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HomeMy WebLinkAbout1271 SHOOTFLYING HILL RD - Health 1271 Shootflying Hill Road Centerville A= 190— 111 SMEAD No. H163OR UPC 10259 smead.com • Made in USA y y Ha ardous Materials Inventory Sheet Checklist Date , Hazardous Street Address-Check database to ensure it exists t,_-Working Phone Number _(,,-Xctual Amounts—(i.e.gas being used to fuel machines,thinner to ,el'ean brushes all count as hazardous materials) i/ St rage Information—location of storage,how long is storage for? f none,note that. �/��V Disposal Information—where and who? If none,note that. _LIApplicant Signature—understand what is listed and noted. Staff Initial—any questions,know who to ask. Vehicle Washing/Rinsing?—provide a vehicle washing policy and Axplain 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. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. - Fill in please: Date: APPLICANTS NAME: t l NV VV H+�► YOUR HOME ADDRESS: �� E Sac 149 BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION: ; t 'NAME OF NEW BUSINESS . `c i L- IIL TYPE OF BUSINESS.. PAIPAP IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS I hI'i >'i�, CE►�iCt`ViA MAP/PARCEL NUMBER (7� i (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 20,0 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 C IONER'S OFFICE This individual h Leen ir�m d f any permit requirements that pertain to this type of bus' e - C�- MUS�9' 8bmPLY WITH HOME OCCUPATION Authorized nature _ - COMMENTS: &)ae- 2. MPLY MAY RESULT IN FINES. BOARD OF HEALTH This individual lrbZn info m of a per; it requirewm4ts that pertain to this type of business. Authorized Si ure** COMMENTS: HAZ4RD0USIIA-A-'— MTIO" 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: U /23 / 0 $ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: Sc 61 A IIV4 lN5 BUSINESS LOCATION: 1 �am -� c.1 (iU^� hl I R(� a CM(Ayik INVENTORY m MAILING ADDRESS: S TOTAL AMOUNT: V TELEPHONE NUMBER- 119S ZcjZC q�4S CONTACT PERSON: 11z2R�C A M 10 EMERGENCY CONTACT TELEPHONE NUMBER:___501 2 IZ 9445 MSDS ON SITE? TYPE OF BUSINESS: fjS 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 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 removersXIV 1UT1 VA el 6090 (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers etc Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r " COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ® DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Prop"Address: 1271 Shoot Flying Hill Road 1a Centerville Owner's Name: Karen MacCloud Owner's Address: 1271 Shoot Flying Hill Road Cpntervill Date of inspection Name or inspector:(please print) Sean Jones—, t _r Company Name: William E.~'Robinsori-Septic Service Mailing Address: P 0 Box 1 089 Centerville, MA Telephone Number: ( SO8) 775-8776 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information re c p�rtedr- below is true,accurate and complete as of the time of the inspection.The inspection was performed, ased on my training and experience in the proper function and maintenance of on site sewage disposal systems;l am a DEP 5 approved system inspector pursuant to Section 15340 of Title 5(310 CNIR 15.000). The system1 Passes 00 j Conditionally Passes co Needs F r uation by the Local Approving Authori = r-� Fails✓` Inspector's Signature: Date: _I 1 t e -:)00? 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. 