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HomeMy WebLinkAbout0021 LIBERTY LANE - Health 21 Lt_)BERTY LANE -- --- -- MARSTONS MILLS r f y TOWN OF BARNSTABLE ' 1 LOCATION 21 SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1000 CGc L. F LEACHING FACILITY:(type) 600'2s j (size) J X i j NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any we ands exist within 300 feetry ,� frig fa a Feet FURNISHED e �" ��� ® `� �� � � � �.,y -.5�.. � � �, � 3� � �..��_� �J � �� vy� No. —00 ( r Fee /00 �— THE COMMONWEALTH OF MASSACHUSETTS Entered in computer.; PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es Rpplitation for Misposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. La r M Owner's Name,Address,and Tel.No. M./Yl,1 Is Assessor's Map/Parcel l 2�{ p L)y Q j 6 I 2, $b�'—fK--9 q 7 7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 4 R ("Asfirvice, (yeh Irr1h h 9 4?M Its/svi- gZ�-?�6d Type of Building: Dwelling No.of Bedrooms ! Lot Size sq.ft. Garbage Grinder(4 Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date © (� ��1 Number of sheets Revision Date �7y Title ON A Size of Septic Tank !d 00 Type of S.A.S. 0ox .4 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 aFe described on-site sewage disposal system in accordance with the provisions of Title 5 o . n e aandot to pl system in operation until a Certificate f Compliance has been issued by 4thiso 0 Date Application Approved by Date Application Disapproved by Date-4 for the following reasons Permit No. �� �_ � Date Issued L Af ­oo No. �;��.t�, ,m- Fee THE COMMONWEALTH`OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS es 0(pplication for Disposal 6pstem. Construction J)Prmit Applicah n for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components t Location Address or Lot No. a I L; to,.�4` L ye , pA n, Owner's Name,Address,and Tel.No. t 4,1)1 Assessor's Map/Parcel 12-11/®0,11 v 16 too i'�'►A J e i v1 i 5D�-S%L-9 Y7 7 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. i<t'h (,,151Y-VChc)h Type of Building: t v Dwelling No.of Bedrooms. Lot Size sq.ft. Garbage Grinder(1\19 Other Type of Building.- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd 'Design flow provided gpd F -,Plan Date 0 y � ��1� Number of sheets Revision Date Title Size of Septic Tank /O 0 O Type of S.A.S. Description of Soil ,t 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 1 e,and not to pl he system in operation until a Certificate f Compliance has been issued by this B�o Health. _ /// Date Application Approved by k, d fin, Date Application Disapproved by Date for the following reasons Permit No. Date Issued ,- -------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that th n- ite Sew Dispos s stem Constru ( ) Repaired ) Upgraded( ) Abandoned( )by at & has been constructed in accordance with the prro ision-Pof Vt 4 5 he for 's 6sa1 Syste Construction Permit No.;qz� p0/ I J dated-vo� � 1 f Installer [ _Q/l.l Designer ,�J r^ ,{"el--To bedrooms Approved design flow Lr),_ and The issuance of 's e i s 11 nj be construed as a guarantee that the systemftKl� geed. � G C Date Inspector �i No. Fee Uu - -o THE COMMONWEALTH OF MASSACHUSETTS ` PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal bpstem Construction Permit Permission is hereby granted to Con tru t( /) R pair(x) Upgrade( ) Abandon( / d/v� < System located at fir, ,,.� r. Aj s ,U and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. -Provided:Construchohmust be completed within three years of the date of this permit. Date Z ( l Appr ved by d__� f ,(a � "l�o n c h Hey'+ f! ✓�a-�Q ,3� M.,k. uvfr 3' only Ovr!' 54n-C Sec '• o�S>,s Town of Barnstable VMS Regulatory Services Thomas F.Geiler,Director MAS& = Public Health Division 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 �� Fax: 508-790-6304 VDate: /4 / Sewage Permit#NO sor's Map/Parcel —00LI—®I6 Installer&Designer Certification Form Designer: 6"E_ �OL v✓1 Installer: Address: 9 L.ode.. A5t L a.v, L Address: 01 �P__J111 JA1"04 On was issued a permit to install a (date) (installer) septic system at 'Z 1 L o la based on a design drawn by (address)' 6" C-. r4,1.44 h F. dated 30 A/0V 2�i� v-W• PI 'V "I (desi 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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if required cted and the soils werefound satisfactory. OF AtAs�9c GLEN y�N ERI ( ' sta ler spSig�atuie) $ HP�RRINGTON Co ------ No.1070 0 - SgFGiS'IEQPe� esigner' i tur (Affix Desi ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUH T CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice formsWesignercertification form.doc opy��� Town of Barnstable Barnstable Al�ftRegulatory Services Department erica F } nABNSfABLE, MASS Public Health Division �j 1639• �� ArEb"`0�a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard Scali,Acting Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 1067 - November 12, 2013 Martin S Stein & Christine.J. Clements 21 Liberty Lane Matstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 • The septic system'located at 21 Liberty Lane, Marstons Mills, MA was inspected on 9/30/2013, by John Graci, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • System is in hydraulic failure. You are ordered to repair/replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH Thomas cKean, R.S., CHO Agent of the Board of Health • Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\21 Liberty Ln MM Nov 2013.doc I _ Parcel Detail http://issgl2/intranet/propdata/ParcelDetaii.aspx?ID=7906 Logged In As: Parcel Detail Thursday, November 7 Parcel Lookup Parcel Info Parcel 1124-004-016 - 1 DevelopeerILOT 10 Location 121 LIBERTY LANE I Pri 100 Frontage SecI�__._.�,. —.—....____.,�__ ._.�_ � Sec ------- Road Frontage' Village MARSTONS MILLS + Fire District Town sewer exists at this Road 12233 address No Index Asbuilt Septic Scan: Interactive 124004016 Map � t Owner Info Owner!STEIN, MARTIN S&CLEMENTS, CHRISTINE J Co- Owner Streetl 1221 LIBERTY LANE Street2 — City;MARSTONS MILLS �� State EAj Zip 02648 Country Land Info Acres i 30 5 � Use Single Fam MDL-01 _ Zoning RF _ Nghbd Topography[Level Road Paved Utilities Septic,Gas,Public Water Location Construction Info Building 1 of 1 Year 1991 � Roof Fable/Hip I Ext Wood Shingle Built Struct Wall Living 17381 Roofl�sph/FGIs/Cmp ACNone Area Coverll"� Type' _ Mr Style Cape Cod Wall Drywall Rooms 4 Bedrooms ��' __ _ _ Resident ial Int Car et Bath Full Model. rr �: figs I Floor Rooms ---- Grade m i Average Heat CHot Water Total 9 Rooms Type Rooms' e Stories 1 3/4 Stories I Heat FGas 1 Fou tionnd-j P Fuel aoured Conc. ` Gross http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=7906 11/7/2013 13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required_for every MARSTONS MILLS MA 02648 09/30/2013 page. City/Town 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your 1 fV) lVJ I cursor-do not JOHN GRACI use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS, LLC Company Name PO BOX 2119 Company Address TEATICKET MA 02536 City/Town State Zip Code 508-641-6694 S1468 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 tov� ction 15 340 of Title 5(310 CMR 15.000).The system: ZLI ❑ Passes "lrv�❑ Conditionally Passes ® Faits' ❑ Needs Further Evaluation by the Local Approving Authority 09/30/2013 Inspect s Signature Date Y The s#stem 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. t5ins•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,. 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityrrown 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: 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 5 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 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 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 must be attached to this form. 3. Other: NA 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 Y2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 I Commonwealth of Massachusetts Ij Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Citylrown 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. ❑ ® 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 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. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Citylrown 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 f El ® volumes g e o 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, 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? ® ❑ 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 Lt5.r,sl13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityfrown State Zip Code Date of Inspection D. System Information Description: 1000 GALLON SEPTIC, DISTRIBUTION BOX AND 1000 GALLON LEACH PIT WITH 1 114 TO 1 1/2 WASHED STONE Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage TOWN 9 ( Y 9 (9Pd))� Detail: 2011-68000 2012-96000 Sump pump? ❑ Yes ® No Last date of occupancy: