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0235 CEDAR TREE NECK ROAD - Health
235 Cedar-Tree Neck Road „P. , Marstons-mins �±A = 076 024 l `. TOWN OF BARNSTABLE LOCATION `�3 S �° D�R /R �v�c%- SEWAGE # VILLAGE " 1AJ / L L S ASSESSOR'S MAP & LOT�� Z /d �(/C' O �R'S NAME&PHONE NO. l SEP 11C TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER Plf 1,V C E ®L'r Al, PERMTTDATE: 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 ' lq©,4,-� Y 34, , 4 ' IA� +-*r v�r Lciau VJi JJ ,J vim; f VJVLV ni vniv�.V i ntin� �L COMMONWEALTIJ of MASSA.CHUSE71,S EXECUTIVE OFFICE OF ENVI;RONMEN TF AFFA IRS MPARTMENT OF ENV111ONMENTAL P O FEC CION 350 MAIN STREET A WEST YAPUOUTH,MA a06^77S-2ach) TITLE 5 OFFICIAL INSPECTION VORM—NOT FOR vOLuN,.rARY ASSESS 'ENTS SU2;S[.RFACE SEWAGE DISPOSAL SYSTEM FORM PART A, C RT ICATION ' Trees i.�c.ck. Property,Address, . Owner's blame; Owner's Address: Dittc of$ispt�tion 73 4 Name of1wT-tctor:(plenseptvtt) AIM .S :Z) _5�,19fPS Cotnpauy Name: A bt.R Ca_nco Mailing Address: 350.Main Street West Yatxztguth,MA 02673. _ Telephone Number: 5a.775-280o CERTIFICATION STATEMENT I ccrtifv that.1.lmve personally i U-,,*cted the sewage disposal system'at this addross and that th,t'in -mi ition n aorted below is true;accurate and coq.)Iete as of the time of the inspection, The ir31m tion was pert',an, based on tty training mid experitnce in the prow function and maintenance of on site sewage dispose syst:t I o m ti D tF approved system htspector pursuant to Section 15.340 of Title 5910 CMR'(6,W). The cyst r"Passes Conditionally Passes Nwds Further Evaluation by the Lmd Appming At totity Fails Inspector's Signature: Date; The system inspector shall subtrit a copy of this inspection report to the Approving Authority(.Bo; I o-'Healt,4f DEP),within 30 days of eompletitig this inspection, if the system is a shared ov9t'e1n or had a dnsig to v of 1(,000 gpd or greater,0A inspector and the systan owner shall submit the report to the appmptiate regionttl of :e-tf the I iu. The orWrial should be sent to the system owner and copies sent tot he buyer,if applicable,and the >p oving,uthority,. Notes and Con�.itiients "'*'(his report only descrtbet;conditions at the time of iaspectttstt and ender tho conditlties us:at th it there. This Inspection does not address bow the,systom will perform in the future cinder the sanm of Iff ereat caadidons of use, Title 3 Iztspe.tion Form(7111/2p0(1 1 kt4/f9t3/2 t7 fly:d'� bt7L f(WJbLb Fits tFArJuu ray-1ar page 2 of l l O1FFICUL INS]PEC71ON FORM——NOT FOR V 0LUN'TARY ASSIt;S,'1 +'STS SUBSURFACE SEWAGE DISPOSAL SYSTRIVI INSPECTION FC .M PART A CERTIFICAnON(contituad) Property Addreu: Owner: Data of bspc•ciion; -- JMspection Summary- Check A,B;C,D or E/ALW�XS complete a of Seddon lb A. System JPasses: I have not found any infotzlaatiom wlticb indicates that any of the failure tnteria desaribeia.JA 0-:MR 13.303 4r hn 310 CMR 15.304 enist, Any failure criteria not evaluated are indicated brlow. Comments: B. System Conditionally Passes: �, A Oqz or more system components as deem rioed in the"Conditional Pass"section need to lw re ao:d or rt patted. 'ilia systtat,upon completion of the replace=[or repair,as npproved by the l:�owd of Hmitll,vv pe ss. Answer yes,na or not determined(Y,N. ND)in the�for tllt following statomenu. "tot&-I rmin-d' please a\plaiu. _ The septic tank(s metal turd over Zo years old*or the septic tank.(whether metal or riot) st ;w-ally it sound, exhibits vhst;.in ia1 intittr:,tion or exfIiitratiat or teak failure is lttttnttter`t. Systein will pass iaivae6 ;n,if tN a:isuag tank is nipiated%Kith complying:septic tack as approved by the Hoard of Health. *A ittetal septic tiurLk will pans inspection if it is structurally sound,riot leaking and if a Certificate 'C Ntatpba ice itidicadns.titan the Wttl:is less thalt 20 years old is available. ND expltin: Observation of sewage bat:k,.ap or break out or high stutio water level in the disebution tox t :tt broke n or obstructed pipe(s)or due to a btaen,settled or unevert distribution box, System will paw it pao't t i.l (arch ipproval of Board of Health): broken pipe(s)ire replaced obstruction is removed distribution box is leveled or mrplaced ND"pWn: The sysicn.required pumping more that 4 times a year due to broken or otstnteted pig(>), t:vsteni Aill pass inspection if(with approvat of ttc Board of Health)" broken pipes)we replaced ob.trtu:tion is removed NO e.