HomeMy WebLinkAbout1971 MAIN ST./RTE 6A(W.BARN.) - Health �1971 Main Street/Rte.6A (W.Barn)
W. Barnstable P
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TOWN OF BARNSTABLE
TOXIC AND HAZAR
DOUS MATERIALS REGISTRATION FORM
NAME OF BUSINESS:
BUSINESS LOCATION: C '' (�)6 it 5 &Vn&A rh15 INVENTORY
MAILING ADDRESS: I �`�/ G l,r' & Vvk g— TOTAL AMO T:
TELEPHONE NUMBER: S� 0-
CONTACT PERSON:
EMERGENCY CONTACT TELEPHONE NUM ER: 5�� �` MSDS ON SIB?
TYPE OF BUSINESS: Pglr` C )��acto?- ,,�" iP
INFORMATION / RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
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 a month re uires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic or
hazardous characteristics and must be registered regardless of volume.
Observed / Maximum Observed / Maximum
Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive
❑ NEW ❑ USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
❑ NEW ❑ USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel,Aviation gas
Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED
Miscellaneous petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil ❑ NEW ❑ USED -
Degreasers for engines and metal Printing ink
Degreasers for driveways&garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Miscellaneous Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt& roofing tar PCB's
Paints, varnishes, stains, dyes Other chlorinated hydrocarbons,
Lacquer thinners (including carbon tetrachloride)
❑ NEW ❑ USED Any other products with "poison" labels
(including chloroform, formaldehyde,
Paint&varnish removers, deglossers hydrochloric acid, other acids)
Miscellaneous. Flammables Other products not listed which you feel
Floor&furniture strippers may be toxic or hazardous(please list):
Metal polishes - �rG'GG�✓�
Laundry soil &stain removers
(including bleach)
Spot removers&cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
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WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS Applicant's Signature Sta 's Initials
TOWN OF BAMSTABLE
,UkAr,0N 1011 I ✓mAil l f T SEWAGE #
VILLAGE �/`�• �3arns �� ASSESSOR'S MAP & LOTaI-9 O
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INSTALLER'S NAME&PHONE NO. 002
SEPTIC TANK CAPACITY tZ Ub
LEACHING FACILITY: (type) " P.7-; (size) r&4
NO. OF BEDROOMS 3 �►�o
l- G;C(. 1 ST'Dµ — Per
BUILDER OR OWNER !- 3 is a-VX S rl"
PERMITDATE: COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by
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COMMONWEALTH OF MASSACHUSET 1"ti tMS TABLE
EXECUTIVE OFFICE OF ENVIRONMfTAh AFFAIRS ;
DEPARTMENT OF ENVIRONMENTAL PRO ECTIO�NS
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TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 1971 Main Street '
West Barnstable, MA 02668
Owner's Name: Richard Grimm
Owner's Address: t-",w " ; V ro 6 Ci f)
Date of Inspection: April 20, 2005
Name of Inspector:(Please Print) James M. Ford
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. 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:, 4M
Date: April24, 2005
The system inspector sha\submicopy 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 1
Page 2 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1971 Main Street
West Barnstable AM
Owner: Richard Grimm
Date of Inspection: April 20, 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:
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
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Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1971 Main Street
West Barnstable, MA
Owner: Richard Grimm
Date of Inspection: Al2ri120, 2005
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: 1971 Main Street
West Barnstable. MA.
Owner: Richard Grimm
Date of Inspection: Aril 20, 2005
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''/2 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 l 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. 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 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
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Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1971 Main Street
West Barnstable, MA
Owner: Richard Grimm
Date of Inspection: April 20, 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?
✓ _ 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
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Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Richard Grimm
Date of Inspection: April 20, 2005
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): See plot plan on back page Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330
Number of current residents: 2
Does residence have a garbage grinder(yes or no): No
Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required]
Laundry system inspected(yes or no): No
Seasonal use(yes or no): No
Water meter readings, if available(last 2 years usage(gpd)): Unavailable
Sump Pump(yes or no): No
Last date of occupancy: Currently occupied
COMMERCIAL/INDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):
Industrial waste holding tank present(yes or no)
Non-sanitary waste discharged to the Title 5 system(yes or no):
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information: Never pumped-per owner
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:
Installed approximately in 1985-per information on file
Were sewage odors detected when arriving at the site(yes or no): No
6
Page 7 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Richard Grimm
Date of Inspection: April 20, 2005
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: 1200 gal• (per as built card)
Sludge depth: 4"
Distance from top of sludge to bottom of outlet tee or baffle: 28"
Scum thickness: 10"
Distance from top of scum to top of outlet tee or baffle: 4"
Distance from bottom of scum to bottom of outlet tee or baffle: 10"
How were dimensions determined: Measuring stick
Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Cement tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakaize.
The inlet cover was to grade. Recommend pump ng.
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: 1971 Main Street
West Barnstable, MA
Owner: Richard Grimm
Date of Inspection: April 20, 2005
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 D-box was level No solids were present 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
a
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Richard Grimm
Date of Inspection: April 20, 2005
SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required)
If SAS not located explain why:
Type
✓ leaching pits,number: 2-older pit was 6'x 6'w/3'stone: newer pit was 6'x 6'w/P stone
leaching chambers,number:
leaching galleries,number:
✓ leaching trenches,number,length: 1 -Y x 25'x 5'depth
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 older pit had 4'of liquid on the bottom. The newer pit had 2'of liquid on the bottom. The scum line appeared at the same
level. A video camera was used to inspect the pits. The covers were deep. There did not appear to be any signs offailure in the
pits or the trench.