OCCUPIED Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: Source of information: NA 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M z 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 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: 1991 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: GREATER THAN 10+' feet Comments(on condition of joints, venting, evidence of leakage, etc.): NO COMMENT Septic Tank(locate on site plan): Depth below grade: 20"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 5" t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Citylrown 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 29" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 0 Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND RECOMMED PUMPING EVERY TWO YEARS Grease Trap(locate on site plan): Depth below grade: NAfeet 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owners Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Citylrown 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: NA 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•3/13 TAIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Uo Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Corrown 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 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX LIQUID LEVEL UP OVER PIPES 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.): NA *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1000 GALLON ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): LEACH PIT WAS FULL AT TIME OF INSPECTION LIQUID LEVEL WAS OVER PIPES Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth—top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments , 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityrrown 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.): NA Privy(locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Citylrown 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 AYE 21 o I�YS �q 3 CAD 31 S GAK D F_CI< c) o a G � 1 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 5 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Citylrown 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: GREATER THAN 10+ FEET 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: 09/31/2013 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: PLAN Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Forth: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 M , 21 LIBERTY LANE Property Address MARTIN STEIN Owner Owner's Name information is required for every MARSTONS MILLS MA 02648 09/30/2013 page. Cityrrown 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 t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 �rt1E Town of Barnstable P-# '. Department of Regulatory Services A/z sz� Public Health Division Date MA8.4 • � 105g. 200 Main Street,Hyannis MA 02601 ��FD MA't R ' Date Scheduled_ �' : Time ]Fee Pd. Soil Suitability Assessment for ,Se Performed By:* : .Gt Y /o/Seil!/ Witnessed B Y y. I LOC TIO GENERAL INFORMATION" / { Location Address ' J / Owner's Name /// L//[✓ f�[ Address r @w✓t'2 e Assessor's Map/Parcel: Vo Q(t D' / Engineer's Name ;S!Z.6AI � NEW CONSTRUCTION REP IR Land Use I<P1 t c'?, Slopes(35) Surface Stones *014 Distances from: -Open Water Bodyr�� .ft Possible Wet Area v ft Drinking Water Well ��11-f—ft -ts Drainage Way *Ot'� ft Property Line Q ft Other ft SKETCH'(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands fu proximity to holes) y 9Aet-- of .Nek TN _ Pert Stied .. ' 4 � -3/ Th —� C, l�J lid as Parent material(geologic) l�IGI"� 0, t✓af 4 Depth to Bedrock Depth to Groundwater. Standing Water in Hole: ���� Weeping from Pit Face yoN Estimated Seasonal High Groundwater T14 DETERARNATION FOR SEASONAL HIGH WATER TABLE /- 0// — IVO (r � Method Used: Depth Observed standing in obs.hole: Mb y.e_ _ In. Depth to soil mottles: Depth to weeping from side of obs.hole: In. Groundwater Adjustment ft. Index Well# Reading Date: Index Well 1ev:t r Adj.factor _ Adj.(Groundwater Level PERCOLATION TEST gate// 9 _ Time /o a•ti Observation Hole# ` Time at h" _ Depth of Pere 0 p Time at 6" Start Pre-soak Time @ � '` _ �'�� r"4`' Time(9"-6") End Pre-soak `L./A4 r Rate Min.Anch Less Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back`---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:\S EPTICIPERCFO RM.DOC ----------- --------- DEEP.OBSERVATION BOLE LOG Hale# Depth from Soil Horizon Soil Texture. Soil Color Soil. Other Surface(in.) (USDA) (Mansell) Mottling' (Stnucture,Stones;Boulders. �'N'S onsistency.