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 I F• Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1271 Shoot Flying Hill Road Centerville Owner:_ Karen MacCloud Date or inspection.:_ Inspection,Summary: Check A,B,C,D or E/ALWAYS complete all of section D A. Syste Passes: 1 have not found an information which indicates Y m [cafes that any of the failure criteria described in 310 CMR 15.303 or in 310 CUR-15.304 exist.Any failure criteria not evaluated are indicated below. Comments: p„ 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'bat 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 ldgh static water level in the distribution box due to-broken or obstructed pipes)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 obsu LKted pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is rcmotrod ND explain: 7 Page 3'of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY.ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1271 Shoot Flying Hill Road Centerville Owner: Karen MacCloud Date of Inspection: . t o� C Further Evaluation is Required by the Board of Health: /1 / Conditions exist which require further evaluation by the 130ard 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 l 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 froul 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 r. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1271 Shoot Flying Hill Road Centerville Owner: Karen MacC oud Date of Inspection: 1 D. System Failure Criteria applicable to all systems: You must indicate"ycs".or"no"to each of the following for all inspections: Yes No/ _ ✓✓ ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or pondin&of effluent to the sur rice'of the ground or*surface waters due to an overloaded or _V/ 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 _ y 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 ater supply. _ y portion of a cesspool or-privy is within a Zone 1 of a.public well. o a cesspool r ri is within 50 feet of a rivate water supply well: _ �y portion fo privy p pp y i/ Any portion of a cesspool or privy is less than 100 feet but greater than 50 f et from a private%ater supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory.,for coliform'bacleria and volatile organic compounds indicates that the well is free.from pollution from that facility and (fie 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.) �J (Yes/No)The system fails.1 have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E: Large Systems:• . To be considered a large syst m 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 druuking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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 faded.The vwTtcr or operator of ally 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 o«-ner should contact the appropriate.regional office of the Department. 4 r Page 5 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1271 Shoot Flying Hill Road Centerville Owner: Kar n MacCloud Date of Inspection: 1 ;}off 7 Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Y No /umping information was provided by the owner,occupant,or Board of Health VWcre any of the system components pumped out in the previous two weeks?