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HomeMy WebLinkAbout0117 MINTON LANE - Health 117'MIN.T N LANE Marstons Mills A = 174 - 017 f 4 I I TOWN OF BARNSTABLE LOCATION /1'7SEWAGE# VILLAGE _ /l ASSESSOR'S MAP /&P/A�R,,C,�EALI I U U' INSTALLER'S NAME&PHONE NO. ��-/Wt 0��/ 1 ®�C yu`�V SEPTIC TANK—CAPACITY. / 0d 0 q LEACHING FACILITY:(type) m hR4� (size) S-5r S-?(1l 4A NO.OF BEDROOMS OWNER � 12 S S� PERMIT DATE: 2 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 wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Y ell O_V304.1440 A 6 I q� I r No. � �� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9pplitation for MispoBal *pstem Construction permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 117 14jyl LQ,(CG Owner's Name,Address,and Tel.No. Assessor's Map/Parcel `? 01 �n es J^ Installer's Name,Address,ak Tel No. r/1 Desi ner's Name,Addr s,and Tel.No. Type of Building: V Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ��O gpd Design flow provided Yle gpd Plan Date l 1,eE Number of sheets Revision Date Title Size of Septic Tank Z0,00 Type of S.A.S. 54 Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 4the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. Si Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 7 Date Issued ,j zezj i �aY �,.fjr-,�_'t. `-i-.Zp M,.y ;�' �' . q , j � �j .. �r ., ,. Y ' T� y t.��,f..r1n s. .1"•: f- -'.yam! Y''.0 n'h'YM+.'13.. No. Fee /' � � � �? i THE COMMONWEALTH-OF MASSACHUSETTSEntered in computer: p ' PUBLIC HEALTH DIVISION "- TOWN`OF BARNSTABLE, MASSACHUSETTS $ Zlpplicatiowfo i8po! al *pstem construction Permit `' r' x r t17 Application for a Permit to Construct( ) Repair(� )«U pgrade O Abandon( ) ❑Complete System ❑Individual Compon4q�s Location Address or Lot No. l/17 Min looe .I a,,w'3 Owner's Name,,Addres's,tand Tel.No. Assessor's Ma /Parcels i (� p C y'l 61�.- . lilt tit g s CY) Installer's Name,Address,and Tel.No.�� ' f - # �' tln`d:Designer's Name;Address;and Tel.No. Type of Building: J• ;1 L :�t' � Dwelling No.df Bedrooms q g Lot Size s .ft. Garbage Grinder ( ) Other Type of Building r IA-" No.of Persons Showers( ) Cafeteria( ) y Other Fixtures ,r Design Flow(min.required) gpd Design flow provided S'f..� gpd Plan Date Number of sheets Revision Date Title / Size of Septic Tank 0 0« TYPe of S A S. ..7 Q/'� x b C'Qs"J Description of Soil 1� '/'"M-ntwy�.`�'M•wn+..'wlwMiyyVJYa.,... !I r G° Nature of Repairs or Alterations(Answer when applicable) /J} ,1._42 Ca�Q Date last inspected: Agreement: x 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.Enviromental`Code and not to place the system in operation until a Certificate of r Compliance has been issued by this Board of Health. X r, Stgned =?mac c °: ., -' J " T'' Date _ — Application Approved by / ., Date Lf t, Application Disapproved by" � Date , for the following reasons _ r Permttlo - �'► '�- p r r-- Issu �tf' * !, Date ed = .,yam ,-.--�. ____�__� .____.__.__..:_,-.-_.-.-..-,.._-..._ _:_._�._..-.-._�_�.__.ti--,�--�_._.,_ _._•..._,_.__-.__ -..__-.�,-�.__._.___.___.__ _._.-__---_._-_.__._.__.___._.__.__.-.-J. ..-. " THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS y Certificate of Compliance THIS IS TO CERTIFY,that.the On-site Sewage'Disposal system Constructed,.( )�� Repaired AA Upgraded( ) Abandoned( )by r at has been constructed in accor ce with the provisions of Title 5 and the for Disposal.System Construction Permit No. ��/ 0 -dated L/// / / i• + Installer -(//,Wl /Q. ( Designer A4f #bedrooms' 5' Approved design flow T'0-4, gpd The issuance o this permit shall not be construed as a guarantee that the system will-function as designed. Date �( / � _ Inspector t o �.- _..--- No. liy��-'. �(t,J,� -•--------•--- --•--- ---------•-�----� •-f`,_.__.__-_.____-_ .--,------.....