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Home My WebLink About0423 BISHOPS TERRACE - Health 423 BISHOPS TERRACE, HYANNIS A = 250 089 f I i 1 TOWN OF_BARNSTABLE SEWAGE a ASSESSOR'S MAP & LO IfISTALLER'S NAME&PHONE NO. 4 SEPTIC TANK CAPACTI-Y LEACHIIVG FACILITY: (type . > ��, PC (size) NO.OF BEDROOMS << BUILDER OR OWNER PERMTTDATE: y COMPLIANCE",DATEr 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 Leac ' g Facility(If any wetlands exist within 300 feet o f Feet Furnished by t cN Aj 1 / \ 4 i G TOWN OF BARNSTABLE LOCATION 1113 jAn .,m re SEWAGE'# VILLAGE A"OJA ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY j5XJSrJeJ Q LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 3cta OWNER C% PERMIT DATE: 5 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 leachi Feet FURNISHED B r N � v�► (� W -IC3 N No. r' � * _,;. � � z Fee �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprication for XDigool *proem Cougtructiou Permit Application for a Permit to Construct( ) Repair v/upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 7. ll 8/S� S _ie'reo Owner's Name,Address,and Tel.No. Assessor's Map/Parcel hlye &WIS AAC, C�e�Lba�y3 2s Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Z Lot Size 1 LI&-Z— sq. ft. Garbage Grinder ( ) Other Type of Building L1 .;%-e No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 'j "3® gpd Design flow provided C`C) G gpd Plan Date G I low, Number of sheets 11_- Revision Date T Title Size of Septic Tank '()(Xj F.XPSy,tv Type of S.A.S. 6.)tyt(-C Description of Soil Nature of Repairs or Alterations(Answer when applicable) Y0Si-C,)j eJ eU3 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 Bo rd of Health. Signed / Date 2 Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. '?'00 Date Issued 6 — 5 / }i No. "��qqq��r..�,-:x:,x � _ _� Fee i `THE,COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE, MASSACHUSETTS Yes RpOtration for atoo.5al 6p5tem CCok5truchon J)ermtt Application for a Perm'ifto Construct( ) Repair Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. y Z-3 ��5 S T P//(,�C t" Owner's Name,Address,and Tel.No. Assessor's Map/Parcel S 3- Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Zbo,16 s 4 W E3-y00 T/S ctis rir ref'% wa/IC S a Type of Building: Dwelling No.of Bedrooms '2— Lot Size l 0 '•I&Z- sq. ft. Garbage Grinder ( ) Other Type of Building tl UPS P No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 3 Q gpd Design flow provided -54I O. % gpd 4 'Plan. Date L {6(�0�7 Number of sheets 'L_ Revision Date .Title pp Size of Septic Tank {( F)(/5f 1y& Type of S.A.S. QoIC1C y nri-1 tfa� Description of Soil i Nature of Repairs or Alterations(Answer when applicable) �NSf ft�1. N rLo SAS Date last inspected: - Agreement: M 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. Signed - Date 617, S 699 -1- A Approved by ' " r cj Date i J Application Disapproved by: Date for the following reasons Permit No.�•2 U 0� —'8 ——.----.—---•——Date Issued— '-6----��—b�---. —---— -- �. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired (Ir }/Upgraded ( ) Abandoned( )by .I,,,,Jgye. G• A 7,(au1 n) ZNC at N 2 'a) I SV1 nIQ S, ` !(c r f" �') V Gnu has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction„Permit No. d 009-f�(j dated ' a '5 Installer ' ,./c'��.�G S h �J f[�,�)n7 .�,-NC' Designer l� ,Jc t 1)F w y ,j, ��^��./I( #bedrooms Approved design flo , ), _ gpd The issuance of'his per it shall not be construed as a guarantee that the system Zvi func�pn s designed. . Date �. J� Inspector No 7 fib ! p U X/. .—.—.——_--———.——.—.—.—yFee 1•00 THE COMMONWEALTH OF MASSACHUSETTS - PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS i' QisSpOal *pgtem CCon.5truction Permit Permission is hereby granted to Construct ( ) Repair ( L, 'Upgrade ( ) Abandon ( ) System located at y z -5 i� ,5 n n c r r�, r� 1 �r C•vN t S 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. I Provided: Construction must be completed within three years of the date of this permit. Dates �j " a S-�� Approved by �j TRANS NO CITUTOWN:: }-� 4r►ns� �'1A APPLICANT. A • �caw.� f 1nt : F,. ADDRESS: 23 lS �`na PS Tec.co,cc-* DESIGN FLOW: 3'3 gpd . REVIEWED BY: w DATE: i Of N/A OK NO. Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [31-0 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] ✓ System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR ✓ 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required andprovided) soil absorption system (required andprovided) whether system designed for garbage grinder v North arrow [310 CMR 15.220(4)(g)] Existing and ro osed contours [310 CMR 15.220(4)(g)] .� Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] i Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address Sheet,l,of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the`case ' of surface water supplies and gravel packed public water supply _ within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water su ly wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other-subsurface utilities located [310 CMR 15.220(4)(m)] (if waterline cross see 310 CMR =5.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] / Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable_material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.000] System components not> 36" deep (unless Local Upgrade / Approval or LUA requested) [310 CMR 15.405(1 b)] Address Sheet 2 of 7 _., Ar N/A OK,. NO Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] ✓ Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid ell depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under,LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [3-10 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] 41�. Setbacks from resources [310 CMR 15.211] .. Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200%.daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and 3)] LA "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] r' Address Sheet-3-of 7 N/A OK NO ,..... ..- :i ° s, �mit .'• r � r ems '' :�=Wr. ��>t s ... ..� _.��'«�a' �_ ,f ;yr.,y o�� :ta Located at least ten feet,from any water line? [310 CMR / 15.222(2)] ✓ Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR'15.211 1 [1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)] ./ Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphonproblem/(leachfield below pump clamber) Endca s or vent manifoldspecified? ./ Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 / CMR 15.252(2)(h)] Materials,specified (310 CMR 15.251(5) specifies various pipe types allowed) ::�.. ss, im 'f+,� 'ham. f�".,"' `�� e, ��g7 y � a� �-'��,�sNf >' ,�. .h• 6�', « s� a 'Y,-;; Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] c� Splash plate or baffle tee required on inlet/ provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] / Minimum sum 6" [310 CMR15.232(3) e ] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] i. FIVE UMM B I Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2) ,Buoyancy calculations needed ? Provided? [310 CMR 15.221(8)] Address Sheet 4 of 7 Y. : . •� ' ' I M N/A OK NO . _. F u BZ+.�_ ✓sonN � 3AL9 YFa. :: .�.'t'li. rc Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] ✓ Required separation to groundwater? [310 CMR 15.212)] Aggregatespecified as double washed [310 CMR 15.247(2)] ✓ System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] $, .. Chambers and Gal. in-trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253 2)] ��- Aggregate I' minimum- 4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] r Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] ✓ 100 feet-maximurri length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1) d ] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211 1 [4] and Guidance Document] minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] V�- Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only [310 CMR 15.252(2)(i)] Address Sheet 5.of 7 N/A OK NO �§''�. s' ffia,,;y � c�•x t 4 R:. �f {�:�. �� -� "d�� ..Wes. NSh's -x` i�.6 nz ,zc• .�, ...A <.. s .. cs Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems>2COOgpd or alternative systems under remedial approval [310 CMR 5.254(2) and UA Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly (>2000 dgood to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional /L Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)IMAM Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface 9 f�z i�. �:m. z ��aFx Y�Y• G'"[w. Ys : F�,. ,x,9� �f .e��'.• .� F {A 'rc,. .gar Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all / DEP Approval Conditions? Is there a note on the plan regarding the requirement for ✓ perpetual maintenance agreement? Any alarms involved on separate circuits ./ Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CMR'l5.220 / (4)( ] RLS Stamp necessary on plan if a component is within five / feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed [Refer to 310 CMR 15.414] Address Sheet 6 of 7 N/A OK NO xt Is the system in a Designated Nitrogen Sensitive Area(Zone H for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address Sheet 7 of 7 Y COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENERGY & ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner MODIFIED CERTIFICATION FOR GENERAL USE Pursuant to Title 5,310 CMR 15.000 Name and Address of Applicant: Infiltrator Systems,Inc. P.O.Box 768 6 Business Park Road Old Saybrook,CT 06475 Trade name of technology and model:High Capacity chamber,Quick4 High Capacity chamber, Standard chamber,Quick4 Standard chamber,Infiltrator 3050(Storm Tech SC-740),Equalizer 24 chamber,Quick4 Equalizer 24 chamber,Equalizer 36 chamber,and Quick4 Equalizer 36 chamber (hereinafter the"System"). Schematic drawings of the System and a design and installation manual are attached and made a part of this Certification Transmittal Number: W023699 k Date of Issuance: February 21,2003,Revised August 19,2005,December 22,2005,July 24, 2006,July 19,2007 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Certification to: Infiltrator Systems, Inc., P.O. Box 768, 6 Business Park Road,Old Saybrook,CT 06475(hereinafter"the Company"),for General Use of the System described herein. Sale and use of the System are conditioned on and subject to compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Certification constitutes a violation of 310 CMR 15.000. July 19,2007 Glenn Haas,Acting Assistant Commissioner Date Bureau of Resource Protection Department of Environmental Protection This information is available in alternate format Call Donald AL Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-500-298-2207. MassDEP on the Worid Wide Web: http://www.mass.gov/dep 0 Printed on Recycled Paper Infiltrator Modified Certification for General Use Page 2 of 7 I. Purpose 1. The purpose of this Certification is to allow use of the System in Massachusetts, on a General Use basis. 2. With the necessary permits and approvals required by 310 CMR 15.000, this Certification authorizes the use of the System in Massachusetts. 3. The System may be installed on all facilities where a system in compliance with 310 CMR 15.000 exists on site or could be built and for which a site evaluation in compliance with 310 CMR 15.000 has been approved by the local approving authority, or by DEP if DEP approval is required by 310 CMR 15.000. R. Design Standards 1. The models listed in Table 1 are covered under this Certification. Table 1. Chamber Dimensions Dimensions Invert Model W x L x H Height Inches Inches Equalizer 24 15 x 100 x 11 6 uick4 Equalizer 24 16 x 48 x 11 6 Equalizer 36 22 x 100 x 13.5 6 uick4 Equalizer 36 22 x 48 x 12 6 Standard Chamber 34 x 75 x 12 6.5 uick4 Standard 34 x 48 x 12 8 Infiltrator 3050 or 51 x 85.4 x 30 24 StormTech SC-740 High Capacity Chamber 34 x 75 x 16 11 Quick4 High Capacity 34 x 48 x 16 11.5 2. The System is an open-bottom leaching unit molded from polyolefin resin. It can be installed without aggregate or distribution pipe as an absorption trench in accordance with the requirements in 310 CMR 15.251 or as a bed or field in accordance with the requirements in 310 CMR 15.252. 3. The use of aggregate as specified in 310 CMR 15.247 is not necessary with the System when installed as a trench, bed or field. When designed with aggregate in accordance with 310 CMR 15.253, the System shall be designed in accordance with Section II item 10. Infiltrator Modified Certification for General Use Page 3 of 7 4. The minimum separation between any two trenches shall be as specified in 310 CMR 15.251. 5. The requirement that the Chamber installed in trench configuration as specified in 310 CMR 15.253(6)be provided with inlets at intervals not to exceed 20 feet is not applicable to the System.In accordance with 310 CMR 15.240(13)a minimum of one inspection inlet shall be installed per system.The inlet shall be capped with a screw type cap and accessible to within three inches of finish grade. 6. The total effective leaching area for any Chamber Model shall be calculated by multiplying the Effective Leaching Area per square foot of chamber times the total length of chamber from end cap to end cap including end caps. 7. For new construction, the applicant can size the System in a trench configuration without aggregate, using the effective leaching areas presented in Table 2. No System, however, shall be designed and constructed with a soil absorption system area of less than 400 square feet of effective area. Table 2.Effective Leaching Area for New Construction And Remedial Sitesl Effective Effective Model Leaching2 Leaching3 Area Area SF/LF SF/LF Equalizer 24 3.75 NA Quick4 Equalizer 24 3.90 NA Equalizer 36 4.73 NA Quick4 Equalizer 36 4.73 NA Standard Chamber 6.53 NA Quick4 Standard 6.96 NA Infiltrator 3050 or NA StormTech SC-740 High Capacity Chamber 7.79 NA Quick4 High Capacity 7.91-DI NA 1. Effective April 21,2006,310 CMR 15.251(l)(b)maximum trench width is 3 feet. 2. Effective leaching area is equal to 1.67(bottom width+(2x invert height))for Systems 3 feet or less in width. 