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Home My WebLink About0606 OLD STRAWBERRY HILL ROAD - Health 606 Old Strawberry Hill Road `Hyannis F/R _ h. _ u d e 0 II a " u ti 0 3' i �I J a u 1 u o y v X v�. a. Mai 16 2011 1 : 18PM HP LFISERJET FRX P. 1 CLEAN SURFACE DELEADING , INC . 203 Essex St. (781) 340- 6 Weymouth, MA 02188 D 1 D FACSIMILE COVER SFEMZT DATE; May 16, 2011 . T0: Director, Asbestos b Lead Program (617) 626-6965 Director, Childhood Lead Poisoning Prevention Program (781) 774-6700 Board of Health, 'Town of Barnstable (508) 790-6304 FROM: bark 'S. Bianco RE: Notification of Deleading Work 606 Old Strawberry Hill Rd. , Centerville, MA PAGES: 3 i Ma,y 16 2011 1 : 18PM HP LRSERJET FAX p. 2 COMMONWEALTH OF MASSACHUSETTS Department of Labor& Industries and Department of Public Health NOTIFICATION OF DELEADING WORD Alt sections of this form must be completed in order to comply P PY with the notification requirements of M.G.L. Ch. 111, § 197, 454 CMR 22.00 and 105 CMR 460.000 as most recently amended File Number: (AGENCY USE) Contractor performing project Mark S.Bianco License #DC 001055 Lead Paint Inspector _ Frederic J.Hemmila _�License 92736 Date of Inspection 4/27/11 If low-risk deleading work is being performed, complete the following line: Property Owmer: N/A Agent: Address of Project Building Name(if any) Floor Street Address_ 606 Old Strawberry HUM. Apt.No. City Centerville Zip 02672 Deleading Method: CScrapi Heat G _ cs ry Liquid Encapsulant ovenng Demolition Replace nt'` Other .___ If"Other"selected,please explain Check One: Dwelling is multi-family Single family X Start date 5/2511 L Completion date 4/11 When will work be done: A.M. X P.M. Weekends X Project Supervisor's name Mark Bianco License# DC001055 Property Owner Geraldo Cazdoso Address 67 Delta St. City Centerville State MA Zip 02601 Telephone (508)577-7422 In case of emergency contact Mark Bianco Phone: day 6 7 340-0816 evening_(781)34O-0544 (over) May 16 2011 1 : 113PM HP LASERJET FAX P. 3 Page 2 of 2 . I accordance with RMassaehusettsGlneral LawsC-111 ¢197,454 CMR 22AD and 105 CMS 460,000,notice of the date and method(s)af amoval or covering of paint,plaster or other accessible materiak containing dangerous keels of lead is to be provided and must be received by the following agencies,at least IM(10)days prior to the beginning of deleading. NOTIFICATIONS MAY BE COAXED. 1. Department of Labor,Lead Program,Division of Occupational 660y 19 Staniford Street,V'Floor,Boston,MA 03114 FAX:617-626-6%5 2, Director,Childhood Lead Poisoning Prevention Program Department of Public Health,Donovan Health Building,5 Randolph Street,Canton,MA 02021 FAX 781-774.4700 3. Occupants of dwelling unit 4. All other occupants of the residential premises,if any S. Local Board of Health/Code Enforcement Agency r 6. Massachusetts Historical Commission (if premises are listed on the State Register of Historic I 220 Morrissey Blvd. Places,this notification must be made upon receipt of an Boston,MA 82202 Order to Correct Violations or at tent 30 days prior to FAX(617)727-5128 ioitiating preventive delending) NOTIFICATIONS SHALL BE COMPLETED IN THEIR ENTIRETY,DATED AND SIGNED-INCOMPLETE NOTIFICATIONS WILL NOT BE ACCEPTED AND WILL BE RETURNED BY THE DEPARTMENT OF LABOR&WORKFORCE DEVELOPMENT. 1PROFFIn OWNVER(If owner or unlicensed owner's agent will be performing)ow-risk deleading work,complete the fog lowing): a Property Owner Agents) Address _ Telephone Number (_ _)- — I certify that 1 have complied with the training requirements of the Commonwealth of Massachusetts lead Poisoning Prevention and Control Regulations.105 CMR 460.175,for ownertagent low-risk abatement and containment. I further certify that I or my agent will be performing the following Mw•riskactivities (I have circled all"apply): applying liquid encapsrlant capping baseboards removing doors.cabinet doors,shutters applying exterior vinyl siding covering surfaces I certify that all inform 'on contained in this notification is true and to the best of my knowledge and belisf. Date o Sigaed Revised I V2007 YOU WISH TO OPEN A BUSINESS? For Your Information Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does"not give you permission'to operate.)' Business Certificates are available at the Town Clerk's Office, 1°` FL., 367 Main Street, Hyannis, MA..02601 (Town Hall) ' 10 W. 07t Fill in pleaSB: OATE- `�" APPLICANTS YOUR NAME: 1�0,!p �4' `- #' BUSINESS YOUR HOME ADDRESS: y SA TELEPHONE # Home Telephone Number 1 a2 DMA NAME OF NEW BUSINE5'5-. BUSINESS: D l o�r1 1S THIS A HOME OCCUPATION?. YE-S NO.. —'� . . Have you been given apls:o rorn Nisi YES NO _ADDRESS of BUslwEss T :MAP/PARCEL NUM �7$ER / 3 (s) When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations bf the Town of Barnstable. This form is intended to assist you in obtaining the information you [nay 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 operas siness in this town. 1. BUILDING COM ER'S O IC This in, idu F,h s n-inf r d' ermit re uiremen MUST COMPLY WITH HOME OCCUPATION Y•P q pertain to,this type of business. RULES AND REGULATIONS. FAILURE TO Authp d i' ture** COMPLY MAY RESULT IN FINES. COMME S: _ 2..BOARD OF HEALTH This individual has b e inf® d_of th er it �q i=reme that pertain to this type of business. (Jt�i,�Q n Aut ized Sjg t re** COMMENTS: (( = WCOMPLY WITH ALL . ,1I7� Q AI AMMOMMR1111 REGULATIONS 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature.* COMMENTS: Date:.pw /0� /o$ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS:, VAL po�y lip , or\A- Ulof Y ih a BUSINESS LOCATION: GOO old SiiWab-err�, tilU RA c�, �rv�LL� INVENTORY MAILING ADDRESS: 606 al.d 2(1rc Wb-e.