Loading...
HomeMy WebLinkAbout0040 WINDLASS LANE - Health q LOT #13 40 WINDLASS LANE, CENTERVILLE 1 M-Q- E w USA iE sun 0 0 ® o f I i I i . Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. A. General Information ] 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification 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 ,w- V- sewage,disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of 6� Title 5.(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails r�w ❑ Needs Further E uation by the Local Approving:Authority zzf W 7-7-10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****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. I --�/I� 40 windlass Centerville•03l08 Title 5 Official Inspection Form:Subsurface Sew4Disp System•Page 1 of 15 ti Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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: System is in good working with no sign of failure.. 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 40 windlass centerville•03/08 Tittle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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. 40 windlass centerville•03108 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent 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: 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 '/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. 40 windlass centerville•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No . ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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 design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D.- 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 ❑ E 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. 40 windlass centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 16 Commonwealth of Massachusetts - Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is Centerville MA 02632 7-6-10 required for every page. City/Town State Zip Code Date of Inspection C. Checklist 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? I ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ 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 CM 15.302(5)] 40 windlass centerville•03/08 Title 5 Official Inspection Form:subsurface Sewage Disposal system•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No i Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 7-2010 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 40 windlass centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of inspection D. System Information (cont.) General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No 40 windlass centerville•03/08 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 36"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints,venting, evidence of leakage, etc.): Good condition. Septic Tank (locate on site plan): Depth below grade: 30"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 1500 gal Sludge depth: 12 Distance from top of sludge to bottom of outlet tee or baffle 20 Scum thickness 0 6- Distance-from top of scumto top:of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape 40 windlass centerville•OWN Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): 40 windlass centerville-03/08 1Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: , Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 40 windlass centerville•03/08 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'w 