3. Effective leaching area is equal to 1.0 (3 +(2x invert Height)) for Systems with a width greater then 3 feet. 4. The maximum trench width allowed to calculate effective leaching area is 3 feet. Infiltrator` ' Modified Certification for General Use a Page 4 of 7 8. Systems installed on remedial sites shall be allowed to utilize the effective leaching areas presented in Table 2 above or additional reductions in soil absorption leaching area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 9. In accordance with 310 CMR 15.240 (6) absorption trenches should be used whenever possible. When the System is installed for new construction without aggregate in a bed or field configuration, as defined in 310 CUR 15.252, the System shall be designed using the effective leaching area for the bottom width presented in Table 3. No system shall be designed and constructed with a leaching area of less than 400 square feet of effective area. Table 3. Effective Leaching Area for Bed or Field Configuration Effective Model Leachingl Area SF/LF Equalizer 24 2.08 uick4 Equalizer 24 2.23 Equalizer 36 3.05 uick4 Equalizer 36 3.05 Standard Chamber 4.72 uick4 Standard 4.72 Infiltrator 3050 or 7.1 StormTech SC-740 High Capacity Chamber 4.72 uick4 High Capacity 4.72 1. Effective Leaching area is equal to 1.67 times bottom width only. 10. The System, when installed in a bed or field configuration without aggregate on remedial sites, shall utilize the effective leaching areas presented in Table 3 above or additional reductions in soil absorption system area approved by the approving authority in accordance with 310 CMR 15.284. In no instance shall the reduction in the soil absorption system area required in 310 CMR 15.242 exceed the maximum reduction allowed for alternative systems approved in accordance with 310 CMR 15.284. 11. The System, when installed as specified in 310 CMR 15.253: Pits, Galleries, or Chambers, shall have an aggregate base and/or be surrounded by aggregate and shall be sized as specified in 310 CMR 15.253 (1) (a) and (b), effective leaching Infiltrator' ' Modified Certification for General Use Page 5 of 7 area is equal to 1.0 times a conventional aggregate system.. Effective depth can be increased up to two feet with the corresponding addition of up to 14 inches of base aggregate. Bottom width can be increased by two to eight SF/LF with the corresponding addition of one to four feet of aggregate per side. 12. When the System is installed as specified in 310 CMR 15.255: Construction in Fill, the finished 15 foot horizontal separation distance, item (2), shall be measured from the from the top of the chamber. III. General Conditions I. All provisions of 310 CMR 15.000 are applicable to the use of the System, except those that specifically have been varied by the terms of this Certification. 2. The facility served by the System, and the System itself, shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 3. In accordance with applicable law, the Department and the local approving authority may require the owner of the System to cease use of the System and/or to take any other action as it deems necessary to protect public health, safety, welfare or the environment. 4. The Department has not determined that the performance of the System will provide a level of protection to the environment that is at least equivalent to that of a sewer.Accordingly, no new System shall be constructed, and no System shall be upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer,unless allowed pursuant to 310 CMR 15.004. 5. Design, installation and use of the System shall be in strict conformance with the Company's DEP approved plans and specifications and 310 CMR 15.000, subject to this Certification. IV. Conditions Applicable to the System Owner 1. The System is approved for the treatment and disposal of sanitary sewage only. Any wastes that are non-sanitary sewage generated or used at the facility served by the System shall not be introduced into the on-site sewage disposal system and shall be lawfully disposed of. 2. For new construction, the owner initially shall size a soil absorption system in accordance with 310 CMR 15.242 to demonstrate that a conventional Title 5 soil adsorption system using aggregate, including a reserve area, can be installed on the site. The owner may than size the soil absorption system for the System. The total area required for the aggregate system, which may include the area designated for the System, and a reserve area shall be preserved and the owner shall ensure that no permanent structures or other structures are constructed on that area and that the area is not disturbed in any manner that will render it unusable for future installation of a conventional Title 5 soil absorption system. f Infiltrator ► r R ` Modified Certification for General Use Page 6 of 7 3. The owner of the System shall at all times properly operate and maintain the on- site sewage disposal system. 4. The owner shall furnish the Department any information that the Department requests regarding the operation and performance of the System, within 21 days of the date of receipt of that request. 5. No owner shall authorize or allow the installation of the System other than by a person trained by the Company to install the System. V. Conditions Applicable to the Company 1. By January 31 st of each year, the Company shall submit to the Department a report, signed by a corporate officer, general partner, or Company owner that contains information on the System for the previous calendar year. The report shall state known failures, malfunctions, and corrective actions taken for the System as well as the date and address of each event. 2. The Company shall notify the Department's Director of Watershed Permitting at least 30 days in advance of any proposed transfer of ownership of the technology for which this Certification is issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Certification applicable to the Company shall be applicable to successors and assigns of the Company,unless the Department determines otherwise. 3. The Company shall furnish the Department any information that the Department requests regarding the System, within 21 days of the date of receipt of that request. 4. Prior to any sale of the System, the Company shall provide the purchaser with a copy of this Certification. In any contract for distribution or sale of the System, the Company shall require the distributor or seller to provide the purchaser of the System,prior to any sale of the System,with a copy of this Certification. 5. The Company shall prepare an installation manual specifically detailing procedures for installation of its System. The Company shall institute and maintain a training program in the proper installation of its System in accordance with the manual and provide a training course at least annually for prospective installers. The Company shall certify that installers have passed the Company's training qualifications, maintain a list of certified installers, submit a copy to the Department, and update the list annually. Updated lists shall be forwarded to the Department. Infiltrator ' Modified Certification for General Use Page 7 of 7 6. The Company shall not sell the System to installers unless they are trained to install these Systems by the Company. VI. Conditions Applicable to Installers of the System 1. Each Installer shall install the System in accordance with Company training on the installation of the System and the conditions of this Certification. 2. No Installer shall install the System unless the Installer has been trained by the Company on installation of the System. VII. Reporting 1. All submittals of notices and documents to the Department required by this Certification shall be submitted to: Director Wastewater Permitting Program Department of Environmental Protection One Winter Street- 5th floor Boston,Massachusetts 02108 VIII. Rights of the Department 1. The Department may suspend, modify or revoke this Certification for cause, including, but not limited to, non-compliance with the terms of this Certification, non-payment of an annual compliance assurance fee, for obtaining the Certification by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Certification, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Certification, the System, the owner, or operator of the System and the Company. 1 06/29/2009 04:31 5084775313 ENGINEERING WORKS PAGE 01 Town of Barnstable Regulatory Services Thomas F.Geller,Director 1 1. Public filth Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508462-4644 Fax: 508-790.6304 Installer Designer Certification Form Z-9 �+ Assessor's Ma \Parcel Date. Sewage Permit# M p Designer: f WoI(W Ian Installer: Address: '2- W • erp i s-C"'t e-l d Address: P. O. On 6At f�. 0%41v I n C , was issued a permit to install a (daft) (der), septic system at 4 7.3 ?''S k c,c-.c -R� �Ay S, -based on a design drawn by (address) Me ,+Ax- P L dated (designer) I certify►that the septic system referenced above was installed substantially according to the desip, which may include minor approved changes such as lateral. ovation of the distributtozi box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance wide State &Local Regulations. Plan revision ar certified as-built by designer to follow. �tN OF A14S gg� PETER T. MCENTEE @i' $lgnatllre) CIVIL r No.35109�0 �Q 6 ' S8 -NAL (Designer's Signature) (Affix De-s'lgnees Stamp Here) B MCU A B i:HE pARN&TABLE POBIJIC�II;ROOM— THANK YOU. Q:HedwswadDesiper Cotfication Form 3-26-04.doc Town of Barnstable P# Department of Regulatory Services ' Public Health Division r : .sAaMASS SAare. on Hate IL6 39. 200-Main Street,Hyannis-MA 02601 Date Scheduled Ti l.. .Fee Pd. ' Soil Suitability Assessment for Sewage isposal Performed By:_ � �� `" L��2-e Witnessed By: t LOCATION& GENERAL INFORMATION Location Address 7 Z 3 f? Oxop-s —Ne f� Owner's Name n QVG1�e 0l"VX l S Address Assessor's Map/Parcel: 2SU/G 7 99? Eigitieer's Name ) NEW CONSTRUCTION REPAIR. ' t<i* Telephone# Land Use ",Slopes(%) 4 Surface Stones x . Distances from: Open Water Body 7[5V ft Possible Wet Area�_ft Drinking Water Well ft Drain e Wa �, Zp, g y _ ft Property Line �ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) Jt M Parent material(geologic) c/�tNG1! Depth to Bedrock Depth to Groundwater. Standing Water in Hole: 1��i4 . . Weeping from Pit Face '✓J rA Estimated Seasonal High Groundwater } ZU t� DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: Af in, Depth to soil mottles: In.z ;- y,_ ---Depth_to-weeping-from-side;of-pbs::hole:- in;�©rOn1ldWAtCrAdju9tmenE t1. Index Well# Reading Date: Index Well level Adj,faetor Adj.Ciroundwater Level o PERCOLATION TEST Data 4WThne.�v Observation Hole# 2 Time at 9" Depth of Perc Time at 6" I Start Pre-soak Time® ;J n 'rime(9"-6") _ End Pre-soak 2 5 Rate MinJInch Site Suitability Assessment: Site Passed _ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the: Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Yiunsell) Mottling (Structure,Stonea;Boulders. i toGravel) 6�3 Z DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) A to ya y/Z �-3 5L to /� 2 �- N►-c �► 2 s Y 713 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color k' Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) r b DEEP OBSERVATION BOLE LOG , Hole# Depth from Soil Horizon Soil Texture t� Soil Color _� Soil Other Surface(in.) (USDA) 1 (Munselij Mottling (Structure,Stones;Boulders. consistency. S' Flood Insurance Rate Man: Above 500 year flood boundary No- Yes' -- Within 500 year boundary No Yes..�, Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet.of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? YeA If riot,what is the depth of naturally occurring-pervious material? Certification I certify that on 11 - (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with .T the required tra' ' ,expertise and experience described in 310 CMR 15.017. Signature [� Date y1619 Q:\SEPTl0PSRCFORM.DOC F Town of Barnstable CFTHE A Regulatory Services Thomas F. Geiler,Director Public Health Division * BARNSTABLE, * Thomas McKean,Director 90o MASS. `�� 200 Main Street, Hyannis,MA 02601 prED Mp►�A Phone: 508-862-4644 Email: healthQtown.barnstable.ma.us Fax: 508-790-6304 Office Hours: M-F 8:00—4:30 May 14, 2007 Mr. Thyago Silva 423 Bishops Terrace Hyannis,MA 02601 RE: BR.USA. Mobile Car Wash Detail and Power Wash Dear Mr. Silva: On May 7, 2007, I conducted a site visit at the following residence for a complaint of excessive vehicle washing that takes place daily at the location of 423 Bishops Terrace,Hyannis,MA 02601. Upon arrival,there was no one present at the residence. The vehicle washing truck was in the driveway. Please continue to use the vehicle washing mat when washing vehicles and utilize the proper disposal operations at the Water Pollution Control Facility. Vehicles shall not be washed unless on the mat described in the business plan proposed to the Health Division. Thank you for your cooperation in this matter and if you have any questions or need further information, guidance, or assistance,please do not hesitate to contact the Public Health Division. Sin erely, Alisha L.Parker Hazardous Materials Specialist Failure to comply wi the vehicle washing policy will result in fines. Thomas . McKean, RS, CHO Director of Public Health Date:05 /l(e�/Dg TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIAL ON-SITE INVENTORY NAME OF BUSINESS: 0� BUSINESS LOCATION: INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) __ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes 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 removers 5 (� (including bleach) Spot removers & cleaning fluids I /� (dry cleaners) i�re�t3 17 l�,r71i)Tlca_1e e Other cleaning solvents �� . �j' ue ® e,-ale LAG vtvCt.�/�: Bug and tar removers 4S de.rel,;b 4 f�7 61 Windshield wash Na 155[tes A"if4 <_r4,-d°us WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Wr!a IS v yes af�.� � Q erer-,,t�-�• TOWN OF BARNSTABLE ._ O LOGATIO 1 SEWAGE # yoI ,a VILLA ASSESSOR'S MAP 6T LOT INSTALLER'S NAME & PHONE NO.T SEPTIC TANK CAPACITY . LEACHING FACILITY:('type) fft (size) U�J NO. OF BEDROOMS _PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED- q _ DATE CO'ZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4 t U� I� Y 1 f � TOWN OF BARNSTABLE LOCATiONV't a 3 RtJ�OP� S lCQRi9ce_ SEWAGE # VILLAGE ' HvAnriS ASSESSOR'S MAP &LOT ,r INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /060 6l LEACHING FACILITY: (type) a' U400 0 (size) A /D /AD[) NO.OF BEDROOMS_„3 BUILDER OR OWNER L��UAS PERMITDATE: COMPLIANCE DATE: 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 WE, O VSW ZAISO��t m V n su � 5 70 � O 0 a 0 R1 4 r' ..?0..00...... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .........Town....................OF..........Barnstable Appliratiun for Disposal Works Tondrurtiun Prrutit Application_is hereby made for a Permit to Construct ( ) or RepaiK)(X ) an Individual Sewage Disposal System at: �+2 _Bishops Tor race Hyannis Location-Address w or Lot No. J.2 Ma.acLmber-...Jr...................................... .............................................................................I..................... Owner Address ar.x...S ...Downs.........................•--................ .........