%plain: Tidc 5 Inspection Form 4/15,'2+)0() Z I b4/hFi/110013 u1j:J`! 5baf fd�JbYti €b UANUU rm= ego page 3 of 1 I OFTTCTAL TNSPEC'TION FORM-NOT FOR VOLUNTARY ASS]CSS X VTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM INSPECTION FC M FART. D CHECKLIST Property Address, Owner: _ Date of Thspecdon: Check if the following taave been done. You must ir4cate`yes"or'nu" as.to each.of i s fi aawi 11Z yes No launtpiztg information was provided by the owner,occupattt,of Board of Hetthth Were any of ttte system components pumped out in t"te previous two weeks', Has the sy, em received nom al flows in the previous two 1Yeei1(pet'od7 FTave large volumes of water been,inttoduced to the system reaertly or as part o: us imspec ion? Were as built plats of the system obtained and exaznined7(Lf ilwy were not;tvai ale note a NIA) Was the Thai-bty or dwelling inspected for:signs of sewage back up? Was tb,e site iiipected for signs of break oat? Were all system compottents,excluding illy SAS,located oil sje? Were thA sept,c tank maAholes uncovered,opened,and the inlonor of the tank it ec,ad for he condition of rite bal)les or tees,.material of construction.dimensions,depth of liquid c�eFth of s,luc r at td dept i of scum 1/ _ Was'the tnciat:y owner(and occupants if diOf mm from ommert provided witi:•,im tn:.bon o:,the proper maintmance of subsurth a sewage disposal systems? Tha eras imd Wcatbn of the Soil.Absorption Sysretn(SAS)has been detex:nit I t aced,rc +Yres� No _ n Existing idonuation. For example,a plan at the Board of F.ealth. Vol' _ Determined in the tidd'{if any of the failure criteria related to:Pats cis at iss,ut a r,.).j elti(n of distance is tmacceptable)[310 C.`%15.302(3<b)] Title 5 LnspertlonFortn Gl1S/2(tpp 5 41�,�bts�'Lbbo by:dy t7lti(/tiyb'La Ab UANUU rAlt �70 Pagos 4 of 11 OFFICIAL INSPtCTION FORM-NOT FOR VOLUNTARY ASSESS INTS SUBSURFACE SEWAGE DISPOSAL SYSTEM IN,SPECTION'FG M PART A CtRTIFICATION(CONT'BJM, Property Address: Owner: _ — Date of Inspection: dam_ D. System Failure Ctyteria applicable to all systems: k� You mum indicate"ves"or"no"to each of the following for ll>j inspections: Yes Nq Backup of simgc into facility or system component dace to overloaded or c.1og V AS or :esspool k- Discharge or pouting of effluent to the a ace of the ground or surface wavers Lei o&A o erloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert clue to an overload of cioggi d SAS or cesspool .4 CA CAOAl f- Liquid depth in is less them 6"below invert or avC ablc volume is les; tat.Ya da, Clow fi Required pumping more than 4 times in the last year NOT due to clogged cut of rut:ted pit is(s). Number of tmes pumped Any portion of the SAS,cesspool or privy is below Might ground.water►elevatia. Any portion of cesspool of privy is within 1 OC feet of a snufa.e water supple,of ibi.tary tc a l�d surface water mpply 17/f Any portion of a cesspool or privy 1s within a Zone 1 of a public well Any portion of a oesspool or privy is within So feet of a pt9vedc water supply w Any portion of.a cesspool or privy is less than 100 feet but greater than 50 lioet mi a phv;to water supply with with no acceptable water quality analysis, (This system passe:;if, ,H ell we er analysis performed at a'DRP certified laboratory,for cotiform bacteria an tot xtile o gagic compounds lndicites that the well is free from pollution troar that futility! d i he pro fence of ammonia a tnogen and mitrata nitrogen is equal or lees than 5 ppm provid. tb at uo i ther failure criteria are triggered. A copy of the annalysis must be attacbad to fit;far .) (Yewo)The system fnilg I have deterrttined drat one or more of the above fai. e c rlteria :xist as described in 310 C1NM 15.303,therefore the system fails. The systern ov sr;Mould ;ontact the Dart of Health to deteratirte what will be neoessaty to correct thy!fa re. Z. )Large Systems: A'04 To be considered a large system the system must service a facility with a design f'lov if 10,00( gpd to 15,000 gpd. You must indicate either''yc;'' or"tic to each of the following: (Tltc following criteria apply to large systems in addition to the criteria above) Yes No the system is within 40A)feat of a swlece driaz mo water supply the system is vrithta 200 feet of a tributary to a surfaca ddn)iq water supply the system is 1,xated