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HomeMy WebLinkAbout0218 OLD MILL ROAD - Health 21.8 Old Mill Road Osterville F/R a A 142 132 ° , • � _ , .-a r. ° - ° -° - ° YOU WISH TO OPEN A► BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.] Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 026P1 (Town Hall) Fill in please: DATE (� � ' ii;57t1NMI. tim-if 4l APPLICANT'S YOUR NAME/S:__ �IyQI'ut�li;{{{{ I f'" ��rr_6, BUSINESS YOUR HOME ADDRESS: a1B QW— (v\, 1 ! \ �}�Lco S * f 3" rC r�llfi l _ 1 L� ' ,} , nr7i'0k�:t7T1I�F�3 r9 t k��r��`�^i� f a A q TELEPHONE # o '�. . . ��J NAME OF CORPORATION: �S o�--�/��/ �►-�t � -�"S- =1� NAME OF NEW BUSINESS DAB-oS IPaJdS� � TYPE OF BUSINESS IS THIS A HOME OCCUPATION. YES NO ADDRESS OF BUSINESS mh t �Lti' MAP/PARCEL NUMBER 1�I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may,need. You MUST GO TO 200 Main St. .- (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business'in this town. 1.- BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** -� COMMENTS: 2. BOARD OF HEALTH s This individual has rn i rvil of the permit requirements that pertain to this type of business. MUST COMPLY WITH ALL �/ t(/ I HAZARDOUS MATkRIALS REWLAT" Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has b iMic the licensing requirements that pertain to this type of business. uth r'z COMMENTS; fi� , _r Date: (�I/;f / ZVI TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS O NAME OF BUSINESS: BUSINESS LOCATION: .o2t`d h 0 _ n�qasl%Le - fin- r< INVENTORY MAILING ADDRESS: fit$ CIL M6:1lL 9i1) c) j%(l.Q _ o4 . TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: e,�,.� Dn cn�`r�1 EMERGENCY CONTACT TELEPHONE NUMBER: T-t,aj MSDS ON SITE? TYPE OF BUSINESS: L4>ojd,S±j,)i L, INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: -rr\jck. Last shipment of hazardous waste: 0o�u Name of Hauler: Destination: Waste Product: QrC� Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month 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) Miscellaneous 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 Z2 NEW ❑ USED (insecticides, herbicides, rodenticides) 5 l Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) �J lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners - (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers OP L (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash 4_ �tafffi's WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Initials YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI.,367 Main St., Hyannis,MA 02601 (Town Hall)and get the Business Certificate that is required by law. DATE: u7) It Fill in please: 9� �g .001 APPLICANT'S YOUR NAME/S:a. aJ 1 DP tQ 1�A r .atas�t "s` a" BUSINESS YOUR HOME ADDRESS:___Q i tt Yam. Q iV. l P V -nS�tP-J¢tie ejd� � n TELEPHONE # Home Telephone Number_<o 9, '>0j-)-- 11`25 Wo atu Qlfiit7gDkY NAME OF CORPORATION: NAME OF NEW BUSINESS 'Sih N sLtq i Nf TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS 4 ".\ Vik 4 i-� MAP/PARCEL NUMBER I (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.-{corner of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1., BUILDING CO MISSION R'S(�E`E This individ al h b n form d an r u nt th p m to t is type of business. rti a Si ature* COMMEN 2. BOARD of HEALTH HAZARDOUS MATERIALS RE T This individual has been irements that pertain to this type of business. Authori ignatur COMMENTS: 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:(Q/;0/ G TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM . NAME OF'BUSINESS: nN(.oiyj, BUSINESS LOCATION: -U6 ��� t�n.:t� aj�rV4L� _A,,,o, :9�ti�—r INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: +44 — .2�?,r- CQ CONTACT PERSON: -SzprJ tin, as i 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 material 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) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants c; Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals(Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED D c wi Miscellaneous petroleum