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HomeMy WebLinkAbout0023 WEST BAY ROAD - Health 23 WEST BAY ROAD; OSTERVILLE A= 441 017 YOU WISH TO OPEN ABUSINESS? OS�— For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. � kr - DATE: Fill in please: �suz ligoiLgt x ''' APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOME ADDRESS:( . Laac,. tnlcu, Qb'itn, b(a ht4- ® 1,bgS 92d b5.2 A57'S xp+ TELEPHONE # Home Telephone Number �� r�S- Alas , p Tl 1 F NAME OF CORPORATION i � " "}" ' . ` NAME OF NEWyBUSINESS U hYko.�� 1- ..v. l c*ti3�12^ TYPE OF BUSINESS (�sna�lcn IS THM A HOME OCCUPATION? YES ADDRESS OF BUSINESS. 3 r- OS~e�v I'` '! MAP/PA„RCEL NUMBER .�f.l v [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has b e in fined o a y permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH . This individual has b en iVfpr}ne of the permit requirements that pertain to this type of business. ` 't't�l V �f/1 - Authorized Signature**. - COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: YOU WISH TO OPEN A BUSINESS? [For Your Information: Business certificates (cost$3o.00 for 4 years). A business certificate ONLY REGISTERS YOUR N you must.do by M.G.L.-it does not give you permission'to operate.) Business Certificates are available at the Town.Clerk's Office, 1"` FL. 367 NAME in town [which Main Street, Hyannis, MA02601 (Town Hall) ticsu.mya;L'iRyd au;�a{, '•• , .• GATE' 4 �( g - ?" ,_, yst Fill in p1 �s t� »` 1 Qase., APPLICANT'S YOUR NAME: ' ,,.. ',��� 3 " • '��«` BUSINESS Sz„ 5 - "�•v.,: YOUR HOME ADD O ESS: as r 'h S ,�� ©?S4 TELEPHONE # Home Telephone Number S / NAME OF NEW BUS%INESS J3sE�/Sl r� y�U �tF 24 0 V IS THIS A WO'ME°OCCUPATION? N ,,. TYPE 01:BUSINESS: YES O.�!" ADDRESS OF BUSINESS 3, J J J - MAP/PARCEL NUMBE When starting i new business there are several things youmust do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you may need.. You MUST GO Main St. — corner of Rd. & Main Street),to make sure you have the appropriate permits and lice nses.required to IIegally operaOte y0our business in this town.armouth 1. . BUILDING COM •IER'S OF ICE This individu I has 6 n jr!fo d- f a y ermit re irements that pertain to,this type of business. Au ized45ignature** . COMMENTS: i 2. BOARD OF HEALTH This individual has be nformed of t it requirements that pertain to this type of business. COMMENTS: Authorized Signature* . 3: CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b en infor, ed of th lice,nsing requirements that pertain to this type of business. Authorized Signature** COMMENTS: - Y YOU WISH TO.OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). 'A business ceMifirate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L-*it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, I'FL, 367 Main Street,Hyannis,-MA 02601 (Town Hall) �R DATE: Fill in please: APPLICANT'S -YOUR NAME: v _ BUSINESS YOUR HOME ADDRESS:_ 5 cl-7) ,1:C. TELEPHONE # Home Telephone Number NAM . F NEWRUSINS '� TYP>~Qr$!LSINESS W THIS.;A:14bM-Ii LICCUmT[d1117, .' I YES' flaveyd❑b`asn.givei .approval fi�Qt .th ' uil in dJy'iwrv. YES_NO . �4DDRESS P BI1STIVE' 5. MAP/.PARGEI.N.uMB>MR When starting a'new business there are severa things,you must do in order to be in compliance with the.rules and regulations of the Town of ' Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIDNER'S OFF1C This individual ha en'informe of ny permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: Yv C 2. BOARD OF HEAL TH. This indiuidua Ih ni nfo r f hapm' a ui rements t that ertain to this. a of business. P tYP Authorized gnature** COMMENTS: 3. CONSUMER-AFFAIRS (LICENSING'AUTHORITY� �euiretnents This individual ha�n'infor e"f t e lice�isin that pertain to this type of business. Authorized Signature** COMMENTS: TOWN OF BARNSTABLE LOCATION SEWAGE# u� "TRIAGE /"44-`e2 A/S�SSESSOR'S MAP&LOT � �10 , INSTALLER'S NAME&PHONE NO. P r - `d V SEPTIC TANK CAPACITY =1 So LEACHING FACILITY: (type) - ' CCVW (size) 3NO.OF BEDROOMS BUILDER OR OWNER PERMUDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 L 4�ov� 4ILd-TOWN OF BARNSTABLE LOCATION CA SEWAGE # VILLAGE 03FP— h ASSESSOR'S MAP &LOT `//— O/ INSTALLER'S NAME&PHONE NO.