in a nitrogen set:Wdve Area(Interim WeLlwd Protcctio;'k Aj L-IWPA, Ora napped Zone.'l of public water apply well. If you 11M aitmvrcd"yes"to any question in ScLtiot E the System is considered a sigctiticartt thre of answo red "yes"in Section D above the large system is failed, This owTier or operator of any large system cot &•ed a ;r Heart threat under Section E or failed tinder Section D shah upgrade the system,in mcotirdance with I10 i IR t 3.3tk. The system owlter,should contact the appropriate regional office of the Department Title 5 Inspection Form 6/1512000 4 i G4/GO/LGG.7 G7:.37 .7G0 I I07OLO - HD klml4l'U MAk=- G4 Page 3 of 11 OFFICIAL INSP1ECTION FORM—NOT FOR YOUMARY ASSESS :E: TS. SUBSURFACE SEWAGE.DISPOSAL SYSTEM INaPECI'I'ON PO M `PART A CERTIFICATION(CON'l" D) Property Address- Owner: Date of]nspectlOtY: C. Further Evaluation is Required by the Board+of Health: _ Cottditioni s exist which rec uire 6 rther evaluation by the Board of Health ui order to dote;stir if t he sys;nn;s failing to protect publc health,;safety,or the envirotunent. I. System will pass un1ms Board of Health determines in accordance with 316 CN R 1 30.1(1)(b) that the sYstent is not tlamdoaring in a manner which will protect public health safety awl ti an riroun act: Cesspool or piivv is within 30 feet of a sud£a:e water ry` Cesspool or privy is within 50 ree:t of a bordering vegetated wetlond or salt mars 2. System will fail uniers the Board of Health(and Pub.iic.Water Supplier,if any)Clete ,it ea tha the syscent is functioning in a Malsoer that protects the public health.,;Infety and enviro sent: The system has a septic tartk and soil absorption system(SAS)and the SAS i;;w in 1(t)fe t of a sartaee water supply o-tributary to a sud£ace water supply. __ The system he$a septic tank and SAS and the SAS is within a Zone 1 of public� ter suppll The system has a septic thank mid SAS and the SAS is within 50 feet of a pfrivtse ml suppl' well. _ The system has a septic tank m-d SAS and the SAS is lei than 100 feet but Sp fe .or tnors i'ozrz a private water supply well'". Metltod used to dens mim distmiee This system passes if the well water analysis,perforated at a MY certified labor or+ for c Iliform bacteria and volatile oqstiie compounds indicates that the well is iWe from pollutic from tha;facility and the presence of ammonia nitrogen and nitrate nitrogen is equO to or im thins., Ipt u prm ided that no other failure criteria are triggered. A copy of the analysis;must be ttttncited tl is fan i. 3, Other: Tide 5 Imsp=-tion Forma 611 Mow 3 04/08/2005 09: 39 5067789628 AB CANCQ PAGE 09 Page 8 of I OFFICIAL MS PECTION VO17M T NOT FOR VOLUNTARY•AuSS:KS! tL N TS SUBSURFACE SEWAGE DISPOSAL SYSTXM INSPECTION V &: PART C SYSTEM INFORMATION(conti+tued) Property,A.ddress: 'Owner, _ Date of Inspection: TIGHT or HOLDING TA,i•TK: � (titttk must be pttt>xped at tixDt ol'irrspectic n',t(: at.o on sit:plan) Depth below grade: Material of crost.-action: concrete metal £iioezglass polyethyletie ethc. (eacplain) Dimensions: rrrr..�.�r`rr+rr+im..r, C913aCttV: ga1l.�C8 Design Floor: gatlors/day Alarm prue:rtt(yes or no) Alarm level: I IAlain in working ordw(yes or rw. ): Date of last pumping Comments(condition of alam amd loons sv&itches,etc.): DISTMBUTION;BOX: (if presentmust be op", d)(16cate on'site plan) Depth of liquid level above outicot invert: Comments i;noteif box is levi:i.and distribittion to outlets equal,any evidence of solids=Tyovet r y evide:az of leakage Wu or out of box.ctc„): PUML P CIiAMBEIL (locate on site plan) Ptunps in tvo€l ing order(yes or no): Alarm3 is working order(yes 3r no): Comments+;mote condition of lxunp chamber,condition of puin;n and appa ter'tances,etc,): Title 5 Irr ction fomi 611 S1'2UOQ 8 ( 000z";119 mloa uolr*dmi C 211u. ........... �. :('942 ai l Io xmpua'}tontn lap5►o of pateCu Se Sratiar mbir t4r pill)7mlonm`tropYpuoa;Ujva ao as;ael;no put,}�rur 4sumppummuoaai ftdumd uo!s;izsmttto' :v=UInd;sQl3o a;uC :3tUEg10;gjapno ao U102 q 03 umas)o ut0goq moig aatttrtstc :aq;eq la oe;tertno jo 450103 tunas�o dot 0).4 eauastQ :csainranp tunog :suorSttatu?a dxa agtu av:aIAgja.4)od svuT3.agq rutatu ••". atwauOn mo?tott�ctto^�alor.2taNr :apotE.5lUroq gtdac (void ails uo pa;Ml)Jvlu mylaJ :( ya`a�¢yeal�o a;�saprna itanttf tarlito of parorat sE sYanal amber �lr alu!lgm�m�s ito?trpuo0 aft q is eat term0 puo 3eru}`sttoppua��'tu0+ai 8ttiduuul ua I stttattttuo� ��c>�G'�� 3 ..