855 --------------------------------------------------- --.r ------......----•--------- ---------------------------------••......----••-- as shown on the application for Disposal Works Construction Permi No.-/- -JT11-__ Dated........................................... -------•---••-••-••--•-- --� ``------------------------------------------------------•---- Board of Health DATE......................'l ,�' . ................................ FORM 36508 HOBBS&WARREN.INC..PUBLISHERS TOWN OF BARNSTABLE' LOCATION f ii!WAGE # c/3`IS-/ VILLAGE ASSESSOR'S MAID LOT INSTALLER'S NAME & PHONE NO. - 776 SEPTIC TANK CAPACITY P LEACHING FACILITY:(type) (size) 0 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 4 BUILDER OR OWNER ` iDATE.PERMIT ISSUED: �-� DATE COMPLIANCE ISSUED: ' `�,�J"' 3 l VARIANCE GRANTED: Yes NO �/