�I� � i SEPTIC TANK CAPACITY //�� LEACHING FACILITY: (type)_ �Xld%N� d (size) /AOL NO.OF BEDROOMS 6 BUII.DER OR OWNER yv / PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: f r Maximum Adjusted Groundwater Table and Bottom.of Leaching Facility L� 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 Leachin Facility If an g ty( Y wetlands exist within 300 fee of leac a Feet Furnished by � 7� / a3 ! \ v n � � 1 co, ` \ , No. Fee IQ_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0(ppricaltion for Mi.5pont *p5tem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System O Individual Components Lo�' Address orb of No. �� Owner's Na Ad ress and T .No. Assessor's Map/Parcel P ID `'-7 —2,70 � Inst er's NUne,Address,and Tel.No. Designer's Name,(kddress and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size21 AZ I sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures G' Design Flow gallons per day. Calculated daily flow gallons. Plan Date z!2 l 2 3 t Number of sheets Revision Date �71 Title � r Size of Septic Tank To4, Type of S.A.S. Description of Soil Nature of R&pAirs or Alterati ns(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions pffiW of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by thi Bnard of lth. Signed Date ' Application Approved by Date Application Disapproved for Re fo wing reasons Permit No. Date Issued Fee �; THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: d � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS '� 2p plication for Mi.5 poe ar 6pgtem Congtruction Permit i Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) Complete System ❑Individual Components Lo©i dress or Lot No. a� (��� Ow�'s Nam Address and T . o. Assessor's Map/Parcel ���A (J Y-I 1-7 Inpsfl erg Nye,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size �T t sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria(gV ) Other Fixtures r < Jv Design Flow gallons per day. Calculated daily flow gallons. Plan Date 3 9 Number of sheets Revision Date C? Title i Size of Septic Tank /s v b Type of S.A.S. (6 X 1 2. x Z Description of Soil r Nature of Remairs or Alterati ns(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions ofTitle­.5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by this B d of lth. Signed Date 3a Application Approved by ' Date — rI Application Disapproved for Re fo wing reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS 'yam BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded Abandoned( )by j P M at © has been constructed in accordance with the provisions of Title 5 and the for disposal System Construction Permit No. dated Installer Designer The issuance ef1his permit shall not b on ed as a guarantee that the 'll functio�s d t :ed:'" Date 0 i' Inspect . ------------------e---------------------- No. q7 "' 6 Y Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS Mf 6pogar *pgtem Construction Permit Permission is hereby granted to Construct )Rg�air(,<)U a ( )Abandon System located at 3 l� 0 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: /0 — Approved by • TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE / 44- /2 ASSESSOR'S MAP & LOT // INSTALLER'S NAME&PHONE NO. YJ SEPTIC TANK CAPACITY ---15'O 0 LEACHING FACII.TTY: (type) �'f— c �� S (size) NO.OF BEDROOMS BUILDER OR OWNERS PERMITDATE: COMPLIANCE DATE:l Z' Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 w within 300 feet of leachingfacility) Feet Furnished by t=2om t b �t CD I a� ibJ �; Y FG.42.0 F.G.42.0 ri In .0 39.0 7404.