� :paprtuuatap sua�suatJx}•n axati nwlr ;aj�'8q x0 pat ialtno;o umuoq of umns ao wottoq uto�,t 7ap91srd y�/ � :e�vq xa pet tartno,)o doa of tttnaE Io dvt tittox;eattets� a "r" :ssauxOp tunas �" :a'fcq so aw ta;tna)o atoitoq ate of af4pn)s 3o dot ta�A aaums :tpdep eSpnlS (OICal}tea {0 Adc:P A�;NiAr.— ^wl.. �tOt3w.._ .Il— A^��idW°',�.{0 33AJi�IL�7�A Aq�9Yf111Y1i00 a^dA S� —��� :aSe tsi��t0au�s�yuAt31 (WBrda:a)SatrtO aua)�Cg�adra i � ssnr8xagg � [Aim ....�. atasotzoa � :uortanststw:�o retat4}�r 0 :apax8 n.5olaq tP�Q � :(ts�rd al?SUP alt;aor)7i�t�'x.�ir,>L��S 1051noo 10 ootztiptaa vullim 114triof3a uogtpvao uo)s;u9uratoO --"— :auq uogons io rlam Ardd•:ts lameAft atsnud mo$aoumsi (u)ardxa) uon;set _ uet;atu;suoa,;o STOLL"UN :apez8 nnol*q qXj2Q :ttD;taadls��OeieQ :iatteAQ :stuppV kpadot$ (pa,xntuaz)NtOxx.VmOm fv'3.' xs :)JLwd 1aT t��T.Y���SNRNr .LS1CS'I�dSOdSl(��rJ'6'M�S �'a1S�RS S,I lSl TI )S,-3:SSV AHVIKR'TOA XOA LON—Lt d(M KOLLZ)3dVQ I :)UjYO as �nt�a nINV'0 RV SZ968LL809 6E:60 900Z/80/b0 04/08/2005 09:39 5087789628 AB CANCO rant �r Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNrA.RY A95lrSS lE 1TS SUBSURFACE SENVAGE DISPOSAL SYSTEM INSPECTION PE 31 PANT C SYSTEM INFORMATION Property Andress: Owner: Date of Inxlbecttow �^ FLOW CONDITIONS RESIDENTIAL Numbr of Bedrootas(design): , Number of bedrooms(actual): DESIGN flow based on 310 04215.203(for exempla: t 10 gpd x q of badroorm; Number ofsurrent residents: Does residence have a garbage grinder(yes or no); Is laundry on a separate sewagt:system(yes or nor (if yea sepersae kwpection re!RAre Laundry sysseln inspected(5v or no): Seasonal Use(yes or no): _ Water ureter readings,if available:(last 2 years usage(gpd)): Stttnp pwap(yes or tw) Last date of=tpancy: �m C0MMERCIAL4NDUSTR1A1L it CCU ca Type of estahlishmrtrt; r o,,d2,c S Design flow(based an 310 CMR 16.203): (.tJtg K 51,f of d Basis of design Row(mts/personslsgft etc.): Grease trap prescm(yes or no): /V b 5 ��1C l�= k Industrial waste holding tame pie=tt(yes or no): Non-sanitary tvaste discharged':o the Title 5 system(�no): NO Water n*cr readings,if availatk 4/4 -- Last date of occupancyAi8c; o. p OTHER(dewnbe): _ '�_7 el )(115 = GENERAL INFORMATION Pumping Records 50111tc of inf=lati0n; Was systeii ptunped as part of the inspection(yes or no): VIE If yes,volume pumped gallons-How was gut�totity pumped d.tentvn+ed? _ Reason for piutlpittg: -._. TYPE OF SYSTEM _L,e- Septic tank, ®,soil absorption system tesspool Overflow cesspool Nvy Shared system(yea or no;(i,f yes,attach previous•ins-tion records,if am) Innovative/Alternative technology. Attach a copy of the current operation and mainternauce ant act(te be obtairted front system owner) w` Tigltt tank Attach oopy of the DE approval Other(describe): Approximate age of all components,4ate installed(tf knpwa)and source of InformAtion; Wale sewage odors detected wben arrlvitrg at the s1�vp or no): Title 5 Inspection Form 61151'20) 6 04/08/2005 09:39 5067789628 AB CANCO PAGE 10 page 9 of 11. OFFICIAL INSPECTION FOMI—NOT FOR VOLUNTARY ASSES rONTS SUBSURFACE SEWAGE DISPOSAL SYSTEM DiSPECTION Fi t1[ PART C SYSTEM A`t;FORMATION(cmt:itued) Property Address: _ Owner, Nte of SOM A.BSOR TION SYSTEM(SAS): (locate on site plan,eXcavatiota not re Sred) If SAS not located explain why: � r ■ .� wr.�r��rrr Type leaching pits,number: leaching chambers,nttatber: leaching goileries,n,urober � r leaching trenches,number,length -T- leaching fields,number,dimensions . overflow cesspool,auaatlxr. Innovative/alternative rostetn Type/flame of technology: Continents(note condition of 5cil.signs of llvdmulic failure,level of ponding.dramp soil,cor.dit t o'� vesetatiott,etc,) r 1- E 4 C .tfC. /.7 ON ®ram'£._.1� D V 1 s4 -CA AJ�T Y....�. CESSpOI)LS: Al A, _ (cmpooi must be pumped at pact of iztsWtion.(locate on site 1 nt Number and configuration: Depth—top of liquid to inlet inven: Depth of solids lavdr: Depth of seam layer. _ VITIansion:t ofcesspoot: Materials of consttuetion: _ Inclicatidn of groundwater inf.ow lees or no): CoUt cuts(note condition of sell.signs of hydraulic level of pondixi3,condition of vagi :ioit atc.)