_ as 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? y 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 thje battles 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 maintenance of subsurface sewage disposal systems? on the proper The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ xisting 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 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1271 Shoot Flying Hill Road Centerville Owner: Karen MacClou Date of Inspection: o"? FLOW CONDITIONS RESIDENTIAL. Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x N of bedrooms):�6 P P Number of current residents:_ Does residence have a garbage gander(yes or no):N'v Is laundry on a separate sewage system(yes or no): A/0[if yes separate inspection required) Laundry system inspected(yes or no):�A Seasonal use:(yes or no): /V ti 2006 — 100,000 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Alt) ZUUb — 108, 000 Last date of occupancy: C%rrer'f- COMMERCIAL/INDUSTRIAL N ✓� 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-sanitarywaste 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: 0.—✓-cr- Was system pumped as part of the inspection(yes or no): y e j If yes,volume pumped:/.,L`� gallons—How was quant- pumped determined? S, 3e, ooc Reason for pumping: cl vc -�o Cwn e' 1 e.. e 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: // Were sewage odors detected when arriving at the site(yes or no):✓Vti 6 Pja c7of II OFFICIAL INSPECTION FORM—NOT FOR VOLUN'1'ARV ASSESSMENTS SUBSURFACE SELVAGE DISPOSAL SYSTEII'1 INSPECTION F0101 PART C SYSI'M INFORMATION (continued) Properly Address: 1 271 Shoot Flying Hill Road Cent ervi e Owner: Karen Mac ou Dale of Inspecllon: j j © BUILDING 5E1VEIl(locale on site plan) Depth below grade:. PIS i Materials of eonsliuclion: cast iron _ 0 PVC outer(explain): Distance from private walcr supply Dell or suction lint:_ Comments(on condilion of joints,venting,cvidcncc of leakage,etc.): SEPTIC TANK: ✓(locale oil site plan) Dcplll below grade: / Material of construction: ✓cunctcle ntctal fiberglass pUlycUrylcne othct(explain)� — — If tank al metal li certificatst age:— Is agc cunftrutcd•by a Certificale of Cunytliance Oyes or nu e) ) -(attach a cup}of . Dimensions: SluJgc depth. Dislance from lop of sludge to bullum of uullcl Ice or bafllc: Scwn thickness: Distance from top of scum to lop of uullcl ice or bafllc: -- Distance Gom buitum of scum to bosom of outlet Ice or ba111e: low wcre dintcniions Jctcnnincd: ' "^ 1 L Comments fun pumping recununcndalivns, inlet and outlet ice or bafllc condition,struciuial inicgrity,liquid lc%.cls as related to oullcl invert,cvidcncc of leakage,c1c.): ✓VS� •_-�a__r'' l r i.v Ca^� L'1 -i , Cyr"l I ILF , GIIEASETKAP.Itllocalc un site plan Depth below grade:— Malerial of construction:`concicle metal lberglass_pul).etltylene _outer (explain): — Dimcnsions: Scum thickrlcss: Distance from lop of sctu❑to lop of oullcl Icc or bafllc:_ Dislancc Gom bottom of'scum to bullum of uullcl Icc or bafllc: Dalc of last pumping: Conuncnls fun pumping rcconuncndalluns,inlcl and oullct tcc or bafllc cunditiv:t,sliuciuial iniglily,liquid IcN.cl, as related to oullcl iilcrl,cvidcncc of Icakabc, 7 Page 8 of I 1 OI.I.ICIAL 1NSPEC-1'I0N FORM -NOT FOR VOLUNTARY ASSESSI11ENTS SUDSUI ACE 8L11'AGL DISPOSAL SYSTEM INSPEICTION P-01ol PAM. C SYSTE111 INFORMATION�cuntinucd) ProperlyAddrew 1271 Shoot Flying Hill Road Cen ervi e Owner: Karen MacCloud U�It of Inspcclloo: � - a-j TIGHT or HOLDING TANK:�,4a%k must be pungred at time of ill slit ction)(lucate on site plan) Depth below