%Oravell 0- 6 Fill g31V3� 9 /0 A ESL f0 0, 3� ftt_3� a3—/do C /1c,5 /0 6 /VO DEEP OBSERVATION HOLE LOG Hole#' 02 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. q S• Consistency.`Yo (�Z,gz - 5 Q Ly�S o �.� r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Co i to c %Gravel) 1\ y ]DEEP OBSERVATION HOLE LOG Hole# Depth from. Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders, Consistency. Flood Insurance Rate Mau: Above 500 year.flood boundary No—/Yes Within 500 year boundary No_ es Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? --6�- ---- If not,what is the depth of naturally occurring pervious material? ..--- Certification // , 13 I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trai ' g,exp Ilse and x rienc escribed in�10 CMR 15.017. Signature G�rJ4 Date Q:\S.EPTlMERCPORM.DOC t�number laLl PANT DF P y�Q/+N'!� yo�TWCTo`` !f Or): a bW w .mbar o ENSTALLE® IN COMPLIAN prtment(3rd floor): / YI� 5 D�r.Sa Lt r O ENVIRO. o t63V. �,a Approved by,Planning Board , 1911 I° �UL 'ffi �'D JIONS PROCESSED 8:30-9:3o A.M.and 1:00- :00 P.M.only gn o� Com'z c' TOWN ® F . B11` �TAL X� °n BUILDING INSPECTOR oa a � APPLICATION FOR PERMIT TO �.D LC�CC�( � CG°7�ZLGTif__ TYPE OF CONSTRUCTION U/(1(�j� F�/� ,411 4 i a -2 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed UseQ— Zoning District Fire District Name of Owner Address (�4j4zlltzb . 11 LA Name of Builder Address Name of Architect �C -e�i� Address Number of Rooms ! Foundation J'"oLamx ' Exterior ( r� 9` �!/�'v, Roofingf OF Floors L Interior Heating �� �� 17 Z Plumbing VC, Fireplace l�WC1Z�� / •�%o�- ��f�'"✓���- Approximate Cost on, Area 39a Q- S Diagram of Lot and Building with Dimensions Fee 10-21 p' /lo2t� 4"4 ,.a v OCCUPANCY PERMITS REQUIRED"FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License ��.J ' 116 8 Bath closet 7 Bed 1 186 134 closet `. closet 106 Sitting room Master Bed `.� hall �• ♦� ----------------- ----------------------- -------- I 1 10 114 closet closet Bed 2 ...............-...------ ----------------------- STEIN SECOND FLOOR 21 LIBERTY LANE w v A` � '3�xIG.wC�O� t9lS4C'��41L � 3 • e h r ' �--• viz s:» $ {y E ILI 44 ' �♦ �..��r ..�-% x...-_ .w emu:.. 14d:.�.FlCd u1L p00 a Q4►6 '` wmw ctn .0 V=a.et�'.fr ?row. t � �..,�i t•aT.r�t "L 'sue, .-_ - fi cr 44 *fps•'�•G �t•.2t.—� .,�;, } a , + 4,-�."co a rt w&" y f 1 t 1 wont { : ,' Kl.i Ary t G A W,AG I� C.'+n y t't` cr `I i; + 1 • t'. tb ir�{;'#t,�';`-C+r y'C�e..�fit..• t y , 4: t k , t x a k. Hn f t 'nz" �. .. .!�.w .v ._..< r .,x .:. •a �_ ....s .,-c>.,:.. [ wi. J _„ --,.,_, ._.. .�- ,...�-- -'F �':,-- x;-_ d r mot= .,w: - "� T,f.5 ....`Y .:_ '-: "._... �` ,.. _a 3z,.�', '-a. .,,. ...,'a ..,..r:... �:_.✓ t ,..:...-, t_.','_ '' "T fiY„-v P-�v . :34:3 xfa }c ht� gg� r . _2ox12�Voo0 OE ti II oil t y ------- —13 }- .... " Z s ' t o'_2• '-S•' Wt 0 . 93xlsg ��t 1f I t[�� y � ter"= ! ' 1 a. ( f , I �� qq � OO Ti �,0 o r-'4i .,1 Is'_-d''_�___li__1\_ r sl'm+ ,r w t � �P.TZ.�AC�.T►�e a x r�, I.o 's > R�st t �Yk "!`-: . {I ---- -�T I�EA rz✓�•C-. - i' �, OG1C air l'' CJ1 Ct IN CEIU N_G. ro IL FUT r7.UHOW � �Qwp .. _ r co 't 5 PAN 1.1�GA�C¢k,.. N r C � w. � 4- (LE I�J�f L'o NC.2 ��jC110.s��u..� h%>�:.rb'r+�,�'•�g�"����" 7��,� / 3 m 5_o � 3 " �'� a 00 fL d ` ..*r'. °"�''•��z��r'PT.7`s�"�"��3 x i} � �a4�': � ' —WIT ; lM ieS '"tw-ur 1 t v #.x. �y Y ty P r ds y S 3 S`i Y4 't'+'• C ' n,� k i `x .� �, , t� �'r '"itx ♦ LI\,/.I N CG zF rK • fir �'a'�v 'n i ' gt `+i,- - 1 — y�Y1�a H F000TL y 1. i n+az.r' f .�Got� STEP — � I t f almost t � yr r�t�Py c 3 {�la v�tl� ���1 I i,�nH; --....._._-..---- - _- ----- Co'-0'• E S 7 r 1 p O �a y�3,yk � x*�-,'P'� }rY�s�,yfi�' ! l2e-O•' �� sic � �' 7�`3�'>xm 3�'- 0• �I _— a f KS2'`�" k .' t I � :Coy- g�• 13� � � - „! fc�-4'. rdz s� 3� 43any 44, a lot �, 00 2'- 41 I��. 3 1 r 1 3.ox.s4 >�a �.�"�'t 0 .O O ...\\ ;;t' n' �• L�NEF.! �� rr�r ' .Gb.1L C? _ as N %hEt7 .GGri �t�nae�t ti(oi. a EV t.;"i n d. I OWE& �1s, .•�x4Z r:.a +. F _ I'f { oI It k 4 I n. 1 i i _ w i - { 14S ftPAFJ 4Yf i� A;,11{'L 1rt MIN C 94 xrF g 04 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY RE lsTERS 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 Clork's Office, I" FL., 367 Main Street, Hyannis, MA 02601 ('town Hall) and 200 Main Street Offices at the Licensing counter. DATE: .,5 3O o Fill in please: APPLICANT'S YOUR NAME: ari-, BUSINESS YOUR HOME ADDRESS: of I. L't �.P� -/ ceki< - _..