� 0 Top E1.40.0 39.8 1500 Gallon 39 Septic Tank 394 39 Bot.E1.37. .2 —Bedding as , Per Title 5 5.0 Bottom of Test Hole El.32D No Ground Water DEVELOPED PROFILE OF PROPOSED SEPTIC SYSTEM Not to Scale DESIGN DATA Finish Grode Office/Professional 4160 SF 75 GPD Per 1000 SF-312 GPO Filter t Retail 600 SF Fabric Compacted Fill 50 GPS Per 1000 SF=30 GPD _ Apartment/1 Bedroom=110 GPD aAA I/81L Ile Total GPD-_452 Pea Stone Septic Tank: 452 GPD X 200%--904 Gallons Use 1500 Gallon Septic Tank in Leaching „ a LEACHING AREA 'N Chamber 3/4 1Wc 2 452 GPD/0.74=611 SF Required Stone Use a 12' x 36' Bed I Sidewall 2(12 + 36)2=192 SF 4�10„ I I Bottom Area 12 x 36�32 SF rz-0 Total=624 SF CROSS SECTION OF CHAMBER LEACHING CHAMBER DESIGN All Pipes to be Schedule 40 PVC '-:NOT TO SCALE Use 4-500 Gallon Leaching Chambers In a 12' x 36' Washed Stone Field as Shown TH- 1 EL,`12.0 EL, HZ.0 o., p„ 0 TOP501L-/LOAM 12, O TOp501L�1-CAM .— BRN. COARSE SAND E BpyRCS/3 6 SANb 1 o Y R 5/3 23' 2y B� YEL. BRN. COR, SAND B, Y yR�A. CAR, SAND I o Y R 5/G 39' 40" [3RN•YEL. OR SAND dz pR1.1,`/E COR. SAND ,, 13-a 10 YR G/6 (,. 10 YR GyG G5, LT.YEL. C.OR. SAND IPG CLT. YEL. GAR SAND G IOYR 4/y 12o� Io.YR QERco1_A-riON TL=ST s- CLASS 1 MATERIAL OF In DEPTH- S Io'i qpJ �.n�"s LESS -THAN 2 M1N INCH "' PETER NO \A/ATER StAcOUNTED MULLs UNNI DATE: N/13/9 9 NO.a7"+'3--� � No. : I'—9390 CEVa B'Y- SULLIVAN ENGINEERING- INC. •e: WITNESS' D.MIORANDI °dPz .,:� t.r6`1. CJ 9�3D199 HOSTETTER REALTY 23 WEST BAY ROAD SHEET202 OSTERVILLE,MASS. U Cammonweof h of Massachusetts Z9 Executive Office of Environmental Affairs Department of ► Envi ronmental Protection � Wullam F.Weld Trudy Cox• s.u.c.ry aowno. David B.Struhe Arpso Paul Celluocl r LL Go.emw IV/ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM 00 PART A - C ERTI FI CATI O N PropertyAddresa: 23 West Bay Road Osterville,Mass . AddresaofOwner. Date of Inspeatl,ow4/24/96 (If different) Name oflwpector.Joseph P. Macomber Jr. Company Nano,Address and Telephone Number: J.P.Macomber & Son Inc. Box 66 Centerville,Mass . 02632 CERTIFICATION STATEMENT 508-775-3338 I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurata and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-sits sewage disposal systems. The system: Passes _ Conditionally Passes u _ Needs Further Evaluation By the Local Approving Authority _ Fails //, J Inspector's Slguat "471VI Z.G�LGFi'If� Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design Dow of 10,000 gpd or groater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner And copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AJ SYSTEM PASSES: _ZI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are iudi:atod below. B) SYSTEM CONDITIONALLY PASSES: One or more system components nood to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N,or ND). Describe basis of determination in all instances. If"not determined", explain why not) Alta� The septic tank is metal, cra:ked, structurally unsound, shows substantial infiltration or exfrltration,-or tank failure is Imminent. The system will pass inspection if the existing septic tank is replaced with a Fonforming septic tank as approved by the Board of Health. (revlsed 11/03/95) 1 One Winter Street 0 Boston, Massachusetts 02108 6 FAX(617)1 556-1049 a Telephone (617)292-SS00 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(oontinuod) 23 West Bay Road Osterville ,Mass . 