(-y4 14 ►cu ka TOTAL AMOUNT: TELEPHONE NUMBER:" 2% 6 S 6 O,� CONTACT PERSON: �,,-,.',�,-A EMERGENCY CONTACT TELEPHONE NUMBER: dnLj 21�) G G (2 O '� MSDS ON SITE? TYPE OF BUSINESS:�c'n\�1Gn G ck-,a �U00 Y) 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 E Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) j 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 (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS ._ �,.. ,., .. ...+.. ... • -. .F-. •4r�',:'L`fi.�C.P�" �•�'•s.3%'k�'�?,x�'� �;.a -.e'ii ,� ... t.... ...+^.�',.�'" ...-� -vim«. - - `1 :� • pt Date:04 /0 ` /08 TOWN OF BARNSTABLE --TOXIC AND HAZARDOUS MATERIALS ON—SITE INVENTORY . ai NAME OF BUSINESS: pa�Yn Jn6 °nd `L oo,(%hG BUSINESS LOCATION: C06 Ot6 S ywabe_rry o 11,L - Cad c�Itry�LL a INVENTORY p 606 TOTALAMOUNT: MAILING ADDRESS: TELEPHONE NUMBE 1-1 <�rb 6 5 6 O S CONTACT PERSON: Ok I�N O �.. -e SSA EMERGENCY CONTACTTE.LE HONE NUMBER: "� f� g� 6 S 6 O MSDS ON SITE? TYPE OF BUSINESS: PG`�� ` �� k 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 S Paints, varnishes, stains, dyes /}. A Other chlorinated hydrocarbons, Lacquer thinners � �"/ (inc. carbon tetrachloride) gym_ `:: NEW - Any othe r products with poison" labels_ J PaintT&varnish r mo*),,, Ibssers (including chloroform, formaldehyde, Misc. Flammqbles 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 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Df�O IL-e�� Bug and tar removers Windshield wash V i WHITE COPY HEALTH DEPARTMENT/.CANARY COPY-BUSINESS Lii r 13 r Z.6. tz I , 4 0 P � v r` r2 oa �s ��v ��oarL 3g t5 by SAW- 1 c,0^5 CC 7' L J �o L4e 49 �3 rz �S✓n� W„�v�� ry Z�W TOWN OF BARNSTABLE LOCATION �-� I SEWAGE cIU VILLAGE �-115 ASSESSOR'S MAP& LOT"F—, �O j INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ��` LEACHING FACILITY: (type) (size) NO.OF BEDROOMS— BUILDER BUILDER OR OWNER V r o-j V PERMIT DATE: 1 COMPLaqCE DATE: O� 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 ,' 4 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 ��_ � _ C��--� �/� ,. ��, V-° � � yi� �� --- � � � � -�. � _ � - � � ----, � � . - .. �� . f .�, l � ... l'� ZO4� No. `v Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: t Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplication for M.5poOl bpgtem Con!5truction Permit application for a Permit to Construct( . )Repair>4 Upgrade( )Abandon( ) Complete System El Individual Components Location Address or Lot No. (QP6 p`d i V�'�11 Owner's Name Address�and QATel.ue � M t�ca G�ac-i Assessor's Map/Parcel C;? o Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. +Z�becks `c " �Cse �H�`; ��• ca-\ JCS Dt- COLAIB--5310. 5%-61%. Type of Building: Dwelling No.of Bedrooms P Lot Size 81 1D� sq.ft. Garbage Grinder(410 Other 'Iype of Building ocnQ__ No. of Persons Showers( t/) Cafeteria( t/) Other Fixtures Lj4 fi y%m . --nr n)c .1 Design Flow 1330 gallons per day. Calculated daily flow 2)43 gallons. Plan Date t0 iq I 4 Number of sheets I Revision Date Title C' Size of Septic Tank WgL,-,�n1 C r_.AN -1 Type of S.A.S. 56` X g-° XX -2 ZtKk4 Description of Soil -,Fa oQn Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu b th' Board h. Signed Date !90 Application Approved by a Date Application Disapproved for the following reason Permit No. Date Issued No. t _�. Fee ( \THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer: ~ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for ;Digpogar *psstem C-on5truction Permit ° a a Application for a Permit to Construct( )Repair Upgrade( )Abandon,( ) Complete System ❑Individual Components Location Address or Lot No. 41', Owner's Name,Address and Tel.No. ME 'F�A��5 MVeQN� '" 5A Assessor's Map/Parcel �Z I D99 Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.No. "t�obec�s �c �ce SHAY �e�v� cn-��\ SJCS 50I�s- COLA -5310 Type of Building: Dwelling No.of Bedrooms�� Lot Size S, \0O sq.ft. Garbage Grinder(46 Other Type of Building No.of Persons 5 Showers( ✓) Cafeteria(✓) Other Fixtures Le"s-rog,%? , W,, 'k6-go Jit)K 1_Avc�c�t�-t 4 Design Flow o gallons per day. Calculated daily flow gallons. Plan Date 1.0� \91 n 4 Number of sheets Revision Date Titlem UpC,C'c�ttc�o Size of Septic Tank h\,e,-,n- 1 SD (ZAn\1(S) Typ of S.A.S. SlQ X 4' X-' _TR T11X_k4 Description of Soil -?)2 S C -)m, Nature of Repairs or Alterations(Answer when applicable) q-v) An Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with,the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issu d by s Board-of,'ealth. Signe / n �, Date pplication Approve by r' vja2 Date Application Disapproved or the following reasons ,/ i Permit No. � Date Issued 1 I :THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (,Certificate of Compliance a THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( )Repaired ( )Upgraded ) Abandoned( )by KU +- TJ G-- al Q Y ( (. ' i,u bo n C� �:,1^ted:. aCC�r.4 with the p-o`viisionIs�o�f Title 5 and the-for Dispos--'L yste Construction Permit No. ' dated 1�� Installed �il �(�t//�,Q, Designer The issuance of this pe&nit shall not be construed as a guarantee that the system `will f nction as designe . Date \1 t �� Inspector--------------/ � , No Fee 7 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS ligponf *pgtem CCon5tructiou Permit Permission is hereby granted to Construct�'�)Repair( )Upgrade� )Abandon ) System located at d�� 01C `�J f'f a A �.� f-� I ' I and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. /� Provided: Construction must be completed within three years of the date of thin'erm�itr Date:_ (:/ Approve( PP Y // d5 � TOWN OF BARNSTA/BLE LOCATION O CLc/t/ 1 SEWAGE VILLAGE ASSESSOR'S MAP& LOT -O INSTALLER'S NAME&.PHONE NO. I k /b SEPTIC TANK CAPACITY ® . • LEACHING FACILITY: (type) NO. OF BEDROOMS BUILDER OR OWNER Y v W V PERMITDATT: C TCOMPL CE DATE: �L Separation Distance Between the.` • Maximum Adjusted Groundwater TAble to the Bottom of Leaching,Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility.) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Pr OU A Aai 6h .2it ' Town of Barnstable _ pF VE Tp do Regulatory Services Thomas F. Geiler,Director 9 p b`& �m� Public Health Division °i Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: p Designer: Installer: � - i Address: '�h�) , d Address: �5 On C) Stj was issued a permit to install a (dat ) (installer) septic system at JXC) Q\A, 5 �+"?. M\ 1N-4k based on a design drawn by (address) dated �p `_-��(�/ ( e igner) S`lj-c I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution 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 with State & Local Regulations. Plan revision or certified as-built by designer to follow. (Inst ) oho` Cif SHAY N No. 1181 (Designer's Signature) (Affix De ere) t PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVIS N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION FAILED INSPECTION 'AAR PARCEt, LOT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:606 Old Strawberry Hill Road,CeQterrift MA 02632 RECEIVED H'i a-9 N V� Owner's Name:Francis Murphy&Sharon Mittelman AUG 0 2 2004 Owner's Address:606 Old Strawberry Hilt Road,Centerville,MA 02632 TOWN OF BARNSTABLE Date of Inspection:July 9,2004 HEALTH DEPT. Name of Inspector: REED C.ELLIS Company Name: ELLIS BROTHERS CONST.CO. Mailing Address: 23 ENTERPRISE ROAD,, P.O BOX 59,YARMOUTH PORT,MA 02675 Telephone Number: 508-362-6237 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CMR 15.000). The system: Passes Fusses ,,Needs Further Evaluation by the Local Approving Authority Conditionally ails Inspector's Signature: . Date: -7-17— a Y 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. 1 Page 2 of l 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:606 Old Strawberry Hill Road,Centerville,MA 02632 Owner:Francis Murphy&Sharon Mittelman Date of Inspection:July 9,2004 Inspection Summary: `Check A B C,D or E 1 ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that y of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not c raluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in t1 le"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacemen or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the or the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or he septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration oz tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as pproved by the Board of Health. *A metal septic tank will pass inspection if it is structura y sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is availat le. ND explain: Observation of sewage backup or break out or hi static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven stribufion box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are r laced obstruction is remo distribution box is 1 eled or replaced ND explain: The system required pumping more than 4 times i 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 rq Placed obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address:606 Old Strawberry Hill Road,Centerville,MA 02632 Owner:Francis Murphy&Sharon Mittelman Date of Inspection:July 9,2004 e t C. Farther Evaluation is Required by the Board of Conditions exist which require further evaluation Yy the Board of Health in order to determine if the system is failing to protect public health,safety or the environme it. I. System will pass unless Board of Health detern ines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner whichwri R protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surfai v water Cesspool or privy is within 50 feet of a bordt ring vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(ani I Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorpt ion system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface wate r supply. — The system has a septic tank and SAS and th SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and th SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and th SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to det ine distance "This system passes if the well water analysis,p formed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicatv. that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitr en is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analys s must be attached to this form. 3. Other: 3 (I Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:606 Old Strawberry Hill Road,Centerville,MA 02632 Owner:Francis Murphy&Sharon Mittelman Date of Inspection:July 9,2004 D. System Failure Criteria applicable to all systems: You ust indicate"yes"or"no"to each of the following for all inspections: Y No ckup 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 S tic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or sspool iquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow quired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number V oRtimes pumped ny portion of the SAS,cesspool or privy is below high ground water elevation. py portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ portion of a cesspool or privy is within a Zone I of a public well. y portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (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 se e 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 f Alowing: (The following criteria apply to large systems in additi 3n to the criteria above) yes no the system is within 400 feet of a surface dr' king water supply _ the system is within 200 feet of a tributary t a surface drinking water supply _ the system is located in a nitrogen sensitive rea(Interim Wellhead Protection Area—I WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section JE the system is considered a significant threat,or answered "yesP 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 j Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:606 Old Strawberry Hill Road,Centerville,MA 02632 