Loading...
HomeMy WebLinkAbout0050 WILLOW RUN DRIVE - Health 50 W141low .Run Drive , A = 210-069 Centerville — 1 r p. 1�1 I e No. 42101/3 ORA ESSELTE 10% (* O O O O � a � I 3 I i —z7, E d i jl i b F li f. 9 � f i e I T Y No. Fee 016 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:I I-, PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitation for Disposal *pBtEm Const rtion permit Application for a Permit to Construct( ) Repair(_1_11U*1`pgrade( ) Abandon( ) �mplete System ❑Individual Components Location Address of of No. 5-0wt ovw3 R JtJ r Owner's Name,Address,a�o. C_eN-Pfv tiff Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �.At ,-()r_.3 T IC. PV t v ee 4 ►ry S 60cul s Type of Building: Dwelling No.of Bedrooms 3 Lot Size aCj 110d sq.ft. Garbage Grinder( ) Other Type of Building PS No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) �j`djn gpd Design flow provided 3:2oO gpd Plan Date �lT,�y Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. CQ ('�,m o s Description of Soil Nature of Repairs or Alterations(Answer when applicable) a Ism qrd S tom* — knox AAM Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board Health. Signed - Date f f!A0 Application Approved by r 0 Date 0, /c, Application Disapproved by Date for the following reasons Permit No. 0 ! �' Date Issued 16 —('a 7 t � 1 'lI No. / f Fee Md �. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS V Y 2ppYication for ]Disposal �bpstem Construction Vermit Application for a Permit to Construct( ) Repair(0) Upgrade( ) Abandon( ) [/complete System ❑Individual Components LInstaller's Address or Lot No. 5-O tN��� �,� r Owner's Name,Address and Tel.No. .'Ji-P f V 0) e 's Map/Parcel f� Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms '2 Lot Size / sq.ft. Garbage Grinder( ) Other Type of Building (Pe,� � ��, N,o of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S!? gpd Design flow provided eg_10 gpd Plan Date pa Number of sheets �- Revision Date Title Size of Septic Tank /S( Type of S.A.S. 'j!u= aoyco r- b ( Description of Soil Nature of Repairs or Alterations(Answer when applicable) rn\� C, 1900 4-low {c� V X i Date last inspected: Agreement: s The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signe ` Date Application Approved by Date Application Disapproved by Date for the following reasons w Permit No. ' Qm-3 011 Date Issued�l THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(V< Upgraded( ) Abandoned( )by!:Z A AN T )r,- at Cr" �'.\, �.. .1 �� ( has been constructed in accordance t with the provisions of Title 5 and the for Disposal System Construction Permit No , Hof; - dated f 6 Installer D A J 0kh :1 c% _t ;. {Designer r<.�1 fnly-.F' ��C2 #bedrooms Approved design flow �T and a A (tte issu ee of this erm' shall not be construed as a guarantee that the system wi ct' as desi ed. ' Date Inspector --------------------------------f-----------------------------------------------------------=-------------------------------------------- No. 9 W �3q j Fee 1 THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS �is�Dsal �pstem onstruction'�ermit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit,'�— Date Approved by !' Town of Barnstable y o� Regulatory Services Richard V. ScaIi,Interim Director i63 9- Public health Division p ♦�' TEDM0.d� 'Thomas McKean,Director 200 Main Street,Hyannis,IMA 02601 Office: 508-862-,4644 Fax: 508-790-6'04 Installer&Designer Certification Form Date: Se`v g Permit# o201q Assessor's 1la:pil'arcel 21 C q -- 'l c �_ is �C V Desianer: L a1�Er�:n v r 41� Installer: ?J , a •. Ohl Address: Cr3rs C e/c/ 1Z�i Address: G 3G7c 1�� 5' _ -_�— ialct 'e G Z(1' � on 1p � L?rGk ��.►� was issued a permit to.install a (date) (installer) septic systeili at. �� �!lQrn► rZ`J" Pr C �vj- based on a design draw-n by (address ik_�_ dated S (designer) - __J�,/l certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution boa and/or septic tank. Strip Out (if required) was. inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes greater than 10' lateral relocation of the;SAS or any vertical relocation of any component of the septic. system) but in accordance with State & Local Regulations. Platt revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify,that the system referenced above was constructed in o > > with the terms of the l`,A approval letters Of applicable) �aller'sSi6a�ture) c►wt. .