40 Windlass Ln M ' Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 2-36'x4'x2' ❑ 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.): Leach trenches in good condition with no sign of back-up or break-out. 40 windlass centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Windlass Ln Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Cesspools (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 ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (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.): 40 windlass centerville•MOB Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 40 Windlass Ln 'M Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. bC.f4gy i � C O 7 3 U yII i s a 3Y'3` �3- - 3�' '13'7.. A-�r- 3yf Q-f 7�` 40 windlass centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 40 Windlass Ln M Property Address Alan Simoneau Owner Owner's Name information is required for every Centerville MA 02632 7-6-10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10 feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ® 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: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. I 40 windlass centerville•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 Hazaydous Materials Inventory Sheet Checklist t/ Date Physical Street Address-Check database to ensure it exists ._'Working Phone Number �L Actual Amounts—(i.e.gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) Storage Information—location of storage,how long is storage for? f 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?—provide a vehicle washing policy and explain it—note that it was given. 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 (/ J TOWN O1~BARNS'TA.BLE .00ATION T� VL° �+ 4 S� `� SEWAGE #' 1YLLAGE ��`� f e�J.:l le ASSESSOR'S &LOT NS3;,L ER'S NAAM&PHONE NO. ;E171C TANK CAPACrrY 15S()D _ .FACkiING'pAOIH.I'I`Y: (size) 10.OF'BEDROOMS y MILDER OR OWNER IERMITDATE: COMPUANCE DATE: separation Distance Between the: rlaximurn Adjusted Groundwater Table to the Bottom of Leaching Facility Eect 'tivatc Wator Supply Well and Leaching Facility (If any wells exist on site or within 20,0 feet of leaching facility) ee;4 lldge of Wetland mid Leacigng Facility(If any etlands'exist within 300 feet f leaching fuci�V)/ -urnishcd by._1-5,�,,,41 /UI = v 31. - o c 1� TOWN OF BARNSTABLE Date: /U / /7 A TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: *A. BUSINESS LOCATION: 40 41Indlass L-Cnc C'err[Arville 03.43), INVENTORY MAILING ADDRESS. 1 ,d •0®-� 1313 Qnnis A. 41.6,01 TAL AMOUNT: TELEPHONE NUMBER: go r'a"d, -J a- �1t 11(6 ' NTACT PERSON: _ �AERGENCY CONTACT TELEPHONE NUMBER: d -�Ly'���� MSDS ON SITE? TYPE OF BUSINESS: C I-cr, _1n tr ILLS INFORMATION/RECOMM DATIONS: Fire District: Waste Transportatio Last shipment of azardous waste: Name of Hauler- Destination: Aft A Waste Product: 140u a r® Licensed? Yes No NOTE: Under the provisions of Ch. 111, ection 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 cleaner p Automatic transmission fluid DisinfectantsA cc Engine and radiator flushes Road Salts (Halit Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbici es, ro&�tici&'�s) Gasoline, Jet fuel, Aviation gas Photochemicals (Fix s) 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 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): 6 Laundry soil & stain removers NIA (including bleach) 6 Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers I Windshield wash WHITE COPY-HEALTH DEPAR ZCANARYCOP)Y-BUSINESS YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates (cost $30.00 for 4 years.) A Business Certificate ONLY REGISTERS YOUR NAME in iry town (which you must do by M.G.I.