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
OFFICIAL INSPECTION.FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1971 Main Street
West Barnstable, MA
Owner: Richard Grimm
Date of Inspection: April 20, 2005
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.
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Page 11 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1971 Main Street
West Barnstable, MA
Owner: Richard Grimm
Date of Inspection: April 20, 2005
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 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:
You must describe how you established the high ground water elevation:
Using Barnstable topographic and water contours maps, 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 warranty or guarantee that the system will function properly in the future. There have been no warranties
or guarantees, either expressed, written or implied,relating to the system, the inspection and/or this report.
11
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YOU WISH TO OPEN A BUSINESS?
For Your.Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in. the 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" FL, 367 Main St.,,Hyannis, MA 02601(Town Hall) and get
the Business Certificate that is required by law.
DATE: ZLI d .
Fillip please:APPLICANT'S YOUR NAME: �lG� L,v CTYI(�3-jdh
B SINESS YOUR OME ADDRESS: !
Flo �fsl
TPIEPHONE # Home Tele hone Number:
NAME OF NEW BUSINESS 'f:^ E yjr_ p-\,1 y, TYPE OF BUSINESS r'Gc
IS THIS A HOME OCCUPATION? YES NO
Have you been given approv I from the building divisign? ESN ADDRESS OF BUSINESS V1/e MAP/PARCEL NUMBER
I
When starting anew 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 been informed of any permit requirements that pertain to this type of business.
Authorized Signature** s.
COMMENTS:
2. "BOARD OF HEALTH
This individual h s informe�of rmit requirements that pertain thi
�--be��_ �( ,�;o this type of business. MUST COMPLY WITH ALL
Authorized Signature** I`MRDOUS MATERIALS REGULATION,.S
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual ha t e,�n infor ecEof the lii ng r gy�ire ents that pertain to this type of business.
Authorized Signature**
COMMENTS:
Hazardous Materials Inventory Sheet Checklist
ILjI o1 Date
Physical Street Address-Check database to ensure it exists
Working Phone Number
Actual Amounts -( ie. gas being used to fuel machines, thinner to
clean brushes all count as hazardous materials-no blanks)
Storage Information location of storage, how long is storage for?
If none, note that.
Disposal Information -where and who? If none, note that.
Applicant Signature -understand what is listed and noted
Staff Initial -any questions, know who to ask
Vehicle Washing/Rinsing? -give a vehicle washing policy and
explain it
Attach the Business Certificate with your sign off and comments
*"The inventory form should explain what the business consists of and the procedures
they are doing. Notes need to be left to explain what you discussed with them.
• Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
Ie
NAME OF BUSINESS: ,-e161P�►�
f B.USINESS LOCATION: I ;MAt r)+ a I INVENTORY
' 2 TOTAL AMOUNT:
MAILING ADDRESS: r
TELEPHONE NUMBER: *-j j (��
CONTACT PERSON: r i M rr
EMERGENCY CONTACT TELEPHONE NUMBER: 4-- ak ` i 3o93 MSDS ON SITE?
TYPE OF BUSINESS: �►. � �. ���
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use,
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS
The Board of Health and the Public Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maximum
Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes 7
y � ��1/a^� Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
NEW USED Any other products with "poison" labels
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor&furniture strippers Other products not listed which you feel
Metal polishes may be toxic or hazardous (please list):
Laundry soil & stain removersG�I�� J
(including bleach)
Spot removers & cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
., ,. Date:
TOWN OF BARNSTABLE
TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY
NAME OF BUSINESS: hc
BUSINESS LOCATION: 1 y �� r �Grr` �61e IN
MAILING ADDRESS: M/ lbVe f PLC TOTAL AMOUNT:
TELEPHONE NUMBER: 5D f-J �J h�hP
CONTACT PERSON: i dv",4
EMERGENCY CONTACT TELEPHONE NUM ER: 4-3 MSDS ON SITE?
TYPE OF BUSINESS:
INFORMATION/RECOMMENDATIONS: Fire District:
Waste Transportation: Last shipment of hazardous.waste:
Name of Hauler: Destination:
Waste Product: Licensed? Yes No
NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, r
storage and disposal of 111 gallons or more a month requires a license from the Public Health Division.
LIST OF TOXIC AND HAZARDOUS MATERIALS 1
The Board of Health and the Public-Health Division have determined that the following products exhibit toxic
or hazardous characteristics and must be registered regardless of volume.
Observed/Maximum Observed/Maxim.um
Antifreeze-(for gasoline or coolant systems) Misc. Corrosive
NEW USED Cesspool cleaners
Automatic transmission fluid Disinfectants
Engine and radiator flushes Road Salts (Halite)
Hydraulic fluid (including brake fluid) Refrigerants
Motor Oils Pesticides
NEW USED (insecticides, herbicides, rodenticides)
Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers)
Diesel Fuel, kerosene, #2 heating oil NEW USED
i
Misc. petroleum products: grease, Photochemicals (Developer)
lubricants, gear oil NEW USED
Degreasers for engines and metal Printing ink
I Degreasers for driveways & garages Wood preservatives (creosote)
Caulk/Grout Swimming pool chlorine
Battery acid (electrolyte)/Batteries Lye or caustic soda
Rustproofers Misc. Combustible
Car wash detergents Leather dyes
Car waxes and polishes Fertilizers
Asphalt & roofing tar PCB's
Paints, varnishes, stains, dyes S, Sa S Other chlorinated hydrocarbons,
Lacquer thinners (inc. carbon tetrachloride)
._NEW.___USE_ USED ._, FAny-other roducts-with poison" labels'' `- -
Paint &varnish removers, deglossers (including chloroform, formaldehyde,
Misc. Flammables hydrochloric acid, other acids)
Floor &furniture strippers Other products not listed which you feel
kr ^
Metal polishes may be toxic or hazardous (please list):
G/I�r
Laundry soil & stain removers �"•� �
(including bleach)
Spot removers &cleaning fluids
(dry cleaners)
Other cleaning solvents
Bug and tar removers
Windshield wash
WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS
No. (((///��' Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
21pprication for ;Mi!6poga1 6 gg M tonotructfon Permit
Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) O Complete System O Individual Components
Location Address or Lot No. Ci 7/ /Hj41 S r/ ®' owner's Name,Address-and
eTel./No.