----•-----..............._•-••--.......................................---.....----..... Installer Address UType of Building Size Lot............................Sq. feet Dwelling-No. of Bedrooms..............3............._.............Expansion Attic ( ) Garbage Grinder ( ) aer Oth —Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------------------------•-••--•----------•--•---•.....--•--------••---••-••••-----•----•-••-------.................•......._.---•-- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................. Diameter................ Depth................ W' Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. x =. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..........--------sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Gr, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a •---------••--------------------•-•--•-------•--------••.....•-------•.....-•-•-----......---....--•.........................................................O Description of Soil------------------------------------------------------------------- --.--•-- x Sand & Gravel w x --•-------•-----------------------•--------•-•--•-•••-•--•----••------•---------•••-••....--------------••------•-••----•-----..--•-•---.---•----------••••••--•---.........•-•-•---•-.-----••...... U Nature of Repairs or Alterations—Answer when applicable._.._.._.. _._ 1=IDO.O_-.gall:ori----iea;c-hInn--ytt------... --------------------------------•-------------------------------.--------•••-••--•--•---.........--••-------....---------•--••-•---•-•-•---------•••---•-----••-•-••••••-••••---•••--------•-••-•--•.--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance hajbe n issued y`�ard of he lth.Signe • .•------- -------•-••-•--------_.. .9/�9a9........... Date Application Approved By----•-•---•----- - ic-.�.----r .... ................. --- - Date Application Disapproved for the following reasons:---•-------------------•---------...--------------------------•---------------------------•--•••-----.........-- ---------------------------------••-•--..........---•---------•-••-----....------•------------•------------------------•----------------------------------------------- ............................... -.. Date PermitNo..------..0... .'_..�� I---•-----•---•-------- Issued---•...................................... ------ Date ..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Torn Barnstable ...........................................OF..........................._..........-- Appliratinn for Disposal Works Tonstrurtinn Urrmit Application is hereby made for a Permit to Construct ( ) or RepaW ) an Individual Sewage Disposal System it . :_30 ............. ................................................... ...............................................Lo --......... l `" ocation-Address or t No. p "ir. .................................... .... ._.... ...------- - ----........------•--•---•-_........... .......----•--------.................---.-. ..----•--••-•-•-•---------•---.-.....--------. W Mr. a,,E..Roov,8yer Address a -•-•--•....................••----•--.............•-•-••--.....--••--............................. .............,..•--..........-•---••----•-----..........-•••••----•-........................... Installer Address Q Type of Building Size Lot............................S . feet Dwellinj—No. of Bedrooms............ .............................Expansion Attic ( ) Garbage Grinder ( ) aOther—T e of Building . No. of persons............................ Showers YP g ----------•••--•--------••- P ( ) — Cafeteria ( ) QOther fixtures ..............................................-................................ -------- ------------................................................ Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter_------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length..................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-••---•---•----••••-••-•-•-•--••--••••---•---------•---••---•-•-•-•••---• Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water---.----_--__-_--__--_-. rs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 -•---------•------------------•••----•...-•---••......••-•-•-•----•••--••-•-----•---....-••••-------......................................................... 0 Description of Soil............................................ U ..-••-••-•••----•-••--••••••-••-•--••-•--•••---••--••--••-•---•-•-•--•------•-•----••----••---------•---•. w ---------------------------------------------------------------------------------------------------------------------------------------------.......................................................... U Nature of Repairs or Alterations—Answer when applicable g xn can•._ _.___. .....� .�,--.----__. ........... •----•--•-----------------------•----•-••......................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T IT?.i� 5 of the State Sanitary Code— Thel undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issue ' f a =`oard of 1 ;V lth./e Sin .--•---- ......................- ----------------- -. g � ---•-------- .--------- --- ------------------ Application Approved By--•••......-•--. ... 44'."."': ............ C�-Date ApplicationApplication Disapproved for the following reasons---------------------------------------------------------------•---------------------........................... ------•--------••-•-••--••-•---••-•----•---••--••••---•--•----....••--••-----------•.........-•-•-•••--••-•••-••-•••---•••------•-•------••------••.................................................... Date Permit No. . ..-I I ...... .•.. Issued ---- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.............0F........BarIIsta*.; e ......................................................... Trr#if irtt#r of Tomp1, anrr THIS IS TO (7ERTI-FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ) c�..L"�o��ac ota a r Jr. by..................................... ................ ... ............Installer ......._.....----•-------•---••---.....--------------................................ 4?3 .Bask}® ; c rrac �1y 8 i!r1 l..: at............-•--•----------•--.......•--•-•--•--•---•-•••------•-------•--•-•--••---•--•-•-......---- has been installed in accordance with the provisions of 9'1'T7 ' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No------- .:_:Y__...1_._.._.. dated-----------------------_-----_--___-___-__----- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE............................. ............................... Inspector...---•------••--- .......................................... �( 7 '' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tocwm.....:...............OF.........Barns table G. ........................ No.-•-•a—•/ �/.�{1 FEE:........n.oC.... Disposal Works Tnlstra inn rrmii 7,P.t comrber r. Permissionis hereby granted..........-.....................................••-••--•-••-•--•--••--•---•-•-•-•-•--••••••---.......-•--•-•••••-•---•-•..................... to Constru ( ) oy,Repair(' j. q�nd' isival,Swage Disposal System �F3 B_�s ohs Ter � �::�.� atNo.•---••---•-----••- --------•....•-----•-••••......•--.......... Street as shown on the application for Disposal Works Construction Permit No.. Y- !_.. Dated.......................................... ...............................-•• --._-.----------------------------•-----•--- oB and of Health •- DATE................................................................................ FORM 1255 HOBBS & WARREN, ING•. PUBLISHERS TOWN OF BARNSTABLE TOX C AND HAZARDOUS MATERIALS ON-SITE INVENTORY BUSINESS LOCATION: INVENTORY TOTAL AMOUNT- EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OFBUSINESS: INFORMAT1122� Fire District: | | - ' i | Waste Transportation: Last shipment of hazardous waste: , � Name of Hauler: Destination: � Waste Product: Licensed? Yes No | � yJOTE: Under the provisions OfCh. 111, Section 31. of the General Lovve of K4A, hazardous rnatehu|a use, | atorogeanddiapOS8| nf111g�||onsor more amonth 8 |ioG000fromth� Pub|icH98|�hOiviSiOn � ` ^~~~ � � LIST OF TOXIC AND HAZARDOUS MATERIALS � / The Board Of Health and the Public Health Division have d8t9[rOiO8d that the fOUOvviOg products exhibit toxic � � Or hazardous characteristics and must be registered rag8[U|eou of volume. / . � O Observed/MaximumAntifreeze (for gasoline or coolant systems) Misc. Corrosive ! NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) � / | ' � gerants Motor Oils Pesticides ^ - - -. _ Gasoline, Jet fuel, Aviation gas Photoohnnnioa|o (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochennioa|o (Deva|oper) � gear oil �� USED� -_-_- � Degreasers for engines and metal Printing ink � drivewaysDegreasers for &garages Wood preservatives (cneosuta) Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Mion. Combunhbha _4 Car wash detergents Leather dyes ! Fertilizers ! � Auphak8 roofing tar PCB'o � � / Partu, varnioheu, stains, dyes Other chlorinated hydrocarbons, � Lacquer thinners (inc. carbon tetrachloride) NEW USED Anyctherpnoductowith ^poioon^ |abe|u | Paint 8varnioh removers, deg!ooaero (including chloroform, formaldehyde, � Misc. F|ennnnab|eo hydrochloric eoid, other acids) Floor & furniture strippers ` ------8---- Other products not listed which you feel ` Metal polishes may be toxic orhazardous (please list): Laundry soil & stain removers . (including bleach) 5 Spot removers &o|oaning fluids (dry cleaners) ' Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY'HEALTH DEPARTMENT/CANARY COPY'BUSINESS ° = s.ALT�H OF KASS-SACHUSE T'I`S EXECUTIVE OFFICE OF ENVIRONMENT-AL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION h yv TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: - 74,fmce • t Owner's Name: Owner's Address: ' Date of inspection Name of Inspector: P print) twolease rint Company Name: ( n 1�F5 ' Mailing Address: X Telephone Number: 76 Q CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my trainingand experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 1 Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: j,t4 Date: S GZS 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 1 f Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) "`A' 1 Property Address: y073 Z tb irtace Owner: e05; ---` Date of Inspection: _ 15 (S'q Inspection Summary: Check AAC,D or E/ALWAYS complete all of Section D A. System Passes: X 1 have-not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section to be replaced or repaired.The system,upon completion of the replacement or repair,as approved b e Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the follow' g statements. If"not determined"please explain_ The septic tank is metal and over 20 years old*or the eptic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or enfiltration or failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank approved by the Board of Health. 'A metal septic tank will pass inspection if it is stru y sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old' vailable. ND explain: Observation of sewage backup break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a bro ed or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)an replaced o iisremoved distribu>tioa box is lewled or replaced ND explain: The system re ed pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if( th approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Poe 3 of I l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: is tticrfw4s -9 Owner: ,p,G Date of Inspection: C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to d ermine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance wit 10 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public hea 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 vegetate wetland or a salt marsh 2. System will fail unless the Board of Health(a Public Water Supplier,if any)determines that the system is functioning in a manner that protects t e public health,safety and environment: _ The system has a septic tank and soil rption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surf a water supply. ` The system has a septic tank and AS and the SAS is within a Zone I of a public water supply. The system has a septic tank d SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**, ethod used to determine distance **This system passes if the ell water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile org c compounds indicates that the well is free from pollution from that facility and the presence of ammoni nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are trio red.A copy ofthe analysis must be attached to this form. 3. Other: 3 i Page 4 of 1 k OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE RI' AL.SYSTEM INSPECTION FORM PARTA- CERTIEICATION`(continued) Property Address: '��a��; %56p5Iemzce Owner: Date of)fnspection: $ g o y 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 r Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 6X Liquid depth in cesspool is less than 6"below invert or available volume is less than'/2 day flow Jul' Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 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.FlIds system passes if the well water..analysis, performed at a DEP certified laboratory,for aoliform bacteria and volatile organic-co eds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equatto.or less than 5 ppm,provided that no other.failure criteria are triggered.A copy of the analysis must be attached to this form.) (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a fa ' ' th a design flow of 10,000 gpd to 15,000 gpd. 4 You must indicate either"yes"or"no"to each of the awing (The following criteria apply to large systems in to the criteria above) yes no — _ the system is within 400 fee f a surface drinking water supply the system is within 2 feet of a tributary to a surface drinking water supply the system is loc d in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone H of a pu 'c water supply well If you have answere 'yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section above the large system has failed.The owner or operator of any large system considered a significant under Section E or failed under Section D shall upgrade the system in accordance with 310 CUR 15.304. system owner should contact the appropriate regional office of the Department 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM FART B CHECKLIST Property Address:�/7 v ,-e/rjtc,e f cGts+ Owner: 1� Date of Inspection:Check if if the following have been done.You must indicate`des"or`no"as to each of the following Yes No Pumping information was provided by the owner,occupant,or Board of Health AL