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HomeMy WebLinkAbout0081 BARNICLE DRIVE - Health 81 BARNACLE DRIVE, M.MILLS A=057-060 TOWN OF BARNSTABLE,OCATION - 8/ 6A� �n c% SEWAGE #' M:.i GE ASSESSOR'S I+hAP&L,O'd NSTA1.4XR'S NAIvtE&PHONE NO. ;EMC TANK CAPPACITY /S L ,EACHING PACII[M: (type) -'� T �UY� (size) s 10.0F'BEDR.O0MS___, ___...,_. ' r 't MILDER OR 0 R - SRMIT®ATE: COMPI A1gCE DATE: reparation Distance Between tltc: Aaximum Adjusted Groundwater Table to the Bottom of beaching Facility EeM 'ivate Water Supply We91 and beaching Ppacility (if any wells exist on site or within 200 feet of leaching facility) east idge of Wedand and Leaching Facility(if any wetlands exist within 300 feet of/ aching facility) lFect ,umished by k�G✓va = �� a s Ck , o 0 L7 i D� 33 r A 1 s I Commonwealth of Massachusetts ✓ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. CityfTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Furthe Ev tion by the Local Approving Authority 1-14-13 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. d v [Sins•11/10 TiNe 5 4lnsFrm:Subsurface ge . sal am•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-11/10 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 2 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Bamicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ 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 ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 l Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 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 aseptic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliforrrt bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or . clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. 4 ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool,or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form :Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® 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? • F ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® E] Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D..System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i^ a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 12-2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day Y(9Pd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1998 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ cast iron '® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 16"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by;a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City[Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 20" litScum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts , Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) - Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5-Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/attemative system Typel'name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Infiltrator leach field in good condition with no sign of back-up into d-box or surrounding stone. