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HomeMy WebLinkAbout0128 LOVELL'S LANE - Health 128 Lovell's Lane Marstons Mills F/R A = 078 037 a J � f TOWN OF BARNSTABLE 1� LOCATION ��`g L� r//S L:✓ SEWAGE yI,-,WDE AA,1Is ASSESSOR'S MAP & LOT Ul �® INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) feV G�� f�cn�.j L`�'.� (size) //�X34 �X.2 NO.OF BEDROOMS BUILDER O OWNER 69111 s7 PERMITDATE: COMPLIANCE DATE: ?� v5J(/ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Srf Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet i Furnished by Der",) C,,,ot 73 / TOWN OF BARNSTABLE LOCATION,1�k Z60fA fir, e SEWAGE # VELS GE lG,:s Y �SZm AS ASSES70"',/ AP&LOT D 7�- 6�3 7 NAME&PHONE NO. �`�/6ks4 ��O -5F SEPTIC TANK CAPACITY LEACHING FACILITY: 7"/ (i/ d��/l/�size) (type) , ( _P,i4- - /ac5o�/�GrJ NO.OF BEDROOMS j BUILDER PERMTTDATE: COMPLIANCE DATE: Separation Distance Between the: i Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300_fee t of leaching faa ty) /, / /1/� Feet Furnished by:Z�/ 1 D i (/n, /�C.�C, /6 Z7V( . 1� � �'I �� �'' � �3 �� ��`" Ha ardous Materials Inventory Sheet Checklist Date Ha Street Address-Check database to ensure it exists. �.-----Working Phone Number Actual Amounts -( ie. gas being used to fuel machines, thinner to clean brushes all count as hazardous materials-no blanks) Storage Information - location of storage, how long is storage for? A none, note that. ! Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and /explain it 1' Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: ,Business certificates [cost$40.00 for 4 years]. A business certifica te ONLY REGISTERS must do by M.G.L.- it does not give you permission to operate-] You must first obtain the n TEAS YOUR NAME In town (which you necessary signatures T natures Take - 1 y on this the cornpleted form to the Town CleiI: s Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall t�is form u ine Main ific Hyannis. required b law. ) and et the Business Y g ss Certifica te that i s DATE: Fill in please; :: ;.• APPLICANT'S YOUR NAME/S: '/7+BUSI ESS /p�� (/��/ YOUR HOME ADDRESS: r je TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW.BUSINESS TYPE OF BUSINE IS THIS A HOME OCCUPATION? ADDRESS OF BUSINESS r C MAP/PARCELGy NUMBER - [Asseesing] 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) -t❑ 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 b 1pformed of permit requirements that pertain to this type of hh��� s ?VC-. . - ��,� OOMPL.Y WITH HOME OCCUPATION Authorized Signature* ' �Ul_ a JCS REGULATIONS.. FAILURE TO COMMENTS: ?(`* ' i1AIAY RESU(.T IN FINES. 2. BOARD OF HEALTH ; This individual hlAuthoriz b an in ad of the p mit r ments that pertain to this type of business, ign ture** COMMENTS: .( B. CONSUMER AFFAIRS(LICENSING AUTHORITY] This Individual has been informed of the licensing requirernenLs that pertain to this type of business. �. Authorized Signature* COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS O&SITE4NMENTGRY NAME OF BUSINESS: BUSINESS LOCATION: /'ICI�a5��� �l//S INVENTORY MAILING ADDRESS: LcfA e ee7_rs,&n M, 5-TOTAL AMOUNT- TELEPHONE NUMBER: /Off® in of oz696' CONTACT PERSON: �G1 YS011 e� f EMERGENCY CONTACT TELEPH NE NUMBER: S'bw 7 76 ^/e�6c) MSDS ON SITE? TYPE OF BUSINESS: WC0d OOr-/—,, n INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene,#2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT I CANARY COPY-BUSINESS � is is Signature Staff's Initials Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address k'VJ JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every 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 A, General Information forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return p key. DOUGLAS A BROWN INC Company Name P.O. BOX 145 Company Address CENTERVILLE MA Cityrrown State 02632 Zip Code 508-420-4535 S14297 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 Further Evaluation by the Local Approving Authority 10/13/10 Inspe ignature 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. t5ins•09/Of - Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page t of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Properly Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Cdyrrown 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: OPENED CHAMBERS AT THIS TIME THERE IS ONLY 3 INCHES OF STANDING WATER WITH NO STAINING ABOVE THAT LEVEL 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/13/10 every page. Cttylrown State Zip Code Date of Inspection B. Certification (cunt.) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the dis tribution 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 I4 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name informatics is MARSTONS MILLS required for MA 02648 10/13/10 every page. Cityrrown 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 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 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: 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 dogged 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 1 Commonwealth of Massachusetts Title 5 Official Inspection Form d Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 every page. Cltyfrown 10/13/10 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 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•09N8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 every page. Ctty/Town 10/13/10 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? ® ❑ 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 460 t5ins•09M Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 I� N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments °t 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Cltyrrown State Zip Code Date of Inspection D. System Information Description: ACCORDING TO AS BUILT CARD SYSTEM CONSISTS OF A 1500 GALLON TAND D-BOX AND 4 500 GALLON CHAMBERS 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)): SEE BELOW Detail: 2009-208 GPD 2008-200GPD Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: 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•09H)8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachus etts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information isrequ MARSTONS MILLS every page for. MA 02648 10/13/10 every page. Crty/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: 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•090 Title 5 Official Ins I pection Form:Subsurface Sewage Disposal System•Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form a) Subsurface Sewage Disposal System Form-Not for Vo luntary oluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: ACCORDING TO AS-BUILT CARD SYSTEM INSTALLED IN OCT OF 2002 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 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.): Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene El 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 GALLON Sludge depth: VARYING t5ins•09i08 Title 5 Official Inspection Form:Subsurface Sewage Dis sat 9 Po System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (coot.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness TRACE Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? i Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): RECOMMEND PUMPING EVERY 3 YRS 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•09108 Title 5 Official Inspection Forth: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 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Clt fr wn 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•09/08 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 't 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Cltyrrown 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.): BOX LEVEL NO LEAKAGE 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•09/08 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13l10 every page. CWTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number. 4 ❑ 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.): OPENED PIT AT TIME OF INSPECTION THERE WAS ONLY 3 INCHES OF STANDING WATER WITH NO STAINING 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form al Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/13/10 every 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.): 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 I I I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. City/Town 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 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 LOVELLS LN Property Address JOHNSON Owner Owner's Name information is MARSTONS MILLS required for MA 02648 10/13/10 every page. Clty/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: 5+ 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 f o 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: OFF AS-BUILT CARD FROM B.O.H Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form;Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments "< 128 LOVELLS LN Properly Address JOHNSON Owner Owner's Name information is required for MARSTONS MILLS MA 02648 10/13/10 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ��t-er J�9v�N5Q/v r TOWN OF BARNSTABLE I LOCATION -(SEWAGE #.. Nv k �f] VILLAGE S115 ASSESSOR'S MAP & LOT 4' O l� /i /1onsT INSTALLER'S NAME&PHONE NO. �e� ` ��` ' SEPTIC TANK CAPACITY �SO� GAG LEACHING FACILITY: (type) �Qd is fd�,,�I.