-.. TELEPHONE # Home Telephone Number: fps-S ^Y Y 7 NAME OF NEW BUSINESS TYPE OF. BUSINESS IS THIS A HOME OCCUPATION? Y S NO Have you been given approval from the building division? YES NO _ ADDRESS OF BUSINESS 9-1 L a 4- Lc, t4/-s-- ; ( MAP/PARCEL NUMBER -W� 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 HEALPas This individuaen 'nfored of the p it requirements that pertain to this type of business. zed Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHO TY)��g;7 �' x This individual een inf ed of the nsre irements that pertain to this type of business. x� ar> �., ' Authorized Signature" COMMENTS: o e . Date: ,S /3,� / n� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS US MATERIALS ON-SITE INVENTORY L NAME OF BUSINESS: L U ,,\_ L n r&c BUSINESS LOCATION: /u1(1r44-0M5 INVENTORY MAILING ADDRESS: TOTAL AMOUNT- TELEPHONE NUMBER: `y -77 CONTACT PERSON: SAe_` `~ EMERGENCY CONTACT TELEPHONE NUMBER: �Q F 'S 6 W 9 t( 7 MSDS ON SITE? TYPE OF BUSINESS: &2 A S 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. 1 Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons r more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDO MATERIALS The Board of Health and the Publi Health Division have determined that the following products exhi it toxic or hazardous characteristics an must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gas ine or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic trans ission fluid Disinfectants Engine and r iator flushes Road Salts (Halite) Hydraulic fl d (including brake fluid) Refrigerants Motor Oil Pesticides N W USED (insecticides, h bicides, rodenticides) Gasoli e, Jet fuel, Aviation gas Photochemic s (Fixers) Dies I Fuel, kerosene, #2 heating oil NEW USED Mi c. petroleum products: grease, Photoche Icals (Developer) I ricants, gear oil N W USED Degreasers for engines and metal Printin ink Degreasers for driveways &garages Woo preservatives (creosote) Caulk/Grout Swi ming pool chlorine Battery acid (electrolyte)/Batteries L or caustic soda Rustproofers isc. 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 Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS iw f - �, tea, .�._.. .-.""w.; .,}, J s`.ryt. .. .✓•. .....r- -,.-.:.�.a..-...�... n'�u ,5.,+..t s. I / P Date: 5 /3 J � r. TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY F BUSINESS: NAME• BUSINESS LOCATION: �. r �"` b P�+-2 i'"` ,. ��ans S. INVENTORY MAILING ADDRESS: _ TOTAL AMOUNT: TELEPHONE NUMBER: y S -77 CONTACT PERSON: (4 r k ` EMERGENCY CONTACT TELEPHONE NUMBER: 52k � MSDS ON SITE? ` TYPE OF BUSINESS: A 2 t INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of,hazardous waste: x Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 1 /1, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons r more a month requires a license from the Public Health Division. , LIST OF TOXIC AND HAZARDO MATERIALS The Board of Health and the Pubtr Health Division have determined that the following products exhibit toxic or hazardous characteristics an ust be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gas ine or coolant systems) Misc. Corrosi/te NEW USED Cesspool cle Automatic tran ission fluid Disinfectants Engine and ra iator flushes Road Salts (H Hydraulic fl Id (including brake fluid) Refrigerants Motor Oil Pesticides N W USED (insecticides, ticides) Gasol' e, Jet fuel, Aviation gas Photochemic Dies I Fuel, kerosene, #2 heating oil /hh W USED ; Mi c. petroleum products: grease, icals (Developer) I bricants, gear oil W USED Degreasers for engines and metal k Degreasers for driveways & garages servatives (creosote) Caulk/Grout pool chlorine Battery acid (electrolyte)/Batteries stic soda Rustproofers bustible Car wash deter ents es 9 Y Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) N-EWF' 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 TOWN OF BA.RNSTABLE _ V LOCATION _L®�- ld t"60 �yw ���.-e SEWAGL. #_ VILLAGE M Aii jk5 d0- �t$ ASSESSOR'S MAP & LOT 1 INSTALLER'S NAME & PHONE NO. �•� OC�sco1) �7 j��Gyd SEPTIC TANK CAPACITY 1,000 LEACHING FACILITY:(type) L2:,c.L, i (size) It DUO yet lloy'5 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER Ae (o. DATE PERMIT ISSUED: LL Z ZSZ 4 DATE COLIPL1ANCE ISSUED: VARIANCE GRANTED: Yes� �No �/ hoC 33, ♦ f r, c .