! PRfVY: f locate on si:e plan) Niiuetials A t'C onStruction: Dimensions: - Depth of solids: Comments(note condition of soil..signs ofhvt:reulic fWure,level of ponding,cmdilion of vqs Title 5 tnspection Form 6/t 5/20tx' 9 04/06/2005 09:39 5087789629 AB CANCO PAGE 11 Fagx 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS]IS5 ims SUBSURFACE SEWAGE DISPOSAL SYSTEM,INSPECTION FC 4-4 FART C SYSTEM INFORMATION(umtinu:d) Property Address: Owner' Date of Ibspection; SKETCH OF SEWAGE 1G►ISPOSAL SXS'ITjM Ptovida a sl.stch of the sewage disposal system gicluding ties to at least two permanent refere—nce tdt wrks<r betu:hmazics. Locate all walls within 100 feet. Locate where public water supply enters the buildi a A/ 'title 5 inspectlon.Form 6/1sl2WQ 10 W 04/08/2005 09.39 5087789628 AB CANCO PAGE 12 Page 11 of 11. OFFICIAL INSPECTION FORM[—NOT FOR VOLU.VCARY ASSESS E 1TS SUBSURFACE SELVAGE DISPOSAL SYSTEM INSPECTION;FC tip PART C SYSTEM INFORMATION(canciztuuxl) Property Addresv Owner: Date of Inspection: ^ SITIE 1XV4 Slope Surface water Check cellar Shallaw wells Estimated*th to grow ndwatet � fee: Flease in+9ieace(check)all methace used to determine the high ground water elvadon, O taityed from system dtsiga plaits on maor d•If checked,date of design plat revievAxi Observation site(Abutting property/obscr"tion'hole within IJA fees of SAS) Checked with local Boca-d of Health�e\plain: Checked with local excavators,ixts'.allers-(attach documentation Awomed USQS database-e.Vlain: You most descrbL Flow you established the high ground water elevation: 13(9 pia �_E,4Cjllwc- j jr tqt�E'h Alt _ Titie 5 Inspection Form 6/I9t,1000 1 i Aso �a7,j VY/VV/GVVJ V7.J7 JVV I f 4JJVLJ r�✓ vr'...vv . ••.•� �� CCqr= 330 MAIN STREET-WEST YARMOQ7K MA 0267 PHONE 500-773.2800 FAX 508-77$-9tas PLUMBING-HEATJN*-SEPTIC PUMPING 8t INSTALLATION-FIRE SPR24K iR SEAN rCES Sand ta: From. ?attention, Date: Fax Number: O �.�+ Phone Nurn�i , rig °.�• �T6� C� Urgent 0 Reply ASAP PlCUe comment Please review © For your information Total pages,including cover: Age Comments: Page 6 of 11 OFFICM INSPECTION FORM-NOT FOR VOLUNTARY ASSEM lE!TTS STIBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION PC ,M PART C SYSTEM INFORMATION Property Address: - Orwoer: — ]Dote of Inrpeetl0h: - FLOW CONDITIONS RESTAIENTIAL Number of Bedrooms(design): Number of bedrooms(actual): DE51GN flow basest on 310 C14t 15.20- (for example: 110 gpd.t 0 of bedrooms, Number of currant tr:.5idents: Does residence have a garbage Fiudet(yes or no); _ Is laundry ou a separate sewage system(yes or ti0 �� (ifyes$eparaz kwgpeetton req''irs Laundry systetn inspected(Y116 or no): Seasonal uu(yes or no): _ Water teeter readings,if available(last 2 years usage(gpd)): _ Sump puunp(Yes or no) Last date of occttlsancy: -- COMMERC ALANDUST12iPMIr V Y Ca tType of establishment: �__ - r�-r • r c I ,y4 S w� K s -3 ° S Nsign flow(based on 310 04k 15.203): `_ Basis of design now(se wpasorr,/sq�etc•): Grease trap;v acnt(yes or no): t7 (JJ Industrial waste holding la&ptem t(Yes or no): Non,%rl tsry waste discharged'-.a the Titles 4 sYst M(Yes or no): A10 G Water meter readings,if available: Last date of accupancY/uae; _ OTHEE(de unbe): 1 l �o ' GENERAL INFORMAxION Pumping Recordsd�- 5ouroa of udo mation; Was systefn pumped as part of the inspection(yes or no) If yes,volume pumped: gallons—How was quantity pumped datattniritd? _ 1Lettson for pantping: TYPE OF SYSTEM �G Septic tank:, ®,soil absorption systern Singh"=pool Overflow resspcol Privy Shared system(yes orno,(ia Yes,attmh previous•inspection records.if an)') lnnovative/Altamative t&hrkoloey, ,Attach a copy of the cutertt operation,and maintenasuce nt act(te be obtained from system owner) Tight track Attach copy of the DEP approval Other(desmbe): ...� -. Approximate age of all components, ate tailed(if knp,Po)and source of ltttbrmatian: 1_ _ Was$sewage odors detected wben arriving at the site Ives or not: Title 5 Inspeetionlorm 6/15 0()4 6 TOWN or BARNSTABLE COMMONWEALTH OF MASSACHUSETTS Z EXECUTIVE OFFICE OF ENVIRONM N AL AFFAIRS, 36 r a DEPARTMENT OF ENVIRONMENTAL PROTECTION �qM V0� 350 MAIN STREET �,n WEST YARMOUTH,MA 508-775-2800 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner's Name: PRINCE COVE MARINA Owner's Address: HARBOR MASTER 1189 PHINNEY'S LANE _ Date of Inspection CENTERVILLE,MA 02632 Name of Inspector:(please print) JAMES D.SEARS Company Name: A&B Canco Mailing Address: 350 Main Street West Yarmouth,MA 02673 Telephone Number: 508-775-2800 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 