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 li Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) - Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments sa`'y 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately <t C, j a d L7 A G- 17 ` Y- i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12 feet Please indicate all methods used to determine the high ground water elevation: ® - Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no water at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 81 Barnicle Dr Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 1-14-13 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file tSins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost$30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL.,367 Main Street, Hyannis, MA 02601 (Town Hall). DATE: r= Fill in please:„ x APPLICANT'S YOUR NAME: :S a l i e- { BUSINESS YOUR HOME ADDRESS: 8'\ SQL ni s S2�—�Ss-o44Q YNucs}n ry1�uT_Y�I��Cn�l�' TELEPHONE # Home Telephone Number: S-Q$- - ti Q) 2ZF ................ ...:.... ....._............................ ........_.............. i i., ....I..._r:,ii...:,_...............a...._r..., .., .r .,.,._,...,...,:,. _v,...nA�..,. .,..._....,_..v.r..t.,........a.......,..rl:.l......... .. ... , .: .. r , :._.. :..�:r:.,:,-•.v::. ... .,. r., .r. .... 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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 This individual een in or a f the ermit re uirements that pertain to this type of business. Authorized gnature*" COMMENTS: 3. CONSUMER AFFRheen ICENSING AUTHO This individual in d%c Jf the I" s re uirernents.that pertain to this type of business. Authorized Signature" COMMENTS: TOWN OF BARNSTABLEr,, V y LpCATION./.BT' 66 &na dw-, SEWAGE # VILLAGE At2 r ZOrL Pl a A ASSESSOR'S MAP & LOT ip9�'7 P60 INSTALLER'S NAME&PHONE NO. It-Ei�Cev 6.-sr Cam, m SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) /I.�Sll NO. OF BEDROOMS BUILDE OWNER 7ne- e- PERMTTDATE: COMPLIANCE DATE: 4 7i 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 G on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of luching facility) cility) Feet Furnished by s . '� ,� � - f��" r �� p i .. �� ' � D � .:� - � - - t . W � -- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pprication for Mioozar *pztem Construction Permit Application for a Permit to Construct( l5Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No.8' 04ZA11 U t 17riV e- Owner's Name,Address and Ted l`ll/#�S'taA1S /�!1 BLS �sa Mc{>i:./Gi use TQus'/� �hn J. ecfic Assessor's Map/Parcel ,pp-^�� /ov. 3—X asp Weyj B�/�/�TRLitG i`9�},v V 0 2- —53i Installer's Name,Address,and Tel.No. De igner's Name,Address and Tel. CpK No. f74L,C-n0 44e-L� et4su,�4"t oAry' ' ur,��aX X. / 0-I r S q0 Z �f 03 )I/LcJ 1 Fr-D Os Typeo / [/ Dwelling No.of Bedrooms 3 Lot Size �Ji TKO sq.ft. Garbage Grinder(NM Ot er Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow I gallons. Plan Date 10 /0 517 Number of sheets 2i Revision Date Z15 Title Size of Septic Tank C)C) Type of S.A.S. Description of Soil 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 issued by this Board of ealth. Signed o Q4 _11 d Date kA lk- Application Approved by a Date Application Disapproved for the following reasons 0— Permit No. Date Issued -r. , .__.. .:-/afar. .✓?' ,r y"" _»..._ .. r.sar Fee THE COMMONWEALTH OF MASSACHUSETTS �" Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Zlpplicationlfor ;Digpogar *pgtem Con!truction Permit Application for a Permit to Construct Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.e/ 3A.ZAIlUiE rIV a Owner's Name,Address and Tel.No �t} /y6t j'/%✓G uI TtQt[S l� Assessor's Map/Pazcel n Q ,}, a� � 0— B,i.�/j'jq� 2. 