� � t A THE COMMONWEALTH OF MASSACHUSETTS IZq -oo� -o1(o BOAR® OF HEALTH TOWN OF BARNSTABLE z Appliration for Miposal Works Tnnwtrnrfinn Prruat Application•is hereby made for a Permit to Construct ( <) or Repair ( ) an Individual Sewage Disposal System at: --......L/—,8_—j6._7R.. �...L�1 d LL4 . ----------------------B--------- ---- -•--•.._...... - .......---.....•------•---•••.........------•- 6T9 � I c - .....ssC4 . C ,F,I/To/e lfr tLr -_••-- . Lo e__ ...............•---•-•----•_. ... _ .._....----------------•---------------•-•--•-•---•--•...._...........------------- w / Ownez Address a ... .1<.� SCOWL /'4 dy1 Ldt—S Installer Address ..�...Sq. feet Type of BuildingSize Lot___�S�3 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder (Vc� Other—Type of Building No. of persons......._.................... Showers — Cafeteria a Other fixtures ..................................... w Design Flow..................U0..................gallons per pew er day. Total daily flow........... .....................gallons. WSeptic Tank—Liquid ca.pacity./00�_gallons Length___�`�"___ Width.`f_,8.'___ Diameter-_�,Y.._. Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. r r Seepage Pit No........I............. Diameter._____/D________ Depth below inlet______.._._..._. Total leaching area__426.17.....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by__________________________________________________________________________ Date................... a Test Pit No. 1...K_5;�...minutes per inch Depth of Test Prt____f --r...... Depth to ground water.._N©!U .._. 44 Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water-------_................ 9 ----•-•••----•-----------------••-•------•-•-•--•--•--•--....._...--•-•-•--.....••••--•-•----------...------------•-'-•---•••-••-....._......---•------_--•- O Description of Soil...P•-q_?t 4 Q Y9 tM 5 MSOIL I M ED. 519AI x w UNature of Repairs or Alterations—Answer when applicable................................................................................................ ...-•---••-----------------------------------------•-------•---•----...-------------._...---.......-----.....-------------------------------•-•-------------------------------------•--......_..---••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian e as been issued by the board of health. Signed----- --------------------- ------------- ----�0 �" �Z ---.. Date Application Approved By ------------------ -- -- - - ------ 3�- � Application Disapproved for the following reasons: --------------------------------- ------------- .........................---- --. ---- ---- -----------.....------------------ Date PermitNo. ......... ......... .°-. �....�...`� ......................... Issued -- ---- ------- ----- ------------------------... --- Date Fzz---,L/2 e71 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE t I Appliattion for Disposal Works Tonsh-udiatt Permit Application'is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: Location-Address or Lot No. Owner 44. Installer Address Type of Building Size Lot-- --Sq. fed Dwelling—No. of Bedrooms----------3-----------------------------Expansion Attic Garbage Grinder (V6) Other—Type of Building WOO1?-12Z19_!??E No. of persons---------------------------- Showers Cafeteria Pa Other fixtures -------------------------------------- ---------------------------------------------------------------------------------------------- Design Flow-----------------J J.0------------------gallons per pper day. Total daily flow------- 330 ---_-----------gallons. 9 Septic Tank—Liquid-capacity,/00C).gallons Length----8-'4?"___ Width__` _�'�a"___ Diameter__:��'_4 '-- Depth--------------- Disposal Trench—No--------------------- Width--------------------xTotal Length--------------------Total leaching Seepage Pit No------I------------- Diameter______J0_I------ Depth below inlet---.6.............Total leaching area__dk2____sq. z Other Distribution box Dosing tank ( ) Percolation Test Results Performed by--------------------------------------------------------------------- Test Pit No. I----<,.--)-----minutesperinch Depth of Test Pit--- 0---------- Depth to ground water--_AIO ti�---- 44 Test Pit No. 2----------------minutes per inch Depth of Test Pit---------------______ Depth to ground water----------------------- C40 --------------------------------------------------------------------------------,-___— --- ___--------- Description of Soil 0 - q/_ .