Fails / Inspector's Signature: Date: T — s�a- The system inspector shall subPtapy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of complel uig 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 appm diate regional office of the DEP. The original should be sent to the system owner and copies sent tot he 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 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5,2005 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: N/A 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 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: to Title 5 Inspection Form 6/15/2000 2 r ; Page 3 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CON RRMD) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5,2005 C. Further Evaluation is Required by the Board of Health:N/A Conditions exist which require further evaluation by the Board of Health in order to determne 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 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 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: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5, 2005 D. System Failure Criteria applicable to all systems: N/A You must indicate"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 N/A Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in leaching 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 N/A Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply N/A Any portion of a cesspool or privy is within a Zone 1 of a public well N/A Any portion of a cesspool or privy is within 50 feet of a private water supply well N/A 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 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 Systems: N/A To be considered a large system the system must service 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 H 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 is 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. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5, 2005 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? N/A 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)has been determined based on: Yes No N/A 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(3xb)] •3 k� Title 5 Inspection Form 6/15/2000 5 f - Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5, 2005 FLOW CONDITIONS RESIDENTIAL Number of Bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x lI 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: MARINA—66 BOAT SLIPS Design flow(based on 310 CMR 15.203): 660 Basis of design flow(seats/persons/sqft,etc.): Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,if available: N/A Last date of occupancy/use: N/A OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: N/A 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,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 copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: UNKNOWN Were sewage odors detected when arriving at the site(yes or no): NO Title 5 Inspection Form 6/15/2000 6 f t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5, 2005 BUILDING SEWER(locate on site plan): ✓ Depth below grade: 8" 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 onsite plan): ✓ Depth below grade: 8" 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: 1000-GALLON PRE CAST Sludge depth: 6" Distance from top of sludge to the bottom of outlet tee or baffle: 24" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: 12" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: TAPE&PROB Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): MAIN TANK AT WORKING LEVEL,INLET BAFFLE—OUTLET BAFFLE. NO SIGN OF OVER LOADING OR LEAKAGE SEEN. GREASE TRAP(located on site plan) N/A 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: Continents(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5,2005 TIGHT or HOLDING TANK: N/A (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: N/A (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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.,): PUMP CHAMBER: N/A (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.): Title 5 Inspection Form 6/15/2000 8 f � Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5, 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: leaching galleries,number leaching trenches,number,length T leaching fields,number,dimensions: 1-12'X 4' 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.) LEACHING IS ONE PIPE FIELD 4'X 12',F BELOW GRADE. FIELD IS DRY—NO SIGN OF OVER LOADING. CESSPOOLS: N/A (cesspool must be pumped as part of inspectionX 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: N/A (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.) yr Title 5 Inspection Form 6/15/2000 9 Page 10 of t t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORlV1 PART C SYSTEM INFORMATION(continued) Property Address: 23: CEDAR TREE NECK ROAD MARSTONS 14IILLS. MA 02648 Owner: ILAR.BOR MASTER Date of Inspection: MARCH 5. 