02655 Owner. Jack Cotton Data of Inspootlon: 4/2 4/9 6 o B1 SYSTEM CONDITIONALLY PASSES(contiauDd) e Sawage backup or breakout or her;tacic water level observed in the distribution box is due to broken or obstructed or due to a broken,settlad or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): . broken pipe(,)are replaced .'.:. obstruction is removed distribution box is lsvelled or reel The system required pumping more than four times a year due to broken or obstructed pipa(s). The system will page inspection if(with approval of the Board of Health): broken pipes)are replaced _ obstruction L removed Cj FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALT& ,ID„ Conditions exist which require further evaluation by the Board of Health in order to datermins if the system is tailing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS-NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 60 feet of a surface water Cesspool or privy is within 60 feet of a bordering vegetated wetland or a salt marsh. Z) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank aad soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water.supply. The system has a septic tank and aoII absorption system and is within a Zone I of a public water supply w�• . The system has a septic tank and soil absorption system and is within 60 foot of a private water supply well. To The rpum has a septic tenk and soli absorption system and is lass than 100 feet but 50 foot or more from a private water supply wall,unlau a well water analysis for coMrm 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 lass than 6 ppm. 3) OTHER 2-81x10l brick cesspools and 1-81x101 b in cesspooi acts as a septic tank e overflows are dry. Main cesspool as slight puddle.. (revised 11103195; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(oontlnuod) PropertyAddresa: 23 Great Bay Road Osterville ,Mass . 02655 Owner. Jack Cotton Date of Inspection: 4/24/96 ;, • • D) SYSTEM FAILS: • ,fl0 I have determined that the system violates one or more of the following failure criteria as deliaed in 310 CUR 15.303. Th•basis for this determinatlon is identified below. The Board of Health should be contacted to determine what will be necessary to Correct the failure.•; � I 4W ' Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or pondiag of effluent to the surface of the tround or surface waters due to an overloaded or clogged SAS or pool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. 1 Liquid depth in cesspool it less than 6"below invert or available volume is less than 0 day flow. &0 Requirod pumping more,tl=4 times in the last year NOT due to cloggod or obstructed pipe(+). Number of times pumped _ Airy portion of the Soil Abaorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 foot of a surface water supply or tributary to a surface water supply. ,etc Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 60 feet of a private water supply well. Any portion of a cesspool or privy is loss than 100 feet but greater than 60 feet from a private water supply well with uo acceptabls water quality analysis. If the well has been analysed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El!LARGE SYSTEM FAILS: The following criteria apply to largu systems in addition to the criteria above: A0 The rystem serves a facility with a design flow of 10,000 gpd or greaterAlArge System)and the system is a dguificant threat to public health and safety and the environment because one or more of the following conditions exist: the rystem is within 400 feet of a surface drinking water supply A 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 Aron(MTA)or a mapped Zone II of a public water supply well) The owner or operator of any such system sha.l bring the system and facility into 0 COmpliaaU with the gtrolawater traltmeat PrOgram requirements of 314 CMR 6.00 and 6.00. Plow:a consult the local regional office of the Department for farther information.. (revised 11/p3/45) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Prope,tyAdd,,m 23 Great Bay Road Osterville ,Mass . 