� � 1yp,3g109 (Designer's Signature) (,�ftix I3esior ere) PLEAS P: RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COTMPLLA CE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD .hRE RECER'ED BY THE BARNSTAI3LE PUBLIC HEALTH DIVISION. THANK YOU, ti:'.set:ric--Designer i::ertifio^.tion Form Rev 3-14-U.doc Engineers note:This certification is limited to an as-built inspection of system components as installed prior to 5ackfill.The engineer did riot supervise construction of the system.The installer assumes responsibisty focal)materials,workmanship,baekfilting to specified grades with proper compaction and setting riserstoovers as shown on the design plan. TOWN OF BARNSTABLE LOCATION 50 Wi A) 7,oro Dri ve SEWAGE# aQ IC( ' `59 VILLAGE ASSESSOR'S MAP&PARCEL ID-19[,�>q INSTALLER'S NAME&PHONE NO. fl ;Br0, L tJC SEPTIC TANK CAPACITY ]S70 p 14^)O r LEACHING FACILITY: (type) 2 S O ` ® (size) NO.OF BEDROOMS OWNER-A)o�e$ PERMIT DATE:iD -10 1 COMPLIANCE DATE: Separation Distance Between the: N GNC 4+- 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 4 ,I�(Q V.1 A� Z� 2- i4 i OUT--rf Cyr fr1 r 0 v Commonwealth of Massachusetts Executive Office of Environmental Affairs .Tohn GradD.E.P. Title V"Septic Inspector Department' of O. Box 2119 Environmental Protection (508) 5,�Teaticket,MA 025361 �t 64-6813 10� JUL 2 4 1997 N SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR Tp HDEpT PART AfAIT48tE CERTIFICATION 1 Property Address: 50 Willow Runt�enterville Address of Owner: Date of Inspection:6130197 (If different) S Name of Inspector:John Gracl Josephine Sion:23 Boblink St.w.Roxbury Ma.02132 Company Name, Address and Telephone Number: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes This inspection is based on criteria defined in Title V Conditionally asses code 310 CMR 15.303.My findings are of how the system is performing at the time of the Inspection.My Inspection does Nee/ubmit r Ev luation By the Local Approving Authority not Imply any warranty or guarantee of the longevltV of the _ Fail septic system and any of its components useful life. Inspector's Signature: Date: 7122197 The System Inspector shallcopy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C, or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) The septic tank is metal, cracked, structurally unsound,.shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 . FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50yulllow Run Centerville Owner: Josephine Sion:23 Boblink St w.Roxbury Ma.02132 Date of Inspection:6130197 Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four 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 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 the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 11/15195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 Willow Run Centerville Owner: Josephine Sion:23 Bobllnk St.w.Roxbury Ma.02132 Date of Inspection:6130197 D] SYSTEM FAILS(continued) 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for COliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 11115195) ` 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 50 Willow Run Centervil le Owner: Josephine Sion:23 Bobllnk St w.Roxbury Ma.02132 Date of Inspection:6130197 Check if the following have been done: X Pumping information was requested of the owner,occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. n1a As built plans have been obtained and examined. Note if they are not available with NIA. x The facility or dwelling was inspected for signs of sewage back-lip. x The system does not receive non-sanitary or industrial waste flow. x The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge, depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 Willow Run Centerville Owner: Josephine Sion:23 Boblink Stw.Roxbury Ma.02132 Date of Inspection:6.130197 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 gallons Number of bedrooms. 