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0544 RACE LANE - Health
544 RACE LANE, MARSTONS MILLS A=126-001 - i 0 r i i 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills MA 02648 April 30, 2010 required for P every page. Cityrrown 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 I to move your Patrick M. O'Connell cursor-do not Name of Inspector use the return key. Septic Inspection Services Co. Company Name .- . . 189 Cammett Road - ^, Company Address r Marstons Mills MA 02648 City/Town State Zip Code- 508.428.1779 S112855 Zl"z Telephone Number License Number > B. Certificationryl 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 April 30, 2010 InApectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •'y 575 Race Lane Property Address Charles Re Owner Owner's Name information is April Marstons Mills MA 02648 A 30 2010 required for p � , every page. Cityr town 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: ® 1 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: Tank is not in need of pumping at this time, leaching system shows no signs of surcharge or saturation. Recommend removing garbage disposal. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills MA 02648 Aril 30, 2010 required for p every page. City/town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): bg ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills MA 02648 April 30 2010 required for p � , every page. Cityrrown State Zip Code Date of Inspection R. 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 clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is Mairstons Mills MA 02648 April 30, 2010 required for p every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone 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•09108 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 y 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills MA 02648 Aril 30, 2010 required for _p every page. Cityrrown 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills required for MA 02648 April 30, 2010 every page. CityfTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 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)): 133,000 gal. _ Detail: 182 gpd. Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills required for MA 02648 April 30, 2010 every page. Cityrrown 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: Tank pumped 2-3 years ago. 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills MA 02648 Aril 30, 2010 required for p every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date.installed (if known) and source of information: 1996 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 1' 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): 311 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.5' long x 5.8'wide- 1500 gal. Sludge depth: 3" t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •'' 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills MA 02648 Aril 30 2010 required for p , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is not in need of pumping at this time. Liquid level was found at bottom of outlet invert and tees were intact and clear. 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 Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is April Marstons Mills MA 02648 A 30 2010 required for p � , every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is April Marstons Mills MA 02648 A 30 2010 required for p � , every page. Citylrown 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.): No solids or high stains'present. 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 Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '<a 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills required for MA 02648 April 30, 2010 every page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: One 15 x 30 field ❑ 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.): Lateral lines were video inspected, found no evidence of surcharge or saturation. Stone and soils were probed with no evidence of hydraulic failure found. 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 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills required for MA 02648 April 30, 2010 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM .•'r 575 Race Lane Property Address Charles Re Owner Owners Name information is required for Marstons Mills MA 02648 April 30, 2010 every page. Cityfrown 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 38 32 2 a / /`/`/`/`/`/`/`/`/`/`/`/`/`/`/ / Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is Marstons Mills required for MA 02648 April 30, 2010 every page. Cityrrown 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: 20+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ® Accessed USGS database-explain: USGS topo map and town GIS You must describe how you established the high ground water elevation: Town groundwater contour map shows water below el. 45 and topo map shows property at el 70 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 575 Race Lane Property Address Charles Re Owner Owner's Name information is April Marstons Mills MA 02648 A 30 2010 required for p � , every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist 9 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-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 /o3- l3_3 No. �& 'd'�O _ Fee i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 01pplitation for 3Dtgpoga1 *pgtem Con!Arurtion Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name, [dress and Tel.rjo Act, Mc t1f 3�N�� LOW Installer's Name,Address, d Tel No. Desig er's N e,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Garbage Grinder(Mo Other Type of Building A No.of Persons cz Showers Cafeteria( ) Other Fixtures V A Design Flow gallons per day. Calculated daily flow 3� gallons. Plan Date �1 Number of teets A Revision Date Title D *It-L P i t i re i, "i Description of Soil L C Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo ealth. Signed Date 7—g Application Approved by Application Disapproved for the following reasons Permit No. �� — Z� Date Issued No. ^. -- .i� Fee t� #. 