Owner:Francis Murphy&Sharon Mittelman Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes N Y:umping information was provided by the owner,occupant,or Board of Health /ere any of the system components pumped out in the previous two weeks? Aas the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) — Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,eK luding the SAS, located on site? �� C___ _ Were the septic tan manholes uncovered,opened,and the interior of the tank inspected for the condition of th baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? _ _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? /Thize and location off the Soil Absorption System(SAS)on the site has been determined based on; �Yessting information.For example,a plan at the Board of Health. Determined in the field if an of the failure criteria( Y �a related to Part Cis at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] 5 Page 6 of I i OI+FICh&___, IN SPEC TION_ I"'ORM —NOT FOR VOL 1,`N'TAt3Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION __ e • r r=�•a-=--. ...-_•rya_3re--mac__ __ y Owner:Francis Murphy&Sharon Mittelman Date of Inspe€asonn:July 9,2004 FLOW CONDITIONS Es sS3a;:El,N gT. (Number of bedrooms(design): � ;Number ofbedrooms(actual): � a DESIGN flow based or,310 CIv1R 15.2 t3(for example: 1 id gpd x#of bedrooms): Number of ctm7enat;es4dents: �% C a!�a 1 �P l t t•Y� �-.�� -�a_ mod.►-.-�3--��-�_.-,� Does residence have a garbage grinder e or no): _ I Is laundry on a separate sewage systcin (•yes r no)�,;� R f ye-s separate inspection required] Laundry system inspected(ves°6 no): Seasonal use:(yes or no): ^ -7 ` Water meter rea d ngs if.availabie Oast 2 dears usage(gp :;• �� — ' �� .� �� , Sump pump(yes or no): A/P 6 Last date of occupancy: C®IVAMERCUL/I(IelI USTRIAL i Type o'cstablis-mcnt: Design flo:xa(based on 310 CN4R 15.203): d Basis of design flow(seats/persons/scifl.etc.): Grease trap present(yes or no):_ a Industrial waste holding tank present Ives tw n„):_ Q Non-sanitary waste discharged to the'ritle 5 system (vesgor no): :dater t.atvr rel dings, ifavailable- ! Last date of occupancy/use: �,f O'IME''a (describe)- dV>��. s GFNER°AI.:INFORMATION Pumping Records Source of inforatation: +`�-'�$u Sj'Stedn piiaefu%d as['cart of iii."- inspection(ye;,('jr no): is�� s If yes,volume pumped( gallons--How was quanti�umped Aete,rmined? for pau::.ri:g: etc talk.,distribution box;soil absorption sstcn` ogle cesspool V Overflow cesspool Privy _Innovative/Alternativ-technology. Attach a copy of the current operation and maintenance contract(to be obtained from system oy:ner) vttaca `uGJtpaL'�P. %-pproximate age o ?gf c:iiI pon i5, date installed(3 trl oS.rP l a_ SI SC1tIrc.�c4f i fC�i'rl=iooti` F g ' leoio / ) "9 Were Swile7e odors?S detected when a $EST aL the site ) ' a (}°_ or nc ' 6 Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �f'lo 01 C,STr Awlu T 141]1 P.1, canmoxljt 1 ie.JVI A Owner: Tro—,,1 lri I C�IyY, v� Date of Inspection: AD0121 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_east iron Z- 40 VC_outer explain): Distance from private water supply well or suction line: p •�- Comments(on condition of joints,venting,evidence of li4e,etc,): t/ U iA/t M) .�yi k+� i�i�i�✓� d� Q 1Q« SEPTIC TANK:i(locate on site plan) Depth below grade: Material of construction: concrete metal _polyethylene _other(explain) _ if tank is metal list age:— is age confirmed by a Cad Cate of Compliance(yes or no):_(attach a copy of ccrtiftcate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or bal le: 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 e: How were dimensions determined: Comments(on pumping recommendations,kM and o tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc_): GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction: concrete metal hglass_polyethylene other (explain): Dimensions: Scum thickness: Distance fiom top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee o baffle: Date of last pumping: Comments(on pumping recommendations,inlet and ou let tee or baffle condition,structural integrity, as related to outlet invert,evidence of leakage,etc.): liquid levels OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM IIVFORNIATION(continued) Property address:L-b, YAA Owner: rxaYh�lc'fY1 rnb,vi r.S F3ri}a� rY i—Jj(J AAV% Date of jnspoction 1 1, . Ppi_ TIGHT or FOLDING TANKS (tank must be P4 att, ime of inspection)(locate an site plan} Depth below grade: Material of construction: concrete metal polyethylene other(explain}: Dimensions: Capacity: gallons Design Flow: . aallonslday Alarm present(yes or nor Alarm level: Alarm in working order(yes or no : Date of last piunping: Comments(condition of alarm and flat switches,etc.): DISTRIBUTIONi BO)L (if present must be opene on site plan) Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets eNal,any evidence of solids carryover,any e ' of leakage into or out of box,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 chamber,edition of I wmps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:606 Old Strawberry Hill Road,Centerville,MA 02632 Owner:Francis Murphy&Sharon Mittelman Bate of Inspection:July 9,2004 4 , I SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ teaching chambers,number: le hmg galleries,number: Ching trenches,number,length: eaching fields,number,dimensions: overflow cesspool,number: innovativelalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): i- N-� hOA 5,t- CIA dZ,te, r,4iQJh.A.— NO i 4 ly- - oft. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: o j(�y �igL,� C Depth-top of liquid to inlet invert: 14 -� Ar ,,, Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Tom,2 � Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of pondmi ,condition of vegetation,etc.): ih/ / q/q�(j lNc`. —� i7 f4/iJ A''� !Qf.