- it does not give-you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is requi ed by law. n 4 Fill in please: Date: JQ / 0 M APPLICANT'S NAME: MR �a.5 r r S ?* � '7- W�7 . YOUR HOME ADDRESS: �Q W rnelcsS Lane, t BUSINESS TELEPHONE 30Q g0 A rig HOME TELELPHONE # 30 3L4 Iii .s NAME OF CORPORATION: NAME OF NEW BUSINESS 70S{ h (R. iraS C eanln� pri�r� C�a�l TYPE OF BUSINESS( IS.THI$ A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS CIO G1i last 1�anj (�r}{cryillt M A 0a43), MAP/PARCEL.NUM BE (Assessing) When starting a new business there are several^things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is 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 town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has en informed the pe requirements that pertain to this type of business. PLY NTH ALL tfibrlied Sign u * HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHOR TY This individual V b en infq e0•of the .n i r �ements that pertain to this type of business. Authorized Signature** COMMENTS: l a I 6 •t~'Z - 9 �6s - 9 Z104 - h E 916B - /7 al � a-J- TOWN OF BARNSTABLE LOCATION o L VII.LAGE C SEWAGE # f!L ASSESSOR'S MAP& LOT ` /9 2 INSTALLER'S NAME&PHONE NO. 0 19 SEPTIC TANK CAPA L cIIY /s-o o C- LEACHIIVG FACILITY: (type) 2 LF o ' i RIC �r u srsize) 34 NO. OF BEDROOMS _ BUELDER OR OWNER PERMITDATE: 2-/6- COMPLIANCE DATE:— 7- /-7 Separation Distance Between the: 9 Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Private Water Supply Well and Leaching Facili Feet on site or within 200 feet of leaching facility) �any wells exist Edge of Wetland and Leaching Facility within 300 feet of leaching facility) (If any wetlands exist Feet Furnished by Feet RICHARD J. JUDD, R.S. Professional Sanitarian 775 Freeman 's tray Brewster , Massachusetts 02631 (508) 896-8615 July 201 1998 Mr. Gerald Gunning' Health Director Torn of Barnstable 367 Main Street Hyannis, MA 02601 Res Certificate of Substantial Compliance Mark Franciosi 40 Windlass Lane Centerville, Massachusetts Dear Mr. Dunninq: As per your request and in accordance with 310 CMR 15.021 (3) of the D.E.P. State Envoronmental Code, Title 5, I am addressinq this correspondence to you directly regarding the abode captioned Project. I hereby Certify that the existing Sanitary Subsurface Sewage Disposal System has been installed in Substantial Compliance with Design Plan by Richard J. Judd, R.S. If I can be of any further assistance to you on this matter , please do not hesitate to contact me. ' Respectfully submitted, Richard J. Judd, R.S. a No. r _3F e Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipprication for Mgpogai &pgtem Congtruction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 2 Complete System ❑Individual Components Location Address or Lot No. Lot 13, 40 Windless Lane Owner's Name,Address and Tel.No. Assessor's Map/Parce Centerville, MA Mark E. Franciosi ]Plan Book 236 Page 127 49 Amos Road, S. Yarmouth, Ma Installer's Name,Address,andjel.No. 912 J' �7 Designer's Name,Address and Tel.No. C ��' „t✓G "7 Richard Judd, 775 Freeman's Way c •70--,q 04)6 �� F Brewster, MA Type of Building: Dwelling No.of Bedrooms 4 Lot Size 15,001 sq.ft. Garbage Grinder W Other Type of Building 