Were any of the system components pumped out in the previous two weeks? e� — Has the system received normal flows in the previous two week period? a 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 NIA) 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 ofthe baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? -a( _ Was the facility owner(and occupants if different from owner)provided with information on the proper mamtenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no 4- _ Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15302(3)(b)) 5 Page 6 of 11 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM I.NFORMATION Property Address: ��' { 3 ��Y�-C�• Owner: Hate of Inspection: RESIDENTIAL g �S! FLOW CONDITIONS �1 Number of bedrooms(design): Number of bedrooms(actual): o� DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: a Does residence have a garbage� grinder(yes or no):/lam Is laundry on a separate sewage system(yes or no):%[if yes separate inspection required) Laundry system inspected(yes or no): A)O Seasonal use:(yes or no): Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 3I0 CMR 15.203):_ =pd Basis of design flow(seats/persons/sgketc* Grease trap present(yes or no):_ Industrial waste holding tank presen es or no): Non-sanitary waste discharged a Title 5 system(yes or no):— Water meter readings,if av 'able: Last date of occupancy/ OTHER(descri GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped:_gallons—How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool —_Privy —Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ____Tight tank _Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):AV 6 Page 7ofII OFFICIAL INSPECTION FORM—NOT FOR VOI,UN7ARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM-- INFORMATION(continued) Property Address: 41� .Dt /{rdtcv- �a�trtics Owner OGuX, Date of Inspection: BUILDING SEWER(locate on site plan) . Depth below grade: e7 1 Materials of construction:_cast iron Ot40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: / (locate on site plan) Depth below grade: ja"0_ Material of construction:-concrete_metal_fiberglass_polyethylene _other(explainj If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) / Dimensions: JOVO Sludge depth: �3 Distance from top of sludge to bottom of outlet tee or baffle: o2l e Scum thickness: 1 a Distance from top of scum to top.of outlet tee or baffle: t t Distance from bottom of scum to bottom of outlet tee or baffle: _ How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage, tc.): n ��fpcs Sovti� a. dt rt j�l GREASE TRAP:_(locate on site plan) Depth below grade: Material of construction:_concrete metal erglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of o et tee or baffle: Distance from bottom of scum to bo om of outlet tee or baffle: Date of last pumping: Comments(on pumping reco endations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,ev' ence of leakage,etc.): 7 Page 8 of I 1 OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: CA ok 40 Date of inspection: $(a`i co TIGHT or HOLDING TANK: (tank must be p at time of inspection)(locate on site plan) Depth below grade: . Material of construction: concrete me fiberglass_polyethylene other(explain): Dimensions: Capacity: gallo Design Flow: g ons/day Alarm present(yes or no): Alarm level: Alarm' orking order(yes or no): Date of last pumping: Comments(condition of and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out ofbpX,etc.) PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no):. Alarms in working order(yes or no): Comments(note condition of pump ber,condition of pumps and appurtenances,etc.): 8 Page 9 of l l OFFICIAL. INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENT'S SIUBSUPFAC] SEWAGE DISPOSAL SYSTEM INSPECTION FORM PANT C SYSTEM INFORMATION(continued) Property Address- Owner. a�G . Irate of Inspection: ��5-- SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type 0( leaching pits,number. .2 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.). l V 6>re iA4 . t 0(.94A. ' co a r f r~ f Xbo vc. 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(ye r no): Comments(note condition of soil, ns 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 oil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): 77 Page 10 of i 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: i e`+�w►3 Owner. Date of Inspectian: 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. r dv elf ab r f Page I I of I 1 OFFICIAL INSPECTION FORD_RIOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM!INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 'y Z516 Owner: Date of inspection: per_ SITE EXALM Slope Surface water 00 Check cellar 0b, Shallow wells � Estimated depth to ground water v76'feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting ProPerEY/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) 0y Accessed USGS database-explain: You must describe how you established the high ground water elegvation: S f*s.� s g k our C-c else v4tce d o 11 ' 0ATff : 9/10/01 PROPERTY AOORESS: L23, Bishops T_er_r_a_c_e_---Hyannis, r ----------- ss------------------------- --- 02601--- -- S� On Iho above date, I inapeoted the aeptlo sylte`M at the above address Thll iyvem conslala of the lollowing, 1 . 1 -1000 gallon septic tank. M ® 2 . 2-1000 gallon precast leaching pits. ( 6 'X10 ' ) eased on my Inspection, I cortity the following oondltl I onvqV 0 q 2001 # . This is a title five septic system. ( 78 Code ) '� ItSTASLE 4 . The septic system is in proper working order at the. present time. 5. Pumped the septic tank at time of inspection. SIQNATURI?:-/ Name : ktc-.Lr-r_-..--- Company: Jo! .,ph_P__N•comb.r-6 Son , Inc , A 0 0 r e a a :_ Box_ 6 6---------____ --Crncrrrille � He ,- 026�2-0066 Phone: 508- 71_5- 77�8--_ THIS CCRTIFICATION 00es HOY CONSTITVTC A OVARANT'Y OR WARRANTY C,7 P, MACOMBER & SON, INC, T+nk�•Or i�pooll•l,r+chllrld+ PVmprd G In+ttllyd Town 5rwr� Connrvtlont 66 Clnlo(Yllll, MA 026JZ-006o 77s-mo 775.6112 �Y. ,per �—\ COMMONWEALTH OF MASSACH'V'SETTS r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL, PROTECTION i TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address..423 Bishops Terrace Hyannis,Mass, Owner's Name: Alfred & Patricia Morin Owner's Address: Same Date of Inspection: Name of Inspector: (pplease print) Joseph P.Macomber Jr. Company Name:J.P.Macomher & Son Inc. Mailing Address: Box 66 Centerville,Mass. 02632 Telephone Number: 508-775-333a _ CERTIFICATION STATEMENT 1 certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15,000). The system: a/ Passes _ Conditionally Passes _ Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature Date; L df The system inspector sha bmit 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 Page 2 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:423 Bishops Terrace Hyannis,Mass. Owner: Alfred & Patricia Morin Date of Inspection: 9 10 01 Inspection Summary: Check A,B,C,D or E/ALWAY complete all of Section D A.=SystemPasses. I ave not found anY information hich indicates that any of the failure criteria described in 310 CMR 15.303 or in-3T1fCMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B. System Conditionally Passes: _&A One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. _,d&2 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: 44..ele Observation of sewage backup or break out or high static water level in th istribution box ue to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: /(�`C/ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 1 I s OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 423 Bishops Terrace yannis,Mass. Owner: Alfred & Patricia Morin Date of Inspection: 9 1 0 0 f C. Further Evaluation is Required by the Board of Health: .4)0 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: AZ 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: 4)D 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. ,09 The system has a septic tank and SAS and the SAS is within a Zone I 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 5 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:423 Bishops Terrace Hyannis,Mass. Owner: Alfred & Patricia Morin Date of Inspection: 9 10 01 D. System Failure Criteria applicable to all systems: You must indicate"yes"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 — �ischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool �cld-cV 'Static liquid level ' th distribution box bove outlet invert due to an overloaded or clogged SAS or /cesspool �Q-:�J — '/ Liquid depth ia-Q*&&poW is less than 6"below invert or available volume is less than h day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number — �of times pumped �Atty portion of the SAS, cesspool or privy is below high ground water elevation. — f/ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface Rater supply. �/�.ny portion of a cesspool or privy is within a Zone 1 of a public well. _ _/ y portion of a cesspool or privy is within 50 feet of a private water supply well. �y portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303.therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no/ Y the system is within 400 feet of a surface drinking water supply _ Zthe stem is within 200 feet of a tributary to a surface drinking water supply stem is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped g - Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304, The system owner should contact the appropriate regional office of the Department. 4 P2ge 5 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:423 Bishops Terrace ya nis, ass. Owner: Alfred & Patricia Morin Date of Inspection: 9/1 0/01 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 -Z Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? _/Have large volumes of water been introduced to the system recently or as part of this inspection ? Were as built plans of the system obtained and examined?(If they were not available note as N/A) Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? -lam Were all system components,*Kluding the SAS, located on site? Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of thhe baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum ? V _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no i Existing information. For example, a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)) 5 APage 6 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address:423 Bishops Terrace yannis, ass. Owner: Alfred & Patricia Morin Date of Inspection: 9 1 0 01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_y_ Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):-eX110=,;VXtK?1* Number of current residents: & Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system s or no):-Ze [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: r� COMMERCIAL/INDUSTRIAL )A- 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):,40 Non-sanitary waste discharged to the Title 5 system (yes or no):N Water meter readings, if available: Last date of occupancy/use: OTHER(describe): 16W GENERAL INFORMATION Pumping Records Source of information: !J Was system pumped as part of the inspection(yes or no): If yes, volume pumped: Z&b gallons-- How was ua ti pumped determined? Reason for pumping:�,g j& �v1 �- V TYPkOF SYSTEM Septic tank,dj 'budan 1u�moil 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 syste owner) &bTight tank Attach a copy of the DEP approval Other(describe): Approm ate aog of all components date in�ed (if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): 6 ' Pl3ge 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 423 Bishops Terrace Hyannis,Mass. Owner: Alfred & Patricia Morin Date of Inspection:9/10/01 BUILDING SEWER(locate on site plan) Depth below grade: Al Materials of construction: cast iron ✓40 PVC!ldother(explain): z/,+ Distance from private water supply well or suction line: O`VL m Coments(on condition of joints, venting,evidence of leakage,etc.): Joints appear t i c1 it Nn Pvi dpri p of 1 eakage Thp ayctrPM is vented throug the house vents. SEPTIC TANK: (locate on site plan) JlbO z5 P 1l' Depth below grade: JD�/ l Material of construction: concretes.$ meta l.t frberglass4167 polyethylene ,4other(explain) ,cam If tank is metal list age:,�,Q Is age confirmed by a Certificate of Compliance(yes or no):4t)(attach a copy of certificate) , � ( i I Dimensions:p6 ,`�No'�O'.1J/ Sludge depth: _d Distance from top of sludge to bottom of outlet tee or%�a,iW, Scum thickness: Distance from top of scum to top of outlet tee or bafft"e: 4 Distance from bottom of scum to bo om of outlet tee op baffle: 0 How were dimensions determined:�rJ& • ly d� 22 ) _ Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidet�de'of.leakage, etc.): . Pump the septic tank. ,1every 2-3 years. Inlet & outlet t rG are in place.The tank is striiefurall ) SSlhnr1 and shows no evidence of leakage. GREASE TRAR(,�Calocate on site plan) Depth below grade;iTd Material of construction:IfAconcretegAmetal f&fiberglass,!4!Q polyet glep*► other (explain): Dimensions: J" 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:4 Date of last pumping:—�-� Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Grease trap is not present- 7 Page 8 of 1 1 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 423 Bishops Terrace yannis, ass. Owner:Alfred & Patricia -Morin Date of Inspection: 9 1 0 01 TIGHT or HOLDING TANK:�t��/L(tank must be pumped at time of inspect ion)(locate on site plan) Depth below grade: Material of construction: �)Aconcrete &Ametal dA2fiberglass j2 polyethylene��other(explain): �1r4 1 Dimensions: Capacity: A gallons Design Flow: 14 gallons/day Alarm present(yes or no): Alarm level: _A�d _ Alarm in working order(yes or no):_— Date of last pumping: " Comments(condition of alarm and float switches, etc.): Tight or holding tanks are not present. DISTRIBUTION BOXit (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: .f,1 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.): Distribution box is not present. PUMP CHAMBER.f. (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is not present r 8 Page 9 of I I , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 423 Bishops Terrace yannis, a . Owner:Alfred & Patricia Morin Date of Inspection: 1 SOIL ABSORPTION SYSTEM (SAS): Zlocate on site plan, excavation not required) 2-1000 gallon leaching pits 6 'X10 ' in series If SAS not located explain why: Located Type leaching pits, number: Ale leaching chambers, number: leaching galleries,number: leaching trenches, number, length: leaching fields, number, dimensions: overflow cesspool, number: —10 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.): Loamy sand to boney sand to fine sand.No signs of hydraulic or ponding. Soils are ffF Vege a ion is normai. waste -iva eer is 66" below the invert pipe. of the second leac ing pit. CESSPOOLS(cesspool must be pumped as part of inspect ion)(locate on site plan) Number and configuration: Q Depth—top of liquid to inlet invert: Depth of solids layer: 14(14 Depth of scum laver: �4 Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): 1A Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Cesspools are not present PRIVY4&g(locate on site plan) Materials of construction: Dimensions: 160 Depth of solids 'Z' Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy is; no present _ 9 Page 10 of I I i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address; 423 Bishops Terrace Hyannis,Mass. Owner: Alfred & Patricia Morin Date of Inspection; 9 1 0 01 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. tia1 0s _ 2, 1' 5/� � � b- 10 bPage 1 I of I 1 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 423 Bishops Terrace Hyannis,Mass. Owner: Alfred & Patricia Morin Date of Inspection: 9 1 0/01 SITE EXAM Slope Surface water Check cellar Shallow wells 7 Estimated depth to ground water� feet Please indicate (check)all methods used to determine the high ground water elevation: .fib Ob ans on record - If checked, date of design plan reviewed: �Observed,s'ite(abutting prope bservation hole within I50 feet of SAS) Vecke th loca oar o Health-explain: ecked with local excavators, installers- (attach documentatiorij- cessed USGS database-explain: ' t r F si You must describe how you established the high ground water elevation: Used Gahrety & Model; C;rolinr3 wai-,=i'r rnntojlr_s a}aeue sea level Used; 11_S Geal acd cal survey- 92-0001 P1 ate#2 C'_ - Used: USGS nnservai-i nn a W1 1 nai-n Jur.