02655 Owner. Jack Cotton Date of Inspection: 4/2 4/9 6 ' Check if the following have been done: ,,,Pumping information was requested of the owner, occupant, and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 41 As built plans have been obtained and examined. Note if they are not available with N/A ZThe facility or dwelling was inspected for signs of sewage back-up. 2The system does not receive non-sanitary or industrial waste flow ZThe site was inspected for signs of breakout. All system components,including the Soil Absorption System, have been located on the site. N6IL' The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge, depth of scum. ZThs size and location of the Soil Absorption System on the site has been determined based on existing information or app.1 ted by non-intrusive methods. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub- surface Disposal System. C. (revised 11/03/95) 4 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION PropertyAd&c". 23 Great Bay Road Osterville,Mass . 02655 Owner. Jack Cotton Date of Inspection: 4/24/96 FLOW CONDITIONS RESIDENTIAL_ Design flow:_ .'Var JAI Number of bedrooms:�p Number of current residents: , Garbage grinder(yes or no): C Laundry connected to system(yes or no): J Seasonal use(yes or no):-10 Water meter readings,if available: Q IF Last date of occupancy:PCff2iPVdX t CO MMERCIAL/I NDUSTRIAL Type of establishment: AIR• Design 1low:__A,4:j_gallons/day Grease trap present: (yes or no))I& Industrial Waste Holding Tank present: (yes or no)AM Non-sanitary waste discharged to the Title 5 system: (yes or no)A Water meter readings, if available: Last date of occupancy: OTHER(Describe) 04 Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS end ao of Pi ormation: J1�d�J� �lui9'��iO4�,, System pumped as part of ins ion: ()es or no) If yes,volume pumped: V eallons 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) Other(explain) APPP OXIMATE AGE of all components,date installed(if known)and source of information: Sewage odors detected when arriving at the site: (yes or no) revised 11 03 95 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinuod) property Addree,: 23 Great Bay Road Osterville ,Mass. 02655 Owner. Jack Cotton Date of Inspeotion4/24/96 SEPTIC,TANKAO*V-- e (locate on site plan) Depth below grade: Material of construction:06ncrete_metal_FRP_other(ezplain) Dimensions: 8hulp depth. Distance frcm tc-p of sludge to bottom of outlet tee or baffle: Scum thickness: `� A Distance from top of scum to top of outlet tee or baffle: A) Distance from bottom of scum to bottom of outlet tee or baffle: d)A Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence f leakage,etc.) A/o --•.•r���tJ�S GREASE TRAP: G.ti2- (locate on site plan) Depth below grade:N4 Material of constructionr0concrete_metal_FRP_other(ezplain) .i,T� - -- Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: VA Distance from bottom of scum to bottom of outlet tee or bafTleX/9 Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) A) (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) p,opertyAadresa: 23 Great Bay Road Osterville ,Mass . 02655 Owner. Jack Cotton Date of Inspection: 4/2 4/9 6 TIGHT OR HOLDING TANY-AbOe- I (locate on site plan) "" s Depth below erade:1L!L _ Material of constructionncseta_metal_FRP_cther(esplain) Dimensions: 11;'R Capacity:—ILL 113A jrallons Design llow: onalday Alarm level: Comments: (co floe of inlet tee,condition of alarm and float switches, etc.) T DISTRIBUTION BOX Aa)4,e- (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of lea]cage into or out of box,etc Cc rrl.