Assessor's Map/Parcel � Z
G 3T—
Installer's N Ad s,and Tel No. ` Designer''ss Name,Address
and Tel:No.
c etc c�1�4 J �L2 W lu
Type of Budding:
Dwelling No.of Bedrooms 4- Lot Size I G A- sq.ft. Garbage Grinder( )
Other Type of Building S9.4 No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow W 4 0 C 116 0A oc-t4 gallons per day. Calculated daily flow 6 gallons.
Plan Date W A-/ Number of sheets Revision Date
Title
Size of Septic Tank /25' Type of S.A.S. A/Z:5 yt 92 ra 4f ti
Description of Soil 4-iw sC4 A4 Y t/C, .7` - Go a4,V Cq jj e,.-
Nature of Repairs or Alterations(Answer when applicable) 4do-i' !�XbarYl �O�wi�
Date last inspected: .2'X&v a -
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 an not to place the sys in operation until a Certifi-
cate of Compliance has been issued by this Board of HealA 4 .
Signed Date 7- �-�
Application Approved by Date
Application Disapproved for the following reasons
Oq
Permit No. Date Issued
No. Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
-—Yes
P`,UBLIGNEALTH DIVISION - TOWN OF BARNSTABLEs MASSACHUSETTS
'3pplication for ig ogaY 6p5t �Con�truction Permit ;
Application for a Permit to Construct( . )Repair(• )„Upgrade( Bandon( ) El Complete System ❑Individual Components
e
6
Location Address or Lot No. 7/ /t�A C� T wo uwper's Name,Address and Tel.No. f
Assessor's Map/Parcel �1 _ ���_ I� 4 V"C-�, (2 ►rK
Installer's Name,Addres and Tel. o, Designer's Name,Address and Tel.No
Type of Building: i�(� f4-
Dwelling No.of Bedrooms Q- Lot Size I ! A-sq.ft. Garbage Grinder( )
Other Type of Buildings No. of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow t_.l`"( y ( I I(,IVA gallons per day. Calculated daily flow L4 Ll b gallons. �
Plan Date Number of sheets Rev i ion Date
Title j
Size of Septic Tank /2 5 C-' Type of S.A.S. i Z),
Description of Soil 66> ,s-/s��L �P ���-� �, r /C gz
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected: A "
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 systeri in operation until a Certifi-
cate of Compliance-has been issued by this Board of Health.
•;Signed /-/ < /1 «` 'f �� >wi Date b
6
Application Approved by :'f Date �Jl
Application Disapproved for the following reasons 172
Permit No, Date Issued
C THE COMMONWEALTH OF MASSACHUSETTS
J 1 BARNSTABLE, MASSACHUSETTS.
Certificate of Compliance
THIS IS TO CERTIFY, that the n-site Sewage Disposal System Constructed ( ) Repaired( )Upgraded
Abandoned(
at "7 i-n S' - has bee onstructed in ccorda ce
with the provisions o Title 5 d th for Disposal System Construction Permit No. ted a�
Installer ��� �1/rSYtQ_✓ Designer
The issuance of this�ermj shall n-t be construed as a guarantee that the sys ' will t; s designed.
Date _ Inspector
—-) ---;--- —————————————————————————————
No. ` Fee 062� _/L2:)
-
THE COMMONWEALTH OF MASSACHUSETTS
A PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS
�1 Miopogal *p!6tem Con5truction Permit
Permission is hereby to o Co c ( )Repair( )U~grad ( P) IaZ� n )^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 mkst be Vompleted within three years of the date of th 1 i.
Dater Q Approved by
4 �.
oz
Obi r4
S.V-P C,,- -(�-� �e�- -L
'loots - R— kA
f
i
�.5 gyp✓r �7"" —� �—`�
RECEIVE®
TROY WILLIAMS t_ -
SEPTIC INSPECTIONS AUG 1 4 2001
asi E Certified by MA Department of Environmental Protection HEALTH DEPT. 508 385-1300
19 Hummel Drive
South Dennis, P4A 02660
COMMONWEALTH OF MASSACHUSETI'S
EXECUTIVE, OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENV
IRONMENTAL PROTECTION
"TITLE S
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
PropertN Address: 1971 Main Street
West Barnstable,MA
O-A ner's Name: Arnie Ctjala
Owner's Addres,. 1971 Main Street
West Barnstable,MA 02668
Date of Inspection: August 7,2001 O
Name of Inspector: TroyM. Williams
Company Name: Troy Williams Septic Inspections
Mailing Address: 19 Hummel Drive
Telephone Number: South Dennis,MA 02660
(508)385-1300
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 as performed based on m
P P P p y
training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP
appro,ed system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sv-ten).
Passes
Conditionall\ Passes
Needs further [:valuation by the Local Approving Authoni)
Fails
Inspector's Signature: 5�,,,-,, � ,_,,,.,z Date: 8 /7 /D /
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of I lealth 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
authorit).