� 6U 6✓Li�u"l�� 4 !6.'4r„ i7 q _'' ®fir' �Lr3 PRIVY: (locate on site plan) Materials of construction: Dimensions: r Depth of solids: Comments(note condition of soil,signs of hydraulic ilure,level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM !NSPECTION FORM P ART C SYSTEM INFORMATION (continued) Property Address: 606 Old Strawberry Hell Road,Centerville,MA 02632 9 -4-A/ Owner:Francis Murphy a&Sharon Mittelman Date of Inspection:July 9,2004 rr 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. ell &A 1 Lty I I i a. "V", riv 10 Page I l of I I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMA TION(continued) rroperry Aaron«:two ilia;aaa-:awucl a'y Klan b uy��aasd�rasac�i�irs vea�� ®miner:Francis Murphy&Sharon Mittelman Date of Inspection:July 9,204 4 SI a E EXAN$ Slope ��—�'a' `— Surface water - Check cellar a Shallow wells i_. Estimated depth to ground water `% feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked;date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SFAS) i wrlawiR'tf_laree of Health-explain:Checked with local excavators,installers-(attach documentation) Recessed USES data' t: t. !�v L• _, A�- !�e -z t€ ��—=r—ter-�r � e_; �; �� •.r '� .r— .,••� �' -=s--_r �.,_ F f: 11 t� I OL COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE \TINTER STREET. BOSTON,MA 02108 617-292-5500 WILLIAM F.WELD TRUDY CO\E Govemor 1 Secretar\ ARGEO PAUL CELLUCCI 1� V B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR misswner PART A 1 CERTIFICATION Property Address: 606 Old Strawberry Hill Road Address of Owner: Date of Inspection: Febtuar.y 11, 1998 (If different) yFq�l9g9s 'l9 Name of Inspector: Robert W. Sab�en, tioFllge� 98 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15 00. Company Name: Barnstable County System Inspectors Mailing Address: 25 Mid—Tech Drive, West Yarmouth, MA 02673e] r•^ Telephone Number: (508) 778-0101 — CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: X Passes Conditionally Passes Need urther Evaluation By the Local Approving Authority Falls Inspector's Signature: H1, 1 Date: February 17, 1998 The System Inspector shall submit a copy 6f this inspection report to.the Approving Authority within thirty (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 Department of Environmental Protection. The original should be.sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or. D: A] SYSTEM PASSES: ° X I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303 Any failure criteria not evaluated are indicated below. COMMENTS: B) SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance.(attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank . failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as'approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: hitp1twww.magnet.state.ma.us/dep Z�'j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution boa is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM, IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to.a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet.or more from a private water supply well, unless a well water analysis 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. .Method used to determine distance (approximation not valid). 3) OTHER (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued). Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 D] SYSTEM FAILS: You must indicate ei;!,er "Yes" or "No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. _ . Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is.%vithin 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen.sensitive area (Interim Wellhead Protection Area - IWPA) or a mapped Zone 11 of a. public water supply well) The owner or,operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of.314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 f 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 Check if the following have been done: You must indicate either "Yes" or"No" as to each of the following: Yes No X _ Pumping information was provided by the owner, occupant, or Board of Health. X _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. X _ As built plans have been obtained and examined. Note it they are not available with N/A. X _ The facility or dwelling-was inspected for signs of sewage back-up. X _ The system does not.receive non-sanitary or industrial waste flow. X _ The site was inspected for signs of breakout. X _ All system components, excluding the Soil Absorption System, have been located on the site. X _ The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: X _ The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. X _ Existing information. Ex. Plan at B.O.H. X _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) (revised 04/25/97) Page 4 of 10 v` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 FLOW CONDITIONS RESIDENTIAL: Design flow: 50 g.p.d./bedroom for S.A.S. Number of bedrooms: 4 Number of current residents: 1 Garbage grinder (yes or no): YPG Laundry connected to system (yes or no):Yes Seasonal use (yes or no): No Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no): No Last date of occupancy: Current COMMERCIAUINDUSTRIAL• Type of establishment: Design flow: gallons/day , Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available. Last date of occupancy: . OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: June 1996 — property representative System pumped as part of inspection: (yes or no) yes If yes, volume pumped: 1,000 gallons Reason for pumping: To determine ground water sepping in and condition of walls of cesspool TYPE OF SYSTEM Septic tank/distribution box/soil absorption system —� Single cesspool X Overflow cesspool Privy Shared system (yes or no) (if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 1975 Sewage odors detected when arriving at the site: (yes or no) No (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 BUILDING SEWER: (Locate on site plan) Depth.below grade: Material of construction: _cast iron _4o PVC other (explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —Other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How dimensions were determined: Comments (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) GREASE TRAP: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) I (revised 04/25/9.7) Page 6 of 10 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 606 Old-Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm level: Alarm in working order _ Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, 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 chamber, condition of pumps and appurtenances, etc.) 4 (revised 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 606 Old .Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type_ leaching pits, number:_ leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number:_ 6x8 Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: X (locate on site plan) Number and configuration: 1 Depth-top of liquid to inlet invert: 411 Depth of solids layer: 11" Depth of scum layer: 2" Dimensions of cesspool: 6x8 Materials of construction: Concrete Blcok Indication of groundwater: No inflow (cesspool must be pumped as part of inspection) Yes — cesspool pumped ro dPt-Prmina if water seeping in. Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) Cesspool functioning as a new air tight septic tank. integrity looks good. No ponding. Vegetation normal. Recommend installation of. tees i Soil absor tion s stem. (SAS) S.A.S. - 6x8 cesspool - level of liquid 4" below inlet invert - integrity of pool looked good. PRIVY:_ (locate on site plan) Materials of construction: Dimensions: Depth.of solids: Comments: (note condition of soil, signs of hydraulic failure, level of,ponding, condition of vegetation, etc.) (revised 04/25/97). Page 8 of 10 III - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection; February 11, 1998 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) S T-P es,I o Hovae, •o ro b (revised 04/25/97) Page 9 'of 10 t _< e ^ f I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 606 Old Strawberry Hill Road Owner: Cecilia Beucler Date of Inspection: February 11, 1998 i Depth to Groundwater bje Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) (revised 04/25/97) Page 10 'of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ADDRESS: 606 Old Strawberry Hill Road, 1a*4-!v! S ASSESSORS' REFERENCE: Map 273, Parcel 99 OWNER'S NAME: Robert B. Manton DATE OF INSPECTION: May 18, 1995 REM MAY 2 5 1995 PART A HEALTH DEPT. CHECKLIST MWN OF BARNSTABLE Check if the following have been done: X Pumping information was requested of the owner, occupant, and Board of Health. X None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. N/A As built plans have been obtained and examined. Note if they are not available with N/A. X The facility or dwelling was inspected for signs of sewage back-up. X The site was inspected for signs of breakout. X All system components, excluding the SAS, have been located on the site. N/A The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. x The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If Residential 3 Number of Bedrooms 0 Number of Current Residents Y Garbage Grinder, yes or no Y Laundry Connected to system, yes or no N Seasonal use, yes or no If Nonresidential, calculated flow: Water meter readings, if available: see Attached. Water Dept. Consumption History print out. 05/95 Last date of occupancy GENERAL INFORMATION Pumping records and source of information: Barnstable Water Polution Control. No record of pumping. N System pumped as part of inspection, yes or no if yes, volume pumped: Reason for pumping: Type of System Septic tank/distribution box/soil absorption system Single Cesspool x Overflow Cesspool Privy Shared system (yes or no); {If yes, attach previous inspection records, if any) Other (explain): Approximate age of all components. Date installed, if known Source of information: Apppoxmate age 20 yeears; at time of consturction. Town field card. N Sewage odors detected when arriving at the site, yes or no CUSTOMER CONSUIPTION HISTORY ACCOUNT.NUMBER..—273 ---- 09'1-- CUSTOMER NAME BENJAMINKMANTON �7 7 SERVICE LOCATION 606 OLD STRAWBERRY HILL READING DAT1*.*,i:S READINGS USAGE 1---Z 10[) (MMDDYY) (CCF) ( CCF) ALLOWANCE BALANCIE. F I RU'l- OS 4:3 '2 AVERAGE WATER USE 14 THIRD 11 01,04 is Is YEAR TO DATE WATER USE 25 FOURTH 07 30 94 A FIFTH 00 00 01— SIXTI 1 00 00 00 PERIOD 'B ' USE SEVENTH 00 00 00 *G 1-17 d 04.00.00..-171 00 Jja:[,rrv-1 00 -00 0OW". TENT 1 00 00 00 F . 00 00 '00-- ]-W[�-.*] 1 00 00 00 THIRTEENTH 00 00 00 ----------- ENTER FIRST SCREEN PFl--;.T::Y 14 PRINT SCREEN 7 7:77 777 ------------ 777 77' -7�777,777-77-7�. ...... ................ ........ . SAW 7-77 -77777- -7 . 7 q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION (CONT.) SEPTIC TANK: N/A ; (Locate on site plan) Depth Below Grade: Material of Construction: Concrete; Metal; FRP; Other (explain) Dimensions: Sludge Depth Distance form top of sludge to bottom of outlet tee or baffle 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 Comments: (Recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, recommendations for repairs, etc.) DISTRIBUTION BOX: N/A (Locate on site plan) Depth of liquid level above outlet invert Comments: (Note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, recommendation for repairs, etc.) PUMP CHAMBER: N/A (Locate on site plan) Pumps in working order, yes or no Comments: (Note condition of pump chamber, condition of pumps and appurtenances, recommendations for maintenance or repairs, etc.) f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION (CONT.) SOIL ABSORPTION