�!'I t.�9Tl` PUMP CHAMBER:_'a---j/e— (locate on site plan) Pumpe in working order-.(yes or no) A/h' Comments: (note oond4ion of pump chamber,condition of pumps and appurtenances,etc.) 7 (revised 11103/95) ' U SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) PropertyAddresae 23 Great Bay Road Osterville ,Mass. 02655 Owner. Jack Cotton Date of Inspection:4/2 4/9 6 SOIL ABSORPTION SYSTEM (SAS):,,, (locate on Sit*plan,it possible;excavation not required, but may be approximated by non-intrusive methods) e If not determined to be present,explain: Type: lesching pits,number.Q leachia8 chambers,number.0 lw:hing galleries,number.f� leaching trenches, number,length• leaching fields, number,dime io�— overilow oesspoolsnumber. Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of ve tatioa,etc.) Soils ;Loamy sand to sand & Gravel to fine sand. l�0 signs of hydrauiic failure or Donding. All vegetation is normal. No repairs are needed at the present ime. CESSPOOLS: -Z (locate on site plan) Number and configuration: . Depth-top of liquid to inlet invert:_- Depth of solids layer. Depth of scum layer. Dimens, us of cesspool: Q Materials of construction' ^1-' Indication of groundwater: A)zfV e inflow(owspool must be pumped as part of inspection) Comments:(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.) Same as above PRIVY:�•v� (locate on Sits plan) Materials of construction: Al#' Dimensions: AM Depth of solids: AM Comments:(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) Ali Cotitry)riY7'i (revised 11/03/95) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) PropertyAddrem 23 Great Bay Road Os•terville ,Mass . 02655 Owner. Jack Cotton Date of Inspection: 4/2 4/9 6 SKETCH OF SEWAGE DISPOSAL SYSTEM; • . include ties to at kart two permanent references landmarks or benchmarks locate all wefls within 100' Centerville Osterville Marstons Mills Water Company 428- 91 V � A. DEPTH To GROUNDWATER Depth to groundwater ' +feet method of determination or approximatio ; Shot transit from lot to parking lot of Wimpy' s restaurant. Wat.e gives (revised 11/03/95) 9 U. i THE COMMONWEALTH OF MASSACHUSETTS DEPARTMENT OF ENVIRONMENTAL PROTECTION BE IT KNOWN THAT Joseph P. Macomber, Jr. Has satisfied the Department's qualifications as required and is hereby authorized to use the title CERTIFIED TITLE 5 SYSTEM INSPECTOR as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the General Laws. Issued by The Department of Environmental Protection. June 8, 1995 Acting Director of the ion of Water Pollution Control •T.T.T1T'M•-Rs•rs�.-rrz-t:.—•nsr..rr..r.e•c—T—.r:-:�rer:-s:r.:-n.r...z:r=--_rc.:.� .- ...... .. ... —. �' • Barnstable �''�� '�" '- TOWN OF BOARD OF HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D .- CERTIFICATION ..it��.�T.T.T:�f•r:i'S:�T.T::1T.�T.rt'r—!':�:.�'�..,T...T`�'�TT.T..-��1'i'S�L .- If T'iRJ'•/:TCTTR.�t•1'Tr!�T•tT'T•-[.•-.I -TYPE OR PRINT CLEARLY- I PROPERTY INSPECTED STREET ADDRESS 23 Great Bay Road Osterville ,Mass . 02655 ASSESSORS MAP , BLOCK AND PARCEL # OWNER' s NAME Jack Cotton PART D - CERTIFICATION r NAME OF INSPECTOR Joseph P. Macomber Jr. COMPANY NAME J-P.Manomber & Son Inc. COMPANY ADDRESS Box 66 Centerville ,Mass . 02632 Street Town or City State EIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX ( 508 ) 790 _ 1578 _>a CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and complete as of the time; of .inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of oil- site sewage disposal systems . Check one: XXXXXXXX System PASSED The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public Health or the environment as defined in 310 CMR 15 . 