-- '---•----- - - -•- --- ---- -- ` --Fee �� --0�"-------_. - THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS C Disposal 6pstrm Construction i3ermit M : Permission is hereby granted to Construct( ) Repair( Upgrade( ) ~Abandon( ) "" System located at 113- AA I e 1Ak IA� 5'Tz�►1S /�10,6 i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with, 3 Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three'years of the date of this permit. Date LA 1 11 24)2-�t Approved by •tom,... f 'Town of Barnstable Regulatory Services Richard V.Scali,Inte 'run Director 9.6 Public HeIdth Division Thomuas McKean,Director 2U0 IViaip Street,uyanp�s,MA 02601 Office: 50&862-4644 " Homeowner eerd cation Form for Alt rnativ Fax: 508-790-6304 Property Address- e S stems Assessor's MaPTarcek C� Property Owners Nance. In accordance with Massachusetts DEP alternative s applicable le bion is required by the Owner of record. hte aPProval letters, the following aPphcable box next to each line certifying the info owner of record must b certification. Yes N1A information. place an in the ❑ I have been provided a co (15 page S PY of the Title 5 I/A technology Approval letters. tandar d Conditions defter and the s ❑ � I have been Provided specific technology letter) P with the Owner's Manual ❑ XLI have been provided with the ❑ Operation and Maintenance Manual ❑� For Systems installed under a Remedial Use responsibilities to provide a Deed Notice Approval,Y agree to fulfill my and the Approval as required by 310 CIVflz 15.287(l U) ❑ For Systems installed under a Remy Use A ro Provide written notification of the A PP val,I agree to fulfill my re 3I0 CMR d 5.287(ti Approval to any new Owner, as r responsibilities to equired'by ❑ Ifthe design does not provide for the use of garbage del and accepted grinders,the restriction is understood ❑ Whether or not covered by a warranty, I understand the requirement or take any. other action as required b the Department or to repair, replace, modify LAA determines the System to be fail u p LAA,if the D environment,as defined 3 10 CMR 15.303 Protect public health and safety apartment or the Y and the rOL, nf � Pibperty Owners pr' ed name agree to comply with all terms and conditions above. Prope ers Signature Date Note: This form must be submitted axon 17 with the se tic a stem dis a lication for all I1A s. stems yacludiu new con osal Works ermit without traction re �irslu rade crl� ate stone d with conventional des' criteria or with and credited deli n QASepticVA homeowner certification.dw Town of Barnstable ' Regulatory Service Richard V. Scali,Interim Director MAM ; Public Health Division Thomas McKean,Director 200.Main,S.treet,Hyannis,MA 02601 Office: 508.-862-4644 Fax: 509-790-63©4 Installer&Designer Certification'Form j7q 6q Dates t`, ' Sewage Permit# 1 - /0 AsSes�ar's Map\Parcel Designer: ' d` Installer: �/-� Address• G _ Address: f" �' On c't was issued"a permit to install a (date). (installer) t septic>system.at ! t-" based on,a design drawn by (ad esss) ( szgner t I certify that the Sept syste .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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with iria}or. changes ( .e. greater than 10' lateral relocation of the SAS"or -vertical relocation.of'any component of the"septic system)but in accordance with:State &Local Regulations. Plan revision or ; certified as by.designer to follow. Strip out(if required)was inspected and the soils were found'satisfactory.' I certify that the system referenced above was constructed incompliance with the terms of the I\A approval;letters(if applicable) F a (Ins er s Signature) esigner's.Signature) (Affix ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH D N "CER.TIFICATE OF COMPLIANCE WILL::NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT:CARD'AItE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. `I HANK YOU. Q:\Septi,\besigner Certification Foi7n Rev 8-14-13:doc YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1" FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). Fill in please: ti o APPLICANT'S YOUR NAME: BUSINESS � �� YOUR HOME ADDRESS: / /t?%A/7"� TELEPHONE # Home Telephone Number: (¢too Q ) y 835 NAME OF NEVIi`BUSINESS E o!u !,f r`v TYRE OF 13USINESS 1S THIS A HOME OCCUPATlON7 YES NO Hare you been g�ve�approval from the ull" YES NO "? gpPRESS OF111806NogrSSR //�- /YJiicJo� n e.. ...W;/'3ai-n_5 .