�w Ly'. (size) NO.OF BEDROOM BUILDER O OWNER PERMIT DATE: COMPLIANCE DATE: U'— 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 Feet on site or within 200_feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist 1- Feet within 300 feet of leaching facility) Furnished by- Sept- .5 2©02 /Gq G �� _ tG LJ ilk `7 YU o � 73 / / 75; a-M � a o bcftd Town of Barnstable Barnstable Regulatory Services De partment M&NSfABLE, 1 9: Public Health Division w arFa `� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6_,04 Thomas A.McKean,CHO CERTTIFIED MAIL 7007 3020 0001 3429 8196 June 4, 2009 Peter Johnson 7 Penelope Lane Cotuit, MA 02635 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION O AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located atl28 Lovell's Lane, Marstons Mills was inspected On March 23, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of the rental registration in accordance with Chapter 170 of the Town of Barnstable Code. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 & 310 CMR 15.00—Title V. Septic system (permit#2002-426) capacity is only for 4 bedrooms; 5 bedrooms observed. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by removing the 5rn bedroom (basement room) by constructing a five foot cased opening entrance to the room and applying for building permits to do the work. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Heaith Division d ask to speak with the inspector who performed the inspection. OF HE BOARD OF HEALTH s A. McKean, R.S., CHO Director of Public Health Town of Barnstable I� (cl Ge TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date 3 2 3 f Zoo Time: In A'SO4 Out Owner ?f-T f V2- JOVA � so t4 Tenant DA �4 L_ Address ' Rg-t-r L-o Pe- LA-t1 1F- Address '- 2 L c>VE L L'S LA N E (foTo1-1 'MA MAP-SiyN S to iLL S MA Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities C) tL-oco-,"A C-r- l.i`� 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities L9CA4-' �o 10. Curtailment of Service CtaVt2 lvfLeq N rew Sw 1Z 11. Space and Use p ti 9 Y-'0 -Co 12 f- 12. Exits 13. Installation and Maintenance of Structural �"( ^'gam' �-`"i^''C, I Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 'I 16. Sewage Disposal r-, 17. Temporary Housing k///a- 18. Driveway Width YJ U D 19. Number of Tenants Observed 3 PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms- O Number of Vehicles Allowed (max) Number of Persons Allowed (max Z 2GG Person(s) Interviewed Inspector c • S If Public Building such as Store or Hotel/Motel specify here I •r � FORM30 C&w HOBBS&WARREN'" THE COMMONWEALTH.OFMASSACHUSETTS BOAR OF H ALTH CITY OWN = W f DEPARTMENT/ ADDRESS G„M 5 By`0W ^ TELEPHONE .. Address����/— Occupant— Floor Apartment N No. of Occupants No. of Habitable Rooms_ No.Sleeping Rooms No. dwelling or rooming units No ies Name and address of owner Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: ❑ 110 11220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den Living Room Bedroom (1 Bedroom 2 0 Bedroom(3) ;Ecv Bedroom 14 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: S ks,Flues V n ,Safeties: Kitchen Facilities ginQ ve Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS YHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PER MIRY." INSPECTOR TITLE_�4* DATE��3 0� TIME (5 A• A.M. THE NEXT SCHEDULED REINSPECTION P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s)pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash,which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish,filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550.. (P) Any other violation of 105 CMR 410.000 not enumerated in 105,CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. 1 ns pec-hcn�, �ri -cJ u nt 13 ���� ° f � 1s Fe J07. auFE' . r pz- R AII),a— - (78 fE" = P� P cz-�l FORM30 CInD HOBBS&WARREN " THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOW W 4 V a •r v '^ C� � ARTMENTI ( {I✓�,�µ" ADDRESS ' M I Is TELEPHONE Address Floor— Occup ant_3� upants _No. of Habitable Rooms `O No.Sleeping Rooms 14 No. dwelling or rooming units _ No.Stories Name and addre s of owner l,C QX 63 S Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress:and Obst'n.: ❑ B OF ❑ M Doors,Windows: s Roof Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows.- HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS O ST ❑ P Waste Line: H.W.Tanks Safety and Vent(s) ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 'Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom —Pantry Den —Living Room 1 Bedroom(1). q 6 Bedroom 21 (5 l l t e Bedroom 31 4o Y_ It, IV Bedroom 41 Li ° Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: 1® Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub.- Infestation Rats, Mice, Roaches or Oth r: E ress Dual and Obst'n: General Building Posted Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." INSPECTOR_12J� TITLE DATE TIME y/�"n A.M. THE NEXT SCHEDULED REINSPECTION IVP.M. '1 f V 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the heaith, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter II, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B) and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof, foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3) or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A) and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0) shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. ..� 144 lei 1 � 1 �L . � �` I � �d � � � �� '� �0 Sla�o'�/ ,_ � i No.�C� a / J, Fee 19 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01ppYication for Mi!6pogaf *potem Con.5truction Permit Application for a Permit to Construct( . )Repair( )Upgrade Abandon( ) Vcomplete System ❑Individual Components Location Address or Lot No. Izq 1,opellN , Owner's Name,Address and Tel.No. Assessor's Map/Parcel 7 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 0f/pA Co pow n Cep 67 /-� Type of Building: / ,�,�/ Dwelling No.of Bedrooms L Lot Size--� sq.ft. Garbage Grinder(�%o Other Type of Building e e No.of Persons7 Showers( ) Cafeteria( ) Other Fixtures Design Flow / gallons per day. Calculated daily flow gallons. Plan Date 119Number of sheets Revision Date Title sl 8) Size of Septic Tank /,5—DD Type of S.A.S. 19,r/©,r-? t' Z Description of SoilT` G (' �. Nature of Repairs or Alterations(Answer when applicable) �7—)/ /4? L,7 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 is Boar of Health. Signed Date �Z Application Approved by Date r'l211,A Application Disapproved for the fo owing reasons F't Permit No. c')Uo R— Ds Date Issued .2 `+. No. �� �.. s<.,, fin. ..,aS Fee THE COMMONWEALTH Of MASSACHUSETTS Entered_n computer: Yes j PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 1 ZIppfication for Mzpaaf *p! tem Construction Permit Application for a Permit to Construct( . )Repair(' )Upgrade(ir)Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 41 , Owner's Name,Address and Tel.No. Assessor's Map/Parcel A?r3�Mf 5 A 1`IS I Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.'77 ; 1-9 11 _4Ks 1// Type of Building: / Dwelling No.of°Bedrooms Lot Size /sq.ft. Garbage Grinder Other Type of Building //to'*/* No.of Persons Showers( ) Cafeteria( )� Other Fixtures T' Design Flow A gallons per day. Calculated daily flow gallons. Plan Date Number%Oets Revision Pate Title Size of Septic Tank Type of S.A.S. ?9"r/a,8'3 -I' Z Description of Soil �`G r 4a. r, r' Nature of Repairs or Alterations(Answer when applicable). "���� v4U1 i. Date last inspected:' I `t •'" Agreement: i �+ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a,Certifi- i cate of Compliance has been issued by is Boar of Hejilth. f i Signed Date Application Approved by Date Application Disapppoved for the f owing reasons Permit No. )00 A— L/ Date Issued g 2 ----------------------- -- ---!y` ---- THE COMMONWEALTH OF MASSACHUSETTS ' i BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIfiY, that the n-site Sewage Disposal System Constructed( )Repaired( j Upgraded(1/ ) Abandoned( )by at Z _ lo . l° . has been constructed in' accordance ��with the provisions.of Title 5 and the for Disposal System Construction Permit No. 0. p — /�ti dated �l �a Installer Designer / The issuance of this permit shall not be 'strued as a guarantee that the system w11'ncti n as designed. Date F7 Inspector No. aa�a Y� / ---------------------------Fee U � X� THE COMMONWEALTH OF MASSACHUSETTS v PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS -Mizpozaf bpztem Construction hermit Permission is hereby granted to Construct( )Re air( )Upgrade(✓)Abandon( ) System located at 7. Z (/ /ZS �rf • �ai1��s>`d� ✓� ��5 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. �D Date: g �U 10;2 Approved by— Th-Y ,, �.1. TOWN OF BARNSTABLE LOCATION � g � / s l ' _ SEWAGE #a al; - Y� VILLAGE 1h V,,115 ASSESSOR'S MAP & LOT j .-2 7 INSTALLER'S NAME&PHONE NO. ir Ile'' SEPTIC TANK CAPACITY LEACHING FACILITY: (type) S� /<o�lbc��.L y� (size) NO.OF BEDROOM O OWNER Co��• �g— BUILDERPERMI TDATE: COMPLIANCE DATE. " 0 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 Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by l7Gar� Cg®t Lsn�s$� 1-16,O G PZ> y�b �7 a yU< \ I O 73 I tel.