gradc: Material of construction:__concrete_tttelal_fiberglass Iiulyelhylate_otltu(explain); Uinrcnsions: Capacity:_ alluns Design flow; gallons/Jay Alarm present(),es or no): Alain level: Alarm in wurkin urdcr Date of last pumping: 6 (J'cs ur nu): Cununents(condition of alarm and float switclies,etc.): DISTRIBUTION BOX:Zorl"scill"lust be o micJ 1 )(locale on site plan) Depth of liquid level above outlet invert:�!r Conwtents(note if box is level and distribution to outlets equal,any evidence of solids cap over an v' leakage/i�nto or out of box,etc.): n y evidence of 6 w c S ("v�rr OIL-A.) 1'UAl1'CIIAP1UC1lN14lucate on site plan) Pumps in svoiking order(ycs or no):_ Alarms in st'o(king order(),cs or no): Conuncnls(nutc condition of pump cltautbcr,untdiliun of pumps and appurlcnan(cs,cic.): . Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1271 Shoot Flying Hill Road Centerville Owner: Karen MacCloud Date of Inspection: SOIL ABSORPTION SYSTEM 7((SSASS)�a/(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: 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.): VQzc- � waS l G /' 1 NI�M^c. Pc.C� �grwl7G/3 h.t/'4 ND"f -G'XCL,Jr-4'4J CESSPOOLS:Nl(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: /V (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 I I ' OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY`ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1271 Shoot Flying Hill Road Centerville Owner: Karen Mae to d Date of Inspection: l l 0"�>7 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. OF pour c o _ �3 I 1 ANK I StiQ �,,Ao.�S .4-1 : s4 13 � Ll 8 SAS CJ�Cc)o2tn'h lnfG .t.SSu�+ee1 .,/?j.. f3`q 2B 10 -Page 11 of 1 I OFFICIAL INSPECTION.FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1271 Shoot Flying Hill Road Centerville Owner. d Date:of Inspection: r 1 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 23 '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: 3 v, 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: Les,-J ?INN S140—S a< S.A-S a-2 Ae ur.,„ pe_J As�A 6rov,�l�.ti/,c4- ltl�Ica{ c2 3' of 11 TOWN OF BARNSTABLE LOCATION a7) 5 Auer ���'` �-{i�1 tRo�t� SEWAGE # a00 13 3 VILLAGE C�✓ufE2�t I �� ASSESSOR'S MAP & LOT 110-1 INSTALLER'S NAME&PHONE NO. L SEPTIC TANK CAPACITY I S o b LEACHING FACILITY: (type) -DAV W CE-l 1 S (size) 13 X P_giK Z NO. OF BEDROOMS 3 BUILDER OR OWNER kA &ry A Mk: ClouiD PERMITDATE:N I3 I y a 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 43r1Cr�. C�'T '14JSF tiu J vc<k 5"Y No.- U 3 Fee 5 0.0 0 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 3pplicatton for Migooal *potem Congtructton Fermat Application for a Permit to Construct( )Repair( Upgrade( )Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. I271 Shoot Flying Hill Rd MacCloud Assessor's Map/Par,el 190-111 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Eco Tech W.W. Robinson Septic Service, 43 Triangle Circle P.O. Box 1089 Type ofB>�l&M�ervi11e 775-8776 Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) install Title 5 Septic to plans of Eco Tech. ETE-1367 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 Certifi- cate of Compliance has been issued by this Boardoof Health. Signed �� Date,,'/-3 o-J Application Approved by \ �/"'. �. Date —3—0 Application Disapproved for the following reasons Permit No. Date Issued —3—o fp { r ,0., ' 3 Fee 5 0.0 0 ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS $.. 