products: grease, Photochemicals(Developer) x �,e. lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink - Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible C*l Car wash detergents Leather dyes Car waxes and polishes 3 bP , Fertilizers Asphalt&roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) ac,pl- Spot removers&cleaning fluids X 1w,* (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applica "gn'f ure Staff's Initials TOWN OF BARNSTABLE I� LOCATION POW 61-cr �1.. . SEWAGE #AG L— , VILLAGE ASSESSOR'S MAP & LOT W—1 INSTALLER'S NAME&PHONE NO. ���, LOrvl € �� z-2 SEPTIC TANK CAPACITY 4-foo LEACHING FACILITY: (type) 50V A-i ��� (size) .3 X724 'X-;2I NO.OF BEDROOMS BUILDER O OWNE PERMTTDATE: S'/3ov OMPLIANCE DATE: i?i vk Separation Distance Between the: Maximum Adjusted Groundwat Table to the Bottom of Leaching Facility S 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 Php,ww-eul,r is 37 � �16 �0` i' .. No. 1400 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS application for Mfgp//ozar 6pgtem Com5truction 3permit Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) 0 Complete System e<dividual Components Location Address or Lot No. Owners JName,Address andTel.No. I / Assessor's Map/Parcel r Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: / 1 Dwelling No.of Be drrCs Lot Size 1 Z q. ft. Garbage Grinder(144� Other Type of Building o.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow ��- gallons. Plan Date 7 Z g, 41 Number of sheets / Revision Date Title O , k Size of Septic Tank pe of S.A.S.r9 Ty Description of SoilJ�i rii �Z•�� Z Nature of Repairs or Alterations(Answer when applicable) ` Date last inspected: I Agreement: IIII The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t 's B and Signe Date Application Approved by Date Application Disapproved for the following reas s OP, Permit No. Date Issued _ yy .rye, ,, f 7rt..,J►yr. .n.y.ti'- ^ .. r ti .. F �... I 4 `h.), F � �a...-, "" .. � .. N.I. y"' +• § r € Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in compute: Yes P0JBLIC. HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Migotal *pgtem Congtructiou 3permit Application for a Permit to Construct( )Repair(�)Upgrade(s )Abandon( ) El Complete System E Individual Components Location Address or Lot No. 7l g ®��� , Owner's Name,Address an Tel.No. t /!//f/�' Assessor's Map/Parcel � S 4 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. t4oy-� f1 ��� Type of Building: / 1` , Dwelling No.of Bed od tP'is Lot Size ��q.ft. Garbage Grinder Other Type of Building S/ P C o. of Persons Showers'(')Cafet na(r�,) Other Fixtures , Design Flow `7 7C/ gallons per day. Calculated daily flow gallons.- Plan Date T f> Number of sheets / Revision•Dat' Title s ✓`��`c� �rs1 Z 8 , Size of Septic Tank E /dDU'.�!' �'�'/S7`�p9 Type of S.A.S. — 5 -e (r 4 Description of Soil Nature of Repairs or Alterations(Answer when applicable) t• Date last inspected: Agreement: i The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t I s B and ofHe th. Signedfn `f Date / Application Approved by _ Date v Application Disapproved for the following reas s i I / r—) - 1 Permit No. _ r Date Issued - THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the,On-sit S a e Disposal System Constructed( ) Repaired ( 1 )Upgraded( ) Abandoned( )by C�� �� �✓` at g C19/a h sn constructEd inla�jordance with the provisions of Title 5 and the for Disposal System Construction Permit N dated q U I t Installer Designer The issuance o!f t�Scpqrn I it shall not be construed as a guarantee that the sys em w 11 nction as d 1si ned.,, Date 1 J 1 Inspector /1,V • w U No. �f / — --=----------------.----. —Fee t— THE COMMONWEALTH OF MASSACHUSETTS A L�d,13 --.-PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mt!5pozat *p!5tem Con!5truetion 3dermit . Perinissiou is hereby granted to Construct Repair t4(Up rade( Aban ora, J System located at � / 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 c70/n / lete wi n three years of the date of this permit. Date: Approved b - f PP Y / Town of Barnstable Regulatory Services Thomas F. Geiler,Director BA MSres[. . MAM ��� Public Health Division Enna'' Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: PIJOWn Sewage Permit# Assessor's Map\Parcel H�a 13aDesigner: e- &h !