SYSTEM (SAS): (Locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods. If not determined to be present, explain: TYPE Leaching Pits and Number: Leaching Chambers and Number: Leaching Galleries and Number: Leaching Trenches, No., & Length: Leaching Fields, No., & Dimensions: Overflow Cesspool, Number: 1 Comments: (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) coarse soil, approximately 2 foot depth, sandy soil. No signs of hydraulic failure. CESSPOOLS (Locate on site plan): N/A Number and Configuration: 1- circular Depth-top of Liquid to Inlet Invert: 24 11 Depth of Solids Layer: 10 3/4" Depth of Scum Layer: s 3/4" Dimensions.of Cesspool: 6 x s Materials of Construction: concrete block Indication of Groundwater Inflow (Cesspool must be pumped as part of inspection) None Comments: (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) No inlet or outlet tee. Recommended pumping annually for regular maintenance due to garbage grinder. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION (CONT.) PRIVY (Locate on site plan): N/A Materials of Construction: Dimensions: Depth of Solids: Comments: (Note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, recommendations for maintenance or repairs, etc.) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to at least two permanent references landmarks or benchmark. Locate all wells within 100 feet. RSAR OF Noose 211 /.Z �AS DEPTH TO GROUNDWATER 60 Feet Depth to groundwater Method of determination or approximation Information provided Barnstable Water Company. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If "Not Determined", explain why not). N Backup of sewage into facility? Observation N Discharge or ponding of effluent to the surface of the ground or surface waters? Observation N/A Static liquid level in the distribution box above outlet invert? N Liquid depth in cesspool <6" below invert or available volume < 1/2 day flow? Observation was greater than require minimum. N Required pumping 4 times or more. in the last year? Number of times pumped? No records found. N Septic tank is metal? cracked? structurally unsound? substantial'infiltration? substantial exfiltration? tank failure imminent? Observation N Is any portion of the SAS, cesspool or privy: below the high ground water elevation? Ground water level well below SAS (Barnstable Water Company, source of groundwater well) . N Within 50 feet of a surface water? Observation N Within 100' of a surface water supply or tributary to a surface water supply Observation N Within a Zone i of a public well? Barnstable Water Company N Within 50' of a bordering vegetated wetland or salt marsh (cesspools & privies only, not the SAS)? Observation N Within 50' of a private water supply well? Public water_in_,the area. N Less than 100' but greater than 50' from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Pubic water in the area. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION NAME OF INSPECTOR: ROBERT W. SABEN, JR. COMPANY NAME: BARNSTABLE COUNTY SYSTEMS INSPECTORS COMPANY ADDRESS: 25 MID-TECH DRIVE, WEST YARMOUTH, MA 02673 CERTIFICATION STATEMENT I certify that l have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. The inspection was preformed 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 One f I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. In have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. INSPECTOR SIGNATURE: DATE: May 18, 1995 Original to system owner Copies to: Buyer(if applicable) Approving Authority YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Offic Main Street, Hyannis, MA..02601 [Town Hall) e, I' FL., 367 OWO ' N§3_0a a�> Fill in please: WMI. APPLIGANT'S YOUR NAME: ( P'l CEO n, „.,ems:; BUSINESS YOUR ESS: UR HOME ADDR Z29 0L,12j'�/3� TELEPHONE # Home Telephone Number NAME OF NEW BUSFNESS �/U pW.4TTYPE OF BL151NESS_ IS THIS A HOME OCCUPATION? YES. NO Have you been given approval fro th biiilding:divsion? 11E5 NO ADDRESS OF BUSI'NES$ ® �' —�� :MAP PARCEL NUMBER � When starting a new business there are several things you must do in order.to b compliance ith the rules and regulations'of the Town of Barnstable. This form is intended to assist you in obtaining the information you eed. You MUST GO TO 200 Main St, - (corner of Yarm Rd. & Main Street). to make sure you have the appropriate permits and licenses required to legally operate your business in this town. V 1. BUILDING COM ER'S OFFICE This individua h ' n i d f ny permit requirements that pertain to,this type of business. uthor _ i ' tore** MUST COMPLY WITH HOME OCCUPATION CO ENT , RULES AND REGULATIONS. FAILURE TO 2. BOARD OF HEALTH This individual has be formed of the ermit re rements that pertain to this type of business. L uthorized Signature COMMENTS: MUSTCOMPLY WITHALL . �—�� V. tiyis.! 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the lidensing requirements-that,pertainito this type of business. U l; :c qr L— dd ducli. Authorized Signature.**. COMMENTS: T 101;1 C.1)4 V1:? ;;1 tv,il o, Hazardous Materials Inventory Sheet Checklist ,/✓ Date Physical Street Address-Check database to ensure it exists Working Phone Number Actual Amounts-(le.gas being used to fuel machines,thinner to ..0 clean brushes all count as hazardous materials) A)1114 _Storage Information-location of storage,how long is storage for? tZ / If none,note that. AV _Disposal Information-where and who?If none,note that. ` y.Applicant Signature-understand what is listed and noted t,/ Staff Initial-any questions,know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and 1 explain it-note that it was given r/ Attach the Business Certificate with your sign off and comments ""The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. Date:& TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: BUSINESS LOCATION: DK INVENTORY MAILING ADDRESS ® 3 TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: �— 7 47/ MSDS ON SITE? TWE OF BUSINESS: Ar,�� t! 4' FORMATION/RECOMMENDATIONS: Fire District: II a-,.w0 VAI?a _Magma 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 (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers T v Windshield wash T WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS w - _�-_,gm�_ ___z7:z=r-----1 1 I�_. .I I "," I �.,� 17�,_! _- I..... �� -,�,�_-�, - ,- -,------ -I - � ;Rl- --- ,,� -, � - I � � 1 -�� -1 1 -.