1 story, sing, of Persons / Showers(2 ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 4 ,,;, :?,' Number of sheets Revision Date Title Size of Septic Tank z5-00 Co Type of S.A.S.12 Y VAI X Z Description of Soil See :2 NING ENGINEER WRITING INSTALLATIO INSTALiD IN STRICT ,, Mature of Repairs or Alterations(Answer when applicable) THE ^wE1(M�CW�{AS ACCORDANCE6 , 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 s tem in operation until a Certifi- cate of Compliance has been issued b this B and Health. Signed Cl- Date Application Approved b _ Date. ` Application Disapproved for the following reasons Permit No. _ Date Issued TOWN OF BARNSTABLE -a ° LOCATION o W;.) LeS'S LA4e., SEWAGE # 9S7 - 3 06 VILLAGE C c,,,`?"e��, y tLLe ASSESSOR'S MAP & LOT -� �9®9 q INSTALLER'S NAME&PHONE NO. R g tao 141 S LJG 77F-0 y 1/y SEPTIC TANK CAPACITY l S-0 d G 5"T " LEACHING FACILITY: (type) Z LE4okIA"),9 `rfir#J_a9Msize) 3C'x NO.OF BEDROOMS BUILDER OR OWNER 1AA iA A k 1C AAJC_J oS% PERMITDATE: rI-/c~ 4r COMPLIANCE DATE: % J'1 IF Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by L6 9 z No. Fee/ f'n 4171 � THE COMMONWEALTH OF MASSACHUSETTSEntered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEf` MASSACHUSETTS Yes Application for 3ME;pooal *p$tem Con$truction Permit r � Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) 19Compiete System ❑Individual Components Location Address o4ot No. Lot 13, 40 Windless Lane Owner's Name,Address and Tel.No. Assessor's Map/Parce Plan Book 236Centerville, MA Mark E. Franciosi ,, Page 127 49 Amos Road, S.:-Yarmouth, Ma Installer's Name,Address,al Tel.No. Designer's Name,Address and Tel.No. �� �� Richard Judd, 775 Freeman's Way Brewster, MA D.v 06 Type of Building: Dwelling No.of Bedrooms 4 Lot Size 15,001 sq.ft. Garbage Grinder(J✓r Other Type of Building 1 story, singjg0. of Persons / Showers(2 ) Cafeteria( ) Other Fixtures ` Design Flow to d 4 a e gallons per day. Calculated daily flow ,y yy gallons. Plan Date A- Number of sheets Revision Date Title 1 Size of Septic Tank /S'a 0 a s Type of S.A.S. 6 L X VAI X Z P j� Description of Soil 7/RFA/C Y e.V Sic .7/lari Nature of Repairs or Alterations(Answer when applicable) 4 V l Date last inspected: Agreement: 4 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 gstem in operation until a Certifi- cate of Compliance has.been issued by this Board Health. _ s Signed S gnV Date t APPlication Approved by - s rs � � A plcationrDisapproved for the,following reasons Permit No. E Date Issued '� y� THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ) Repaired( )Upgraded ( ) Abandoned( )by at D 1W has been Construc d ' acc rX cge with the provisions of Title 5 and the for Disposal System Construction Permit N dated Installer Designer The issuance of this permit shall not a construed as a guarantee that the system wil function as designed. Date - / - Inspector ------- -----Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MiOPOMI *Pe;tem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( )Abandon( ) System located at 40 Windless,Lane, Centerville, MA and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit; Date: - / - / Approved by Q 1°` l i Zoning Classification °� -CO OCU Zone: RC Zoning _ o EXISTING SEPTIC SYSTEM ' RESERVE LEACHING AREA CB/Disk Min Front Setback 20' a � x FND per 1998 As—built, 40' X 10' X 2' Health Department' Records, Min Side Setbock 10' oia GoQc• o�ca 444—GPD /0 0, o #98-306 Min Rear Setbock 10' sf°9 0 S 7 O' , c o• �? 