® 1 992 Top of Ground Leaching Pit I. :eet Groundwater:oO Feet Below Bottom of Pit High Groundwater Adjustment 11PA'4/ Therefore, the vertical separation distance between the botto of the leaching pit and the adjusted groundwater table is /' �� feet. 11 tic ` :,k •a �, Ay/{}�y`jyy{/�� rernT+.—RI'f7f'TT�ITf.�JRf'nT1R I�TnSsrT.fTrR r.T-r T1R►J�freTIn.1RrR-it�'tl►.vl R+n .. •v ' •Tn-art-.r—tar-:..-.,r-..,1 'I'OHN OF Barnstable BOARD OF HEALTH SUBSURFACE 9EHAGF DISPOSAL ,SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •.•art-r••.-•. .--.err.^.-rnmr.+n•rtmrtr��rstr+rTnr—n•t rnm-�aerisr— rr.►+om�w'rvr7 tsertn r.�rrr-•r•�. —..A -TYPE OR PRINT CI.EARLY- PROPERTY INSPECTED STREET ADDRESS 423 Bishops Terrace Hyannis,Mass. ' ASSESSORS MAP, BLOCK AND PARCEL # �"'� OWNER' s NAME Alfred & Patricia Morin PART D - CERTIFICATION I NAME OF INSPECTOR Joseph P.Macomber Jr. COMPANY NAME J.P.Macomber & Son Inca'.' COMPANY ADDRESS Box 66 Centerville,Mass.02632 StrQvt Town or CSty 3tat• LIP COMPANY TELEPHONE ( 508 ) 775 - 3338 FAX (508 ) 790 -1578 CERTIFICATION STATEMENT I certifythat I have personally inspected the sewage disposal system at this address and that the information reported is true , accurate , and omplete as of the time of -inspection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair are consistent with my training and experience in the proper function and maintenance of on- site sewage disposal systems . Check ne : ' System PASSED ; The inspection which I have conducted has not found any information which indicates that the system fails to adequately protect public health or Lhe environment as defined in 310 CMR 16 - 303 . Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form , System FAILED* The inspection w)lic)i I have con -acted has found that the system fails to protect the public health and the environment in accordance with Title 5 , 310 CMR 15 - 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection form . Inspector Signature Iz. Date O ne copy of this c r ,ification must be provided to the OWNER, the BUYER Where applicable ) nd the 130ARD OF HEAL1111, * If the inspection FAILED, the owner or operatorshall upgrade he syste within one year of the date of the inspection, unless allowed ortrequiredm otherwise as provided in 3.10 CMR 16 . 305 , partd .doc i?uQDW C4,�,,w off, �ck 02, 4 nN. P-) � pols,4� Iwrl cn r YOU WISH TO-OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME'in town(which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, I'FL.,367 Main Street,Hyannis.-MA 02601 (Town Hall)- DATE:04 Fill in please: APbLICANT'S YOUR NAME: NESS YO R HOME ADDRESS:_C� � U - a6' o o o a s TELEPHONE # Home Telephone Number e NAME OF NEW BUSINESS ' (J� �TYP>✓OF BUSINESS I$T141S,A 14 t]GOUPAT-10N YES N f laire.yriu heoh giveri. pprov. f Q the buildn idrt . YES NO _ ADDRESS Ofi�BUSINESS "�_ �. `L MAP PN"CEL NUMBER 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 Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this_town. 1. BUILDING COM ER'S OF IC This in.( Ju I h• s n info d• y permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION u horize RULES AND REGULATIONS. FAILURE TO COMPLY MAY RFR' TIN COMMENTS L,_�A InfN I A 2. BOARD OF HEALTH. This individual has been' ed of p it requirements that pertain to this type of business. Authorized Sig ature** to COMMENTS: . 3. CONSUMER-AFFAIRS.(LIGENSINGAUTHORITYJ- This individual has been irrfp med of tha licensing rewirements that pertain to this type of business. Aef author a ignature* COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your kftrmat ion: Businew certificates(oust$30.00 far 4 years). A business certificate ONLY REGISTERS YOUR NAME in torroar(which °s Office 9"FL. 367 ore too Business Cetcates are mailable at Torte Cierh du OIA.fsl..-iit does redL peraraissl operate.)you must f�y� Main Street,Hyaninis.MA 02601 (Town Hull CRATE; V112?,lb 6 Fill in please: APPLICANT'S Y€.�JR NAME. S% V _ BUSINESS YD R HDME ADDFFM,- S 7 T E # Home Telephone NumberTELEPNC�! p 1 NAMIE OF NEW BUSINESS o U �' . TYPE OF BUSINESS Cry iN!5L re k.)as IS THIS A HOME OC WPATION? Have yrau been given appra,yal from the bui division? YES N® ADDS OF BUSINESS Z� 3 Ir'f k6ps:7" 'Y fi I Pf PARCEL NUMISE%j �S } When starting a new business there are several things you must do in order to be in compliance,w th the rules and regulations of the Tmvn of 3amstable. This fern is intended to assist you in obtaining the inforrnation you may need. You MUST 60 TO 200 Main St-(cornw of Yarmouth Rd.&Main Sure") to make sure you have the appropriate permits and ficmaes reWired to leply operate your business in this town. 1. EBUI LDING C®MjrlilSS*NER`S OFFICE This individual h@s en�rr�vr of any perms re irernents Lhat pertain to this type of business. A or Enitur6fj COMMENTS- 2. ®DAM OF HEALTH This individual has e n inform d f.4khe uirements that pertain to this type of business. orized'Signa x x COMMENTS: 3. CON IVIER AFFAIRS(UCENSING AUTHO This individual Ices b i ed a ants that pectin to this type of business. v o ed Signa ure* 1 t~ t MENT'S: �799� �.� &Y _ III F' II �. t h s BUSINESSfNAME ,BR. USA. MOBILE PRESSURE WASHING v 16 F a CORPORATE NAME, m _ IL:ADDRESS 423 BISHOPS TERRACEY ,a ;# Es i gk " HYANNIS ; "STATE ,MA , , �ZIP. 02601 VILL fir?AGE E.4 :,�. ..-._ BUS ADD;1F DIFFERENi* Any 44 T: 4. i fh � . , OWNER#1NAMETHYAGO LEAST SILVA FlRST ` STREET y 423 BISHOPS TERRACE wain rfl�€ VILLAGE HYANNIS � �° " ESTATE MAC ZIP. 02601 P - q v I ySROWNER#2 FIRSTiNAME�, 1� LAST, q k P'S -STREET:,] x n_ f an x ;• — �, a� , T« p - ° "" VILLAGE * `, ",�" STATE •r21P *�"� STATUS° NEWY 11iEXPIRE,DATE 02/23/2010 5 E� BOOK 192 PAGE', 06-064 DATE ISSUED ,, 02/23/2006 -DATE CLOSED:" " DATERENEW t- �RENEWBOOK: ENEWPAGE ��hj DATEDISCONT DISCBOOK � o DISCPAGE ¥ { a CONDITIONS HOME OFFICE ONLY MUST COMPLY WITH HOME OCCUPATION REGULATIONS z� REr. 3 Z4�-07 M BR.USA. Mobile car wash & power wash Places where business will be taking act (will be working): • Will serve all over cape area where work is allowed to be performed such as, residences, commercial plazas and office buildings' parking lots. List of chemicals used and respective quantities: o Car Wash Express Detergent/Shampoo (SOAP) - 3 gal./month. • Glass Cleaner by Johnson Wax Professional (WINDEX) - 2 gal./month. • . Leather conditioner by Prochem - (Leather cleaner and conditioner) - 1 gal./month. • Polishing Wax Compound Rapid Wax by ARDEX - 2 gal./month. • Odor Neutralizer by Prochem (Car Fragrance) -2 gal./month. • General Purpose Cleaner by Johnson Wax Professional -for Upholstery, Vinyl and wheels - 3 gal./month. i procedure:Start to finish car washing p ocedu e: o Set up the containment mat on the ground; • Pull vehicle over the mat; • Wet the vehicle's surfaces; • Hand wash vehicle with detergent; • Clean wheels with General Purpose Cleaner; • Rinse the vehicle; • Dry it out; • Vacuum inside - carpet and seats (including floor mats); • Wipe dashboard; o Clean windows using Windex; • Spread wax on; • Wipe wax off; • Spray car fragrance inside; • Pull vehicle off the mat; • Suck the water on the mat with an appropriate Wet-Dry vacuum; • Fold mat and put away in the trailler; • Dump dirty water in the dirty water container; dispose of dirty water at the Town of Barnstable Water Pollution Control -whenever container gets fully loaded. U S/9 In CAP wgsll e FI'Y lye7 VT ON hvsc� -t#e7 C6 re-- y U,-W w a �v n� A ccuAA- �, �o C��Alvb DOW j/� SUO I �OM � � � 04/02/2007 10:38 FAX 508 790 6325 WATER POLLUTION CONTROL 0 001 Town of Barnstable Water Pollution Conrol Division 617 Bearse's Way Hyannis, MA 02601 Date: April 1,.2007 F/� 'y Number of pages including cover sheet: /'7� 1 To: From: Alicia Parker Ann Mastroianni Growth Management Barnstable WPCD Lab 617 Bearse's Way Hyannis, MA 02601 Phone: Phone: (508) 790-6336 Fax. 508-790-6304 Fax: (508) 790-6325 REMARKS: _ Urgent _For your review _Reply ASAP _Please comment Hi Alicia, Thyago Silva, BR.USA Mobile Carwash, asked me to contact you with the results of the washwater from his vehicle. It exhibits no harmful effects to our process here at the wastewater plant. He included the MSDS's of the products he uses, they are "environmentally friendly" products. We give him permission to dump his used washwater into our system. Ann Mastroianni Barnstable WPCD Lab ray.; Ann's Fax Form.xls ' 3 3 Section 1- Manufacturer's Information Manufacturer's Name C.A.R. Products, Inc. Manufacturer's Address 630 Beaulieu St. Holyoke, MA 01040 Manufacturer's Phone Number Local 413-536-9900 Toll Free 800-537-7797 Emergency Phone Number Chemtrec 800-424-9300 Product Information C.A.R. Products 800-537-7797 Effective Date 2/19/04 Chemical Name Car Wash Express Detergent DOT Shipping Description Compounds, Cleaning Liquid (Sodium Hydroxide) 8,NA1760, PGII Emergency Response Guide#154 Chemical Family Strong Alkaline Detergent Chemical Comment Hazardous ingredients in section II are subject to the reporting requirements of Section 313 of the Emergency Planning and Community Right to Know Act of 1986 (40CFR372). Chemical Formula Mixture of alkalies and wetting agents. Hazardous Materials Identification System (HMIS) FLAMMABILITY HAZA7RATINGO 4= EX3=HI HEALTH 2 0 REACTIVITY 2=MODERATE 1= SLIGHT 0= INSIGNIFICANT PERSONAL PROTECTION B N/E= Not Established or Unknown N/A= Not Applicable Date Printed: 03/30/07 Car Wash Express Detergent Page 1 of 4 Section II- Hazardous Ingredient Hazardous Component CAS Number Hazardous % TLV (Units) Sodium Hydroxide 1310-73-02 < 10 2mg/m3 Ceiling Non-Hazardous Ingredients > 90 Section III- Physical & Chemical Data Boiling Point ff) > 212 OF Volatility/VOL (%) > 75 % Melting Point(OF) N/A Vapor Pressure (min Hg) N/E Vapor Density (Air= 1) N/E Solubility In H2O Complete Appearance/Odor Yellow liquid, bland fragrance Specific Gravity (H2O= 1) 1.18 Evaporation Rate Like water pH 11.70 Section IV- Fire & Explosion Hazard Data Flash Point(°F) None Lower Flame Limit N/A Higher Flame Limit N/A Extinguish Media As needed for surrounding fire Special Fire Fighting Procedures None Unusual Fire Hazard May produce flammable hydrogen gas upon contact with reactive metals Section V-Health Hazard Data Routes of Entry Inhalation (mists), skin, ingestion Health Hazards Irritation or burns NTP No IARC Monographs No OSHA Regulated No Threshold Limit Value N/E , blended product. See section II for information on listed ingredients. Date Printed: 03/30/07 Car Wash Express Detergent Page 2 of 4 i Section V-Health Hazard Data continued Over Exposure Effects Skin Contact: Irritation or burns. Eye Contact: Burns. Inhalation: Inhalation of concentrated mists-irritation of upper respiratory tract: possible burns, chemical pneumonia, and lung damage. Ingestion: Burns of mouth, throat and stomach: pain, nausea, vomiting, shock symptoms. First Aid Skin Contact: Immediately flush with cool running water for 15 minutes. Remove contaminated clothing and wash before reuse. If irritation or burn develops and persists, get medical advice or assistance. Eye Contact: Immediately flush with cool running water holding eye lids apart. Remove contact lenses if present, and continue flushing for 15 minutes. Get medical assistance. Inhalation: Remove to fresh air. Immediately call for medical advice or assistance if breathing difficulty or irritation is severe or continues. Ingestion: Rinse mouth with large amounts of water. Drink water, milk or other fluids to dilute. Do not induce vomiting unless directed by medical personnel. Immediately call for medical advice or assistance. Section VI-Stability & Reactivity Data Chemical Stability Stable Conditions To Avoid Contact with Incompatible materials Incompatible Materials Avoid contact with strong acids, reactive metals, strong oxidizers, most organic material such as leather, paper, wool. Decomposition Products Oxides of carbon Hazardous Polymerization Will not occur Polymerization Avoid N/A Section VII- Spill or Leak Procedure For Spill Small spills, less than 1 gallon: Flush to drain with excess water. Large spills: Only knowledgeable and properly protected people should work with a large spill. Get professional assistance if necessary. Stop source of discharge if safe to do so. Evacuate unprotected personnel. Contain spilled material, and keep from discharging to surface waters. Recover to drum for later use, Date Printed: 03/30/07 Car Wash Express Detergent Page 3 of 4 Section VII-Spill or Leak Procedure continued treatment, or disposal. Recover using alkali resistant pump, scoops, absorbent material, or other process as appropriate. Rinse contaminated area well.Notify local, state, or national authorities if required. Waste Disposal Method: Dilute solutions are normally sewer disposable; check local rules for any restrictions. Product is alkaline. Dispose of according to national, state, and local rules. Section VIII- Special Protection Respiratory Protection None normally required. NIOSH/MSHA approved respirator where conditions may cause exposure limits to be exceeded, including mists. Ventilation General or local to avoid exposure to irritating mists. Protective Gloves Alkali resistant, impermeable. Eye Protection Goggles and/or face shield. Other Protection Alkali resistant, impermeable apron and shoes. Section IX-Special Precautions Keep out of reach of children. For industrial or institutional use only. Disclaimer: This information is , to the best of our knowledge, current, accurate, and complete as of the date of this document. However, we make no representation as to its accuracy. Such information may not be accurate when product is used in any process or combined with other materials. In certain circumstances additional information may be necessary. No representation(s), guarantee(s), or warranty, either expressed or implied, or of any nature, is made with respect to the product or data provided. -End of document- Date Printed: 03/30/07 Car Wash Express Detergent Page 4 of 4 Footer Page with Links Page 1 of 1 Carwash y s mom Division y "HEM[ 3 l"Ift pppors gg,,„„,, �74f� Q `°mzi.f http://www.carproductsinc.com/footer/footer.html 3/30/2007 Google Image Result for http://www.interstateproducts.com/logo/car.wash.JPG Page 1 of 1 See full-size image. Remove Frame G000le •-` www.interstateproducts.com/logo/car.wash.JPG image Results))' 2048 x 1536-628k Image may be scaled down and subject to copyright. Below is the image in its original context on the page:www.interstateproducts.comloortable.mobile.co... Portable Containment - L. 