/ O-e-n Installer: 6�. Address: ,39 Address: qJf�1. On tq/l<JGa`7 �D/ ���� �j � as issued a permit to install a (date) (instal ler) septic system at CR le o / I f &J based on a design drawn by (address) dated (des' er) ' 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. SOF I H �SS"90 �o ARNE H. tics (I ler's Signature) o ALA IVIL No. 30792 �Gc P G/STE?_ S N -- IONAL E (Designer's Signa e) (Affix DeM r s Stamp.Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. 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 3-26-04.doc I TOWN OF BARNSTABLE LOCATIONl� SEWAGE #AV VILLAGE n /Ze ASSESSOR'S MAP & LOT lq)-'t INSTALLER'S NAME&PHONE NO._1e �s� ,l, �ivf za,, SEPTIC TANK CAPACITY - 4 soo f. • LEACHING FACILITY: (hype) 52 l 44rwJ, K)J (size) NO.OF BEDROOMS BUII.DER O1 ! PERMIT DATE: S'/3 COMPLIANCE DATE: U° i Separation Distance Between the:, Maximum Adjusted Groundwater fable to the Bottom of Leaching Facility S7 Feet Private Water Supply Well and Leaching Facility (If any wells exist* _ on site or within 200 feet of leaching facility) Feet i Edge of Wetland and Leaching Facility.(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by / Cr_ es 30 O yo TOWN OF BARNSTABLE (� LOCATION /o�/H SEWAGE VILLAGE J ASSESSSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. s /^��1, SEPTIC TANK CAPACITY %3co LEACHING FACILITY: (type) jAe .l «i��,�r t�3� (size) 13 NO. OF BEDROOMS BUILDER O<OWIN::E;�) PERMITDATE: 9 i3 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater...-Table to the Bottom of Leaching Facility t 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 j within 300 feet of leaching facility) Feet Furnished b 1 �.,hr N b �tF, 37 j i � w _ j . M ' Town of Barnstable Regulatory Services i63y. �O �Dta Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 16, 2004 Manuel F&Alina T Morgado P O Box 926 Osterville, MA. 02655. Dear Manuel and Alina, I was given a complaint stating that there were 7 bedrooms in the house located at 218 Old Mill Rd. in Osterville. I went by the property on 1/15/2004 but no one was home to let me in. The septic system located on this property is rated for three (3) bedrooms. I also understand that the septic system is in failure and needs to be repaired. You need to contact me to discuss your options with this property. I can be reached at 508-862-4740. Sincerely, Donald Desmarais R.S. Health Inspector Barnstable Public Health Q:Health/orderletters/refuse/274 South.doc i Health Complaints 16-Jan-04 Time: 2:55:00 AM Date: 1/14/2004 Complaint Number: 17225 Referred To: DONALD DESMARAIS Taken By: RITA Complaint Type: HOUSING Article X Detail: Business Name: Number: 218 Street: OLD MILL ROAD Complaint Description: ON INSPECTING A HOUSE THAT WAS TO BE SOLD HE DISCOVERED IT HAD SEVEN BEDROOMS. EVERY ROOM WITH THE EXCEPTION OF THE KITCHEN WAS A BEDROOM.!!!!!!!!!!!!! Actions Taken/Results: WENT BY ON 1/15/2004 AND NO ONE WAS HOME. I TRIED TO CALL MANUEL MORGADO BUT THERE WAS NO NUMBER. I WROTE A LETTER ON 1/16/2004 TO HAVE THE OWNER CALL ME TO DISCUSS ME GETTING IN THERE TO INSPECT. Investigation Date: 1/15/2004 Investigation Time: 10:30:00 AM i 1 f is �- �, �` ;�;�f �� / �� ,> ,,. � T`�� �; �, ` �'. �' f � . �s� :;�-- _ - - '�! t _ll ry� 4 ��_ � �, ... �..: .,�� � �q� �: .. - - �---- �F -=. i '1 ,1 c=_ � -r"" �; �_._ t e _�� �. ; � -;�� � � �. �� r a� � r�-�.. ff. �, 'n � -- • f,,. �_ .: k�t,,; � �� �� �� A _ 7 �� =�. �'r, rTh '_ „r r '�1 �ds _ _ .� a �.�=jam_ � � i "�{ ._�. `3( ' f 3 s _ f ��k) p 04 _ 4 � — r-� ; �'' sr I • "`*"*ss�d:++e:i-. a 3. 4 }} 6 I' C A rat i # ` 4 �1 a t #jn iO�J l �. t ` � �� `^ A _:t k n �, u i ,� '�'''� � , ��, ���r� �� �� r, �� �'� `TK � s ' {�� \ �� ii� _� 1 f y ;� � f � .� ,� � i � �54 �� '�i�:qP�'��.. �1 4 it '1 Y � } ' i r � I 3. ,, � ; .1 i�+ � � A.