�?/ #P/faARCEI, . 111111R When starting a new business there are several ht niral gs 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 COMMISSIONE OFFIC This individual has be rmed f any permit requirements that pertain to this type of business. AIR-horized Signature** FOLLOW HOME COMMENTS: OCCUPATION R i . .S 2. BOARD OF HEALTH This individual s been in me o the p rmit r quirements that pertain to this type of business. Author ze ignature** 9V ` O ENTS: ' 3. CONSUMER AFFAIRS (LICENSING UTHORITY) This individual ha en inf�tre V requirements that pertain to this type of business. Authorized Signature** ((-�� f r COMMENTS: 2 4 CC Date: /,2y /o-6- TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: S�eyaL1%a/' C_411VsTArilr/O• BUSINESS LOCATION:_ 99O 2-Al + INVENTORY IVIA MAILING ADDRESS: J/� /� 11 lT A/ (4AIF esT Annee 026e9 TOTAL AMOUNT: TELEPHONE NUMBER: y 9-36 6 695 CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: 5DS3 y.213350 MSDS ON SITE? TYPE OF BUSINESS: ?Ft,-?A a Aw k c it i1D>ivl INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum 0 __. Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid 0 Disinfectants 0 Engine and radiator flushes 0 Road Salts (Halite) Hydraulic fluid (including brake fluid) 0 Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) AO Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) d Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, `© Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout 0 Swimming pool chlorine O Battery acid (electrolyte)/Batteries 0 Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes o Car waxes and polishes Fertilizers Asphalt & roofing tar PCB-s Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, 0 Lacquer thinners (inc. carbon tetrachloride) NEW USED Q Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers 0 Other products not listed which you feel Metal polishes may b c or hazardous (please list): Laundry soil & stain removers (including bleach) 'Q Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT!CANARY COPY-BUSINESS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP )1—7 PARCEL LOT 1O TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. s IX-k- A Owner's Name: Owner's Address: 17 d- � ���� ® Date of Inspection: ����/>hl�P��Q, -)�o ?, J ) SEP 1 5 Zoo Name of Inspector: (please rint f-4010 Company Name TOWN OF BARNSTABLE Mailing Address: - HEALTH DEPT. Telephone Number: '12-DOL 77)- 9 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my, training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant toSection 15.340 of Title 5(MO CMR 15.000). The system: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority F . Inspector's Signature: - Date: T ��U- 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 ofthe DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I 1 Page 2 of l 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL.SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: f . q/jrfl Owner: Date of Inspection: k De 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 1530.) 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. Answer yes, no or not determined(Y,N,ND) in the 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. ND-explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or-replaced ND explain: The system required.pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health):. broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of I.1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'A CERTIFICATION(continued) Property Address: IN t, &AX LL14 Owner: Date of Inspection: (hO 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 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 and volatile organic compounds indicates that the well is free from pollution from that facility and the.presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A,copy of the analysis must be attached to this form. 3. Other: 3 c c Page 4 of I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Owner: Date of Inspection: C C �1� ?J D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No/ _ l 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 V Liquid depth in cesspool is less than 6"below invert or available volume is less than '/z day flow Required a pumpm�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 'f water supply. PP Y Y Any portion of a cesspool or privy is within a Zone I 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen.is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] "® (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a.large'system the system must serve a facility with a'design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — 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. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CHECKLIST Property Address: 17 ZAP AA—e WA Owner: Date of Inspection: O� 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 breakout? 1" _ Were all system components,excluding the.SAS, located on site? t1_ Were the septic tank manholes uncovered,.opened, and the interior of the tank inspected for the condition Of tile baffles or tees,material of construction,dimensions,depth of liquid, depth of sludge and depth of scum? v _ Was.the facility owner(and occupants,if.different from owner),provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System'(SAS)on the site has been determined based on: Yes no Existing information.For example,a plan.at the Board of Health.. _ Determined in the field(if any of the failure criteria related to Part C is at issue.approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. 5 Page 6 of 1 l OFFICIAL-INSPECTION-FORIVI NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM[ INSPIJCTI.ON.FORM PART C SYSTEM INFORMATION Property Address: /NXn'l- Owner: Date of Inspection: FLOW CONDITIONS RESIDENTIAL t/ Number of bedrooms(design):— Number of bedrooms(actual): DESIGN flow based'on 310 MR 15.203 (for example: 11:0'gpd x#of bedrooms)-aw_ -Number of current residents: Does residence.have.a garbage grinder(yes or no)-//o Is laundry on a separate sewage system (yes or no)- f if yes separate inspection required] Laundry system inspected(- s or no): Seasonal use: (yes or no):/l�d Water meter readings, if av ilable(last 2 years usage(gpd)): 0/-31, 0Z- --��Ud6 Sump pump(yes or no �,�/• :. Last date of occupancy: NnQ���-fe �o�• COMMERCIAL/INDUSTRIA�3/J ' Type of establishment: Desigri flow{based on 310 CMR.15203): gpd ' Basis of design flow(•seats/persons/'sgft,etc:): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available:- Last date of occupancy/use: OTHER(describe): GENERAL:INFORMATION Pumping Records Source of information: ; Was system.pumped as Part o the inspection.(yes.or 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) Innova '_ ttve/Alternative te chnology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank `Attach a copy'of the DEP..approval L-'Othei°(describe): ,� ; �,�, �r Approximate age of all components,date installed(if known)and source of information: Were:sewage odors-detected when arriving:at the site(yes or no):� 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: i Date of Inspection: '� BUILDING SEWER(locate on site plan),//W- Depth below grade: Materials of construction:_cast iron 40 PVC_other_(explain):- Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:Z(locate on site plan) Depth belowgrade:Ua6l, It Material of construction:_zconcrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a.copy of certificate) Q - Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: ky Scum thickness: (-0 it - Distance from top of scum to top of outlet tee or baffle: Y �i Distance from bottom of scum to bottom Pf out tee or baffle: 7 How were dimensions determined: ? Comments(on pumping recommen ations inlet and outlet tee or baffle condition,structural integrity, liquid levels related to outlet invert,ev' ence of leakage,etc.): , v P/L �ty � GREASE TRAP q Flocate on site plan) Wa s Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,-etc.): 7 Page 8 of 11 OFFICIAL:INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM'INFORMATION(continued) Property Address: / Owner: Date of Inspection: 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): 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.): PUMP CHAMBER: (]ocate on site plan) Pumps in working order(yes or no):: Alarms in working order(yes or no):. Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: Owner: A JAI" Date of Inspection: 3 SOIL ABSORPTION SYSTEM (SAS):. (locate on site plan,excavation not required) If SAS not located explain why: Type (leaching,pits,number:, 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, C 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 or ro): Comments(note condition of soil,.signs of hydraulic failure,level of ponding, condition of vegetation;etc.): __ PRIVY: locate on site plan) l Materia/s of construction: Dimensions.- Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ~ TfcP Y Owner: 1 Date of Inspection: C�� )Oo SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building, ------------------------ j� 10 i Page 11 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: J "A Owner: Date of Inspection: SITE EXAM. Slope Surface water Check cellar. Shallow wells d Y Estimated depth to ground water Z 7 feet Please indicate(check).all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked, date of design.plan reviewed: Observed site(abutting property/observation hole within 150 feet of 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: y,' y�/�2�� vI l l���/ 11 Permit Number Date: Completed by: HIGH GROUND-WATER LEVEL COMPUTATION Site Location: fl w !Jalg5`�f91e-Lot No. . Owner: A&I r`Address: e.. Contractor: Address: �� /�/ST`/ 1✓ STEP 1 Measure depth to water table .......... to nearest 1/10 'it. ........... ..... .. .................. .. . Date morth/day/Year i STEP 2 Using Water-Level Range Zone and_lndex Weli'Map locate site and determine: . i Appro.priate index well.............................. �(�!�!/ �?� Water-level range zone ......... 1 1 STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to 0 �03 water level-for index well ........................... 7 month/year STEP 4 Using Table of Water-level Adjustments I J for index well (STEP 2A), cun:ent depth to Water level for index.well (STEP 3)., and water-level zor:e (STEP 2B) determine water-level adjustment............................................ .................................................. o STEP 5 , estimate depth to hi.gh'water by subtracting the water- level adiustment (STEP 4) from measured depth to water level at site (STEP 1 Figure 13.--ReprCducib1e coMputaoorl Term. i I • I ' WEST BARNSTABLE PROPOSED CONTOUR BENCH MARK TOP OF FOUNDATION ® PROPOSED SPOT GRADE 178.58 — EXISTING CONTOUR BARNSTABLE CIS DATU / + 96.52 EXISTING SPOT GRADE W— EXISTING WATER SERVICE 19 TEST PIT �P{ RAcr�Nf SCALE: 1"=30' � UTILITY ,74 POLE $ rss24 1 75, . �O G A 176, � 175 176 PAVED DRIVEWAY �__-- ----- LOCUS MAP JW "' `` 177 LOCUS INFORMATION TITLE REF: 383/040 TITLE REF: 20164/226 PARCEL ID: MAP 174 PAR. 017 f T FLOOD ZONE: PROPERTY NOT IN FLOOD ZONE do � LOT 10 �� SEPTIC SYSTEM AREA = 45755 sf+— S�� \ / X REPAIR PLAN �O PLAN BOOK PACE 40 - ASSft MAP174 74 PCL 1rJ \ ' LOCATED AT: •- �,, eft 11/7 117 MINTON LANE WEST BARNSTABLE, MA PREPARED FOR • I 176 INES SIGOLINI /175 MARCH 11, 2021 o� DA REN�M y� al;' 1`C40' 1 � I LAN/� MEYER & SONS, INC. P.O. BOX 981 SCALE: 1 in = 30 ft 0 30 60 EAST SANDWICH, MA. 02537 fr \ PH: (508)360-3311 0 10 20 30 60 FAX: (774)413-9468 meyerandsonstitleS@gmail.com t SHEET 1 OF 2 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE: TO PREVENT BREAKOUT, THE PROPOSED GENERAL NOTES: TOF SEPTIC TANK FINISH GRADE SHALL NOT BE < EL:173.09 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX , FOR A DISTANCE OF 15' AROUND THE BOARD OF HEALTH AND THE DESIGN ENGINEER. EL.=178.58t OUTLET AND SET TO 6" OF FINISH GRADE PERIMETER OF THE S.A.S. 2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS INSTALL LOCKING COVERS IF AT FINISH GRADE INSTALL RISER & COVER PROPOSED S.A.S. OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE SET TO 6 OF GRADE INSTALL A 4" DIAMETER INSPECTION PORT OVER LOCAL RULES AND REGULATIONS. F.G. EL.