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BOOK:192 RENEWAL BOOK: RENEWAL PAGE: AGE 06-064 DATE DISCONTINUED: CERTIFICATE EXPIRES: 02/23/2010 DISCONTINUED BOOK: DISCONTINUED PAGE: In conformity with the provisions of Chapter One Hundred and Ten(110), Section Five(5)of the General Laws, as amended,the undersigned hereby declare(s)that a business is conducted under the title below-, located as shown, by the following named person,persons or corporation: +PLNOAT BUsNESS CERTI C P `, TS HTT'E1ANE©PEi�SO(S 5(A. Ql1GSl!TES '$yDE�i4[u ' "s,-uE? .a �s .,vv sE# y�e rs ,4Es �,:r�: F �/ ER�P. RS,t7NAL AME S,� ITr" OES:�:QT P+YTHAT T�iErAP LICgIT S�H'AS HAU, :tMET� L"� C,-NS �^ �`�l e T ftPERMtSSIOPIS''RECtI11R-D BY=T E TOWN!OFPBARNS7l'ABL ",,HU1F DING,_ I1 A NTH AND GONSIiMt=R AF ACRS x ' h ,� •�s��g;.�y `,� �'� �� -•��:.� y.�+��a�mx,� ��'-�,� �9 �'. � ,a. �, ^ 'c�' � -�� DEPARTM ITS FD#?1THE�LEGAL��PERAT OfOFTHIUSILVESSAT'THE�SATEp LO ANTI k r,w Y 4... BR. USA. MOBILE PRESSURE WASHING. MAILING ADDRESS: 423 BISHOPS TERRACE HYANNIS, MA 02601 THYAGO SILVA 423 BISHOPS TERRACE HYANNIS, MA 02601 Signatures: 4'�7 z lte- THE ABOVE NAMED PERSON(S)PERSONALLY APPEARED BE F�RE ME AND MADE OATH THAT THE FOREGOING STATEMENT IS TRUE. TITLE Identification Presented: DATE: February 23, 2006 . CONDITIONS: HOME OFFICE ONLY MUST COMPLY WITH HOME OCCUPATION REGULATIONS In accordance with the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass General Laws,Business Certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter.. A statement under oath 4 must be filed with the city clerk upon discontinuing, retiring or withdrawing from such business or partnership. Copies of such certificates shall be available at the address at which such business is conducted and shall be furnished on request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred dollars($300)for each month during which such violation continues. CERTIFICATION CLAUSE I certify derIsthe penalties of pe ' ry that I,to the best of my knowledge and belief, have filed all state tax returns and paid all state taxes requirq6dder law. * SignatiWof In ' dual or Cor1forate Name(Mandatory) By: Corporate Officer(Mandatory if applicable) ** or Federal ID Number * This license will not be issued unless this certification clause is signed by the applicant. **. Your social security number will be furnished to the Massachusetts Department of Revenue to determine whether you have met tax filing or tax payment obligations. Licensees who fail to correct their non-filing or delinquency will be subject to license suspension or revocation. This request is made under the authority of Mass. G.L. Cha 62C, S. 49A. (MM/DDIYYYY) ACORD �, /2006 CERTIFICATE OF LIABILITY INSURANCE o7/2a DATE RAWDD PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION SCHLEGEL INSURANCE ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 34 MAIN ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. WEST. YARtOUTH, MA 02673 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: COLONY INSURANCE CO Thyago Silva Dba Miracle Cleaning INSURER B: 423 Bishops Terr INSURER C: INSURER D: Hyannis, MA 02601 INSURERE: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR H0.SR0 - TYPE OF INSURANCE OLICYEFFF POLICY NUMBER P ATE MMIDDIYY) POLICY DATE(MMIOI DNY)N LIMITS GENERAL LIABILITY GL3326440 04/07/2006 04/07/2007 EACH OCCURRENCE $1,000,000 A $ COMMERCIAL GENERAL LIABILITY PREMISES Me occurence) $100 r 000 CLAIMS MADE R❑OCCUR MED EXP(Ary one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $1,000,000 POLICY JECT 40C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE S RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS Et EMPLOYERS'UABILFTY E.L.EACH ACCIDENT 8 ANY PROPRIETORIPARTNERIMCUTIVE OFFICER/MEMBER EXCLUDED? EL DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT 8 OTHER. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION CAPE COD HOSPITAL SHOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 27 PARK STREET DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 21 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT. BUT FAILURE TO DO SO SHALL HYANNIS, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY THE INSURER, ITS AGENTS OR REPRESENTATIVES. C/O ROBERT T. ROWAN AUTHORIZED REPRESE!R"'��OAC5DRDCO ACORD 26(2001108) PORATIO 1988 V1 iv, �- MAtn�onwax� ��1I�y�^L Material Safety Data Sheet GP FORWARD SC General Purpose Cleaner National Fire Fire Hazard Hazardous Material ;: 211t 12 Protection Information System 0 { Association Health Reactivity (HMIS) - (NFPA) Reactivity 0 Specific Hazard Protective None required. Emergency Green. Liquid. See Section 9. Clothing Overview CAUTION: May be mildly irritating to skin. May cause eye irritation. Section 1. Chemical Product and Company Identification Product Name GP FORWARD SC General Purpose Cleaner Code 3145395 & 3145408 & 3820&4519&4965 Product Use Industrial/Institutional: Cleaning product. This product is PMS# 3164932 intended to be diluted prior to use. MSDS# F-00382001 Validation Date 5/19/2004 U.S.Headquarters Canadian Headquarters Print Date 5/19/2004 JohnsonDiversey, Inc. 8310 16th Street I JohnsonDiversey-Canada,Inc. n Case do Of ( )800 851-7145 Sturtevant,Wisconsin 53177-0902 2401 Bristol Circle Emergency Phone: (888) 352-2249 Oakville,Ontario L6H 6P1 MSDS Internet Address: Phone: 1-800-668-3131 www.johnsondiversey.com Section 2. Composition and Information on Ingredients Ingredients CAS# %by Weight Exposure Limits LC50/LD50 Alkyl glucoside 68515-73-1 1-5 Not available. Not available. Tetrasodium EDTA 64-02-8 1-5 Not available. ORAL(LD50): Acute: 330 mg/kg [Rat]. Alcohol Ethoxylates 68439-46-3 5-10 Not available. ORAL(LD50): Acute: 1378 mg/kg [Rat]. DERMAL (LD50): Acute: >2000 mg/kg [Rabbit]. Propylene glycol methyl ether 107-98-2 5-10 ACGIH(United States). ORAL(LD50): Acute: 3739 TWA: 369 mg/m3 mg/kg [Rat]. 11700 mg/kg STEL: 553 mg/m3 [Mouse]. 5700 mg/kg [Rabbit]. DERMAL(LD50): Acute: 13000 mg/kg [Rabbit]. Water 7732-18-5 60-100 Not available. Not available. Section 3. Hazards Identification Routes of Entry Eye contact. Skin contact Inhalation. Potential Acute Health Effects Eyes May be m derately irritating to eyes. Skin May be mildly irritating to skin. Inhalation None known. i� Ingestion None known. Continued on Next Page Page: 114 John-non Unix Material Safety Data Sheet PJZOrESs14ONAL GP FORWARD SC General Purpose Cleaner Medical Conditions Persons with pre-existing skin disorders may be more susceptable to irritating effects. Aggravated by Overexposure: See Toxicological Information(section 11) Section 4. First Aid Measures Eye Contact Flush immediately with plenty of water. If irritation persists, get medical attention. Skin Contact Flush immediately with plenty of water. Get medical attention if irritation occurs. Inhalation No specific first aid measures are required. Ingestion No specific first aid measures are required. Section 5. Fire Fighting Measures Flammability of the None known. Product Flash Points Closed cup: >121.1 VC 250°F . Products of Combustion None known. Fire Fighting Media Use water spray to keep fire exposed containers cool. dry chemical, carbon dioxide. and Instructions Protective Clothing(Fire) Put on appropriate personal protective equipment(see Section 8). Special Remarks on Fire None known. and Explosion Hazards Section 6. Accidental Release Measures Personal Precautions Put on appropriate ersonal protective equipment see Section 8). Environmental In the event of major spillage: Use appropriate containment to avoid environmental Precautions and Clean-up contamination. Sweep or scrape up material. Place in suitable clean, dry containers for Methods disposal by approved methods. Use a water rinse for final clean-up. Section 7. Handling and Storage Handling Avoid contact with eyes, skin and clothing. Wash thoroughly after handling. FOR COMMERCIAL AND INDUSTRIAL USE ONLY. Storage Store in a dry, cool and well-ventilated area. Protect from freezing. Keep container tightly closed. KEEP OUT OF REACH OF CHILDREN. Section 8. Exposure Controls/Personal Protection Engineering Controls Nospecial ventilation requirements. General room ventilation is adequate. Personal Protection Eyes Nospecial requirements under normal use conditions. Hands Nospecial requirements under normal use conditions. Respiratory Nospecial requirements under normal use conditions. Feet Nospecial requirements under normal use conditions. Body No special protective clothing is required. Section 9. Physical and Chemical Properties Physical State and Liquid. Appearance Odor Mild. Citrus. Color Green. pH Specific Gravity 1.02 Continued on Next Page Page:214 Johnson wax Material Safety Data Sheet PROFESSIONAL GP FORWARD SC General Purpose Cleaner Boiling/Condensation 100°C (212°F) Point Melting/Freezing Point 0°C (32°F) Solubility in water Complete. Section 10. Stability and Reactivity Stability and Reactivity The product is stable. Conditions of Instability None known. Incompatibility with Slightly reactive to reactive with oxidizing agents, acids. Various Substances Hazardous Decomposition When exposed to fire: Produces normal products of combustion. Products Hazardous Polymerization Will not occur. Section 11. Toxicological Information Acute toxicity ORAL(LD50) Estimated to be greater than 5000 mg/kg (rat). Effects of Chronic None known. Exposure Other Toxic Effects None known. Section 12. Ecological Information Not available. Section 13. Disposal Considerations Waste Information No special precautions. Dispose of according to all federal, state and local applicable regulations. Section 14. Transport Information DOT Classification DOT Proper Please refer to the Bill of Lading/receiving documents for up to date shipping information. Shipping Name TDG Classification TDG Proper Please refer to the Bill of Lading/receiving documents for up to date shipping information. Shipping Name TDG Class Section 1.5. Regulatory Information Reporting in this section is based on ingredients disclosed in Section 2 US Regulations State New Jersey: 1-Methoxy-2-propanol Massachusetts RTK: 1-Methoxy-2-propanol Pennsylvania RTK: 1-Methoxy-2-propanol This product is not subject to the reporting requirements under California's Proposition 65. Registered Product Not applicable. Information Canadian Regulations WHMIS Classification Class D-26: Material causing other toxic effects(TOXIC). Continued on Next Page Page:314 Johnson max Material Safety Data Sheet PROFi SS1ONAL. GP FORWARD SC General Purpose Cleaner WHMIS Icon T Registered Product Not applicable. Information Chemical Inventory All ingredients of this product are listed or are excluded from listing on the U.S. Toxic Status Substances Control Act(TSCA)Chemical Substance Inventory. Section 16. Other Information Other Special Not available. Considerations Version 0.01 Notice to Reader This document has been prepared using data from sources considered technically reliable.It does not constitute a warranty, express or implied,as to the accuracy of the information contained within.Actual conditions of use and handling are beyond seller's control. User is responsible to evaluate all available information when using product for any particular use and to comply with all Federal,State,Provincial and Local laws and regulations. j S.C. Johnson Wax 4-Very High HAZARD RATING Racine, Wisconsin 53403-5011 3-HigYs IIIdIS NFPA y Phone: (414) 631-2777 2:MOderate ea L Emergency Phone:(800) 226-5635 1-S11ght atmm i >t 0-Insignificant eact vit MATERIAL SAFETY DATA SHEET SECTION I-PRODUCT ID8 171CATION 0XV NAM: Pl�I1Ci CODE LANCE CONCENTRATE GLASS CLEANER 14700-3 MAUL Olt ODe"UAW ATE ISSLIE.a: RZEDCS* PARED ST; 05/21/91 12/17/90 Terry A. Meyers Chemical Info. Ad- SECTION II-INGRBDIffiIT INFORMATION yco t er M A 11-76-2) (SKIN) (PA,NJ,MA) Ammonium Hydroxide (CAS# -6 25 m OSHA PEL ACGIH TLV-TWA; 50 336-21-6) etrasodium Salt of EDTA (CAS# 64-02-6) -3 OT ESTABLISHED odium Lauryl Sulfate (CAS# 68585-47-7) -4 OT ESTABLISHED I dium Xylene Sulfonate (CASt -4 OT ESTABLISHED 300-72-7) &ter (CAS". 7732-18-5) 0-55 ONE ee Regulatory Information (Section II) for explanation of bracketed nformation. SECTION 111-PEYSICAL DATA c(.nvoR: Clear blue iqul wit clf+c GRAV+TT (M2a.1): 1.00 a --nonia odor APOR PRESSME (m SSI: CENT VOLATILE ST VMWE (Y); I1S+LITT IN WATER: complete APOR OENS+TT (Alr+1): REEZINC POINT Vf): alow 32 41LINC POINT ( -1rVAPORATIOK RATE (S.TYl AtolsTrt): ND (Rs pckApe6, mina 920): MEORETIUL VOC(IG/SAl): .41 SECTION IV-FIRE AND EXPLOSION INFORMATION LASH POINT ('f) (MRTIwd l)AAd): ove 1 LAW"ALE LIMITS: ND RI)NGLISMINC MEDIA: Foam. COZ. Dry.C emlca . later P09- I c1u f+REf+cNT1Nc PtocEweas: Normal Eire fighting procedures may be used. nu AND EXPLOftd,MAZAADS: No special azards known SECTION o-HEALTH ELXZARD DATA Muntsof ta�TE Of ENTRT; In contact. a STWIms: irect Contact O pr uct wit eyes can Cause irritation. nged or repeated contact of product with skin nay cause irritation. ct may cause severe distress and serious illness if taken internally. ct va ors ma cause irritation to nose throat and lun s if inhaled.a rtocEDutEs: us eyes w t water or minutes. rr ration sts, seek medical aid. Wash skin with plenty of water. If irritation sts, seek medical aid. If product is swallowed, do not induce ing. Seek medical aid at once. if product is swallowed, drink large ts of water or milk and seek medical aid. If mist, fog or vapors discomfort, remove to fresh air and ventilate area. If discomfort sts seek medical aid. L4mI110NI GENE RALLT RECOGNIZED AS SEINc AGCRAVATEO ST EXPOSM: ereons witezistina skin disorders may be more susceotable to irritating effects. 