�� s � .. �t � * $ 4 } ,,�*. J 1 � `� '�_ .'` _ t`� ..a�"I�.v 1•Nr ifJ.._ �I rx { `w 5 fiiC';b� ! INA. .,rrrr -- ,s� ft• .Rs r I 1 A yArLZ-i) CNlzPECTION �117 7 3 1' 0ATE :11120103 PROPERTY ADDRESS : 218 Oid Mi-ei Road 026'S 5 On the above date, I inspected the septic system-et the above address. Tnis system consists of the lollowing: 9. 9- 7500 gai-Ron ae/at.ic .tank. � RECEDVED � 2. I-Dizta.ilut.ion lox, 3. 1-1000 ga-UlOon /22ecazt ieach.ing pit. 'JAN 0 6 2004 Based on my inspection, I certify the lollowing conditions: TOWN OFBARNSTABLE 4. 7hiz -iz a t.itie live zept.ic �syz'tem. (78 Code) HEALTH DEPT. 5. The 3ei pt.ic zyztem .ins in hydaau e is �,a.i euae. ldaste wa:te2 &. wazte .i.6 move the- .ineat pip a.6 o� the .tank, d.izta-ieut.ion txox and the ieaeh.ing pit, 6. A new ieach-ing aaea needs to ge .inztaiied. 7. Pumped the zept.ic tank at time o� .inepect.ion. SIGNATUR Name J . P . Macomber Jr . - - - - - - - - - - - - - - - - - - ---- Company : )9gpph p_ M.0S4mt?pr d_ Son, Inc , MAP � 0a 5S : @QX, -66 _ PARCEL LOT _Ce-n-iP CY LLLP—_ �jd - _Q.Z632- 0066 ?^'one - -508 •� ] 5_ ) ) 38 - - - --- Th15 CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY JOSEPH P. MACOMBER & SON, INC. Tanks•Cesspools-l.eachllelds Pumped & Initalled Town Sewer Connections P 0 Box 66 Centerville, MA 02632.0066 775-3338 775-6412 f - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF �'NV'1�® v-` '.k 1'1'A.i r DEPARTMENT OF ENV1R0'14 r1,N,7 `t ',.. P 11 t ':l'I;c,1, i��N TITLE 5 OFFICIAL INSPECTION FORM-NOT MIR,VOLUNTA11.Yt ASSESS ti1E ,,'f 9 SUBSURFACE SEWAGE DISPOSAL SY4TFM FORM PART A CERTIFICATION Property Address: 218 Ujd Niff Road Owner's Address: Date of Inspection: 11/20Z03 Name of Inspector: (please prinojozeph l. Nacomkev ;a. Company Natne: 1. ?..Na"OMW .& Son Inc. Mailing Address:./3ox__..b..6_ -.-___ CLOyal ffe, lgn.s.s_. 02632 Telephone Number: �5 0 8_7_5_ 3 3 3 8 CERTIFICATION S`X°A°Y EWIFY& 1 certi y that I have personally inspected the sewage 6sposal sysWrn a.ON a. : ns and Tat the WANOWan rep„ned below is true,Lcc'urate afid cornalcte as of the ii mu of the 01,001. 1 rr ills. cn was pe ro !tIc 7 basrsj r;rl my training and experience in the proper function and rna%nAncc of on she i d 5p ;�i S S m, t a m a 0 UP ap;rov€d system Inspector purS?.�l:�rY to eectlf is 1�.���` L ;tit s ,.i l f ""Yi R i 5AK10,1 T Packs — — Condltioiiall\' Tie. s i i:•viilt.mdon by the t..ocai Apr):o? ,ing AuOwrity Fails iTi52Ctvi'Y .3iljai:irl: w. ._= ( aiifC, �4. f d Pie systt.rn inspector shall Sail+!„it a copy of Us ksyctior, mpiql u) Me it p ovkj f{ull nNy UWad of}'1u1T Or' Dl3M within 30 days of coinpkig f is Kp mion. it Q sy mem n a wvqYan x in) a deign , w of d,poo god or greater, the ins:c t`_. and Ac s,mn owmr W . ' mb to nTof" "C ON %1p fJF?''.:att: f+tgKml On" of A DER 1 plc pritK I ciinn d be am ro , o q ,am r vm,r and ,cord:; ;wit to the buy", if ap ii. .bib w n the ap ro•."g 3Ur4?0.'11j. ' \OtCs and COii`mr=tas i- ""This retort only do-zrlbes conditions at the tithe of inspection and under the conditions of use at Oat time.This inspection does not address how the s shm W pcifurn, in the future under the some or different conditions of use. Title 5 ':nspe:ction Form 6/15/2000 page 1 Page 2 of I 1 . OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ' CERTIFICATION (continued) Property Address:218 O.ed M iLe Road 0,3te2uieee, Owner: Naaue.P N61 aidn Date of Inspection: 1 9 ,?o i o 3 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes:( AA— I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The .P i h ' a P hUdgau0ic 4ai-Runo A new .Pear•h jzg area ape ,tn Re B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,_will pass. Answer yes,no or not determined (Y,N,ND) in the for the following statements. If"not determined"please explain. � tS ) 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: yct Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ' broken pipe(s)are replaced ` obstruction is removed distribution box is leveled or replaced ND explain: �C-D 