Notes and Comments
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarantee of future working condition
of system,piping or components. This inspection represents the conditions of the system on the Date of
Inspection noted above.
""This report only describes conditions at the time of inspection and under the conditions of use at that
time. I his 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 pace I
Page 2 of l I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
1971 Main Street
Property Address: West Barnstable,MA
Owner: Arnie Ojala
Date of Inspection: August 7,2001
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
V/ 1 have not found any information which indicates that any of the failure criteria described in 310 CNIR
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 replaced or
repaired. The system, upon completion of the replacement or repair,as approved by the Boar of Health,will pass.
Answer yes. no or not determined(Y,N,ND)in the for the following statement . f"not determined"please
explain.
The septic tank is metal and over 20 years old* or the septic tank(w ther metal or not)is structurally
unsound, exhibits substantial infiltration or exftltration or tank failure is i minent. Svstem will pass inspection if the
existing tank is replaced with a complying septic tank as approved by a Board of Health.
*A metal septic tank will pass inspection if it is structurally sound, t 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 high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken, settled or u ven distribution box. System will pass inspection if(with
approval of Board of Health):
broke ipe(s)are replaced
ob ction is removed
stribution box is leveled or replaced
ND explain:
The system requ' d pumping more than 4 times a year due to broken or obstructed pipe(s). The system will
pass inspection if(w' approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
r
2
Page 3 of I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1971 Main Street
West Barnstable, MA
Owner: Arnie Ojala
Date of IwPection: August 7, 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 %ill pass unless Board of Health determines in accordance with 310 CMR 15.303 )(b) that the
system is not functioning in a manner which will protect public health,safety and the vironment:
_ 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 arsh
2. System will fail unless the Board of Health(and Public Wat Supplier,if any)determines that the
system is functioning in a manner that protects the public he ,safety and environment:
The system has a septic tank and soil absorption s tem (SAS)and the SAS is within 100 feet of a
surface x%ater supply or tributary to a surface water pply.
_ The system has a septic tank and SAS an the SAS is within a "lone I of a public water supply.
_ The sN stem has a septic tank and S S and the SAS is within 50 feet of a private water supply well.
_ I-lie system has a septic tank nd SAS and the SAS is less than 100 feet but 50 feet or more front a
private water supply well". thod used to determine distance
"This system passes if a well water analysis, performed at a DEP certified laboratory, for coliform
bacteria and volatile ganic compounds indicates that the well is free from pollution from that facility and
the presence of onia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria a triggered. A copy of the analysis must be attached to this form.
3. Other:
3
Page 4 of 1 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
1971 Main Street
Property Address: West Barnstable,MA
Arnie Ojala
Owner: August 7,2001
Date of Inspection:
D. System Failure Criteria applicable to all systems:
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
_✓ 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.
Ni,y Any portion of cesspool or privy is within 100 feet,of a surface water supply or tributary to a surface
water supply.
_ ^!A 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 50 feet of a private water supply well.
.v/.,) Anv 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 %%ater 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.)
N G (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as
de,crihed 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:
To be considered a large system the system must serve a facility with a esign 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 cri ria above)
yes no
the system is within 400 feet of a surface drinki water supply
the system is within 200 feet of a tribu o a surface drinking water supply
the system is located in a nitrogen s sitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone 11 of a public water supply ell
If you have answered"yes"to any q scion in Section E the system is considered a significant threat,or answered
"yes" in Section D above the larg ystern has failed.The owner or operator of any large system considered a
significant threat under Section or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner s uld contact the appropriate regional office of the Department.
4
Page 5 of I l
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Arnie Ojala-
Date of Inspection: August 7,2001
Check if the followine have been done. You must indicate"yes"or"no"as to each of the followine:
Yes No
information was provided by the owner. occupant, or Board of I l ald,
_ ✓ 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?
'Nero all system components, excluding the SAS, located on site
Were the septic tank manholeti 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) [3.10 CMR 15.302(3)(b)J
5
Page 6 of I I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Arnie Ojala
Date of inspection: August 7,2001
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN flow based on 310 CMR 15.203(for example: 1 10 gpd x#of bedrooms): 33 0
Number of current residents: v2
Does residence have a garbage grinder(yes or no): N�
Is laundn on a separate sewage system (yes o, no):..'0 [if yes separate inspection required]
Laundry system inspected(yes or no):_&[q
Seasonal use: (yes or no): Ayo
Water meter readings, if available(last 2 yearstisage(gpd)): 00 /�t Aouy gw����,s 9y= 45; 00jy
Sump pump(yes or no): No
Last date of occupancy: 0, ", ; I d.