2005 SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or 4benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. r i /1)0 ", � J / C. i i Title ; Inspection Forth G i 'nuU l ij Pace 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 235 CEDAR TREE NECK ROAD MARSTONS MILLS,MA 02648 Owner: HARBOR MASTER Date of Inspection: MARCH 5, 2005 SITE EXAM Slope Surface water Check cellar >: Shallow wells Estimated depth to groundwater 6 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: Observation site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation Accessed USGS database-explain: You must describe how you established the high ground water elevation: BOTTOM OF LEACHING 1'—4 AREA HIGH Title 5 Inspection Form 6/15/2000 1 1 r//J TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: d�GL� �ULZ � '� ' Mail To: BUSINESS LOCATION: o`� 5 G�DpQ �L�� �/G a Board of Health Town of Barnstable MAILING ADDRESS: P.O. Box 534 TELEPHONE NUMBER: d — J 5 Hyannis, MA 02601 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: Does your firm store any of the toxic or hazardous materials listed below, either for sale or for your own use, in quantities t ailing, at any time, more than 50 gallons liquid volume or 25 pounds dry weight? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above, please indicate if the materials are stored at a site other than your mailing address: ADDRESS: 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: i Quantity/Case Quantity/Case / ' FAG l Antifreeze (for gasoline or coolant systems) � Drain cleaners Automatic transmission fluid I COJ Toilet cleaners Engine and radiator flushes "'� Cesspool cleaners �-- Hydraulic fluid (including brake fluid) Disinfectants �L+Aotor oils/waste oils Road Salt (Halite) Gasoline, Jet fuel i Refrigerants Diesel fuel, kerosene, #2 heating oil �o Pesticides (insecticides, herbicides, �O JDazOther petroleum products: grease, lubricants rodenticides) Degreasers for engines and metal Photochemicals (fixers and developers) Degreasers for driveways & garages Printing ink Battery acid (electrolyte) Wood preservatives (creosote) Rustproofers Swimming pool chlorine -�-- Car wash detergents 1 Lye or caustic soda Car waxes and polishes '� Jewelry cleaners / aph IL&ro�ng tar ! Leather dyes (�L Paints, varnishes, stains, dyes Fertilizers (if stored outdoors) GAL Paint & lacquer thinners PCB's `�--= Paint & varnish removers, deglossers �� Other chlorinated hydrocarbons, Paint brush cleaners (inc. carbon tetrachloride) Floor & furniture strippers Any other products with "Poison" labels -� Metal polishes (including chloroform, formaldehyde, Laundry soil & stain removers hydrochloric acid, other acids) (including bleach) �� Other products not listed which you feel may Spot removers & cleaning fluids be toxic or hazardous (please list): (dry cleaners) Other cleaning solvents Bug and tar removers Household cleansers, oven cleaners White Copy- Health Department/ Canary Copy-Business TOWN OF BARNSTABLE el celo MPLIANCE: CLASS: 1.Marine,Gas Stations,Repair �l satisfactory 2.Printers BOARD OF HEALTH 3.Auto Body Shops Q unsatisfactory- 4.Manufacturers tores COMPANY �✓ � _ A (see"Orders") 6.Fuel Su pl ers j ADDRESS / � Class' 7.Miscellaneous UANTITIES AND STORAGE (IN=indoors; OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test -r9-f1F S .g e #2 (B) Heavy Oils: 2 waste motor oil (C) new motor oil (C) transmission/lry�c Synthetic Organics: degreasers 41 Miscellany us: to a DISPOSAL/RECLAMATION REMARKS: le- 1. Sanitary Sewage 2.Water Supply O Town Sewer PublicL Z On-site O Private - 3. Indoor Floor Drains YES NO-1- 0 Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES N0;_ ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product 