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 ragc..) vl I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PANT A CERTIFICATION (continued) Property Address:218 Oid ( iii Road L NCd2b onz G Owner: agi Mot Q2 O Date of lnspectioo: C. Further Evaluation is Required by the Board of Health: VD, 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. I. Sti'stem 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 wlll protect public health, safety and the environment: ,4)0 Cesspool or privy is within 50 feet of a surface water Cesspool or privy is witbin 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a'manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet ofa surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. V6 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�eet but.50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria 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 I ` Page 4 of I I OFFICIAL INSPECTION FORM —N,0T FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 218 O ed lyl c P 12o ad .6 e2v.c e, azz. Owner:Naaue.P No2Gado Date of Inspection: 11120103 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no" to each of the following for pLinspections: Yes No ackup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Cischarge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool z _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool L= -� Liquid depth inneesspae}is less than 6"below invert or available volume is less than 'h•day flow _ �Requtred pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number Zof times pumped y portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface ,water supply. ,Any portion of a cesspool or privy is within a Zone I of a public well. tv &/,y portion of a cesspool or privy is within 50 feet of a private water supply well. 4Any 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.) 1 (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 �he system is within 400 feet of a surface'drinkingtyater supply �e 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. 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 ' Page 5of11 OFFICIAL INSPECTION FORM—NOT FOR'VOLUNTARY ASSESSMENTS SUBSURFACE:SEWAGE DISPOSAU SYSTEM INSSPECTION FORM PART B CHECKLIST Property Address: 218 Wd Miii Road 0.6 te2v-i e ee. Na s.s. Owner:Nanue.e tlo/z ado Date of Inspection: 11/Z 0/0 3 Check if the following have been done.You must indicate"yes"or"no" to each.of the:following: . Yes No/ . t/ Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous`two week period? 1/ 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 eludin the SAS,located on site? y Were all system components, g Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the—baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and.depth of scum? Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no r/ 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)J 5 Page 6 of I I z OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C At SYSTEM INFORMATION Property Address:218 Oid Ni e e Road ezvi i Te-77azz. Owoer: /7an.uei Noaaado Date of Inspection: 11 i,?0/0 3 FLOW CONDITIONS r... RESIDENTIAL Number of bedrooms(desip): Number of bedrooms (actual): DESIGN now based on 310 CMR 15.203 (for example: 110 gpd x N of bedrooms): Numbcr of current residents:. - Does residence have a garbage g7inder(yes or no), Is laundry on a separate sewage system (yes or no).;Fe (if yes separate inspection required) Laundry system inspected(yes or no): °off Seasonal use: (yes or no): / ► Water meter readings, if available (last 2 years usage (gpd))2001=216, 000 ga eionz=591. 78 C%D Sump pump(yes or no): _ gaiionz=383. 