42 E 1 Deed: Book 24,720, Page 157 '7 Plan: Book 236, Page 127, Lot 13 CB/Disk �� LEGEND FND 0, o� , - - • - - - - - Existing Building �, Edge of Driveway rram�, Q q �1 CL � OS CV �J �e Overhead Utility Lines Ij� sir r� jco CBNDDH e Electric Meter IT ' � �. ��� F gm GoMeter •ha7 Overhang 1? 1' 11. a `'r u 00 �P rti 0� // t r w °� r L = per own r e � Q` � � LL �0�p�L�1 le car 0 Q .Patlo „o , PROPOSED POOL 1 00 IV) - See Plan b Shoreline Pools, Inc. d• ONV em 4 y 9m o) M . ONO l� H EXISTING SHED 1- � Q ONv LOT 13 3 to be Felocoted 15,001 sFt o PROP05ED CONDITIONS PLAN ce/DH or 0.34 Acf o ;0 FND 1 ,, 40 Windlass Lane 126. 'w Barnstable (Centerville), MA N 79'18730" h/ o J David and Carolyn Tinsle ASSESSORS RL SHEEL 19-079 SHEET i Existing Patio $ �ZH OF -NK OF ttgs DAM' EROMP to be removed �`� S$4, ��'� s9Qy 09/26/2019 19-157 o� MICHAEL ti� ° RICHARD G SCALE: 1"=20' or modified �� S. J. � 0 20 40 60 Potential Shed i DUE C JUD J . �' Moran Engineering Associates, LLC Re—location ation o. 375 941 Route 28 N PO Box 183 e o �P ✓ �G/ F South Harwich, MA 02661 0 2019 Moran Engineering Associates, LLC lgNO UR.���� SgNiTAR�P� 508-432-2878 foP of.fo calf iron sch. -40 P v, Pi Pe- w1mii Pitch �14."PE N q1 'zz/ a I 1 P 1 ��'�`' �- TO i t r 4; o o. 0 t� I ' DR►VEWA/ o�,scAB i a..Q \ o 2 ,�� 30 -� _�PROP y c,EDRDo�� 1 � T•0 F ' SH,oS Iel ILI F. •A 0 s z J ,� i. � �• _D - I��I •�r � .r _ NIgyygfl� �. I `M) A � LOT= IS � S �l s a. I r �.5-1�� -�(vi �l_�� 9 fJI,G A AJ y�j �� �` t LEGEtiJ!> �yP• ex%sf-inq spot elev. - 0.0 contour = -- — -- — tir w 1 V �yP. Prof• firs. spot elev. prop. f ir7. con-four o o--- - rest hole location , -�- L /';I A P 5c�9Z_E: _ 1 1 2 3 4 5 6 7 8 9 10 11 12 REVISIONS REV ZONE DESCRIPTION DATE: A A 55' BREAKFAST NOOK B OUT B BEDROOM MASTER BEDROOM LIVING ROOM 00 C f 00 KITCHEN o C 010 BATH 0Li CLOSET 38'-6„ T`1 MASTER BATH BEDROOM LAUNDRY 40 HMO, 51 ' o O O DINING ROOM OUT lz UP DOWN BEDROOM E E rn GARAGE 18 F F 0 21 ' No. REQ. PART No. DESCRIPTION REMARKS G LIST OF MATERIALS G FLOOR PLAN THESE DESIGNS AND SPECIFICATIONS ARE NOW AND DO REMAIN THE PROPERTY OF HEGER DRY DOCK, INC. USE OF THESE DESIGNS OR REPRODUCTION OF THESE DESIGNS WITHOUT OUR EXPRESS WRITTEN PERMISSION IS PROHIBITED. SCALE: 1 /4"=1 '—O" CLIENT HEGER DRY DOCK, Inc. DRY DOCK ENGINEERS DESIGN,INSPECTION,DIVING AND CERTIFICATION PROJECT 13 WATER STREET HOLLISTON, MA 01746 (508)429-1800 TITLE 40 WINDLASS LANE H PROJECT DATE 0000—D 05 30 11 H CEN TER VI LLE MA CHECKED BY SCALE DRAWING UNITS M. PROCTER AS NOTED INCH FLOOR PLAN SUPERVISOR CAD FILE NAME SHEET SIZE R. HEGER 0000-00-00-00 D-22 x 34 DRAWN BY DIMSCALE LTSCALE DRAWING No. 0000-00-00-00 SHEET 1 OF 1 ISSUE A J. HOBART 48 18 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 REVISIONS REV ZONE DESCRIPTION DATE: A A 2X4 WALLS 16" O.C. R-13 INSULATION W/VAPOR BARIER B SEE DETAIL A—A B SEWER PUMP 4' SHOWER STALL O EXISTING o HEAT AND HOT WATER C BATHROOMce C 0 MEDIA CENTER POOL o TABLE 830 SQ FEET 6'—0" D D UNFINISHED 2'-8" AREA Cs o BAR O o 0 O OUT UP E E 0 DETAIL A- A SCALE: 3/4"=1'—O" F F BASEMENT FLOOR PLAN SCALE: 1 /4"=1 '—O" No. REQ. PART No. DESCRIPTION REMARKS G LIST OF MATERIALS G THESE DESIGNS AND SPECIFICATIONS ARE NOW AND DO REMAIN THE PROPERTY OF HEGER DRY DOCK, INC. USE OF THESE DESIGNS OR REPRODUCTION OF THESE DESIGNS WITHOUT OUR COMMWRITTEN PERMISSION IS PROHIBITED. CLIENT HEGER DRY DOCK, Inc. DRY DOCK ENGINEERS DESIGN,INSPECTION,DIVING AND CERTIFICATION PROJECT 13 WATER STREET HOLLISTON, MA 01746 9--% (508)429-1800 TITLE 40 WINLASS LANE PROJECT No. DATE H 0000—D 05 30 11 CEN TER VI LLE MA H CHECKED BY SCALE DRAWING UNITS M. PROCTER AS NOTED INCH FINISHED BASEMENT SUPERVISOR CAD FILENAME SHEET SIZE R. HEGER 0000-00-00-00 D-22 x 34 [DRAWN BY DIMSCALE LTSCALE DRAWING NO. SHEET OF ISSUE J. HOBART 48 18 0000-00-00-00 1 1 A 1 2 3 4 5 6 7 8 9 10 11 12 J 20 ��` to i rl. ` Coi-7C. 