2pplication for Mi5pogal *psstem Con!gtruction 30ermit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. 1271 Shoot Flying Hill Rd MacCloud ' Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.W. Robinson Septic Serv6ceu Eco Tech - 43 Triangle Circle P.O. Box 1089 n E Type ofBt@g&�erville 775-8776 . Dwelling No.of Bedrooms 3 ! Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ;taw gallons. `Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repai or Alterations(Answer when applicable) install Title 5 Septic '. o plans of Eco Tech. ',ETE-1367 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 Certifi- cate of Compliance has been iss ed by this Boarj,4of Health 2 = Signed Date 6/-5<5 3 Application Approved by V 414-. RMt - • Date /`3'-0 3 Application Disapproved for the following reasons Permit No. -Z 3 Date Issued R MacCloud THE COMMONWEALTH OF-MASSACHUSETTS BARNSTABLE;,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFJ',.Eatpe 0lnSonewgge Di posaseyr Constructed( )Repaired ( Upgraded( ) Abandoned( )by at 1271 Shoot Flying Hill Rd has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. o1 d 0 3—)33 dated y` Z-() 3 Installer 'Designer The issuance of �'s p it shall not be construed as a guarantee that the system it k� ighed. Date y �S Inspector No. l 33 Fee 50.00 MacCloud THE COMMONWEALTH OF MASSACHUSETTS x� PUBLIC HEALTH DIVISION- BARNSTABLE, MASSACHUSETTS 1wigP0gal *pgtem Construction Permit Permission is hereby gra�tt� V C9rio'Oct( F ying( HI�J�grandde( )Abandon( ) System located at l 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 thisPermit.� Date: LI`3 'U3 Approved by r#—�"`"� / 4 TOWN OF BARNSTABLE LOCATION 1971 S AOCc ytt>>�R1, « RoAt_:) SEWAGE # Q003-- 133 VILLAGE Ceri.f E2vt ( IE' ASSESSOR'S MAP & LOT ' I INSTALLER'S NAME&PHONE NO. Ro1::ir,�-SotQ 56;(J k C 77 S-e 7 7C SEPTIC TANK CAPACITY 5 U 6 LEACHING FACILITY: (type) _DA A W E 11 S (size) l 3?(P_Z0' Z NO. OF BEDROOMS 3 BUILDER OR OWNER k Aft rj A (1AC C(ou D a PERMIT DATE: 'i/3 I G 3 COMPLIANCE DATE: �J/I I UD I Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility.JIf any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist I within 300 feet of leaching facility) Feet Furnish d by � l �V I sY e ./ i I I wr CENTERVLLE. MA F� PLAN REFERENCE _ Q - CONTOURS . y o Q ism LAND COURT PLAN. 30545-A _ EXISTING - - - - - - - 60 LL 0 ASSESSOR'S MAP: 190 MINIMAL GRADING PROPOSED 00 to �zo LOT: III zT, SQZ 65 Lu Z fONN O Y 1 0 \ / LOCUS N \`✓^ r� • S FALMOUTH ROAD ROUTE 28 LLz o p� � c� LOCUS MAP NOT TO SCALE 00 J z N W } U 1 > Z LOT 23 a G W � Z AREA - 18432 sf `-- J 0 T P-► Z �- � p , A � < p O o Jow� o ND in � W LEGS Z �°, i o ^o c ` Q Z ��` 1 b00 GALLON C o W LL W r SEPTIC TANG >O LL o �5 �$Tb _00 -{ "Ox c U y Z w $ ® `Z 3 ,�o °o Z^ TEST PIT LLI •c R _o N t7�P V l EXSTNG U) 0<n co TB-2 . CESSPOOL O Q JB ft $ = UTLITY POLE _& 0D. {� r DRAIN ® DAVID �� o CA5 TREE COUGHANOWR Z o `- ' T°�AWMOTES i v ,9 #1093 0 co 24 ft x 125 fi :r 2 fi a car M+�+E � FC, �P �0 T LEACNNG GALLERY I 01/VIT RAP LU - w z Y \ I `Vv►WO r6�l Z , `2--vD'3 H 3LL mJ \ - LLD. �5 ° SEWAGE DISPOSAL SYSTEM PLAN Mto to o 0 Q_ -TO SERVE EXISTING DWELLING in 0-- E- � w B�NCH MARK o - PLAN KAREN A. MacCLOUD g E EVATbN FOUNDATION 1271 SHOOT FLYING HILL ROAD CENTERVILLE. MA SCALE: 1 in - 30 f t L!>GS DATUM ASSU-ED 0 . LL a ECO-TECH ENVIRONMENTAL LL a w 43 TRIANGLE CIRCLE SANDWICH MA 025621 o 508 364-0894 ETE-1367 MARCH 28. 