COMM ERCIALANDUSTRIAL
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 syste/(yes no):
Water meter readings, if available:
Last date of occupancy/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:�++� } r , „�; pL}v._ y „� 1 0 , c,w.c✓,
Was system pumped as part of the inspection(yds or no): _Alo
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):
Approxim/ateLa-e of all components. date installed (if known)and source of information:
I(—IC� c,i�✓Ui° a h A 6)cc6 ��,.� w�r � .n Sift•Il.c.� u.. 5 131 7 7 (X /O
l S .r.n K.�u w^, t.t c-c. h �...r S li..�..t.c.✓� O l��/ r ./ C.O µ,pc-
Were sewageodors 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: . 1971 Main Street
West Barnstable,MA
Owner: Arnie Ojala
Date of Inspection: August 7, 2001
BUILDING SEWER(locate on site plan)
Depth belu�� grade: c� '4-
Materials of construction: _cast iron _Z40 PVC other(explain): ) cf— f
Digtancr fron. private water supply well or suction line: Al
Comments(on condition of joints, venting, evidence of leakage,etc.):
SEPTIC TANK: (locate on site plan)
Depth below grade: .3 o-s r 4-
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: S
Sludge depth: 51,
Distance from top of sludge to bottom of outlet tee or baffle:
Scum thickness: l o Y<r
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle: /I/
}-low 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.):
�ON[.✓t }.. �<.� r Gv+ t.ck yr�cl- b�fTlL l h tom, .»tr< Ja..� i ^ KJ..=_�• _h_
UrA<-✓. Al. e y1 c.41 �Ga�e,1..�e,.- e- eras..S� (../�•�-��+✓.�.�t GG✓1 K
no� 1 n A(,X 00 to--^r'-y vim+ �I t'+.�r .-�', IM s-. /
GREASE TRAP:_(locate on.site plan)
Depth below grade:
Material of construction:_concrete_metal_fiberglass /1yeth)lene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outle/etc.):
Distance from bottom of scum to bottom :
Date of last pumping:
Comments(on pumping recommendatione or baffle condition, structural integrity, liquid levels
as related to outlet invert,evidence of lea
7
Page 8 of 1 1
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Arnie Ojala
Date of Inspection: August 7,2001
TIGHT or HOLDING TANK: (tank must be pumped at time of i pection)(locate on site plan)
Depth below grade:
Material of construction: concrete metal fibergla __polyethylene other(explain):
Dimensions:
Capacity: gallons
Design Flo�� gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working ord (yes or no):
Date of last pumping:
Comments(condition of alarm and flo switches, etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Alo i
Depth of liquid level above outlet invert: I z v—)
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.):
ov+ It (tut�Ltr�.�/o cu fit« a c �.JuJ
10rc.$tn� µ ; /h . nc� .J/� ihf?cc I1oN.
PUMP CHAMBER: (locate on site pla/itionof
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber, s and appurtenances,etc.):
I
8
Page 9 of I
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Arnie Ojala
Date of Inspection: August 7, 2001
SOIL ABSORPTION SYSTEM (SAS): _,Z(locate on site plan,excavation not required)
If SAS not located explain why
Type 1 - Old<. G 'XG- ' L� �l-, to:�
leaching pits, number: o I - ' kG ' l_
leaching chambers,number:
leaching galleries,number:
leaching trenches,number, length: - 3 X 2 S 1c 5'd��,✓l L< c Try L, .
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.):�o, W[ S�r.A4 w '1Z C.�c ., . �a {<✓ vcaH .. �z b< I� v �-,f r. AU Io^ 6,t 4,, A
h. c. u.J h 1..�a,.•}-ti•�
CESSPOOLS: (cesspool must be pumped as pan of inspection ocate on site plan) J_ �� p�.s
p
Number and configuration s.t"o-.
__ _ fir,, �� � J<
Depth-top of liquid to inlet invert: c.H'A SG ,
Depth of solids layer. C o�.,J
►� 4- b
Depth of scrim layer: � c"r o.f-,x )r2 4-
Dimensions of cesspool: I / y,
Materials of construction: 5
Indication of groundwater inflow(yes or n s 5
yI'?-" ,
Comments(note condition of soil,sign f hydraulic failure, level of ponding,condition of vegetation,etcy
PRIVY: (locate on site plan)
Materials of construction: _
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic tlure, level of ponding,condition of vegetation,etc.):
9
i
Page 10 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
1971 Main Street
Property Address: West Barnstable,MA
Arnie Ojala
Owner: August 7,2001
Date of Inspection:
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.
_ GS;G ,, L? (,
Wwa� 6 A A L) N /off Y -
A I—
H
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(!. x �Z 'Io�Dg G lam_ ti tp.
L
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I
it
1
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• Page 1 I of 1 1
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1971 Main Street
West Barnstable,MA
Owner: Anne Ojala
Date of Inspection: August 7, 2001
SITE EXAM
Slope ✓
Surface water
Check cellar ✓
Shallow wells ✓
Estimated depth to groundwater y0+-feet Adjusted high ground water elevation 38 feet
Please indicate(check)all methods used to determine the high ground %%ater 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:
Checked with local excavators, installers-(attach documentation)
Accessed USGS database-explain: SOw .2 S.I Z uk, 1/7.Z , �L v'u J_)
You must describe how you established the high ground water elevation:
f'�O h„ � ) �O� -}t � c,• �n� t.. .i c+� Y_ L �c.i w 7j a�. /GU ))w��i 't� /�
6.J c.l( nr o >♦ S� .../. S 4vr.� w �v .T 1 G .B 7y f � S�.(,�a/
4rjs�t Mix 1 -✓ •+ - cA 7A7c I� �� L ti ti w�v I I�•�� GM
Cl.19� .
t� o t1 13.s
cU U
A-,
2.a
11
. ':1"6`C"A T�ION 1li71 SEWAGE PERMIT NO.
V I L L A G E
INSTALLER'S NAME a ADDRESS
p
GUILDER OR OWNER
qtAft AI.
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED `�
74WAt U-W rUL
v � -
�y 1 J
:FE$.. ram-.............
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
-k--........N..................oF... RCS-T. g....-......---------.....---.--..........
Appliratiun for Biiipuutt1 Works Totiutrurtiun rami#
Application is hereby made for a Permit to Construct ( ) or Repair (VQ an Individual Sewage Disposal
System at:
....n�,
. [tl..............................................................`C v 1 �--------------- -C? '.........................................................._...
iLocCat'Ion�A�drtessA - or Lot No..._ _.................. ....................__..._......--------...-•-•- -•-•-•.......__......._...... _. ..---------••-....................._...__...._
Q--.. O.r Address
............. _.