3t Installer' Name,Address and Tel.No. De igner's Name,Address and Tel.No. / y�P G�u rKt�/ �o Astt�1�a/f dJI�S/lr2 /7 pa ax ,���/ c�y�r' S 5l0/� ZHd�j�yy � 1 /N o-26 /� -DoS 1Type gf_Bull ' ee�� LL Dwellin No.of Bedrooms Lot Size 0� TES sq. ft. Garbage Grinder(AA �- Other Type of Building No.of Persons :. Showers( ) Cafeteria( ) Other Fixtures . Design Flow 330. gallons per day. Calculated daily flow �gZ► gallons. Plan Date o lu Number of sheets 7_1 Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: ` l 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 b this Board of ealth o' Signe C-44A -^Wo Date 1\ `18" Application Approved by © Date Application Disapproved or the following reasons Permit No. "" Date Issued ------r-----------=------------- ------------ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS -Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Repaired ( )Upgraded( ) Abandoned( )by k--�`e-V o N>r- C v !— at been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Y vA s16 Designer r The issuance of this permit shall not be construed as a guarantee that the system will'unction as designed. Date - /`� �� , Inspector -- — ---------------------------------- No. Fee-�lr� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Migonf *pztem Construction Permit Permission is hereby granted to Construct(Repair( 1 Up rade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognize' his/her duty to comply with Title 5 and the following local provisions or special conditions. Ie Provided: Constructio must b co ed within three years of the date of thi Date: Approved by I TOWN OF BARNSTABLE LOCATION ,L.QT 6a SEWAGE # ASSESSOR'S MAP & LOT-euT7 P6d `:INSTALLER'S NAME&PHONE NO. 1-4Lc.k olyn n�o►' � 71,,. <; :;SEPTIC TANK CAPACITY ':;;:LEACHING FACILITY: (type) In /trr�satl 3' (size)1L OF BEDROOMS .� ;:.BUff,DE OWNER k ehne.�ek ;e:;PERMITDATE: COMPLIANCE DATE: _ LI —I y .9 Separation Distance Between the: :,IVlaximum 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) ffe��_Feet ,EdgO of Wetland and Leaching Facility(If any wetlands exist 300 feet of 1 Ching facility) Feet :Furiished Y b v P �.,. _ r ) � ' •.'... 1�•• M4R TGAGam' I.NAS'PZC TIOIV PLAIV APPLICANT: LE{GH TOWN: MARSTONS MILLS LOT 63 s - - ==== _-- OT. 4 s 1 dt1 LOT fig � .p Lu I 00 OF g STEPHEN D&LE s c� #37559 a a • F ' • 6 :' .. SRO pQ t ROOD PANEL- 250001 OOf8 .D FLOOD :2.OW--!- QC" Pi4T MAP ft tS 7/ t39 Y air semm Rom.' r-wmw mft 4IPkIE 3f3J13 SCE 7'.... t` ..czxs.. :. ris;fro. DM REF: 26674-149 PLAN REF 272-29 t �s 77� -s F I SFEMAL FLOW :?tom. PER t TA 9OFEC1 a 77�'DM�LltG A 78 C -1B It ff"m AE WwT Tiff SiRLEnm 531 m om*6 NOR7tiUE pc�i PL�NI.ARE'ti=IM By UK SU OR AT 0 7155:of 7W4i ly7H ! i•' C. CKY,W @67Rumm S US A DA=106 5K� ARE A AT 6 7 4� Y AC E Hdt OMER L LA&CiilFP i Ibl di S;t$f2 % Ffl iRi101t' F LtICA7w ERSE1 RF 7 APR? tg 7 OF'Ail r.15 tiF:t Y,. lam!�►IF AY 0 itAY ACC 'imS Y iA9� AS 7K SALE ARE OF WD&FMM AND OW".. AtdY 7 ,yg} SURWEY CO6CPJWY W-NWLL.►2Cat Hgg:dIIBCE FOR:CiRiG(6ES R£1 R�16}3 ANY t t�Tlx:mm FC62.PuRpat SaY7 m TELEPHONE .509—a2 MY Arr FAX: 508-420-5553 '119 ROUTE 149, Morstons: Milts. VA 02f lank omcast net www.yankees4pm net:. .82595 UTM2TTjES-- BENCHMARK- TOP OF TAGBOLT "MARSTONS MILLS ELEV==100. 0'(ASSUMED) A. M. 57 59 C � � � \ VACANT) 1g0" 0 / T 97.6 � 0��� ( 0 N \ L CUS N70°5 Iol 12. 57. 00 o ! / 97.1 7 \ 21 p3.p \ ` PROPOSED\ LOCUS MAP 2 3 O USE _p \ \ ! TPP#-2 5 — CATCH TOP FND=101.0" / \ BASINS 7 p' 5 p' _ N o \® 11 2 0 10.p S.p PLAN REF.' 272/29 \ o \ RES. ZONE: RF 10.0 o GAR. 6� \ ASSESSORS MAP 57 PARCEL 60 96.9 PREP VE SED PROJEC7T L OCA TION \ \ RI D , ASSESSORS LOT 60 BARNICLE DRIVE MAKSTONS MILLS, MA. 96 / OF APPLICANT.