(508)362-4541 939 main street rt 6a 508 fax yarmouth port ( )362-9880 mass 02675 down cape -en��neer�n� civil engineers& land surveyors structural design Arne H.Ojala P.E.,P.L.S. October 22, 2002 Daniel A.Ojala,P.L.S. land court Timothy H.Covell,P.L.S. surveys Tom McKean, R.S. C.H.O. Board of Health site planning Town of Barnstable 200 Main Street Hyannis, MA 02601 sewage system designs inspections permits RE: #128 Lovell's Lane, (Marston Mills)Barnstable, MA Soil Removal Inspection DCE Job#02-264 for Joanne Collin Dear Tom: This letter is to inform your office that Down Cape Engineering Inc. has performed a soil inspection at the above referenced site. At 1 pm today I inspected the soil removal for the leaching field. The work was found to be satisfactory and to the line and grade specified. t ( I hereby certify that the soil removal has been conducted in substantial accordance with the :;v approved plan and Title 5 regulations. E311 Please do not hesitate to call with any questions or comments. co W r Sincerely, Daniel A. Ojala, P.L.S., S.E. Down Cape Engineering Inc. CC: Bortolotti Construction SYSTEM PROFIL_ E TEST HOLE LOGS TOP FNDN, AT EL. 69.2' (NOT tD SCALE) ACCESS COVER TO WITHIN 6' OF FIN. GRADE ACCESS COVER (WATERTIGHT) TO ENGINEER: AH OJALA, PE / 6/.0' MINIMUM .75' OF COVER OVER PRECAST > WITHIN 6' OF FIN, GRADE 2% SLOPE REQUIRED OVER SYSTEM 65.5' DAVID STANTON WITNESS: 2• DOUBLE WASHED PEAS"ION DATE: SEPTEMBER 4, 2002 I RUN PIPE LEVEL a 66.O' / FOR FIRST 2' -9 LRPOSED1SOO / 3' MAX. PER'C. RATE _ 2 MIN/INCH LON SEPTIC Or � S64.7 64.50 62.5 CLASS SOILS P# 10318K (H- 10 ) �40 GAS 62.17' ��� 62.0' o O O O O O qlE BAFFLE61.67 O CD O O O O C3.5 SLOPE) �6- CRUSHED STONE ❑R MECHANICAL o � Q £C❑MPACTION. <15.22I �21) 2' O ED O O ED O C. b 59.67' Q ELEV. 00o e DEPTH OF FLOW = 4' (7.5 % SLOPE) C MIN % SLOPE) 3/4' TO 1 1/2' DOUBLE WASHED STONE � 64.9' TEE SIZES; INLET DEPTH = 10' FILL OUTLET DEPTH = 14 , 30" LOCATION MAP. NTS 4 A/B FOUNDATION- 35' SEPTIC TANK 31' D' BOX 20' LEACHING FACILITY 6 77' LOAM ASSESSORS MAP 78 PARCEL 37 38" 10YR 5/3 B FSL LOT AREA 52.9' 74" 10YR 5/6 58 7' ' + 64.1 47,661 f SO. FT. 5' REMOVAL OF UNSUITABLE SOIL REQUIRED C 1 AROUND PERIMETER OF LEACHING FACILITY, 1.09± ACRES DOWN TO SUITABLE SOIL LAYER (Cl). REPLACE i NTH CLEAN MED. SAND. ENGINEER TO INSPECT AND CERTIFY REMOVAL �j MCS cr + 6 4,-)5 O 7.5YR 4/4 TWIN 14" WHIT1Z PINE 1 + 65.9 / alb � 144" 52 9> + co NO WATER ENCOUNTERED NOTES: BENCH MARK - CORNER + 68.6 1 + 4. NOT ALLOWED ASSUMED OF BULKHEAD � 6 I / ,� � SEPTIC DESIGN' (GARBAGE DISPOSER IS ) I. DATUM IS , EL. = 69.0 _ 440 EXISTING DESIGN FLOW: 4 BEDROOMS ( 110 GPD) - GPD 2. MUNICIPAL WATER IS .. .�. + i. t- 1tLIi ice, _ 6.� TH 5.0 l �� USA R t�Nll lltSihN Lsw t•� 'vt°.� r ; c :` - - 1 �Ts - ', + 692 SEPTIC TANK: 440 GPD ( 2 ) = 880 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10. l / 5. PIPE JOINTS TO BE MADE WATERTIGHT. C- 5.7 /50 WRITE PINE USE A 1500 GALLON SEPTIC TANK 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS. + 66.3 - - - �-�/J _� / LEACHING: ENVIRONMENTAL CODE TITLE V. iF_ 28" OAK SIDES:+, / 2(39 + 10.83) 2 (.74) = 147.5 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT + 66.2 C 6�5 TO BE USED FOR ANY OTHER PURPOSE. B°TTOM: 39 x 10.83 (.74) = 312.5 8. PIPE: FOR SEPTIC SYSTEM TO SCH. 40-4' PVC. 63,5 �� '� + 6 . \ + + 67.5 JI TOTAL: 621 S.F. 460 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT \ \ , 78 68 \ 48'jVMITE PINE USE (4) 500 GAL. LEACHING CHAMBERS (,ACME OR I dSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED 7 i 69.6 FROM BOARD OF HEALTH. \\ I G 682 Z9 8.2 �,� EQUAL) WITH 3' STONE AT SIDES AND 2.5,' AT ENDS 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) EXISTING s.6 SEPTIC SYSTEM 3. EXIST DWELL. 3 + 6 . SHED TF = 69.2' ' X� 69, 6 28" OAK j -LEGEND TITLE 5 SITE PLAN \ 1 i 68.9 � 100,0 PROPOSED SPOT ELEVAT ION 68.6 fig. OF ' t 4.3 j / \\ + .a 100x0 EXISTING SPOT ELEVATION 128 LOVELL_ S LANE s \ kd'" 6 ` -- - 00 IN THE TOWN OF: 68 PROPOSED CONTOUR ( MARSTONS MILLS) BARNSTABLE COG 100 EXISTING CONTOUR PREPARED FOR: s 655 68.2 )+ 69.3 JOANNE COLLINS 4 ,� 58 �y 67.0p 69.2 30 0 30 60 90 \ / //Ct BOARD OF HEALTH \ 6.7/ o, APPROVEDDATEMA SCALE: 1" = 30' DATE: SEPTEMBER 5, 2002 I 6?9 off 508-362-4541 fax 508 362-98M JigARNE H. \ down cape engineering, inc, OJALA ARNE 'Jyfi CIVIL 68.7 No.30792 - CIVIL_ ENGINEERS ,• 'f'f cr�Q 26 #3 1 - LAND SURVEYORS STE IsiTER 939 vain st, yo.rt�outh, rya 02675 02-264 ARNE H. OJALA, :;' P.L.S. DATE f