8F6d305n o soa ax MATERIAL SAFETY DATA SHEET Pa e 2 Ecine,Wisconsin GLANCE CONCENTRATE M=9—C=ER 25 Hove Street Product Number: 14700 . S3403 Serial Number: 3 SECTION VI-R$ACTIVITY DATA TMILITT: Stao e TMILITT-COOItIOrS TO AVOID: None known YCOPWATIDILITT: None Own OtcaMPOELTws P*OX=S- When exposeU to fire, produces normal products o combustion. POLMtITAT1Os: Will not occur. POLINERIZATIOs-M O1TIONS TO AVOID: None own SECTION VII-SPILL OR LEAK PROCEDURES T£aS TO ME TALEV :s CASE MAIEttIAL IS tELEAS£D OILSPILLED: Contains ammonia. Do not let pilled or leaking material enter watercourse. May be toxic to aquatic ife. Absorb with oil-dri or similar inert material. Sweep or scrape up nd containerize. TE DISPOSAL Jef*MtJlx: No special method. Observe all applicable ederal/State regulations and Local ordinances regarding disposal of on-hazardous materials. Waste from normal product use may be sewered to a ublic-owned treatment works; (Po w) in compliance with applicable-. Federal, itate and local pretreatment reouirements. i SECTION VIII-SPECIAL PROTECTION INFORMATION 1SMATOtT PtOTECTIOs: No specia requirements uncer normal use conditions. I vT1uricu- General room ventilation adequate. AOTECTIVE r.LtWE1: Any impervious material. YE MIECTICO: Chemical wor Mrs splash-proot gogg es TMEt PWIMITE W-ASJMS: where gross eye a In contact may be a problem. wear use • i ppropriate protective equipment. Launder contaminated clothing/equipmenc efore reuse. SECTION IX-SPECIAL PRECAUTIONS [andling CALfflQM"T LAaELIw: Contains utoxyec no an aII�[onia. ye irritant. O not t in eyes, on skin, or clothing. Avoid breathing ammonia vapors. Et MAouec A+Q SIMAM CMMSTIOrS: Product rest ue may remain on in empty ntainers. All precautions for handling the product must be used in the e=ty container and residue. SECTION X-ADDITIONAL INFORMATION 1T IOaAL IVFCMMTlOs: This MSDS also covers product codes: 4305. I SECTION XI-TRANSPORTATION INFORMATION cuss: Non Regulated. OT s: NA vL.:ec tLME: Cieaning, scouring or washing compounas. .NO. . Liquid. r volts: None SECTION XII-REGULATORY INFORMATION' ere are no ingredients s }ect to the reporting requirements der California's Propoaition 65. - These ingredients are subject to the reporting requirements der the Flassachusetts Hazardous Substance List. J - These ingredients are subject to the reporting re irements nder the New Jersey Right to know Hazardous Substance List. A - These ingredients are subject to the reporting requirements iiader the Pennsylvania Hazardous Substance List. ARA - These ingredients are subject to the reporting requirements der the Superfund Amendments and Reauthorization Act of 1966 itle III, Section 313 and 40 CFR Part 372. VA-vet 4WINAMe, ME-Sot Estabt(shed, htt-se fpectat cogA ra■rnt, [O-sot Dat—oined Th. {ntorwttan hsrsin to Stv.n In pad loath. so wrranty sW"*.d or 1-0114d Is arch. Any ire of tease dots and Info tlat oast to detarolnd by the awar to to in oeeoc-d�o with owituWe fmk-el, state, and Lout Lars and r.arlatlorr. Tee Ldornstlon esnatn.d In this fe.r is to itdr.tlal and I. aadlttd aotaty for your orpslnitatlon•a Intornat use. • MSDS Material Safety Data Sheet ? n Professional Chemicals Corporation 01 FOitAREASOIYI Fluorosil Odor Neutralizer-Floral MSDS Number:A224 Revision Date:April 7,2006 Page 1 of 4 9 PRODUCT AND COMPANY IDENTIFICATION Manufacturer Professional Chemicals Corp. 325 S. Price Road Chandler,AZ 85224 Contact: EHS Manager Telephone Number:480-899-7000 FAX Number: 4.80-707-5661 E-Mail: jphilips prochem.com Web www.procnem.com Product Name: Fluorosil Odor Neutralizer-Floral Revision Date: April 7,2006 MSDS Number: A224 Emergency Telephone:(800)535-5053[Infotrac] COMPOSITION/INFORMATION ON INGREDIENTS Ingredients: Cas # Perc. Chemical Name ---------------------------------------------------------------- 67630 I <5% 1 Isopropyl alcohol HAZARDS IDENTIFICATION Route of Entry: Eyes;Skin; Inhalation; Ingestion; Target Organs: Eyes;Skin; Inhalation: Minimal respiratory tract irritation may occur with exposure to a large amount of material Skin Contact: May Cause Irritation. Eye Contact: May Cause Irritation. Ingestion: Small amounts swallowed incidental to normal handling operations are not likely to cause injury; swallowing amounts larger than that may cause temporary injury. HMIS III-ratings (scale 0-4): Health = 1, Fire = 2, Physical Hazard = 0 Q FIRST AID MEASURES Inhalation: If symptoms develop,move victim to fresh air. If symptoms persist,obtain medical attention. Skin Contact: Wash with soap and water. If irritation persists consult medical personnel. Eye Contact: Immediately flush eyes with large amounts of water for at least 15 minutes,lifting eyelids occasionally to facilitate irrigation.Get immediate medical attention. Ingestion: If swallowed, DO NOT induce vomiting unless directed to do so by medical personnel. If injured party is conscious,give two glasses of water. Seek medical attention. A MSS Material Safety Data SheetC? Gl Professional Chemicals Corporation 01 FORA REASONt Fluorosil Odor Neutralizer-Floral MSDS Number:A224 Revision Date:April 7,2006 Page 2 of 4 © FIRE FIGHTING MEASURES Flash Point: 113OF Flash Point Method: Closed Cup Wear self contained breathing apparatus and other protective clothing. Use any standard agent-choose the one most appropriate for type of surrounding fire. Q I ACCIDENTAL RELEASE MEASURES Keep away from drains and ground water.Keep all unnecessary personnel away.Spill area may be slippery.Pick up excess with inert absorbant material and place into separate waste container.Ventilate Area and Wash Spill Site After Material Pickup is Complete.Consult an expert on disposal of recovered material and ensure conformity to local disposal regulations. V I HANDLING AND STORAGE Handling Precautions: Avoid contact with eyes,skin,or clothing;Consider normal working hygiene.Handle with care and avoid spillage on the floor(slippage).Keep away from sources of ignition;wash thoroughly after handling. Storage Requirements: Store out of reach of children;keep container closed;store in a cool well-ventilated place away from strong oxidizing or alkaline product. Q EXPOSURE CONTROLS/PERSONAL PROTECTION Engineering Controls: Normal room ventilation is satisfactory for limited use. Protective Equipment: HMIS PP,B I Goggles,Gloves PHYSICAL AND CHEMICAL PROPERTIES Appearance: Clear to Pale Yellow Physical State: Liquid Boiling Point: N/D Odor: Floral Freezing/Melting Pt.: N/D pH: 6.0-7.0 Solubility: Soluble Vapor Pressure: N/D Spec Gray./Density: 8.3 Vapor Density: N/D N MSS Material Safety Data Sheet ; Professional Chemicals Corporation •1 FORAREARON1 Fluorosil Odor Neutralizer-Floral MSDS Number:A224 Revision Date:April 7,2006 Page 3 of 4 STABILITY AND REACTIVITY Stability: Product is stable under normal conditions. Conditions to avoid: None Known Materials to avoid(incompatability): None Known Hazardous Decomposition products: Exposure to fire may liberate carbon dioxide,carbon monoxide,organic acids, and other unidentified thermal decomposition products from this product or its packaging. Hazardous Polymerization: Will not occur. N I TOXICOLOGICAL INFORMATION Route of Entry:Eye contact,and Skin absorption/contact Effects of Acute Overexposure to Product: Eye Contact:Causes eye irritation,redness,tearing and blurred vision Skin Contact:Causes skin irritation,defatting and dermatitis Inhalation:Inhalation of mist or vapor may cause temporary respiratory irritation;temporary central nervous system effects including dizziness,weakness,fatigue,nausea,and headache. Ingestion:May cause gastrointestinal temporary irritation with nausea,vomiting and diarrhea. ECOLOGICAL INFORMATION Refer to Section 6 for information regarding accidental releases and Section 15 for regulatory reporting information. DISPOSAL CONSIDERATIONS Dispose of in accordance with local regulations. TRANSPORT INFORMATION Refer to bill of lading or container label for DOT or other transportation hazard classification. Ship in accordance with 49 CFR parts 100- 185. REGULATORY INFORMATION COMPONENT/(CAS/PERC)/CODES ---------------- *Isopropyl alcohol(67630<5%)MASS,NJHS,NRC,OSHAWAC,PA,SARA313,TXAIR,WHMIS 1% REGULATORY KEY DESCRIPTIONS MASS=MA Massachusetts Hazardous Substances List NJHS=NJ Right-to-Know Hazardous Substances NRC=Nationally Recognized Carcinogens OSHAWAC=OSHA Workplace Air Contaminants PA=PA Right-To-Know List of Hazardous Substances SARA313=SARA 313 Title III Toxic Chemicals TXAIR=TX Air Contaminants with Health Effects Screening Level WHMIS=Workforce Hazardous Material Information System MSDS Material Safety Data Sheet pp , Professional Chemicals Corporation #I FOR AREASONI Fluorosil Odor Neutralizer-Floral MSDS Number:A224 Revision Date:April 7,2006 Page 4 of 4 • OTHER INFORMATION This document is prepared in accordance with 29 CFR 1910.1200.The purpose of this section is to ensure that the hazards of all chemicals produced or imported are evaluated,and that information concerning their hazards is transmitted to employers and employees. All information appearing herein is based upon data obtained from the raw material manufacturer and/or recognized technical sources. While the information above is believed to be true and accurate,the author makes no representations as to its accuracy or sufficiency. Conditions of use are beyond the manufacturer's control;therefore the users are responsible to verify this data under their own particular conditions,applications and regulations to determine if the product is suitable for their particular purposes. The users assume all risks of product use,handling,disposal,reliance upon,publication or use of the information contained herein. This information applies only to the product designated above and does not necessarily apply to its use in combination with other materials,products,chemical compounds, structures or processes. Prepared by:EHS Manager Phone Number:[4801899-7000 END OF MSDS DOCUMENT i 'A MSDS Material Safety Data Sheet pp Professional Chemicals Corporation OFFORAREASON! Leather Conditioner MSDS Number:E675 Revision Date:Aprill 5,2006 Page 1 of 4 9 PRODUCT AND COMPANY IDENTIFICATION Manufacturer Professional Chemicals Corporation 325 S Price Rd. Chandler,AZ 85224 Contact: EHS Manager Telephone Number:480-899-7000 FAX Number: 80-707-5661 E-Mail: jphilips prochem.com Web www.pro em.com Product Name: Leather Conditioner Revision Date: Aprill 5,2006 MSDS Number: E675 Emergency Telephone:(800)535-5053[Infotrac] J COMPOSITION/INFORMATION ON INGREDIENTS Ingredients: Cas # Perc. chemical Name ---------------------------------------------------------------- 112801 1 <3% 1 9-octadecenoic acid (9z)- HAZARDS IDENTIFICATION Route of Entry: Eyes;Skin;Inhalation;Ingestion; Target Organs: Eyes;Skin; Inhalation: Minimal respiratory tract irritation may occur with exposure to a large amount of material Skin Contact: May Cause Irritation. Eye Contact: May Cause Irritation. Ingestion: Small amounts swallowed incidental to normal handling operations are not likely to cause injury; swallowing amounts larger than that may cause temporary injury. HMIs III-ratings (scale 0-4): Health = 1, Fire = 0, Physical Hazard = 0 Q FIRST AID MEASURES Inhalation: If symptoms develop,move victim to fresh air.If symptoms persist,obtain medical attention. Skin Contact: Wash with soap and water. If irritation persists consult medical personnel. Eye Contact: Immediately flush eyes with large amounts of water for at least 15 minutes, lifting eyelids occasionally to facilitate irrigation.Get immediate medical attention. Ingestion: If swallowed,DO NOT induce vomiting unless directed to do so by medical personnel. If injured party is conscious,give two glasses of water. Seek medical attention. MSDS Material Safety Data Sheet LGpGGL ? Professional Chemicals Corporation =f FORARNASO 1 Leather Conditioner MSDS Number:E675 Revision Date:Aprill 5,2006 Page 2 of 4 0 FIRE FIGHTING MEASURES Flash Point: >212°F Flash Point Method: Closed Cup Wear self contained breathing apparatus and other protective clothing.Use any standard agent-choose the one most appropriate for type of surrounding fire. 0 ACCIDENTAL RELEASE MEASURES Keep away from drains and ground water.Keep all unnecessary personnel away.Spill area may be slippery.Pick up excess with inert absorbant material and place into separate waste container.Ventilate Area and Wash Spill Site After Material Pickup is Complete.Consult an expert on disposal of recovered material and ensure conformity to local disposal regulations. HANDLING AND STORAGE Handling Precautions: Avoid contact with eyes,skin,or clothing;Consider normal working hygiene.Handle with care and avoid spillage on the floor(slippage).Keep away from sources of ignition;wash thoroughly after handling. Storage Requirements: Store out of reach of children;keep container closed;store in a cool well-ventilated place area. 0 EXPOSURE CONTROLS/PERSONAL PROTECTION Engineering Controls: Normal room ventilation is satisfactory for limited use. Protective Equipment: HMIS PP,B I Goggles,Gloves Q PHYSICAL AND CHEMICAL PROPERTIES Appearance: Opaque Tan Physical State: Liquid Boiling Point: N/D Odor: r Leather Freezing/Melting Pt.: N/D pH: 5.43 Solubility: Soluble Vapor Pressure: N/D Spec Gray./Density: 8.28 Vapor Density: N/D 1 t MSDS Material Safety Data Sheet L �pGG Professional Chemicals Corporation d:FOR.d REASONI Leather Conditioner MSDS Number:E675 Revision Date:Aprill 5,2006 Page 3 of 4 rM STABILITY AND REACTIVITY Stability: Product is stable under normal conditions. Conditions to avoid: None Known Materials to avoid(incompatibility): None Known Hazardous Decomposition products: Exposure to fire may liberate carbon dioxide,carbon monoxide,organic acids, and other unidentified thermal decomposition products from this product or its packaging. Hazardous Polymerization: Will not occur. TOXICOLOGICAL INFORMATION Route of Entry:Eye contact,and Skin absorption/contact Effects of Acute Overexposure to Product: Eye Contact:Causes eye irritation,redness,tearing and blurred vision Skin Contact:Causes skin irritation,defatting