---------- 1.6-I-----jE&"--5,9A--/--b ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------#--------------------------------------------------------------------------- Agreement: I The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to-place-the- system in operation until a Certificate of Compliance has been issued by the board of health. Signed,---}----- -------------------------------------------- --- Applcation Approved By ---------------- n ------------------------------------------------------ Application Disapproved for the following reasons: -------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- Permit - ---------7 ern No j------ -------------------------- Issued -------------- ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Olertifirate of Olumplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed or Repaired by ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- at ------ -------- 7------- ------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 a ,The State Environmental Code as described in the application for Disposal Works Construction Permit No. _V-------7"_F_';t------- dated ------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------- --------- Inspector ---------- -------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.... TOWN OF BARNSTABLE %posal Works Tonstrurtion Permit '60"_Permission is hereby granted___---_ DR 1-5� ----------------------------------------------------------------------- to Construct ( ?y or Repair ( ) an Individual Sewage Disposal S stem at No_LLL!-----ZlL_LL.8.E:k T'( L t9 A.,E M 'L L .-:y —---------------------------- �S_trc'e Cal 4 as shown on the application f Dispo Works Construction Pe ptnift N Dat6l&14—------------- ------77- DATE----—----------- ---------- B d of Health ---------- r — FORM 36W8 HC.XMS SMARREM Mr—PUBLISHERS L A�C- L.lo r�dLl�( Flow Ilb.+� 3 so Q h - 4 3jj .P15PoSAL. PIT USE ; lPoo G,c�t_ �tIWAI_1 AQEA - cc� ' r JD -675 S=. A t .o TOT,A I_ -c:;)ES1661 = 42S l-.P.D: -Z�w Et 1 iNc �o 8 �LktIU�C) Lx—S<;:' a ` .r6p Ln 1.6 PETER 511LL1' �� .415 ri�ly { :�.- n MO. ZL tR JAL U i 'Mt� P-7.79S u� — ,1►g(9+ o G Tor p �o�ty 'PPS: "Ppe. I000 I{JV tuv`ti� 4 alsr iw. Gat_. ti�� Iuv f to � . (0C)0 i tuv. l4lV. !- N f 'Ufa/a..t1Z AO-1 tb: STO N , j' I CE2TiFt>~D � ._p _. _. .... :.i.. - .. .__. _. .i Pzo�--'t LE—=- — LdCATIo� � � � ATE T I-1 G ixv-L=LL i tv�_ .. 5 t.1aw�.i Pt_A 1�1-- �Z F' 2 c t.1[►E FWD . �CQ:J(RENcci.1'j"y D<~ .r.N� Zowu o= 13AIzrJ57`A�i3l. .: Ab is Eft-Lo�p,ta Lar . o Wr Ct 4t�1 TNT Fw LA L�Z ( Z'L . _ � RC'GlS(-C..FL�D' 1-A1aG SUevc�(oc�� THI5 Pt-AI-1 I cJOT A��EO Ut:�. A4.1 �5TE2V1t,.LC o ASS, Ti-tL= 511awun k.t" (3 L'. �;�;>C i'7 T i.0 t�r'1'C:.R M t►,l.t-- : SITE PLAN P°`�y N SCALE: 1 " = 20' CONTOUR INTERVAL=2' GENERAL NOTES 1. ADDRESS: 2 LANE, MARSTONS MILLS 2. ASSESSOR'S NUMBERMAP 124 PARCEL 04 016 ��l' e B.M.= 10 0.0 0' ASSUMED ON NW CORNER OF 3. DEVELOPER'S LOT: LOT #10 \, 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE e011 FRONT STOOP GROUND INSTRUMENT SURVEY. 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES. \l �; 6. REFERENCE PLAN: LAND COURT PLAN NO. 421122-A & B MCP 97.94' Y REFERENCE PLAN: "CERTIFIED PLOT PLAN", LOCATION: MARSTONS MILLS, MASS., SCALE: 1"=20' ` DATE: 6/5/98 REVISED 6/15/98, PLAN REFERENCE LOT 9 L.C. 42122B, BY BAXTER & NYE, NC. \V_ APPLICANT: scoTr LowE Old Falmouth Road 7. UNDERGROUND LflLrrlES LOCATED IN ACCORDANCE WITH DIGSAFE. 8. NO WETLANDS OR POTABLE WELLS ARE LOCATED WITHIN 150 FFET OF SAS. 9. THIS PLAN SHALL BE USED FOR THE SEPTIC INSTALLATION ONLY. \Q� 98.12' v \ o 0 o: 98.40 _ _ I-andfill /Transfer Sta. m ..o".:::: :: :: ::: ' "• OL.... ,,,� One chamber cover shall be Min. 2"-1/8"-1/2" Double-Washed Stone """"""' within 6" of finished rode or geo-textile filter cloth „ „ p a ............::. 9 M ARSTO� S MILLS ............... T f Pea Bone 24" LOCUS o ;�. Leach Facility Elev.8.92 NO SCALE LOT 10 4' 5' 4' 3/4"-18 Double-Noshed Stone 5' Min. Design Calculation s 98.so,&k REA= 15,238f sq.ft 9 7 ' e° �� LEACHING CHAMBERS 9 .70 �0 00 t Hale Elev./cw Elev. Number of Bedrooms: 4 Existing CROSS SECTION g 9�04 t o� 9y Garbage Disposal: Not Allowed B. M . �^ s Septic Tank Required: Use existing 1,0a0-gal Septic Tank O, Leaching Capacity Required: 440 Gal./Day \ eNY 21 L _ "I. o• S,<, G oho Application Rate for <2 min./inch = 0.74 gal/sq. ft. 98s`, F,'l�\ \,�,\��o • 98.5 ' Proposed Leaching Structure: 1-33.5'x13'x2' Leaching Trench O��e�e� 96 Bottom Lemhin� Area Provided = 435 sq. ft. N., Proposed SAS Side Leaching Ar eu I-'rovidea = 186 sq. ft. Install 3-500 gal H-10 chambers Total Leaching Area Provided = 621 sq. ft. G with 4' of stone all around in 33.5' x 13' x 2' trench. Leaching Capacity Provided =621 s ft X 0.74 al s ft.