. ,
Installer Address
Type of Building Size Lot-..........._.I.....Sq.'feet
�. Dwelling—No. of Bedrooms____________________ .......:..........Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Buildin No. of persons.............._------------- Showers — Cafeteria
04
dOther fixtures -----------••.......................................... ...................................••-------••----•-•-•---................-•--...............
WW Design Flow...........5_�.._________________________gallons per person per day. Total daily flow........... ......................
WSeptic Tank—Liquid*capacity.PK.gallons Length................ Width:............... Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length..................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area---------------...sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
•" Percolation-Test Results Performed by.....:.:... = - --•-•--•-•-•--•----•-•-••...._.•..... Date.__......---•.............•••--•-_-•---
al Test Pit No. 1................minutes per inch .Depth of Test Pit.................... Depth to ground water........................ 3
Li, Test Pit No. 2................minutes per inch' Depth of Test Pit.................__. Depth to ground water........................ ``
ODescription of Soil......................•-•-•=--._.....--••----........--•---•---•---••--••--•-••---------•--••--------------.._..._................-•---•----.._._...------•----••_-••--
� .
W ••.-••-••••--•--•-------- ...................................................................•--------•-•--••----=-.......:-...........................................................................
UNature of Repairs or Alterations—Answer when applicable................................................................................................
._.:..--••-•-•--------------------------------•-•--•----•--•-•-•---•----..-.__...------...._........-_..----•-----•--------------•---••----•-••--•-•--•-------•-••-•---•-----------•--................
Agreement:
The undersigned agrees to install ttie aforedescribed Individual'Sewage Disposal System in accordance with
the provisions of LITL L S of the State Sanitary o e— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issuy t and of health.
Sined- + VC. .------ -•--...-•............................... .................... ._�
Application Approved By... ............
............... ........... ....................•-•--..._..._...-•----•--....
Date
Application Disapproved for the following reasons:.................................................................................................................
....................•----........--•---...--•=---....-----------••---•-•-...•--•-•-••-=-----•----........_.....---.._...-------._..__.......__..........._...__......_......-•-•-----••-•••-•..._•---•-
Date
PermitNo.......................................................... Issued...................=....................................
Date �Y
No..��...�'.��r1� Flck.. . •rJ..............._.'
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Appliration for Uhgp aal Workri Ton.itrurtion Vrrmit
Application is hereby made for a'Permit to Construct ( ) or Repair (V an Individual Sewage Disposal
System at:
R-�?5 �-' ................ - ... 7..................................................
-- ....
��.\���.� Location Address ± - or Lot No.
._�.
O er Address
w .. ............................................... +:--......--•.....................:..•-.------......---......------•......_........................
,., -.•-•.••••-
M Installer Address
Type of Buifding Size Lot_-a�__a ._..._Sq. feet
U Dwelling—No. of Bedrooms................... .......................Expansion Attic ( ) Garbage Grinder ( )
~ Other—T e of Building No. of persons.........:...:........... Showers
Pk —Type lg ....................•------• P --- ( ) — Cafeteria ,( )
Other fixtures •-------------•-------___--•......._•----•••--_.•.......
Design Flow........... ,$'_________________________gallons per person per day. Total daily`flow...______�_�_�__.____.._...._.___gal
W gallons.
WSeptic Tank—Liquid capacityAlk-`�..%._gallons Length................ Width_............... Diameter................ Depth................
x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No..................... Diameter.................... Depth below inlet_................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by..................•____...._..............___............................ Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch. Depth of. Test Pit.................... Depth to ground water........................
0 Description of Soil_..-----••..................:.••-•----•------....._._••••-------....--••-•---•--•-•-------•--------------•----•--.....:_._......... ..__.._.........._...
W ----•-•------------------------------------------- ....................................................=................................................................................................
VNature 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 TITL-_ 5 of the State Sanitary Fiofle—The undersigned fw•ther agrees not,,to place the sysiem-in
'operation until•a Certificate of Compliance has be'fi issued y th Fb ar&of health. Yr
_...._- -
ApplicationApproved By------•-•-•-. ...... ................................................................... �. ... ..............
Date
Application Disapproved for the following reasons---------------•--•-----._._.._....--------------------------.:...._...--•-•-••---------•-------.................
--••----•-•..............•-••--•----.-.....-----••••••------•---------.__...-----•--•-------•-•--•••----•..----••-•--•---._...__....---•-•-•-..__...--••--•-----••------..._._....-----..__..._••••___-•-
Date
PermitNo......................................................... Issued........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
,BOARD OF HEALTH
..........................................OF
Trrtfftratr of Toutphanrr
THIS IS TO TIFY That the Individual Sewage Disposal System constructed or Repaired
( )
�^ �"— Insta er
at................1.--• ..................................................V _J_ ftp
at ..........................................................
has been installed in accordance with the provisions of TIT L� �f Vw��te Sanitary Code as described in the
application for Disposal Works Construction Permit No ______________________________ dated............(12_�f�.��__�...._._._..__
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY. O
DATE...:.-^ .: �l _ _'�'.............•------••------....._....... Inspector..... �' �__ �.. l _1 _t eta/ ---•- .....
_ �.
-- - --------------- t �...... ..... ..........»
44
r THE COMMONWEALTH OF MASSACHUSETTS t�4 Yr
BOARD OF HEALTH
.,
�,. -S'7v ............ ,.
-
oF ........_ �
No........................ T.
Dtspoo Porks Tonotrudw, n prmit �. � 4 .