2003� erz THS PLAN IS TO BE CONSIDERED A DRAFT PLAN UNLESS IT` # BEARS THE STAMP AND SIGNATURE OF THE DESIGN ENGINEER ORIGINAL PLANS INTENDED FOR SUBMITTAL TO THE BOARD OF HEALTH WILL BE SIGNED N BLUE AND STAMPED N RED.- SOIL TEST- LOB y ICALCULATIONS DES G N == DATE OF TEST: MARCH 10, 2003 SOIL EVALUAT,,OR: DAVID D. COUGHANOWR, RS DESIGN FLOW. 3 BEDROOMS X I10 GPD - 330 GPD �, X WITNESS REQUIREMENT WAIVED - NO VARIANCES REQUESTED SEPTIC TANK: 330 GPD X 2 DAYS - 660 GALLONS { NO GROUNDWATER ENCOUNTERED �• TEST PIT I PARENT MATERIAL: PROGLACIAL OUTWASH ELEVATION - 61.10 +_ PERC AT 56 in : 2 MIN/INCH IN C SOILS INSTALL 1500 GALLON SEPTIC TANK (MINIMUM ALLOWED) DISTRIBUTION BOX: USE 3 OUTLET D-BOX. DEPTH SOIL USDA SOIL SOIL COLOR SOL OTHER (INICHES) HORIZON TEXTURE (MUNSELL) MOTTLM SOIL ABSORBTION SYSTEM: A 24 ft x 12.5 f t x 2 ft LEACHING GALLERY CAN LEACH 0-12 Ap LOAMY SAD 10 YR 2/1 NONE FRIABLE A 6 o t - ( 24 x 12.5 ) - 300 of - 12-40 B LOAMY SAD 10 YR 4/6 NONE FRIABLE A s d w - ( 24 + 24 + 12.5 + 12.5 ) x 2 - 146 s f Atot - 446 of 40438 C MEDIUM SAND 10 YR 6/4 NONE LOOSE Vt 0.74 x 446 - 330.04 GPD USE A 24 ft x 12.5 ft x 2 ft GALLERY. Vt - 330.04 GPD > 330 GPD REQUIRED NO TEST BORING 2 PARENTUNDWATER MATERIAL: PROGLACIALDOUTWASH ELEVATION - 61.50 +_ PERC AT 60 in ; 2 MIN/INCH IN C SOILS DEPTH SOIL USDA SOIL SOL COLOR SOL OTHER GROUND YY A E R 44C ES) HORIZON TEXTURE (MUNSELL) MOTTLM LEACHING GALLERY 0-10 Ap LOAMY SAD 10 YR 3/2 NONE FRIABLE ADJUSTMENT 10-42 B LOAMY SAND 10 YR 5/6 NONE FRIABLE EXISTING GROUNDWATER LEVEL CONSTRUCTION DETAIL BASED ON BARNSTABLE GIS DRYWELL UNIT 4 2-120 C MEDIUM SA 8'-6'x 4'-10'x 2'-9' D 10 YR 6/4 NONE LOOSE DEPARTMENT RECORDS STONE OBSERVED GW: 28.0 2 fl EFF. DEPTH INDEX WELL: SDW-252 24.0 ft ZONE: D o READING: FEB 2003 LEVEL: 47.2 M ADJUSTMENT: 3.3 ft o ADJUSTED GW: 31.3 N N ' V N NOTES 2.5' 8.5 2 ft 8.5. 2.5" 1) EXISTING GARBAGE GRINDER NOT ALLOWED WITH THIS DESIGN - REMOVE GRINDER.2) ALL LINES TO BE SCH 40 PVC AND PITCH AT 1/8 INCH PER FOOT MINIMUM. 24.0 ft o NOT NOTSCALEr 3) ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM REOUIREMENTS OF MASSACHUSETTS TITLE 5 SEPTIC CODE (310 CMR 15) 4) INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND UTILITIES BEFORE EXCAVATING FOR SYSTEM. 5) EXISTING CESSPOOLS TO BE PUMPED. COLLAPSED. AND FILLED, OR REMOVED 6) ALL STONE TO BE DOUBLE WASHED AND FREE OF IRON. FINES AND DUST IN PLACE 7) LINES EXITING D-BOX TO RUN LEVEL FOR 2'-0' BEFORE PITCHING DOWN 8) ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION OF LOW FLOW FIXTURES SEWAGE DISPOSAL SYSTEM PLAN AND APPLIANCES. AND BIANNUAL PUMPING OF THE SEPTIC TANK -TO SERVE EXISTING DWELLING 9) SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. KAREN A. MacCLOUD 10) INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE STARTING WORK. - 1271 SHOOT FLYING HILL ROAD CENTERVILLE."MA`y` 1 1) SEPTIC TANKS SHALL BE INSTALLED LEVEL AND TRUE TO GRADE ON A LEVEL STABLE BASE THAT HAS BEEN MECHANICALLY COMPACTED AND ON TO WHICH SIX INCHES OF CRUSHED STONE HAS BEEN PLACED TO MINIMIZE UNEVEN SETTLING ECO-TECH ENVIRONMENTAL =. 12) SEWER LINE SERVING CESSPOOL A TO BE REPLUMBED INSIDE BASEMENT AND JOINED WITH SEWER LINE CURRENTLY SERVING CESSPOOLS B AND C. ANY ORANGEBURG PIPE 43 TRIANGLE CIRCLE SANDWICH MA '02563'^ CURRENTLY IN USE IS TO BE REPLACED WITH SCHEDULE 40 PVC PIPE AS PER NOTE 2 ETE-1367 MARCH 28. 2003 r 2/2,t7 ;