57 G%D Last date of occupancy: COMM ERCIAL/MUSTRIAL Type of esublishment: l} Design now(based on 310 CMR l 5,203): d Buis of design now(scats/persons/sgft,ctc,): Grcue trap present (yes or no): X)A Industrial waste holding tank present (yes or no):,& Non•saniury waste discharged to th'c Title 5 system(yes or no):/X ) Water meter readings, if available: Last date of occupancylust: /1 h OTHER(describe): GENERAL INFORMATION Pumping Records JI Souice of information: Wu system pumped as part of the inspection (yes or no): If yes, volume pumpcd:fi2� gallons •• How was quantity pumped determined? Rcuon for pumping: y .Si�," . Q�Jt ^ 6j 4 1A' vPI'Li, j' TYPE, OF SYSTEM Scptic tank, distribution box, soil absorption system D Single cesspool /IZOOycrflow cesspool &t�Privy !111Shucd system(yes or no)(if yes, attach previous inspection records, if any) �tPInnovativc/Allcrnaiive technology, Attach a copy of the current operation and maintenance contract (to be obtained (tom system owner) Night tank IL14 Atucb a copy of the DEP approval Other(describe): I' Approximate aec of nll cor-7nncnts, ate Installedif /knnown) and so`u!;e of informatio ' Gr Were sewage odors detected when arriving at the site (yes or no): 6 f Page 7 of I I C, OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSt«1RFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) P:ropeny Address: 218 O.Pd 17 ii Road e2vt e. (7a73 . Owner: Nance$ No zaado Datt of ins:pectlow' 9.912010 3 BVILDINC SEWER(locate on site plan) Depth be.1-ow grade: Materials or cons mtctio�t iron A".40 PVC Abother(explain): Distance from pri:vatt water supply well or suction.line: _' Comments(on condition of joints, vsnting, evidence of Ieakige;etc.): joint' aagea2 t.eght. No e-v-idence o� �eakar�e System � 3 vented .thltough the 20o/ ventz. SEPTIC TANK:2(locate on site plan) "' eeo DVth bcipw grade: iY;p/.concretc � nil.of constrvctiQn: Z)dmetaWd ftbcrglass� lycthylene. Gbthcc(-czp.lain) �i If wtk is metal list age;&9 is 4t confumcd by a Ctnincttle orCornpowc(yes or no)�1�(anach a.copy of cercifieue) •� Dimensions: Sludge depth _ Distance from top of sludge to bonom oroutlet tee or baffle: Scum thickness-- CD-.-. Distance from top of scum to top of outlet tee or baffle: Distance from bonom of scum to bottom of outlet tee or ba:ffk: /3_ Howwere dime nsionsdetermined; Pumped at Lime 'off .in,6Rect-ion Comments.(on pumping recommcndations, inlet and onti.et tee or baffle condition, structural integrity, liquid levels &s related.woutle.t invert,evidence of•IcOagc,etc.): once. 3uh.-fen2 .aerzacaed uma the 6e12tic tank eveac.Z 3 Uea2.6. ra Onf P n,if Oof foo .c jinn in nPnCP 74 #.conk l4 A fi/naL/ a .3oand and zhowz no evidence o� eeakage. IdF41L; �..wq-it'e wate2 waz agove. the tt pp }, � a C Xg�TR9I �(ccafe n si c p7ai> t �����' t•• Depth below grad;: 'Vrl Material of construction:.L"dconcrcte metal fiberglass polyethyleneV,4other (explain): 1i'f Dimensions: Scum thickncs:s: VIV Distance from top of scum to top of outlet t`ce yr baffle Disunce from bottom of scum to bottom or outlet tee or baffle: Date of last pumping: 1 ,4 Commenu(on pumping recommendations, inlet and outlet tee.orbsf>le condition, structural integrity; liquid levels as related to outlet invert, evidence of Iealcage,etc.): f Page 8 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Add ress:218 Oid tTi ii Road Owner:- l'la.nue.' fto zgado Date of Inspection: 11120103 TIGHT or HOLDING TANKi&IC(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: V11 concrete metal �)AfiberglassA. olyethylenei�/,�other(explain): Dimensions: -- Capacity: /U,oy gallons Design Flow: gallons/day Alarm present(yes or no): dZl Alarm level: la4 Alarm in working order(yes or no): fir¢ Date of last pumping: Comments(condition of alarm and float switches,etc.): Tight oa ho.eding .tank,3 aae no.t paezen.t 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 of box, etc.): 1121,tfn10.idinn O.nr 'A/-,A nno -Pr/fonnJ Jho,7o iA o»ir/onno nZ AQP.;r1A zoo s e rnnnu 0eon_ 410 ouidonno nO PQCLlt_aye in in nn niiz' nZ fAo Pnx PUMP CHAMBER6' ,I''Vlocate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):LZ- Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): Paola chamlea i.s o n n,svnf 8 Page 9 of l l < OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C I SYSTEM INFORMATION(continued) Property Address: 218 Oid N iii Road eay.iiie, l'la-s.3. Owner: t�anue e Ro z aado Date of Inspection: 17120103 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan,excavation not required) 1 1000 rirzPPnn al ongAi �5� ,,,,. Leaching R.it .iz .in hydit,aui--ic )ea.i euae. If SAS not located explain why: TYPE/ ,p/ leaching pits, number: leaching chambers,-number: 0 P.. leaching galleries,number:_Q O leaching trenches,number, length: - leaching fields,number,dimensions: A,0 overflow cesspool, number: C? A- Minnovative/altemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): l i.