Permission is herebyranted..----_".................................� .__.____-•.-..__.'................................ ..........................:
g -
to Construc ( it i divid e S st
atNo................................. .......`- - •....-•- ...__._ ...._........._ _..._..-------•-----••-.....-- _- ----•- • ... ks---
w
�g. Street
as shown on the applied on for Disposal Works Co`i5struction Permit No D�t�d � �t
-...
Board of Health
DATE----------- --••�........................................................
-LOCATION SEWAGE PERMIT NO.
C,)&,4 ,f,of Rem? )40 cisd" �.
VILLAGE / Aj,¢iA.-O 3/- /97/
INSTALLER'S NAME & ADDRESS
AY04 Q 1 c .5f3'177
B UI*LDE R OR OWNERgat 46
p
T
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED .,
r�
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$o-G Loa SAL '
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ply E PA R E D FOR,`
d Z►.�E P.►,� MP-L-ODY O,lALA
-05CoQA.. !w: �oD DA47-11 3�2Q,j P�Cp
2 NEC EBY GECT/F Y TN�iT 77Ve- AVIA a.Ala-
SHOIV.t/ O,V TN/S PL,4,V /S LOG-,4TEa O,t/ :We- 7-1i_ N- OF lsgsf CAP I1( 71
y^.eoU.va 4i3 3NOWAJ NECB4 A./. / v-C
ARNE £ _V
4.
OJALA N�
1 f. #26348 0Q7
mown ce�oe cn9in�earir'y ,1 �aaF;��'fc►sTc�`�s� l
• ���a L
�OCJTE GAS-Y�BMOCJT�-/, M/753. f Z-.21,097.- •e�G. [.�i�vo st/ev�Trroe
�y .... Fimic .................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
. ..... ......-----OF..:....:.............................. .......................... .......... ...
, pphration -for J%ip oal Warkii Tontitrurtinn Vautit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
S stem at: I q 7
kvV,. ) _ _
Location-Address or Lot No.
Owner Address
-- R C 7
----•••• Q- �-----------v•----2 .......................
Installer Address 00
UType of Building Size Lot_ . --___-- -?__.___Sq. feet
Dwelling—No. of Bedrooms: _ ..............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building _Wo__ ckm?. No. of persons---------------------------- Showers ( ) — Cafeteria ( )
d' Other fixtures ----------------•--_-___-__-_____
Design Flow.... �f Pe'�o✓1..............gallons per person per day. Total daily flow....... 5 _----__________._.__.
W ...gallons.
WSeptic Tank—Liquid capacity------------gallons Length---------------- Width................ Diameter---------------- Depth:..,................
xDisposal Trench—No. .................... Width-------------------- Total Length.................... Total leaching area-.---------------- 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. 1................minutes per inch Depth of "lest Pit-------------------- Depth to ground water...----.-----..-_.......
fi Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--._-.--___-_-__--__----
---•-------------------------•---...------------------•-------•--•-•-------•--------------•---------..........................................................
0 Description of Soil---------------------------------------------------------------------------------------------------------------------------...--------------------- ---------------------
x
--------------------------------------------------------------------------------------- ---------- ma `s �._ h��_k.. � s --- -----
V Nature of Repairs or Alterations—Answer when 4---------
CovsM--- jcc----Co.2koc _---------------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be issued by t board 0i h th.
Signed-------- ----------- --e---- - --------- ------._.-----------•-------- --------------------------------
Date
ApplicationApproved BY----------- --A------=-------------------------------------------------------------------- ................... --- ----------
Date
Application Disapproved for the following reasons:----••--•--•---.....---••-----------•........................................................•-•••--_..---•--•--
-•-•.....-•--•--•-------•--••---•---•--------------------------------------------•---••--•-••-•-•--•-........------------•---------_.._........•----------....._...._...----_...-----------------------•.
Date
PermitNo......................................................... Issued................... ................................
Daatete
No............
.-.-.'r ;. Fus....... .
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
_.. ... .._.....-" .OF........,'..:. ..r.:N.............. ................
oliration -for Db,oviial Morks Tonotrurtion. rrotit
Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage ;Disposal
System at:.
r......S t---------------------------------------------------- L' !
[�A� ^�( /1L�o1caStion-A/d�dress -- or Lot No.
...7.7?R7?�=-�A;----a-.---.... !.T-�T'--'---------•------...-•-•---------•------- ------•--•-•----------------•-•
Ow r Address
�a ----.C.ca..... •---------- ----------- ----�' ------
Installer Address
Type of Building Size Lot: }_d . _Sq. feet
a Dwelling—No. of Bedrooms..__- _ _____--Expansion Attic Garbage Grinder
Other—Type
( ) .� ( )
of Building
owers ( ) — Cafeteria ( )
aOther fixtures --- --- - -- ---- •-•------ - --- ------ -=.
Design Flow__=�3'Qperc,Y►_____________ Mons er erson er da Total dail flow.__.._. _•+�__�__________________ - -
W g g P P P Y Y -gallons.
USeptic Tank—Liquid capacity------------gallons Length________________ Width................ Diameter_____ 1,: ......D.eptli._--______-_-
xDisposal Trench—No_____________________ Width.-..,--------------- Total Length-------------------- Total leaching are a----------:.........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 around water.--_______-______-_----
(z, Test Pit No. 2.............:_.minutes per inch Depth of Test Pit____________________ Depth to ground water......------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------
ODescription of Soil.... -------------------------------------------- ---------------------------------------------------------------------------------------------------------------------
-------------•-•---
V -----------------------------------------------•--••....---------------•-- ---------------------•-•--•---
W ---------- - ,r
---
U Nature of Repairs or Alte-rations—Answer when applicable'&_IkXt�'ftN�e____-
C> ,o , "E A t:4 J ' : _c.�, .- "`�'�t QI- ----- - -------- :.. ----------------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to-place the system in
operation until a Certificate of Compliance has be issued by t board oh tE,.