3 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: n1a Last date of occupancy: 8 Months ago COMMERCIAL/IIVDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title S system: (yes or no) No Water meter readings, if available: n1a Last date of occupancy: n1a OTHER: (Describe) n1a Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system x Single cesspool x Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1069 Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) 5 A' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Willow Run Centerville Owner: Josephine Sion:23 Boblink St w.Roxbury Ma.02132 Date of Inspection:6130197 SEPTIC TANK:_ (locate on site plan) Depth below grade: n1a Material of construction:x concreate_metal_FRP_other(explain) Dimensions: n1a Sludge depth:nia Distance from top of sludge to bottom of outlet tee or baffle: n1a Scum thickness:n1a Distance from top of scum to top of outlet tee or baffle:n1a Distance form bottom of scum to bottom of outlet tee or baffle: n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a GREASE TRAP: (locate on site plan) Depth below grade: n1a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: nta Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:n1a Distance from bottom of scum to bottom of outlet tee or baffle: nla Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) n1a (revised 11115195) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 Willow Run Centerville Owner: Josephine Sion:23 Boblink St.w.Roxbury Ma.02132 Date of Inspection:6130197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: nla Material of con struction:_concrete_metal_FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: rda Comments: (condition of inlet tee, condition of alarm and float switches, etc.) n1a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) nla PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)_ Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) nla (revised 11115195) 7 f � SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Willow Run Centerville Owner: Josephine Sion:23 Boblink St w.Roxbury Ma.02132 Date of Inspection:6130197 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: nla Type: leaching pits, number: n1a leaching chambers,number:n1a leaching galleries, number: n1a leaching trenches,number, length: n1a leaching fields, number, dimensions:n1a overflow cesspool, number:6'x6'black Comments:(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) The overflow is structurally sound and functioning properly.lt was empty at the time of the inspection. CESSPOOLS:x (locate on site plan) Number and configuration: one Depth-top of liquid to inlet invert: empty Depth of solids layer: nia Depth of scum layer: n1a Dimensions of cesspool: 6'x6' Materials of construction: block Indication of groundwater: n1a inflow(cesspool must be pumped as part of inspection) nla Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Main cesspool and all components are structurally sound.Recommend pumping system everyone year for maintenance. PRIVY:_ (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments. (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a (revised 11115195) 8 y + SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 Willow Run Centerville Owner: Josephine Sion:23 Boblink St.w.Roxbury Ma.02132 Date of Inspection:6130197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' IOU rr A A C> O PSI AA a� DEPTH TO GROUNDWATER Depth to groundwater: 12 feet method of determination or approximation: USGS Maps and Charts (revised 11115195) 9 Hazardous Materials inventory Sheet Checklist 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? 1111AIf 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. `RI YOU WISH TO OPEN A► BUSINESS? r For Your Information: Business certificates (cost$gO.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall] lf. � DATE: l r3 Fill in please: _ APPLICANT'S YOUR NAME/S: L h"'I:'_+�" '+r�.0- i ��" ' r Fa�E BUSINESS YOUR HOME ADDRESS: 50 w u 17Szi6c�;r,T' ravTr, �: i r,— a. �: i, :riaFeP 4,^. k':'n:e��q (feEci;n.Nisi{�'i3q'r".; r TELEPHONE # Home Telephone Number l�1L CU i S ,AC -0 h 4W It 0 1Z1 NAME OF CORPORATION: �S "If/ail NAME OF NEW BUSINESS v CiUVt rvc. TYPE OF BUSINESS Coh v a IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESSSy W,I fcsc wZL 6;E MAP/PARCEL NUMBER L O [Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth RBI. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDIN4GE OFFICE _ MUST COMPLY WITH HOME OCCUPATION This r YkAe of n er it requir-e�nants that pertain to this type of busine ULES AND REGULATIONS. FAILURE TG n /� n.PL.Y MAY RESULT IN FINES Si natuENT 2. BOARD OF EALTH ��VLkW L This individual has been inf �edh�errmit requirements that pertain to this type of business. Author ed Sign re** COMMENTS: MUST COMPLY WITH ALL DOUS MATERIALS.REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: y n0n::5fiIJfh6 di BUSINESS LOCATION:Q) (,ti` L(pu) QV44 1,)fL- INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: C� - CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: �O- -3G,q-5'7j�j MSDS ON SITE? TYPE OF BUSINESS: INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: NIA- 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 g 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 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 Applicant's Signatur Staff's Initials EXISTING cEssPooLs d LEGEND N 1 Wequaquet TO BE PUMPED, FILLED x 100.98 EXISTING SPOT GRADE Lake W/SAND & ABANDONED a7 -- 90 -- EXISTING CONTOUR 197 PG 100 x 99,16 PROPOSED CONTOUR \` s oc W EXISTING WATER SERVICE �a kvae f G EXISTING GAS SERVICE rh'eod ° zy `S, 3 Need/e e�ae A ` / --UGW UNDERGROUND WIRES o�Q0 �/ 99.2 TEST PIT / BENCHMARK S CORNER OF STOOP BENCHMARK Great Marsh Rd ,J �9 EL.=99.82 x 99,32 6 20" LOCUS / \\ ' 8 44• Route 28 P / INGROUND SWIMMING I PROPOSED LOCUS MAP / I SEPTIC TANK / 99.19 O POOL 98,6 NOT TO SCALE G, T +99,13 ! stoakoae f PROPOSED S.A.S. / eri�e 2-500 GALLON CHAMBERS / •�N 99, 99,12 ^ 98,39 SURROUNDED W/STONE +�cv 99,27 BM O O +h 97,62 Y / 1 99.43 99.82 99,1 GENERAL NOTES: 99.22 ,---PATIO��,: :' .:.,. 1 . .�_ 98,55 x : /" x 99,60 I x 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL �7 x8,76 DECK k 97 79 BOARD OF HEALTH AND THE DESIGN ENGINEER. / / :..: l I PORCH EX. SEWER-1 O 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS (� 99.53- lNV=97.4t EX; SEWER-2 \ :;;I OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE p� 713 0 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 98,97I�'� -310 CMR 15.405(1)(b): EX/ST/NG I.: TP-a__ 1) A 3' variance, septic tank to cellar wall (bulkhead), for \ I 99,48 HOUSE(#50) 11' O _ / for a 7' setback. 2) A 9' variance, S.A.S. to cellar wall, for an 11' setback. \�9.04 l T.O.F.=99.9f TP-2 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR \ + 98.69 + 98.79 \ GARAGE � D INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE J9 DESIGN ENGINEER. - J 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 99,22 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN �--�` 99.08 ENGINEER BEFORE CONSTRUCTION CONTINUES. 99.90 99'82 C 10 99.41 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. / WkK - G x I ,h 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF \ I C� 97,63 N /� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 99,00 9 80 // 100.05\\ W oN HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PARKING :PAVED:;..•`. �0o Lo� \ o 0 = 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. Dl?IVEWAY`': 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. 99,82 / 20,400f S.F. x 100,24 \ i +J 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS + - i AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 99,52 try \\ GC �a DIRECTED BY THE APPROVING AUTHORITIES. 99.87 99.680 \ O11 + i' 0.18 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 1 i THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING <-- -00.15 157 $ � �^ CONSTRUCTION. Q. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS ++ IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 08'5410 E `J 100.10 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 100.25 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 100,69 100.09 / INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. 100.01 13. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDUCUMENTED SEPTIC OF MRssq�ti WILLOW RUN DRIVE I SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. PETER T. ��, PROPOSED SEPTIC SYSTEM UPGRADE PLAN Mc 50 WILLOW RUN DRIVE, CENTERVILLE, MA � CIVIL CIVIL "' No. 35109 9 Prepared for: Norma Atkinson, 50 Willow Run Dr, Centerville, MA 02632 �! �` OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. ECKMAN, MICHAEL E & ATKINSON, NORMA Engineering Works, Inc. 1'+=20' P.T.M. 235-19 DA TE E N0. UN DRIVE Forest dale, MA 02644 CHECKED SHEET 50 WILLOW R E 12 West Crossfield Road, Fores da , S ► - MA 0263 9/5 19 P.T.M. PARCEL ID. 210 069 CENTERVILLE, 2 (508 477-5313 � 1 Of 2 II NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL. 96.0 PROPOSED SEPTIC TANK FOR A DISTANCE OF 15' AROUND THE PROVIDE RISER WITH FRAME & COVER OVER PERIMETER OF THE S.A.S. INLET & OUTLET MANHOLES AND SET OUTLET RISER PROPOSED D-BOX TO FINISH GRADE. OUTLET COVER SHALL BE SECURED INSTALL RISER & COVER PROPOSED S.A.S. TO PREVENT UNAUTHORIZED ACCESS. SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F=99.9t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=99.4t F.G. EL.=99.1 f F.G. EL.=99.1 f F.G. EL.=97.7 to 99.2f f--10--{ MAINTAIN 2% SLOPE OVER S.A.S. L1 = 53' DECK 2iv vi) L2 = 13' L = 13' L = 1 s't 11 h Q ® S=1% (MIN.) ® S=1% (MIN.) © S=1% (MIN.) (n 4"SCH40 PVC - 4"SCH40 PVC 4"SCH40 PVC 1 2" LAYER OF 1/8" TO 1/2" 0 I 6' DOUBLE WASHED STONE �� a N 6 88a8aa8 (OR APPROVED FILTER FABRIC) EXISTING ? �9 O 1 14" 2' EFF. aaaaaaa 0. '�' Of INV.=96.50 48" LIQUID DEPTH aaaaaaa --3/4" TO 1-1/2" DOUBLE HOUSE(IfW) 1CL LEVEL ADD GAg PROPOSED 2.6' 4.8' 2,6' WASHED STONE T.O.F.=99.9± BAFFLE INV.=95.90 INV.=95.73 INV.=96.25 D_BOx EFFECTIVE WIDTH = 10' " 3 OUTLETS INV.=95.50Jm O am PROPOSED SEPTIC TANK H-10 2-500 GALLON LEACHING CHAMBERS WITH STONE AROUND AND BETWEEN CHAMBERS AS SHOWN INSTALL PIPE CONNECT TO EXISTING SUITABLE SEWER PIPE/S H-10 RATED BETWEEN CHAMBERS SEWER NO.1, INV.=97.4t(VERIFY) TOP CONC. ELEV.= 96.80f Al 1 SEWER NO.2, INV.=97.3f(VERIFY) BREAKOUT ELEV.= 96.00 to 9 fflNOTES: INV. ELEV.= 95.50 easeW-�Iapomaaaaa Baaaa1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPES & aaaa aaaaaINVERTS EXITING HOUSE, PRIOR TO INSTALLATION. BOTTOM ELEV.= 93.502) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' OF NATURALLY OCCURRING 4' ENDS 8•s' SEPTIC LAYOUT TRUE TO GRADE ON A MECHANICALLY COMPACTED PERVIOUS MATERIAL EFFECTIVE LENGTH = 29.0' SIX INCH CRUSHED STONE BASE, AS SPECIFIED 5' ABOVE GROUNDWATER IN 310 CMR 15.221(2). LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. NO GROUNDWATER, EL.=87.7 - 3/4" TO 1-1/2" DOUBLE 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE WASHED STONE AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. rEaMru ® 0 SEPTIC SYSTEM PROFILE 3" LAYER OF HEED T ,E ®®®®® DOUBLE WASHED STONE � 33" (OR APPROVED FILTER FABRIC) N > Z ®®®®®®®® ✓� 102" SOIL LOG DESIGN CRITERIA DATE: SEPTEMBER 4, 2019 (REF#TPT-19-128) lb 3 l� 4" KNOCKOUT 0 SOIL EVALUATOR: PETER; McENTEE SE#1542 I / 20" IA COVE NUMBER OF BEDROOMS: 3 BEDROOMS WITNESS: D-O D_DESM ALTH AGENT D R SOIL TEXTURAL CLASS: CLASS I (LOADING RATE=0.74 GPD/SF) L - __--�-ELEV. - " E EV. T P � DEPTH EL T P 2 DEPTH0 DESIGN PERCOLATION RATE: <2 MIN IN 011 4" KNOCKOUT 4 KNOCKOUT 5g / 0„ 99.2 •�99.4 A A DAILY FLOW: 330 GPD LOAMY SAND LOAMY SAND DESIGN FLOW: 330 GPD 98.7 10YR 4/2 10YR 4/2 GARBAGE GRINDER: NO-not allowed with design B g 98.4 e 12" 4" KNOCKOUT LOAMY SAND LOAMY SAND ' LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 10YR 5/4 10YR 5/4 500 GALLON CAPACITY, H-10 LOADING .74 GPD/SF 96.2 36" 96.4 36" PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY C PERC C CHAMBERS PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-10 RATED F-M SAND 34 /521 F-M SAND 2 5Y 5/4 2.5Y 5/4 USE 2-500 GALLON LEACHING CHAMBERS IN SERIES WITH d3,.�' >20% GRAVEL FC >20% GRAVEL PROPOSED SEPTIC SYSTEM UPGRADE PLAN STONE AROUND AND BETWEEN CHAMBERS (10.0' x 29.0') 39c�- C 84 ( C 84" 50 WILLOW RUN . DRIVE, CENTERVILLE, MA SIDEWALL AREA: 2(10.0' + 29.0') X 2 = 156.0 SF MED. SAND MED. SAND BOTTOM AREA: 10.0' x 29.0' = 290.0 SF 2.5Y 6/6 2.5Y 6/6 Pre pared for: Norma Atkinson, 50 Willow Run Dr, Centerville, MA 02632 <5% GRAVEL <5% GRAVEL SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................446.0 SF 87.7 138" � 87.9 138" Engineering by: Engineering Works, Inc. N.T.S. P.T.M. 235-19 PERC RATE <2 MIN/IN. "C" HORIZONS 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(446.0 SF) = 330.0 GPD NO GROUNDWATER ENCOUNTERED (508) 477-5313 9/5/19 P.T.M. 2 of 2