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. System FAILED* The inspection whic'}I I have conducted has found that the system fails to Protect the public •health and the environment in accordance with Title 5 , 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Date 4/26/96 'a-ter.•.==caaar—.—_—_ �.—�. .--. One copy of this certification must be provided to the OWNER, the BUYER ( where applicable ) and the I30A'RD OF HEAL1'll. * If the inspection FAILED, the owner or""operator shall upgrade ' the system within one year of the date of the inspection , unless allowed or required otherwise as provided in 310 CMR 15 . 3-05 . y N'?.:...:�..�._�..i> :..�.�.mi. --�..:.�x..bill::ae.u'mii.9u..:"ui6ia:.:b'i..,;isak.Jl:Lt�uae'utiwn"`r @� �.ar ..-.u8u -�.— �--_-.• - 'al _nwr.�,,....a.e�em..w°v.+`iJ'.ue — ,. `.. r. �.....�. _ ,� •,�h m�xw.vwaM --alwma...._vY.'=�tuuwm.:•... - =.,wen - _- Date\-" TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBU INESS: � 1Ja�^C P ��'�-I S BUSINESS CATION: . QA9 01 MAILINGADDRESS: t5pry-A.�- Mail To: TELEPHONE NUMBER: Board of Health wn of Barnstable . CONTACT PERSON: o�'A- 5-0ToO. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: S0',P1 Z'�2o7 yannis, MA 02601 TYPE OF BUSINESS:M�tt C_' b-- �� \v� C� - Does your firm store any of the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site otherthan your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating,oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners - Other chlorinated hydrocarbons,NEW USED (inc. carbon tetrachloride) Paint &varnish removers, deglossers Any other products with "poison" labels Paint brush cleaners (including chloroform, formaldehyde, Floor& furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids 000 L 021 S �e-w��11 (dry cleaners) v Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ,ta'eP� r!. •y� .sw..:�e.• a.. ; ,.+�"�+f"-'- {'�.�� ,..i - ��'.+'•i,.���� s .'�i`._...=,.. si :w`�. .� .,�,�•'+ r } ,,. d �'• '. �` f irk • .�! &,.:,.sit..-..,r ;ir7. - Date. � r TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAMEOFBUSINESS: !mot�✓l� 1 Ct.--C�e�hl BUSINESS OCATION: ',"f / e f A td e4 V I I g r � Mail To: MAILINGADDRESS: 5pr1� `F_- TELEPHONE NUMBER: Board of Health Town of Barnstable CONTACT PERSON f..s o�A �^ 50_-el 5 �" ' �a 0 � =� V✓) ;O. Box 534- � . •EMERGENCY CONTACT TELEPHONE NUMBER:. L(� 560117 yannis, MA 02601 ' TYPE OF BUSINESS: . Gv%�l c Does your firm store any of'the toxic or hazardous materials listed below, either for sale or for you own use? YES NO . This form must be returned to the Board of Health regardless of ayes or no answer. Use the enclosed envelope for your convenience. If-you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ' ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS /The Board of Health has determined that the following,products exhibit toxic or hazardous character- ~istics and must be registered regardless of volume. Please estimate the quantity-beside the product that you store. NOTE: LIST IN TOTAL•LIQUID VOLUME OR.POUNDS. Quantity Quantity Antifreeze(for gasoline or coolant systems) Drain cleaners NEW USED. Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants` Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) k Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals,,(Developer) Lubricants, gear oil NEW USED 4 Degreasers for.engines and metal Printing ink Degreasers for driveways & garages Wood preservatives(creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners f Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains,dyes PCB's ri-=Other chlorinated�hydrocarbans, - - NEW USED (inc. carbon tetrachloride) Paint &varnish removers, deglossers Any other products with "poison labels Paint brush cleaners (including chloroform, formaldehyde, Floor & furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spot removers & cleaning fluids '0�1 Ln \5 �V\/\0 V e,� (dry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT./CANARY COPY,-BUSINESS '� D S�P.rvrlle� � aZ• t�tdl�- ®� SME:A KEEPING YOU ORGANIZED NQ.IUU 2PI536 WDEIMUSA GET ORGAN=AT SM€AD.COM i" t V �. o Book W ) CY (PlopB INlde Public �+r/ J S�`>�1 A`6` ` We a7 �T it NOTE% ALL RUN OFF TO OE CONTAINED NORTH y1.6' ps i ON SITE. BAY L S\61J TD ,,e►o°6c'E R.rs l�1R0 4g,23 TREE PLANTIPIG ,.., . Y i. ApJv.SS » (`NALK:_-�:. _ - OVER 20 SPACES= I•PL=R 8 SPACES UC-&I►a N/44'12'50 E:. 3D SPACESZO _ '3.8 , t,.\ 1 a0 i q:/IMiti tXJR9 4 NEW TRIES TO dC PLANTSO \,� 1 ; �} U17LE 'o ISLAND 1 `•� .��'�\ . 'f 5 ..�• Z Z 1 1 , 13 41.0 N '� LANDSCAPING AT2oUND tBAY - © C.)Do rpm NECK Por►a'\ i. 13u11_o1NGS z,2 1 + 0 �� 5 _ _ Location Map W (1 -,2000f') 12� EXIS"r�. rn CP '- ' I ? EP51 MENT OVER EXISTING DR1VE TO 1'RCYVIDE ONE WA`I I-RAFFIC; Z I© _ FLOW 4-ACC1;E,5To PARKING- - -� • - - . . . _ .. . . References: D w .. . ... Assessors Mop 141 Parcel 17 3 123 d �. Deed..gook 14111602. . ... Lot Area 11 "- m -+_ : Plan Book 305/63 PIP187/61 — EXIST, 8 8'X 'X&' Cr-IDAFL ». » V O ' d (� STOCKADE FF-NCe faRourJo _ ..... 387/60 Q U M PSTs 2 Can d "Court Case 3191 -A C,�OFj 13 I9 • , � off: . , ---- ---. . ... . -- -' - - -' --- 1 The topographic information shown Q 14 x! hereon was obtained by conventional �— — ' '°• survey methods. \ s1 uEp o c �� .�,��� 37•47�20' E .._ 7..3 We-, RAv Road ,15 o � ti�J. I 5.0' Own hereon 2)The property information shown Parldng Requirements ; was complied from available record \ 1 - ,yfipTIGTANX + �. J� info(maaon and does not repre3ftn•; I y0.3 actual on the ground survey. - 1 c C. W ITH ►-6 C • ' 3)The datum used is Novo,o. s H � I Existing: s i L16 cox 21 2 2 24 2 PIT,RIM EL.3q 5 4 0 I OI © . Office 560 sq.ft. ` 17 18 �� 7as* 9 REaER� - � 1 Retail 600 sq. ft pos'T R RAIL FENCE \ — 1 B/R Apartment I— T I r 0 t WW ~ Proposed Additions on Existing Building: �-PRIMAR`/ `W Office 600 sq.ft. v 1 . . ti 0.;3 . - — j v'*1C.RAMP / O n�T' 0r ACa New Proposed Building: a 26 Office 3,000 sq.ft. - 30 o C:'•,``' •. 0 IN NEW 2. STCSR`i 0; i EX15T.' •t e�s� -s�� C13. W ITH LEACH LT. POL1= t _ OFFICES 13IJILQ1 bU(LDING O• �' ��?:��• „i r , RIM EL, M9,0 PROPOSED O ' M Parking Requirements: i 4,160 sq.ft Office = 14 spaces r. -� , 10 6.5 0' N. '-• 43.00' ` ' 600 sq.ft.Retail = 3 spaces _ 101.06 . 'i 11•69 1 B/R Apartment = 3 spaces CB�H S. 4945'18" W 153.57' / PlroPosEo N 51'52'19" E I' CB�H N 44.37'46" EC8/b S Total Businesses = �4 paces Fnd ` toun�PSTErz Fnd Fnd Total Required spaces - 24spaces PLAN VIEW 6mon Cothor►c Bishop of roll River Total Provided spaces - 30_spaces �, CCC � 5y6/291 I `v Excess a 6 spaces Scale I = 20' I Title: PREPARED BY PREPARED FOR: Notes/Revislon: -- Plan Revision 3/17/99 NOTE Add building slgnage Sullivan Engineering, Inc. ��� ����� OSTETITER.i REALTY The intent of this drawing is to secure Plan Revision "4/15/99 _ CD SITE PLAN g g� p H Site Plan Review approval only. Site Plan Review Comments PO�- x 659 AT OstervllleoVA 02655 Hyannis MA 2601'0718 770 A MAIN STREET It is not to be used for construction. ; — 23 WEST BAY ROAD* (508)428-3344 (508)426-3115 fox (508)790-7902 (508)790-7905 fox The drawing is only valid with an ' O S T ERV I L L E MA PsullpEonol.com . :copesurvfta;ecodnet O ST ERV I L L E , MA original stamp and signature 20 0 10 20 40 . 80 F7eld: RRL/RJM Draft: RRL Date: Scale: �� �""""' ' .�' Cormp.: RRL Review.- MA Y 23, 1998 1"=20' ` � Pro Drawing� � C—Z86 9 # C286P1 • 970 1 .