2. Person (s) Interviewed Inspector Date ASSESSORS MAPN • r PARCELNO• TOWN OF BAR , COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers ' BOARD OF HEALTH 3.Auto Body Shops O unsatisfactory- 4.Manufacturers (see"Orders") 5.Retail Stores COMPANY r 2- Al � r7/�/ &07 �r 6.Fuel Suppliers ADDRESS + 11 /-}'?' / `t='d` Class: J 7.Miscellaneous QUANTITIES AND STORAGE (IN= indoors;OUT outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground IN OUT IN OUT IN OUT #&gallons Age Test Fuels: Gasoline,Jet Fuel (A) , q. Diesel, Kerosene, #2 (B) Heavy Oils: ;z waste motor oil (C) S' new motor oil (C) transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: 7 , / IVY 4 r Rf°t1 "' 7� J10 71SP0SAL/R.ECLAMATI0N REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic y' Q On-site '!-'+''?"+�. 0'Private w -g f?4 fj-4 C�l I— Al � ,.�5+Y� .�4�.sx-i 3. Indoor Floor Drains YES NO O Holding tank: MDC f � O Catch basin/Dry well fig 1 t�— Z) 4)- '0 19 ;' ' -7 O On-site system 4. Outdoor Surface drains:YES N0,�- ORDERS: O Holding tank:MDC O Catch basin/Dry well O On-site system 5. Waste Transporter Name of Hauler Destination Waste Product 2. V Person (s) Interviewed Inspector Date AUTHORIZED SALES&SERVICE OMC DRIVE SYSTEMS AND MERCRUISER MARINESEflVI. Et �T ONICS C. PriaeGove$Mariria -• '"X } rt ., f:flow Clerk P.O. Box 338 Prince Ave. Tel:428-5885 Marstons Mills, Mass. TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair satisfactory 2.Printers BOARD OF HEALTH P 3.Auto Body Shops 0 unsatisfactory- 4.Manufacturers COMPANY (P�"�tiG� cow�o'di2�v (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS Z 3'�- c c da.,`j'bw Aec6CW Class: 7.Miscellaneous QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATERIALS Case lots Drums Above Tanks Underground Tanks IN OUT IN OUT IN OUT #&gallons Age Test Ftso7lie�jet Fuel (A) iese Kerosene, #2(B) sy K Heavy Oils: Z X waste motor oil (C) .14.6—)L- 0 new motor oil (C) /4 Tr I k transmission/hydraulic Synthetic Organics: degreasers Miscellaneous: DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply + l (4,r 0 Town Sewer fiOublic AS D5,h w -k f. ;6_0n-site DPrivate ., JL 3. Indoor Floor Drains YES—?<,NO 0 Holding tank:MDC 0 Catch basin/Dry well 0 On-site system pi,,_ 4. Outdoor Surface drains:YES NO_ ORDERS: 0 Holding tank:MDC 4 Catch basin/Dry well 0 On-site system 5.Waste Transporter Narne of Hauler Destination' Waste Product YES 0 2. //Ly/-IWX Person (s) Interviewed nspec or Da e TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.BOARD OF HEALTH o satisfactory 3.Auto Body Shops Q unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ip 7.Miscellaneous ADDRESS QUANTITIES AND STORAGE (IN=indoors;OUT=outdoors) MAJOR MATER 5 -ound Tanks / � 6 IN OUT IN I OUT IN JOUT #&gallons Age ITest Fuels: Gasoline Jet Fuel(A) Diesel, Kerosene, #2(B) Heavy Oils: waste motor oil(C) ` new motor oil(C) 14.6 transmission/hydraulic Synthetic Organics: degreasers G Miscellaneous: 90, ;57 DISPOSAURECLAMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic 0On-site OPrivate 3.Indoor Floor Drains YES-Y^ NO- 0 Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO - O ERS: O Holding tank:MDC O Catch basin/Dry well 40 O On-site system 5.Waste Transporter Name of Hauler Destination Waste Product Licensed? YES NO 2. ��el I ka::"&A�N Person(s) Interviewed In pector Date l TOWN OF BARNSTABLE COMPLIANCE: CLASS: 1.Marine,Gas Stations,Repair 2.Printers BOARD OF HEALTH O satisfactory 3.Auto Body Shops Q unsatisfactory- 4.Manufacturers COMPANY (see"Orders") 5.Retail Stores 6.Fuel Suppliers ADDRESS R 63'&5—i�Z5 � `Z�—ze,, Class: 7.Miscellaneous 4Vy QUANTITIES AND STORAGE (IN= indoors;OUT=outdoors) MAJOR MATER�S Above n _ f �t .-✓ IN OUT IN OUT IN OUT #&gallons Age ITest Fuels: Gasoline Jet Fuel (A) Diesel, Kerosene, #2 (B) Heavy Oils: waste motor oil (C) ', new motor oil (C) transmission/hydraulic *-'IF ; Synthetic Organics: degreasers Miscellaneous. �� ell DISPOSALIRECI AMATION REMARKS: 1. Sanitary Sewage 2.Water Supply O Town Sewer OPublic Von-site OPrivate 3. Indoor Floor Drains YES � NO O Holding tank:MDC O Catch basin/Dry well O On-site system 4. Outdoor Surface drains:YES NO ORDERS: O Holding tank:MDC O Catch basin/Dry well c O On-site system 100, 5.Waste Transporter Name of 14auler Destination Waste Produc' t' icense YES NO 2. -17 Person(s) Interviewed In pector Date