- i ne each�rzg ¢tea nee o v ,tn.tfn P p¢.-/ $Q "q Q-6 49,W74 Vegea`_ai ion .i,3 noamai, CESSPOOLS ?`1 e4cesspool must be pumped as part of inspect on)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: W,4 Depth of solids layer: .r14 Depth of scum laver: TIA Dimensions of cesspool: Materials of construction: �`� Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,.etc.): PRIVY�C(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.): PIZ-iVU /A nnf nagAi2aj 9 Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:218 O.ed Ni et Road e2v c e, a,6,6 Owner,elanue-e No2:gado t.,.. Date of Inspection; 11120103 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including tics to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 rect. Locate where public water supply enters the building, "N j © R/ ' G 10 Page I I of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued). Property Address: 218 O ed 17ite Road Owner: Nance e-7' oT 2ga l�o Date or fospection: 3 SITE EXAM Slope Surface water Check cellar Shallow wells r Estimated depth to ground water �� feet Please indicate (check)all methods used to determine the high ground water elevation: No Obtained 6-om system design plans on record • If checked, date ofdesign plan reviewed: NR Uu Observed site (abutting property/observation hole within 150 feet of SAS) N-7 Checked with local Board of Health-explain: N,4 qj,� Checked with local excavators, installers- (anach documentation) qy_-�_Accessed USGS database explain: _ham_, / fmmn 0.yinnn,s,tagie, ma, ub. You must describe how you established the high ground water elevation: 1,6ed: Gah,,zel y R N122vn P1ndp 0 12116194 ovnr/ waiag v.Payr,�ionz move zea .eeve.e. 1,6ed, 11SGS: .1)ecc12 42 4na,1rJ arinaOA 0,1" tlnn,jnr/ ,.,ate2 !bed: USCS: Leaching I Pit :cc( �p1 Groundwater h-ct Below Bottom of Pit High Groundwater watcr Adjustment 1.8 ft per Frimptcr Method l 7lterefore,the vertical.separation distance between the bono '% I Of the leaching pit and the adjusted groundwater table is1/ rcct, II I - r-:•-nirr rr- r.T.-m.•n.a-rrr-r..n+-..r..r.:•.rr�vr.::-ra--e•�r�Trern4:r+svTCT.rm .. �r�....-. ._... TOWN OF Q_?.R,6�-ue-ee WARD OF HEALTH S011S(1RFACR 9FWA(;E DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION •••�••••T••••.1^•T.,,!.^.�.T.T."„i'TI.TT,T TC\CTlT T.T'TI"1'T^^•.•1.••IITTS TTTTJf�'rTTA.T•f'C fl7�0e1TT'i'�TRT{ .. ITTfi/f•'RRTT1Si0'.'TR.�f'T'•.�I••."'r"'T•�• —. -TYPO OR PRINT C UARLY- PROPERTY INSPECTED STREET ADDRCSS 218 Oed lrliii Road ASSESSORS MAP , DLOCK AND PARCEL # OWNER' s NAME Nanuei lio2'6ado PAli7' D - CERTIFICATION NAME OF INSPECTOR Joseph P . Macomber Jr. . COMPANY NAME Joseph P. Macomber V ion Inc COMPANY ADDRESS Box 66 Centerville Mass 02632 Street Town or Cliy Stat• lip COMPANY TELEPHONE ( 508 ) 775-3338 FAX ( 508 ) 790-1.578 n CERTIFICATION STATEMENT i I certify that 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 one ; System PASSED. The inspection tghich I have conducted has not found any information which indicates that the system fails to adequately protect public he-810i 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 wilich I have con� lcted has found that the system fails to Protect the })ublic health and the environment in accordance with Title 51 3.10 CMR 15 . 303 , and as specifically noted on PART C - FAILURE CRITERIA of this inspection. form , Inspector Signature : l�•ate0;r� �- f' ne copy of this�� c.ificaticn must be provided to the OWNER, the BUYER ( where appi icabl e ) and the BOARD OF HEAL'rll, * If the inspection FAILED , the owner or ` 'P' orator shall upgrade ' the ayetem wir.hin one year of the date of the inspection, unless allowed or required otherwise as provided. in 3.10 CFIR 16 . 