4-HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 2pplication for Zigpogal *pgtem Congtruction Permit Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,AWdress and Tel No. S7 —xe wl Installer's Name,Address,and Tel.No. Designer's N &AoAress and Tel.No. uvktA n a f-Fo' �E irf- N4�6//,17 Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder(At) Other Type of Building N 4 No. of Persons Showers( ) Cafeteria( ) ^� Other Fixtures Design Flow f C4� gallons per day. Calculated daily flow � gallons. Plan Date �/ �1� Number of sheets r,I- Revision Date Title ar l lT Description of Soil &e 4?Y& -7 f /3 k t UAA r 4450t;l 57 V Nature of Repairs or Alterations(Answef when applicable) Date last inspected: // I Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo o ealth. Signed Date " Application Approved by Application Disapproved for the following reasons s � Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS r Certificate of Compliance THIS IS TO CERTIFY;that the O -site Sewage Disposal System install Xj'or re paired/replace d( )on by D '-O for (I W a a+,. has been onstructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 6 —le=9 .Use of this system is conditioned on compliance with the provisions set forth below: No. ! 6 o`r Fee 11,90 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS D gpogal *pgtem Congtruction Permit Permission is hereby granted to to construct(?Q repair( )an On-site Sewage System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. All construction must be completed within two years of the date below. Date: _ to Approved by 44 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ```�pluuurlrrr�i on the computer, OF hf use only the tab ��``��•••"••• �SS ''� key to move your 1. Inspector: *7V o��; •qo�%, cursor-do not James D.Sears JA M E S m key.the return Name of Inspector =�: :y CapewideEnterprises,LLC %*' Company Name �. RRTIF��'O, 183 Commercial St. ���'F 5 I N sPEG `��` Company Address Mashpee MA 02649 Cityrrown State Zip Code 508-477-8877 S 1623 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 16.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails lns -;es ' Further Evaluation by the Local Approving Authority cc �r3 6-28-13 *< � t gnature Date ��Q Th jj tem inspector shall submit a copy of this inspection report to the Approving Authority(Board rn of nth or DEP)within 30 days of completing this inspection. If the system is a shared system or s� ha design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the .:._._feport 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. 4 A �3 t5ins•3/13 Title 5 official In orm.Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. Citylrown 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: 1 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: I 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-3N 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �( 544 Race Ln. Property Address Cathleen Hill Owner owners Name information is required for every Marstons Mills MA 02648 6-27-13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,N any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system.passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all Inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ - Static liquid level in the distribution box above outlet invert due to an overloaded -= or clogged SAS or cesspool ❑ ® Liquid depth in GaspW is less than 6"below invert or available volume is less than%day flow A177— tsins•an3 me 5 Official n Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. City/Town 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 forma ❑ ® 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•3113 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 6 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. C4frown 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? 4 ❑ ❑ 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): NA Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ° 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name informationairedfor is Marstons Mills MA 02648 6-27-13 required for every page. Citylrown State Zip Code Date of Inspection D. System Information Description: The system is a 1250 Gal.tank and pit. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2011-74,000Gais 2012-89,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial 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•3/13 Title 6 Official Inspection Form:SLdsurfacs Sewage Disposal System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments I lug 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Fonn:Subsurface Sewage Disposal System•Page 8 of 17 k\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: 1987 Permit # 87-700 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): .Depth below grade: 20"feet Material of construction: cast iron ®40 PVC ❑other :ex lain ( P ) Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40 Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1250 Gal. Precast Sludge depth: 4" t5ins-3113 We 5 official Inspection Forth:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Flame information is required for every Marstons Mills MA 02648 6-27-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 8" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank at 1'below grade in and outlet baffle. No sign of leakage. Note: Maint. pump after inspection. 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•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments < 544 Race Ln. Property Address Cathleen Hill Owner owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 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(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.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments F 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is one 1000 Gal. precast pit. Pit at 25" below grade w/cover at 8",30"water in pit. No sign of overloading or solid cant'over,no high stain. 