- � �,, �`�" 95 � o PAUL `-, J. J. KENNEFICK KESTORA TIONS. INC. / \ A. —� , ISTE�``°�� )"A NKEE SUR VE-Y CONSUL TA N TS A. M. 57/52 A. M 5 716 0 \ \ \ °��e �"1°� P. O. BOX 265 �( AREA=25,410±-S. F. E �3 \ \ r UNIT 5, 408 INDUSTRY ROAD MARS TONS MILLS, MA. 02648 N72 i �� _ ___-- - ;`� ��H '� �► PH. (508)428-0055 — FAX(508)420-5555 ' o H ,E, G.Qv MURPHY SCALE. 1 "=20' �-DA- TE. 10 97__] m10/ / No.749 Grc �,E REV. 1/24/98 REV. PB7��� SHEET 1 OF 2 A. M. 5 7/53 EL. = 101, o' �. TOP OF FOU7v"DATION I 20' MIN. 10' MIN. CONCRETE CO VERS 4" SCHEDULE 40 P. V.C. MIN. PITCH 118 PER FT. 2"LAYER OF _ 1/B"-1/2" 6" MAX ' / / 7 / i CONCRETE COVER WASHED STONE ' EL.=98. 75 EL.=98.0 4" CAST IRON PIPE / ' ' / / / / / / x (OR EQUAL) MINIMUM PITCH 114 ' PER FT. CLEAN SAND FLOW LINE 10' MIN. 10" 1 EL=95 INVERT 1 MIN. 14" f - 98 0' —2.0'-EL.-_-__-- INVERT LEVEL o 0 0 0 00 0 GAS �6 SIlM 0 0 0 000 BAFFLE — 97 5' ° INVERT EL.- INVERT INVERT 0 °0 0 0 ° EL = 97 75' EL.=-96. 75' EL.=-96-5'_ °°o o° °°°°° —93.5' ---- D j T (TO BE PLACED ON FIRM BASE) DISTRIBUTION TION MECHANICALLY COMPACTED OR 6" OF STONE BOX 1500 --GALLONS TO BE WATER TESTED 11' X 38' TRENCH FORMATION Q SEPTIC TANK IF MORE THAN ONE OUTLET PLACE .ON 6" STONE 3/4" TO 1-1/2" SOIL ABSORPTION L PROFIT E OF WASHED STONE S YSTEM (SA S) SEWAGE J� DISPOSAL SYSTEM[ BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV= 87. O' NOT TO SCALE OBSERVATION HOLE 1 ELEV.__ 101_0' OBSERVATION HOLE 2 ELEV 99. 0 PERCOLATION RATE _<5- MIN./ INCH AT 48'_ INCHES DEPTH HORIZ TEXTURE COLOR MOTT. OTHER DEPTH HORIZ TEXTURE COLOR MOTT. OTHER I 0-3" 0 ORGANIC 10 YR 313 0-3" 0 ORGANIC 10 YR 3/3 3"-12" A SANDY LOAM IOYR 4-1 3"-12" A SANDY LOAM IOYR 4 GENERAL NO TES 12"—36" B LOAMY SAND I 10 YR 6/8 12"—36" B LOAMY SAND 10 YR 6/8. 36"-144 ' Cl MEDIU.,l1 SAND 10 YR 7/4 36"-144 Cl MEDIUM SAND I IOYR 7/4 1) ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. EL=89. 0 NO WATER ENCOUNTERED EL=87 0' NO WATER ENCOUNTERED TITLE 5 AND THE TO ON OF _B_A_R_N_STAB_LE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. 2) ONE COVER ON SEPTIC TANK SHALL BE BROUGHT TO SOIL TEST WITHIN 6" OF FINISHED GRADE, OTHERS WITHIN 12" DATE OF SOIL TEST 09123197 SOIL TEST DONE BY BRUCE G. MURPHY, R.S. 3) ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H-10 LOADING" SS 1HEY AHL' UNDER OR WITHINWITNESSED BY: MERRY nUiyNlNr, 10 FT. OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE P# 9011 DESIGN CAL C ULA TIONS. USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 4) ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL NUMBER OF BEDROOMS . . . . . . . . 3 BE MORTERED IN PLACE. GARBAGE DISPOSAL . . . . . . . . NO t 5) NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH TOP LOAD TOTAL ESTIMATED FLOW t, DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO 5 INFILTRATORS WITH ( 11 Q__GAL./BR./DAY x 3--- BR.) 330 GAL/DA Y OBTAIN SUCH ETERMINATION FROM APPROPRIATE AUTHORITY. 4' STONE SIDES AND ENDS REQUIRED SEPTIC TANK CAPACITY 1500 GAL 6) UTILITIES SHO WV_ ARE APPROXIMA TE ONL Y, "EX(,,A VA 7Y01V CONTRA CTUR 11' X 38' IS TO CALL 'DIG- SAFE" AT 1-800-322-4844 AT LEAST 72 HOURS SOIL CLASSIFICATION . . . . . . . . 1 PRIOR TO'­COMMENCING WORK ON SITE. DESIGN PERCOLATION RATE . . . . < 5 MIN./IN. 7) CONTRACTOR IS TO VERIFY GRADES AND ELEVATIONS AS WELL AS EFFLUENT LOADING RATE . . . . . . . 74 GALIDAY/S.F. SITE CONDITIONS PRIOR TO COMMENCING WORK ON SITE. LEACHING CAPACITY (AREA X RATE) 382 GAL/DA Y i 8) PARCEL IS IN FLOOD ZONE __"C" . RESERVE LEACHING CAPACITY . . . 382 GAL/DAY 9) LOT IS SHOWN ON ASSESSORS MAP __57 AS PARCEL _60 (38xllx. 74)f(38-�-38+11f11)( 74) SHEET 2 OF 2 JOB NUMBER — 51412