=177.Ot F.G. EL.=175.50f F.G. EL: 176.10t ONE CHAMBER. (MIN.) AND SET TO 3" OF F.G. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE F.G. EL: 176.05(MAX.) DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 9' MIN COVER/ FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN i 36" MAX COVER s L = 30' L = 18'(MgX ENGINEER BEFORE CONSTRUCTION CONTINUES. • S=1X (MIN.) EL=17528 O S=1X (MIN.) O S=1X (MIN.) INSTALL TWO INSPECTION PORTS (MIN.) 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. all- 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 10" 6 / HEALTH rF0 PROPER INSPECTIONS DURING IFY THE COLNSTRTRUCBTIION. OF INV.=174.20 14 InIk 48'UQl/ID 11.3" TO 7. DWELLING IS SERVICED BY TOWN WATER. LEVEL INV.=173.95 INVERT PROPOSED INV.=172.7 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED GAS gq�E TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. D-BOX INV.=173.30 4 ROWS OF 6 UNITS AT 6.25'/UNIT = 37,5'/ROW 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE INV.=173.5 DB-6 LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. 1d221 SOIL ABSORPTION SYSTEM (PROFILE) 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED EXIST, 1.000 GALLON SEPTIC TANK PER TITLE 5. REPLACE WITH CLEAN MEDIUM SAND. 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION EXIST. SEWER OUTLET RESTORE VEGETATIVE COVER 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY BACKFILL WITH CLEAN PERC SAND AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY TO TOP OF CHAMBERS 13. NO KNOWN ABUTTING PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING e. .. ;. • .• ;;, ,:.,. PLACE FILTER FABRIC 14. ALL PIPING TO BE 4" SCH 40 0 1/8-/FT (UNLESS SPEC. ) :•...:r.:�..',;:y.-� .: OVER TOP OF CHAMBERS 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT=TOP ELEV.=173.09 :.. FOR THE USE OF A GARBAGE GRINDER. PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV. 172.70 �., 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.= 171.76 EXISTING SUITABLE GRADE ON A MECHANICALLY COMPACTED SIX 2•g3' MATERIAL INCH CRUSHED STONE BASE, AS SPECIFIED IN 5' MIN. ABOVE BOTTOM OF 310 CMR 15.221(2) T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH = 4 x 2.83' = 11.32' 3) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLPR PROVIDED) USE 4 ROWS OF 6-HIGH CAPACITY DESIGN CRITERIA GAS BAFFLE AS REQUIRED = INFILTRATOR (H20) UNITS SEPTIC SYSTEM PROFILE NUMBER OF BEDROOMS: 3 BEDROOM DWELLING N.T.S. DESIGN FLOW: RESIDENTIAL: 3 BEDROOMS ® 110 GPD/BR = 330 GPD DESIGN PERCOLATION RATE: <2 MIN/IN SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) SOIL LOGS TPT: 21-31 GARBAGE GRINDER: NO (not designed for garbage grinder) DATE: FEBRUARY 24, 2021 DISTRIBUTION BOX: USE DB-5 (H20) SOIL EVALUATOR: DARREN M. MEYER, RS, CSE 1614 � OF Algss, SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1.000G SEPTIC TANK c��• 9�, LEACHING AREA REQUIRED: (330)/.74 = 445.94 S.F. WITNESS: DAVE STANTON, BARNSTABLE HEALTH. o� DA E. y� i PRIMARY S.A.S. Elev. TP-1 Dept,, Elev. TP-2 Depth N 1 �0 USE 4 ROWS OF 6 - HI-CAP INFILTRATOR H-20 UNITS-NO STONE 176.0 A 0" 176.3 A 0" ,pE IS1 BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.73 SF/LF OF CHAMBER) LOA 3/2 MY LOAMY SAND 3/2 '�MITAR�p� (CHAMBER) 24 UNITS x 6.25 LF x 4.73 SF/LF = 709.5 SF 175.18 B I LOAMY SAND 10" 175.48 B 10" l I 1 TOTAL AREA = 709.5 SF LOAMY SAND 172.75 10YR 5/6 39" 172.97 10YR 5/6 DESIGN FLOW PROVIDED: 0.74GPD SF 709.5 SF = 525- GPD > 330 GPD re 'd 40" PERK TEST C1 C1 FOOTPRINT: 37.5 X 11.32 = 424.5 SF _> MADEP REQUIRED 400 SF. ®EL. 170.50 MEDIUM MEDIUM 1 SAND SAND 2.5Y 6/4 2.5Y 6/4 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 165.0 1 132" 165.3 132" 117 MINTON LANE, WEST BARNSTABLE, MA PERC RATE <2 MIN/IN. ('Bwb' HORIZON) Prepared for: Ines Si olini System Design and Topography Plan by: SCALE DRAWN DATE MEVER&SONS,INC. N.T.S. DMM 03/11/21 PO BOX 981 EAST SANDWICH,MA02537 REV DATE CHECKED SHEET NO. 5083622922 DMM 2 of 2