'vjm•4Ir4 G►'' cove!'S _ -4 cast iron or- L-EACHiNf.('._ I DES sch. 40 PVa pipe w1min. • •, 17.min foot :'.::. :::•::: 4 sch. 20 p v c pipe TM za �� A-Itdoo rain. p1te-her ff ENT F T o M EFFLUENT IL ER�Y WMAX. n c s O .._- LEVEL �'roFYg To FvA. • :F--- 55 �� 2 F'i 5D.03PITCH COVER Ae1►SToNE�WASHED� ';•' ir1 v a/. 10 .in _ TIf rENDCAPS ;� ,�Sh�d:. �9 PAP WI �. :;; 5�.3 �.501J god. stone base irrv. a% FF2c,rFvE I in el. Septic tank '�` 9.7 R GAS (3s~ �E._./ in e/. 9.3.'S oEwrH ry, O O O 11.5�i s ., _� •. •.r. -.-. .�a3� 72. FT. I E s.. :•c-fished„Stone, base;•;•; disf inv, e!, EFFECTIVELENGTHIlk R ' � box 4 FT. Ir 1 EFFECT1vE W1vnZj-7:c]Yz .0 TJ � 87 CRUSHED Gq,eg6 E �TotyE (WA SH ED) ° s SEWFaGE- SY'STE- M PJE Of/LE DRIVEWAY/ / E o.v sr...3B o So*�orH •oF PRoP, y FapgooM 4—af.s' - _ ptnllrl.L1NU 1 m � I pe •mac- '' QC S /GIV L:) 7-f3 2 -- s NUMBS R- OF ,BED)P-00r4S Zq 7 - STT H O L E L 0 G G/Ir2A,3AGC- '0/SPOSl94-' UN/7 : Nor ALLOWED (,�B W� �' G� Dt7wwtnlEr x� � �L °�s TO7 C-ST/MJ9T� l� FLOW dti//TA/F_ SSEO f3Y : RY PC-)2COLAT/ON )eF9TE : �L M/A/.//NCH 7 �I \o s� `l�l� GAL11m PEAFoR...mEJD ay r->gvr0 m,9s04., ,I ,QEQ. SEPTIC 7-J9NM Cl9PAC/7Y: GJ9L. Hoe- 1 HOLE Z _ -, AcrUA L SEPT/C TANK S/Z r- . 1-5 ? __- �� Lt�PGH/AIG P2�A R-E.: //cEMf_-AJTS �_ 3„ �j3G�t— NBC O-4" EOF'.6ANIG� -- - SIDE lt/A LL%{�(�tni- X := lid xw . J GFIl_, rt ivYx���, oyK�/Z• cc 11b'h r I 4- BOTTO/�f ✓ >{a l�_7 . . . ZD'%�. JJ 3-Sri 4oaMy SAND ,q_ g,r Lo O9 !_ ECl / G C ;PGT ' �rr ANQ T r=Q <9. 001 S.F• ate" GPL. �' 32„ L�;�rn 5nrro 5roNES E3-28s La SAN 15, CI 25y` wlr� C 1 26 ' s ,�E SEJ2VE L C-JQCN/NG CPP,9CI7-7- Y �3 W r rM• 9�X +-4 LX r`1c7 <?� MEUIur4 # STor;Eg MEDIvM ro SroNES ` GJ�L. COAP 56 COARSE SAN]> � 2,5y-7 \_ i FINE ALL wo�'KMAAISH/P A"D MPTEP-1,9LS q0-I�1 SAND SHPI L TO O.E.P. T/TL E- S A /U D THE ?'OWN OF t2UL E- S J91VO eC- GUL- P7-/ONS PGJ� ' SCJBSUreFPCE [�/SPoSAL. OF ' SPIV/ T/RP'Y SC-WJ9GC-. • ER R/ TE ' Z� GoMPt»lJ4A/CE IiV/TH 2OJV/NG JE' EGULJ9T/o/VS -�•—�--"=-- • _J_I°/_Ci-1�.oRiz-Oni_ _.- ___________._ SHJ9 L L. 8E• U&TE/2M/A/& �D SY B L//LC//VG �--99#I) MED-L4PR`,,E SAND �/J .' F� # �- /NSPE CToJ2 CoMM/SS IONS F�. , 3) EXISTING J9 /VD F//VFRL, GPADES SHALL a E.gNWATER. EntCAVNTETtED• 2EMP/N ASSENT/ ALLY THE SJ9M�. -��.►Z.LQ1�S0_�..+�1G.k►�!1-L1N6 T+iE.JNSTr�1�tr4riU1(r_7-HE__S�^�►irsa.t,IR�_.f� HE/hL r9TE APP20VC- 0 0. OF H E FI L T H AG & "7 / 7-E- P L... /:3 Ad o f f AR 0 F-> O S E- O G O�L,I S T UC T/O/L/ L ocAT IO N : - 40 WINDLASS LANF� ENr�zvlL_� 1`'Jr4 I R E-F E JE'_ E:- lV C C- : MAP 192- FARCE L 07 q 1 , T�- P L A l`/ P ie E P A,Ee f D F O/2 MAE� FEA n4 C I D S 1 /" =20 , sc A 4- I ;zo o,9TE : 511�19� � '; ICHA DS'cy� T�2E r'�l'(�'�1� By ' �P��NOF�Sn L EGE All ID R i 1� C Q o=� MICSAEL �N 1 �`� �` f . ex•istin s of elev = 0.0 � �' ) > �, 1 K�c?i> �u D ! I;• 5 , LADU S. yP i 9 P our = -- � 'fi —176 F)?ZE N5 a �No 0 eat sting coot s d `�' M� wA y prop. fin. Spot e%v. o. o _ s � prop. fin• contour - o o-- qNJ �Al L.O C AT/oh." MAP -test hole location ; -�-