306 . partd . doc TEST SYSTEM PROFILE TEST LOGSTOP FNDN. AT EL. 46.38' ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS COVER (WATERTIGHT) TO 6" OF FINISH GRADE ENGINEER; LISA LYONS, RS MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM F45.01 WITNESS: DAVID STANTON, �ZS EL. 44.14' RUN PIPE LEVEL 2" DOUBLE WASHED PEASjONE DATE; 7/28/04 Lam` 43.38' FOR FIRST 2 3' MAX. PERC. RATE _ < 2 MIN/INCH a EXISTING MIN. 71 oP 1000 2.7'f* jjj 42.55' CLASS I SOILS p# 10766 GALLON SEPTI7;1�4 GAS � TANK (H- 10 ) BAFFLE occo 41.83 M 0 0 C7 0 CJ CD � Cl a' 42.0' a 41.72 01710171 M 1771,171177171 a' 4' AROUND 6" CRUSHED STONE OR MECHANICAL '0 x ELEV. COMPACTION. (15.221 [2)) gsl $ 2.... Q 0 o a © O O CI o 39,72 0 44.3' DEPTH of FLOW = 4' 4t% SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE A TEE SIZES: INLET DEPTH = 1091 LS sTON HORSE OUTLET DEPTH 14" 10" 10YR 4/3 LOCATION MAP NTS FOUNDATION-- EXIST. SEPTIC TANK 17' D' BOX 13' LEACHING B FACILITY 6.09' LS ASSESSORS MAP 142 PARCEL 132 *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL UTILITIES AND ALL ,. 10YR 5/6 , BUILDING SEWER OUTLETS AND ELEVATIONS ** 27 42.05 PRIOR TO INSTALLING ANY PORTION OF NOTE: CONFLICTING INFORMATION AVAILABLE Cl SEPTIC SYSTEM REGARDING SIZE/CONDITION OF SEPTIC TANK. REPLACE WITH 1500 GAL. SEPTIC TANK IF SMALLER M/CS THAN 1000 GAL. OR NOT IN SUITABLE CONDITION 33.63' 2.5Y 5/4 NOTE: GAS LINE IN AREA OF 68" NEW SAS (NOT MARKED AT 43.98 C2 TIME OF TEST HOLE �F aa.21 SEPTIC SYSTEM IS NOT DESIGNED FOR PERC PROCEDURE) ,r��,' VEHICLE LOADING F/M S 4.18 441 - - 2.5Y 6/2 EXIST. SAS AREA 128" 33.63' �, UNKNOWN �43,es NGWE / +44.7 5.07 NOTES: ?. 44.13 3 82 PARKING AREA r DIRT/GRASS r' O r +4 . 2 73 SEPTIC DESIGN: ) 1 . DATUM IS APPROX. NGVD ,rT 26. (GARBAGE DISPOSER IS NOT ALLOWED r \*44.26 , _ 440 `�I!I�lICIPA!__WAT�R _Ic _EXISTING �.4a2.42 r ' + 3 44.$9 DESIGN FLO440vr: ^�+`BEDROOMS ( 11p GPU) - GPD _ _ - -_' 3. MINIMUM PIPE PITCH TO BE 1/8- PER FOOT, QO '' b 625 ` aa.34 i, USE A GPD DESIGN FLOW / " 'r, SEPTIC TANK: 440 GPD 2 = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 `.� r O�' 44.00 I / 44.44 (-) - +4 7 5. PIPE JOINTS TO BE MADE WATERTIGHT. "�� r 4a.a7 1000 ** `r% USE A ,-,___ GALLON SEPTIC TANK (RE-USE EXISTING) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Wll'-s MASS. O rr -44.34 t44.46 LEACHING: ENVIRONMENTAL CODE TITLE V. o + 1 _ 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT OVERHEAD O" ,, r• 4 ' EXIST. ST** 4 44.17 SIDES; - w1REs 2(33.5 + 12.83) 2 (.74) 137 41 42 7 I - TO BE USED FOR ANY OTHER PURPOSE. -M WATER r 4 7 W No BOTTOM: 33.5 x 12.83 .74 318 ( ) 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. TINE �, +4 8 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT aa.9 TOTAL: 615 S.F. 455 GPD PAVED ! INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED r r r ! DRIVE i USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH. EXISTING i 44.31 EQUAL) WITH 4' STONE ALL AROUND 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED SAS r� 444 DWELLING ' '`MAT REMOVE ANY CONTAMINATED SOILS WITHIN 5' OF NEW FACILITY BENCHMARK TF=46.38' METER Sys COR TOP BRICK LANDING AND REPLACE WITH CLEAN MED. SAND r 45 ELEV = 47.0' 4.92 DECK ; 44.97 LEGEND TITLE 5 SITE PLAN -----j 4.08 ao 100.0 PROPOSED SPOT ELEVATION OF oo. 218 OLD MILL ROAD +44.31 LOT 83 10Ox0 EXISTING SPOT ELEVATION IN THE TOWN OF: 44.09 BARNSTABLE 12,491 ±SF 00 PROPOSED CONTOUR ( OSTERVILLE) 3a.84 100 EXISTING CONTOUR PREPARED FOR: BORTOLOTTI CONSTRUCTION/MORGADO 20 0 20 40 60 BOARD OF HEALTH MA SCALE: 1" = 20' DATE: JULY 29, 2004 APPROVED DATE off %8--M2-4541 fox 508 362--W80 o� (H OF F yAssq�ti JAOifg ' cS down cape engineering Inc. ARNE H, N� ARNE H OJALAOJALAI CIVIL ENGINEERS ° c No.26348 LAND SURVEYORS e�0 ss��`'P �, ►� 3 4 . 939 man s . yarmou , ma G 04-- 1 73 it th 02675 AR N H. OJALA, P . ,� DA E