=460 d. 6 deG 9 P Y q• 9 / q• 9P 97.33 X 4kO0 CONSTRUCTION NOTES 1. Contractor is responsible for Digsafe notification .78' 94.95' SOIL EVALUATION and protection of all underground utilities and pipes. e 9 2. The septic tank and distribution box shall be set J 53' X E a O Date of SOIL EVALUATION: NOVEMBER 19, 2013 level on 6" Df 314' -11/2" stone. s _'::. a Evaluation Performed By. MARK POLSELLI, SE �' j roe ;• O `''' r? Excavator: R & H CONSTRUCTION 3. Backfill should be clean sand or gravel with no Percolation Rate:< 2 mpi stones over 3" in size. <i Witness: Donna Miorandi, R.S., BOH Agent 4. This system is subject to inspection during installation ........ .......... e, ,� ------ -- - _ to Glen E. Harrington. R.S. ;•:. observation , °�� oo ��� `' par lest Hole I Test Hole 5. The contraccr� .��II install this system in accordance No. 1 No. 2 I witl- "tle V of tr, Aassachusetts Environmental Code 2T.H. # 93.9 DEPTH SOILS ELEV. !D`=P SOILS ELEV. and . cal Board of Health Regulations. - 0 94.5' 1 o 95.0' 6. If, during instaliati-n the contractor enc iters any H #2 1� FILL FILL so-' � onditions or site conditions that are different Q 94.78' g» _ 8» _ frc T, those shown on tf•,, soil log or in the design 14" dia. Hol ree Gw o - A A the installer sha; ha'i installation and immediately notify X 9 .10' a andy loam andy loam Glen E. Harrington, R.S. yeQ�G 9 O. 10" 10YR3/2 2.58' 10" 10YR3/2 94.17' 7. No vehicle or heavy machinery shall :rive •:-'er the 10 loa, loa septic system unless noted as H-20 septic corriponents. 61 son son SQP 23" 1OYR4/6 3.67' 25" 10YR4/s 2.92' 8. Install Tuf-Tite gas baffles or equal on septic tank outlet tee. �0 Q�� 32� _c _c 9. All piping shall be 4" diameter SCH 40 PVC unless otherwise noted. gh � PERK edsan�ars sn�ars P•P 9X 92.4 ' 150 120» 10YRs/4 g4.5' 150"led 1oYRs/4 82.50' 10. Install 1 H-20 DB-3 D-Box and 3 H-10 500-gal. chambers O�,o NO GROUNDWATER ENCOUNTERED by Wiggin Precast Corp or equal. �y �p 11. Install a 4 dia. SCH 40 PVC observation port, as shown. PERK TEST #14182 12. Remove leachate contaminated soil from► existing SAS and replace O with fill according to 310 CMR 15.255, if necessary. BEGIN SOAAK:K: 0:00 Contractor s notify oar ea an g DEPTH: 0" 13. The hall tif the Board of Health d the Designer END SOAK: 9: at least 24 hours in advance to inspect and certify the system. 9-6"' N/A TIME: 24 GALS ': LD IN 9 MIN. 22 SEC USE <2 MPI FOR .ESIGN PURPOSES Soil Evaluation Certification REVISEf` 1/` I./14 - Rnw COMMENTS certify that on October, 1995, 1 have passed the soil evaluator - examination approved by the DEP and that the analysis was performed by me consistent with the required trai 'ng, experti and experience described PROPOSED SEPTIC SYSTEM REPAIR in 3.10 CMR 15.017. PREPARED FOR N E. HARRINGT�K R.VMARTIN S. STEIN ET U X AT SYSTEM PROFILE LEGEND Existing Dwelling #21 LIBERTY LAN E Not to Scale Provide 4" dia. observation port Perk Test Location First Fl. = 100.6' to 3" of grade MARSTONS MILLS , BARNSTABLE, MA 3 HOLE H-201 co Double Oak Trees y Existing Grade =97.8't DIST. BOX Finished grade over system=2% slope away Existin Grade = 96.E-94.5f Septic tank covers must be D-Box cover shall be Min. 2 -1 t3"-1/2" Double-Washed Stone -�- Approximalte locationPREPARED BY:. CELLAR p One chamber cover shall be gas in y1 p WALL within 6" of finished grade within 6" of finished grade within 6" of finished grade or geo-textile filter cloth .� S = 0.02' ft. - Approximate location �Q� G Glen E. Harr'ngton R.S. =0.01' ft. To of SAS Elev.=93.3' wa#er , ; ', Leael far 2' s=o.o,�, ,t _ 9 Leda Ro: j Lane fig' EXISTING 16, vet Elev.=92.5' 18- Existing c,•tour �j H I � y 1,000 GAL 12' C3 G p p p p Ex 1,000 cal. H-10 loadino No. 07D M a rsto n s M i l i J, MA 02 648 SEPTIC TANK P=92.62' O 0 0 G 24" O O septic tank '9 tE� Ex. Inv. = H-10 = pt•-,.� Leach F R �el: 508-428-3862 Install Gas �.!` a 33.5 Facility dev.=90.5 S� Gf ATE P. Ex. Inv, elev.=95.18' or a ua =g ,79' Existing Leach Pit N�TAtR�. Fax: 508-428-3862 3/4"-1%" Double-Washed Stone 5' Min. req'd (8't provided) Op (to be pumped & filled) 6" OF 3/4"-11/2" STONE 3 H- 10 500-GAL. SCALE: 1"=20' DRAWN PY• GEH DATE: 30 NOV 2013 6" OF 3/4"-11/2" STONE LEACHING CHAMBERS Hale #2 lev.= 2.5' DATUM: ASSUMED FILE: Stein SHEET 1 OF 1