Signed_
Date
Application Approved By _._ - = -• ---- -------------------------------- ---------
Date
Application Disapproved for the following reasons:...................---------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_-----
Date
PermitNo............................... ....................... Issued......................--------------------•-----------
Date
*• THE CLfViIWONWEALTH O.F MASSACHUSETTS _ rive �{zf!/./ /T^
BOARD OF HEALTHY
............... . ............OF..............,, J?4.140. .......................................
Oiler#ifira#le of Ououtplia a
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired
Installer k
at----------- --`�'-:�-:t-- r-• '.iCr•-=--,.(' •.-----•---•' i !,/r'-iG2{.f/! L
has been installed in accordance,with the provisions"of-Article XI.of The State Sanitary Co as described in the
application for Disposal Works Ct,Vgtruction Permit No.___ y f....................... dated----.-. '• 1'". + _-
---------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT E CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL UNCTION SATISFACTORY.
DATD �� ----- Inspector -•- e ---• ----------••-•--------
L-
THE COMMONWEALTH OF MASSACHUSETTS .�Ll�
BOARD OF I- Q►LTH
... . ......O F............ ,*. A_f.rw11 e-...
Nb.--- ,�e1.q..---- FEE---• 1�.1.�.A..
..:� �i��o�tti ork� Cnono�riir�io�t fir-roti� {, ,r'
Permission is hereby granted----------------- 4i,,rA "------__---t--a-A------------------------------------ -__ 1 - -
to Construct ( ) or Repair ( an Individual Sekage Disposal System t r y
r>a'w
at No
,- ----------- ----- ---------------------------------
-
_ Street
as shown on the application for Disposal Works Construction Pier It No---- + ________ Dated___-__-5*_ 1,7l7_____________
f Health
DATE___
Boa o
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �
r
a «
I o�axe wr�c�s: X- XL n1 fT__A CG rJ �1 oR t1'W RLI.S---
LOFT AaoVc'iD RCr�tA1JV VIVF1nIt51fr�
'LUFT
I S� 3•EOL� UNFLNtsH,cJ .3�"U
f
r .
�N _ C_COS�:�... L�vtN(f/DrNtnlly ROpv..� a"' AI,
- 3oG-B r tk
d(oicg. 2Yy2.
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8.
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a 44'a. -r h lwrnctl
a __.._ - - ---
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q-LrG� .....
�Czo?vSe] sl L1"3 (N?G�c�-CMc
APPROVE BY: DRAWN BT
DATE: REUSED
) � P I I O7
C
I ln4b of ar�n1 P�r r/�✓¢r�'�q I��✓�r�G��
L-C-A 4v-u-
J ✓✓✓ /�f Oki � ORAW�NG NU MBER
i ,gecQN��, vn 44l�w ot�°vo¢. .3
c ;�(Jv5r-18'9 11 c U - '-
\\ J
J
off. 508-362-4541 �0 z
0 \ \ I fox 508-362-9880 F 0
\\\\� down cape engineering, inc. OAK ST. sA
CIVIL ENGINEERS
O \\ \\ LAND SURVEYORS
33.31
\ \ 939 main st. yarmouth, ma 02675 M LOCUS
\ \� LOCATION MAP (NO SCALE)
78 CODE CALCS
\ \ 440 GPD FLOW
3 440x 1.5=66 0 GAL 1( 250 GAL, INSTALLED)
\ \ 6x8 PIT 150.8 S.F. SIDES x1 .83=276 GPD
\ 28.3 S.F. BOTTOM xO.77=21 GPD
\\\ 602 PIT 226.2 S.F. SIDES0.83=413 GPD
EXIST. \ \ 28.3 S.F. BOTTOMx.77=21 GPD
BARN \\ -I_
�\ 25x3x4 TRENCH 200 S.F. SIDESx 1.83=366GPD
�\ �\ 75 S.F. BOTTOMx.77=58 GPD
\\ \ TOTAL=1155 GPD
\
95 CODE CALCS
GP \ 440 GPD FLOW
/ \ \ 440X2=880 GAL (1500 REQ)
8x6 EFF. PIT 150.8 S.F. SIDESx.74=1 12 GPD
50.2 S.F. BOTTOMx.74=37.2GPD
B6 0' O 602 EFF PIT 225 S.F. SIDESx.74=167 GPD
25x4x3 TRENCH 200 S.F.SIDESx.74=148 GPD
75 S.F. BOTTONx.74=56 GPD
TOTAL=520 GPD
/ pE) 1 \
—�._.v,
00
'9 S \
700
3 BEDROOM �' o L\1
(UND> SLAB) AT „----J- ► \
''A 1 l. 104.0. ' 102-
- G I 1
104—
PROPOSED
SLAB= 1 BEDROOM
107.0i IN—LAW APT. / / ```106—`
IN EXIST. BARN
� / O
DIRT DRIVE
/
o � /
LOT AREA
1 .16 ACRES
SI TET PLAN
OF
# 1 9 71 MAIN STREET
IN THE TOWN OF:
(VEST) BARNSTABLE
PREPARED FOR-
44 v
RICHARD AND KATHY Y GRIMM L�14AR
30 0 30 60 90 Feet �+ �o ARNEH o OJALA
.CiSCALE: 30' DATE: APRIL 14, 2005790 �c/ST
DATE
05-097 A "°� JALA, PE, ''/a`
r�
I
w BECEIVI
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