-,r ,---�, �,5v",�F-�,,lu:T��,-��,,-, ,x*,"�v _��,, ,1''l ----11-1 71W_�"'k-1-1 ,� 7% ., g�, , ---�-,,,-�-,r lr,i,-��N,�---Z,--- " Aiiiii� v t� �, � _m , ,,,-,- ,'7"',v,.,W , , " - ", 'W__ ", "",��,,� , ," _", ,1��,�'_1�'" - ��_ , - - , _ 11- - , - "__, _?7F,e4?%y,�rj-'Z',,,"I�,,�"-',�-,,��,,,�,,��,,�7f�,�,�,,��-,'I'��,-Iol,v,*�,�,Y,-,,r,�'ml-.�,�,�,��--�,"�-,V.""W,-,��,�,-��,�'eir'-�,,"��,,�W �� -.7,i-7 :,�,, - � ,; , , q -A" , , ,� ,, � �, Ir" 1�,,I- - I ,; " -,if" .r , , , �,�, i, , ',i)'1;,i I-,�, , , 11�I�, - "P,,,,,,, ",��, "', ��, -:�` " , - I I , , , ��,,�,,,, ,:��,l 1, I , ��,,, , -,',�� ",,;-" " ,;�,, 1�,"I ", _ , , ,��6��,Ii ,�,1411 � � � , _11��I I �� __ 41,'Fiw�,�5,7:N , _,�v"," ,"�, , , , k �,- � �%, , -,,I�_.-11,"..,1;�,w:1�; ',;� __w "� ,"', �i.77�," _W��, ��T,4W� I " - �, �11'111 11 ,,,,W-7K� 1, , � , " , �,- -�,.,�, I '' ,�j z 11�,,�� !%2", 11 .1�7, -i-"""",il,,�_� i� ,-� `�,73,� ��"'11�1r,",-, _'. 1, ,;,, ,,_�'-,",T� � , I _ �, , , ,1,1,I, , - " , , - � , " -r, , - , , -"' - - , -, , �,, �'� ,�,;�,;"�i,,'e_1�j, 1"',, �": �� , I , , 11 I_,li ", � ". ,J�jl�,, ,, , �' , - , - , ," , , "� , ,4, 1� � , -,,�, I � , , - , 11 � I , , I - , , -,,"I - � ,�, _,;;� -� , �, , ,,� I -�11�1'�', ,","I - - I , , , - I ��,,,�e - __ '. 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I r I I I T ,'GRADEr i r I i I I r PERCOLA I . ,r ' i — I L� , "I . I i 04 Xi 11, I SPO � � � ! I - I r _r , I TION ' TEST.: I I . 1 �11;1� NEW 'I ,�- ' I 11 'r,� - I . : 1. I I I I � I- . I I 11 �,� 'r I � I � I �r r septic 6ECK�l" 1. 1�1 . .. 11 _ . 1, I I I I I I - � I - I I �I � , I ,,r, % I I I - I 1� , � I I - ,�� , �% , "I., I I Z"r I I I r I. �% . I � r _: I I , I I r � � I D e. if',Peroolation Test:','� OCTOBER 18, 2004 1 r r, � I I r r _: � r � . 11.1 I I DENOTES EXISTING I I 0 1 1 00 , � I I I L � I - I I � I : � � ,r I I � � r � ,. " I �,� I X1 04.46 1 ' : I � - Test Performed,By. CARMEN E. SHAY - R.S., C.S,E. � ,r � 11 V_ I I I i , I I V�" I I , I 1 . i I , " r , , � ,� :1:�� . Ir SPOT GRADE � 1�11 � 11 I I I., I I � . 1, " , I eq I r � ", I rr I I I I,1 I I I I ' � i I I � I . Resul'ti".Witnessed By. ,WAIVER ( Perl.Bornstable B.O.H.) _ �i Z,, r 'r I - ': ',� "', , ,I 1" � � . I 11 I I - I I I I I I r � r r j �, r I I 1. I EXCAVATOR.- Shay,Environmental Services,r Inc.. 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I I r I I I "Ill I � I I � , � I I I I , I I I . i I ," :, '', � I �' ' Number�of Bedrjo&ris: 3 .Equivalent to�3.50 Cal./Day , , , I % 11 - I I 11 11 J r . 11 I � i" " I � I _��A OF I.,,,4,,- � PREPARED� , Y I� �_ I � � I � ; _r I I . �, � ,�� - "I % � I , E3 " ' "" . I � I � I I , I I ,��i " * r, I � -1 I I ! , A -, - � I I � 1, I I I I I % � I � I . 11, 1. �' r I 11 I %�"I , � I I'' 14� ,, , ,�, I r , I r * I I r I � � I I ,r I 11 11 I r I Irl I Ir r 11 I : I I , 0 - r!,,: I I I I I I I � I I � i I i I ,%. , orbdge Grinder- ,No, j'": �;'',� � I ,,�. I 1 � � - I I � I ,% I r , ; %", � ;,,% I � � I: . � I 11 I I I I I �� :, ,) I I r I I I I I � 11 I I I . %, I I I , r I : I , I I I I I I� I I I � I � I V, - I I ! � , I I I I r � I I : � - , i � �.��,, � "4l I r I I I � I - . . � I ' 1r. I��,_ � ,: � _� � I I I W � � i I � .,,'Lciaching Capacity Required: 330 Gal./Doy Minimum per Title V. ,,� r.. I I r I I . I I. I �I r 1: . V, I , I r - ik'.' ' r 1� I ; I I .1 I � I I 1-1 _r RI VEN,�, E. � �S AY 'r -I - � r % � -Septic3onk :._;� �'�x 336 �"Taf_ ' I . 11 I � , , - I I I I I ' I ... , : - 'r I - r.r" r GoL/Day =,880 USE NEW 1,500 GAL. Septi(�,�,- 1-1 � 11 - � ' �, � r � � I ��, I I . r . I , , iZ ,� I , r I �', I ,"I "I ,,.r . �R , 7 . . I' , � I 1 '40 _ : , ,� � 1 ,�4�,, i, " ,0 �I I I . :, � 11 , I I I 10 ,,20 �% � I ;, �_ 11 11 r I SOIL ABSORPTION A EA, " Using' percolation rate of <2 min./inch , � I I I I r I I I I I'll�r I I I ,r ,,, �5b . I I I I I I r. I " RxIf 0N,0P,NTAL SERVICES,� INC. , 11 - :i - I I I I 1, � I - I j ; , I I ,�e .! _. I I 1, I - I , , , , ", '' , % I I I � j , ,�� ,�� I � I If , I � , �Jl I ja !�, : I . r' , �,;�, Q ,I� -I ,11 ': r 1 i r I � "I � I r j r 11� I I , I I I 'I'll .1 - , , , I '� i�,", �'_, I � I -, I . I I - 4 1,r I I % I , I r '- r . . � I , I yl_,�, I I- . I I , ,I, � I , r I 11%I . �r I I r ,I � I i I I� Tr�,�," , ., "I . _, r (. 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", 0.74'�ol/ I I I , _ , , , i . , ,, r 1, n :,L REQUESTEQ:� , I- 1, � G i,,�,r.. � � � EAST� FAL I 1 6 1 r, 1, .1 I � r ;% _ , � �� , I I i " ' ' '' ' ,:, Ir � I __ ' � 11 � I � , I I l�,,��,�,�,,r , " � � I ".1,r I , , , I �, " I _�fk I r -�', a r','J�'-,� " r, r . r I I I ' , �A, ,r " _, I ,�" ,I r- I- - , � ft r= 177.60 gallons �, , I � ,, ,- � '' 1? I . : �' Var' C _, , ' ' I r 11 I � � �. 1� 8, 1 ��, , I r ��, I ,',' ,1%, Sidewall Ar a: 1, � 4 I 1. ,� *quest a a o'reduce the disto' I I r I - I r�', � �V� ''"!, I .e' ' �0.74 gal./sq. ft. x .240 sq. � " � � . I I � �.�, ��,I"I., .1 _1� �� , 11%, � 1, 4, , , idn_, , I - I * I- I" I � I � I I � I . . ,� 'I,�11 11�, I It, I � 11 " ,Providing: = 343.36 gallons I 1 - I -I S , ,, - , i,"� ,- I I� I I �I I - ",1 � � nce,frown the SAS to the r . , 1vt 1, , TEL/FAX-�,;:, ,60 -54 079 6"11. , 'r :�, I : I I � . I I� . �r I ,�,-i -I., , , I ,. , ,- : 'r I 11 �" I I 1,1, I ',,,4�,V CALE., i�10 1,�,_ I . I "I . 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