and dermatitis Inhalation:Inhalation of mist or vapor may cause temporary respiratory irritation;temporary central nervous system effects including dizziness,weakness,fatigue,nausea,and headache. Ingestion:May cause gastrointestinal temporary irritation with nausea,vomiting and diarrhea Effects of Chronic Overexposure to Product: Exposure limits:N/D for mixture Teratogenicity:None Reproductive toxicity:None Sensitization to Product:None known Mutagenicity:None Carcinogenicity:None ECOLOGICAL INFORMATION Refer to Section 6 for information regarding accidental releases and Section 15 for regulatory reporting information. DISPOSAL CONSIDERATIONS Dispose of in accordance with local regulations. TRANSPORT INFORMATION Refer to bill of lading or container label for DOT or other transportation hazard classification. Ship in accordance with 49 CFR parts 100- 185. MSDS Material Safety Data Sheet bN007OXNE Professional Chemicals Corporation #1 FORAREASON1 Leather Conditioner MSDS Number:E675 Revision Date:Aprill 5,2006 Page 4 of 4 REGULATORY INFORMATION COMPONENT/(CAS/PERC)/CODES •9-Octadecenoic acid(9Z)-(112801<3%)PA,WHMIS 1% REGULATORY KEY DESCRIPTIONS PA=PA Right-To-Know List of Hazardous Substances WHMIS=Workforce Hazardous Material Information System 9@ OTHER INFORMATION This document is prepared in accordance with 29 CFR 1910.1200.The purpose of this section is to ensure that the hazards of all chemicals produced or imported are evaluated,and that information concerning their hazards is transmitted to employers and employees. All information appearing herein is based upon data obtained from the raw material manufacturer and/or recognized technical sources. While the information above is believed to be true and accurate,the author makes no representations as to its accuracy or sufficiency. Conditions of use are beyond the manufacturer's control;therefore the users are responsible to verify this data under their own particular conditions,applications and regulations to determine if the product is suitable for their particular purposes. The users assume all risks of product use,handling,disposal,reliance upon,publication or use of the information contained herein. This information applies only to the product designated above and does not necessarily apply to its use in combination with other materials,products,chemical compounds, structures or processes. Prepared by:EHS Manager Phone Number:[4801899-7000 END OF MSDS DOCUMENT �* MATERIAL SAFETY DATA SHEET Section I -Material Identity uetName: RAPID WAX-#4298 Product Use: Polishing Compound Manufactures(s)Supplier(s)Name&Address Telephone Number: (215)698-0500 ARDEX LABORATORIES,INC. Days: (215)698-0500 2050 BYBERRY ROAD PHILADELPHIA,PA 19116 Nits: CHEMTREC:800/424-9300 DOT Proper Shipping Name:Flammable liquids. n.o.s. May be reclassified as a COMBUSTIBLE LIQUID when offered for (Contains Petroleum Distillate).3.UN 1993.PGIII transportation by ground in the US in containers tapto 119 gallons. FLAMMABLE May also be reclassified as a CONSUMER COMMODITY ORM-D when stripped by vessel in the US in comtainers not exceeding 1.3 gallons. Section 2-Physical & Chemical Characteristics V.O.C.: 1.12%by weight. OTC VOC Compliant for 2005. Vapor Density(air=)):NA Solubility in Water by Weight: DISPERSIBLE Boiling Point:210 212 Deg.F. Appearance and Odor.milky-vvhitc. free-Floxving Specifw Gravity: 0.9-1.10_ Freezing Point: 29 F liquid with a characteristic hydrocarbon-odor. Percent Volatile by Volume: <95° Evap.Rate(Butyl Atxtatt=l .1 ): <0 Vapor Pressure at 20EC:5.% Section 3-Ingredients& Specifications aterials ova TLV Hazard CAS Number a{vdimctM isiloxanc 901 h-00-6 PARAFINNiC 400 Win combustibic 8008-2" HYDROCARBON 8052.4{-? ALIPHATIC HYDROCARBON 100 PPM combustible 8002-53-? Hydrocarbon Wax Section 4-Fire& Explosion Hazard Data Flash Point&Method: >125 F Flammabic Limits in Air%by volume: Lower_NIA Upper:NIA Extinguishing Media: Foam.carbon dioxide.fog.water spray Spatial Fire Fighting Procedures:N/A Utnrsual Hazards:C0MBUSTIR1LE LIQt11D:Due to electrostatic accumulation hazards.containers and equipment must all be grounded.Material highly vtfatile and gives oft vapors which may travel along the ground or be moved by ventilation and ignited by pilot lights:other flames,sparks,heaters,striking,electric motors.static discharge.or other ignition sources-at locations distant from material handling pant.. Section 5-Health Hazard Data Route ofEatry Skin and Ingestion Effects of Acute Exposure: a)Skin Contact: Mild irritation.avoid contact with abraded skin HEALTH: 2 b)Eye Contact: rtay cause irritation.redness..tearing FLAMMABILITY: z e)Swallowing: May cause mild irritation to gastrointewinal tract.vomiting,nausea. PHYSICAL HAZARD: 0 diarrhea.headache.drowsiness.foss of concentration and fatigue. ERSONAL PROTECTION D d)Skin Absorption: Promptly wash affected area with mild soap and water. e)Inhalation: Move person 10 fresh air at once_Get medical attention. a Chronic Effetxs of Overexposure: E:cposure to high concentrations of vapor of this material(i.e..in-inclosed space with abuser may b•.associated with cardiac arrhvthmias.Prolonged occupational over-cxposum may cause brain•ncrvous systcm damagL.. Other Health Hazards: N A Emergency and Fast Aid Procedures: a)Skin:Rinse with uatcr. if irritated wash with mild soap and water. Contact physician. b)Eyes: Flush immediately with large amount of water for 15 minutes lifting upper and lower lids occasionalte. Get mwdical attention. c)Swallowing: Do NOT induce vomiting. Give two i')glasses of water. Contact physician immediately. d)Inhalation: Remove to fresh air. Administer ocvgcn if breathing is difficult. Contact physician. Carcinogen Evaluation N/A Section 6-Reactivity Data Stability- Yes Conditions to Avoid for Stability Sec below Incompatibility(Materials to Avoid)- Strong acids and bases.Oxidizing A-g-crtu Hazardous Polymerization- Will not occur Hazardous Decomposition/Byptodum Carbon monoxide and carbon dioxide Section 7-Spill or Leak Procedures Release/Spill Ventilatc aria.Absorb into noo-reactive media such as vermiculite:sweep into non-rcacti%c vessel(steel Procedures drum), Waste Disposal Method:Above in accordance with local.state and federal regulations. Section 8-Special Protection Information Eyes: Safety goggles Protective Respirator.RECOMMENDED:DUST MASK Equipment Gloves: Protective gloves Other.Protective Equipment:Use Respirator if work-in__in a totally closed system.For splashing,wear face shield with side shield guard. Ventilation General Mechanical: None required Other.USE IN A WELL VENTILATED AREA Section 9-Special Precautions Handling& General: NIA Storage Other. Seetion10-Other Information The information contained herein is based on data considered acanate.However,the information is provided without any warranty,expressed or implied,regarding its correctness.The conditions or methods of handling,storage,use and disposal of the product ace beyond our control and may be beyond our knowledge.For this and other reasons,we do not assume responsibility for personal injury or property damage to vendees,users or third parties caused by the material. We also do not assume responsibility and expressly disclaim liability for loss,damage or expense arising out of or in any way connected with the handling,storage,use ordisposal of the product. Prepared By: ARDEX LABORATORIES,INC. New/Revision Date:03/14%5 • 1 p LEGEND, . N • — —— EXISTING CONTOUR L ' x 100.98 EXISTING SPOT GRADE, e rt w _ --eHW--`OVERHEAD WIRES a = ' Ben chm ark Set EXISTING SEPTIC TANK ° ' G' EXISTING GAS SERVICE a Y x a, (TO REMAIN) a z w o L t. outside Cor: Bulkhead TOP OF TANK, EL=103.61 �, LA W EXISTING WATER SERVICE a a EL.=104.81 (Assumed)Cb INV(ouT)=102.28±(VERIFY) _ Y o I OA TEST PIT o \ • $ BENCHMARK 3 x ' X 101 104.54 S 77'06 20 E-, -Route 2 ^a ^' Falmouth Rd9 .' . ' . . . 151.52' '10� _ f LOCUS o Dunne c \ I X 104.59 X. •10.449. . `x TP 1� .104 63 G 104, - j 104 a Pond '\ _03 t� LOCUS MAP �� NOT TO SCALE G I 2 X/ X 104�3 TP\ x 103,7 101.47 `\ c� G Ix I � GARAGE ; \ GENERAL NOTES: 103�" Gy< <? O EXISTING LEACH PITS l r O 1• ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL TO BE PUMPED, FILLED W1 PAVED _ BOARD OF HEALTH AND THE DESIGN ENGINEER. SAND & ABANDONED 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 101.26 ORIVEWA 0666 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE X ' LOCAL RULES AND REGULATIONS. E � G 10, 4,r�3 7EXISTING ` �� : 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR N 103,3�/ X• 04.7 I TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE a' HOUSE (#58) / w DESIGN ENGINEER. °a N G / �' '87 `Lv T.O.F.=105.48f 104.21 O 4, ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING G 5� 0r 000 `r } FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN X _04,7 � C'i I ENGINEER BEFORE CONSTRUCTION CONTINUES. r_y N 04 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 00 34 _ � Z 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 101,14 1 X�13'88 x 104,49 � 1 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF O \ tp1 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. \ 104.44 101 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. °i \ j�, r ti B. THERE ARE NO WELLS WITHIN .150' OF THE PROPOSED S.A.S. °' X_ 3,97 �'p' 000 t ` x 102,29 ,0 f 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 104,26 i ��' AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ,• � LOT 84 DIRECTED BY THE APPROVING AUTHORITIES. 1OL07 APN 250-V�7 \ i � 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR. TO VERIFY -% THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING 18,462 S.F.t -j CONSTRUCTION. CV 43, 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, . .. .. .� ' �i_ X 102.71 REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). x 102,51 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ''' ' 19 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. X 102,87 s 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 100.74 �O 12 pr��2,83' / IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 00• x-102,38 — — _ — 120 21' x1 6 14. SITE LIES WITHIN A GROUNDWATER PROTECTION DISTRICT. — a9�- - - - - - - - - - — - - - �P�� °f 44 ssq�ti I to ,9 S 77°42 45" E PROPOSED SEPTIC SYSTEM UPGRADE PLAN o� PETER T. o MCENTEE 1pp'6� edge of pavement 9-9 423 BISHOPS TERRACE, HYANNIS, MA CIVIL l0 99 � Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 N0. 35109 qs S O .o RFGISZE� � � ', OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. BRIAN 1"=20' P.T.M. 153-09 VALDEIR RAMOS Engineering Works, Inc. F 423 BISHOPS TERRACE 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (,L tL O'OL HYANNIS, MA 02601 (508) 477-5313 1 6/19/09 P.T.M. 1 Of 2 t - ' ' ,' ' - Ewa . , ,. .. '.w .i,_ �, .. �.. . -. ...i+a•.' + _ Ry., . .�'' ',.. �, ,,.. . ,. NOTE: TO PREVENT BREAKOUT, THE PROPOSED SEPTIC TANK. PROPOSED D—BOX 'PROPOSED'S.A.S. FINISH GRADE-SHALL NOT BE < EL.100.33 • ' INSTALL INSPECT1 N PORT OVER END UNIT R `A DISTANCE OF 15' AROUND°,.THE ELEV. TOP INSTALL RISERS & COVERS 'OVER INLET & INSTALL RISER & WATERTIGHT FO FOUNDATION OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE PERIMETER OF THE S.A.S. (Existing) _ FINISH GRADE 103.33 (MAX.) A. EXISTING F.G. EL.104.2f F.G. EL.104.2f �. r MAINTAIN, 27. MIN SLOPE OVER LEACHING AREA 36" MAXIMUM COVER : INSPECTION RISER PIPE A: L 2' L L =34' _ 6 w 3., 4" SCH 40 PVC 4" SCH 40 PVC 10"I 14" ® S= 1% (MIN.) e" f l ® S= 17. (MIN.) 11.5" TO ® ® a 48" LIQUID INVERT a LEVEL } INV.=102.28± d ADD GAS PROPOSED L . ..- ..BAFFLE D—BOX INV.=99.96 1 ROW OF 14 UNITS AT 4'/UNIT + 2 END CAPS = 56' + 2' = 58' INV.=102.22 EXISTING 1000 GALLON SEPTIC TANK INV.=102.05 SOIL ABSORPTION SYSTEM (PROFILE) .. - N.T.S ESTABLISH VEGETATIVE COVER NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR TO CONSTRUCTION. BACK(NATIVE FI WITH CLEAN NO E OR PERC SANDD S 2) D—BOX SHALL BE SET LEVEL AND TRUE TO GRADE ON A MECHANICALLY COMPACTED SIX BREAKOUT ELEV.= INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). TOP OF UNIT, ELEV.=100.3 3) INSTALL INLET & OUTLET TEES AS REQUIRED. INV. ELEV.=99.96 (3) 5" DIA.OUTLETS 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE BOTTOM ELEV.=99.00Y�11 AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. I t 15.5" F.--16" I 2" 5' MIN. ABOVE BOTTOM OF 2.83' f-----� � EXISTING SUITABLE ` • • SEPTIC SYSTEM PROFILE T.P. EXCAVATION OR G.W. MATERIAL l 1 [12- NO GROUNDWATER AT EL.=94.0 4 LOCATION SOILS APRIOR TO BE RINISTDALLATION AT TRENCH 15.5" 1 `� �; 8" N.T.S. e" SOIL ABSORPTION SYSTEM (SECTION) T E t N.T.& H-10 LOADING /GARAGE DESIGN CRITERIA D—BOX NUMBER OF BEDROOMS: 2 BEDROOMS a S6.4• SOIL TEXTURAL CLASS: CLASS I /EXIS71 G SOIL LOG DESIGN PERCOLATION RATE: <2 MIN/IN „ ' INSPECTION HOUSE (#58) DATE: JUNE 19, 2009 (REF#12,583) DAILY FLOW: 220 G.P.D. oo T.O.F.=105.481 I'i 2',•Z 1 SOIL EVALUATOR: PETER McENTEE PE(SE#1542) DESIGN FLOW: 330 G.P.D. TOP VIEW i 0 WITNESS: DAVID STANTON R.S. GARBAGE GRINDER: NO HEALTH AGENT ELEV. TP— 1 DEPTH ELEy. TP—2 DEPTH EXISTING SEPTIC TANK: 1000 GAL. CAPACITY TOP VIEW 11.5" 1 i 104.0 A 0 104.0 A 0" 31, LEACHING AREA REQUIRED: (330) = 445.9 S.F. 5 i D SANDY LOAM SANDY LOAM 74 �48 34=--� `ram ; ' 10YR 4/2 10YR 4/2 USE 1 ROW OF 14—QUICK4 HIGH CAPACITY CHAMBER UNITS WITH (EFFECTIVE LE GT END VIEW SIDE VIEW m, 1i 103.5 6" 103.5 6" , ��' B B NO STONE FOR A 58.0 S.A.S. TRENCH CONFIGURATION). ® ® 11.5" INVERT i�i SANDY LOAM SANDY LOAM END CAP '0' 10YR 5/8 10YR 5/8 BOTTOM AREA: (GENERAL USE APPROVAL FOR 7.93 SF/LF OF INFILTRATOR) MULTIPORT END CAP 101.3 32" 101.3 34" 14 UNITS + 2 END CAPS = 58.0 FT NOMINAL CHAMBER SPECIFICATIONS ' C G 36" 58.0' x 7.93 SF/LF = 459.94 SF SIDE VIEW PERC SIZE(W x L x H)............................34" x 48" x 16" j 48„ DESIGN FLOW PROVIDED: 0.74(459.94 S.F.) = 340.36 G.P.D. EFFECTIVE LEACHING AREA: ' TRENCH....................................................zs3 SF/LF M-C SAND M—C SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN INVERT ELEVATION..................................................11.5" Y 7/3,, 2.5Y 7/3 INFILTRATOR SYSTEMS,ING. z,5 423 BISHOPS TERRACE, HYANNIS, MA I 34" 6 BUISNESS PARK ROAD P.O. BOX 768 SECTION VIEW OLD SAYBROOK. CT 06475 Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 PH. (800)221-4436, FAX(860) 577-7100 WWW.INFILTRATORSYSTEMS.COM Engineering by: SCALE DRAWN JOB. NO. QUICK 4 HIGH CAPACITY INFILTRATOR CHAMBER 94.0 120" 94.0 120" NTS PRAWN 153-09 INFILTRATOR CHAMBERS PERC RATE <2 MIN/IN. ("C" HORIZON) Engineering Works, Inc. S.A.S. LAYOUT 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. MAGNETIC NAIL NO GROUNDWATER ENCOUNTERED 6/19 09 N.T.S. (508) 477-5313 / P.T.M. 2 Of 2