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-3113 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner owner's Name information is required for every Marstons Mills MA 02648 6-27-13 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 544 Race Ln. Property Address Cathleen Hill Owner owners Name information is required for every Marstons Mills MA 02648 6-27-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately Alf � ,gR Nays� Al a o � o � oO 3 t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '< 544 Race Ln. Property Address Cathleen Hill Owner Owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. C4rrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells �© Estimated depth tolhigh ground water: 47'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: U.S.G.S. well S.D.W. 253 at 47'zone B-2'-3' You must describe how you established the high ground water elevation: U.S.G.S.well S.D.W. 253 47' zone B-2'-3'. Bottom of pit at 8'-6" below grade. Before fling this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yt 544 Race Ln. Property Address Cathleen Hill Owner owner's Name information is required for every Marstons Mills MA 02648 6-27-13 page. Cityfrown - State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 t N1, ' i TF l_J 7 1 it F-T.. I t I i -------- It i F 4t, ------i ------- 7-i Ilk TOWN OF BARNSTABLE �1 LOCATION 57_'4 zj 04— LA M SEWAGE# —766 VILLAGE HIAJQ S'grpP 4 rA t I VASSESSOR'S MAP.&PARCEL INSTALLER'S NAME&PHONE NO. 4f_�t ES M SMi4 SEPTIC TANK CAPACITY / 5D (Z�74 t LEACHING FACILITY.(type) I,DD0 P t T (size) 6 NO.OF BEDROOMS OWNER LA QQV 4M PERMIT DATE: /9 Y(_7 COMPLIANCE DATE: Separation Distance Between the: 1 Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist or `� site or within 200 feet of leaching facility) !~t Feet Edge of Wetland and Leaching Facility(If any wetlands exist within _ 300 feet of leaching facility) Feet FURNISHED BY v' ���� '� r ` ���e� �� ��� � �� .. , �� �''1 ., �2 F.. No... o Fes$.... .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �}T. ....--....OF.............. . .... -.. ........................ Appliration for Uhip iial Workii Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at Syq I I/1 �,� /n��U--n�l---� AL 6 Location Add, ss or Lot - - ......................-----•------_._ ...._--- ------------•------•--••----- .. ... Owner c Address_ a ....................... ------r`'len.�� ��' e_. ,:...�1! trtar�saf --------------------------------------- Installer Address Type of Building(,U op ® r_��w Size Lot----------------------------Sq. feet U Dwelling—No. of Bedrooms..........�A-...........................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ____________________________ No. of persons___.____7-___.___________ Showers Cafeteria ( ) Q+ Other fixtures -------------------------------•-• -•- W Design Flow....... ___________________________gallons per person ger dart'. Total daily flow.......3-�_6_....................gallons. C4 Septic Tank—Liquid capacity/ gallons Length___..:_____ Width)_________ Diameter________________ Depth_ __._.. W Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/._.-______ Diameter______. .._._ Depth below inlet_/,a k . .6_ k u.____ Total leaching area__J�..._!9Aq. ft. Z Other Distribution box ( ) Dosing tank ( ) '~ Percolation Test Results Performed by................................................... __- Date.......................... _..._.____.. ,aaa Test Pit No. 1................minutes per inch Depth of Test Pit___j _________ Depth to ground water..._. . .-_______ 70,'JE Test Pit No. 2................minutes per inch Depth of Test Pit_________-__________ Depth to ground water........................ Ri •-•--------- ---------------- J--------........ ._....�..................... �........................................................ O Des ription of Soil�'-� Lip � '11 .. lJ ��-�-�- & 1 W --------------------- ................-............................................................................................................... UNatur of Repairs or Alterations—Answer when applicable.____SL� `�_1 ��...___ ._°..�_`'�__ . --------•--------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiT .p `}of the State Sanitary Code—The undersigned further agrees not to puce the system to operation until a Certificate of Compliance has been issued((by the board of health. Signe4 '�� .. •- 1 ,C Date Application Approved By-------•-•••- - j ' 7 Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ -•------------------------•----------•-...-•----------------•-------------------•--------............---.•-•--...........--••-•---•---•--...•--••--•••----•--•••-•-•-•----••-----•••-•-•---••-•••------- G Date PermitNo------5'-Z---2a-A-------•----------•-- - Issued....................................................... Date No...32::-_7o b FIms. .. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f�CrL< ti............OF............. ....... .._........ ... --------_-.--_--••--- Appliratinn for Uiipusal Works Towitrnrtiun umit Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at "7 yL� t � �. ft ../v�,,. t7i ll --------------------•-••---•--------•-•------•----------------- -... _...........................................� a •--....... ........... Location Address or Lot No. C101�,. P, l/ ��i�� 2� .<. /,j A_t 11 ,4- . i/s ----------------------_..........•-•••-.---- •-------..._._...--•-•-•----•--•-•--•---•---_.. ...........----•-•--•-•....---• --•--- ---•�---•----•------ ._... / Owner CC Address a �_;I,�, l� S P,I Pn I n.-,, /c 6 , .1 h J n, a+F ........................................ ---•------------------•....;__._....--------------------....--•---...... ........................... •----- .......-- Insta.ler Address UType of BuildingW UU p F(>rCt,r� Size Lot............................Sq. feet �., Dwelling—No. of Bedrooms........ ..................................Expansion Attic ( ) Garbage Grinder ( ) per, Other—Type of Building ............................ No. of persons.......�/- ............... Showers (f ) — Cafeteria ( ) Q' Other fixtures __________________________________ W Design Flow.......//��...........................gallons per person per day. Total daily flow........ ......................gallons. R: Septic Tank—Liquid capacity/_:?_`?7 gallons Length.. .1.... Width_`T......... _. Diameter---------------- Depth_ . W Disposal Trench—No_ ____________________ Width.................... Total Length.........._......... Total leaching area....................sq. ft. x Seepage Pit No------- ----------- Diameter......6..__...._. Depth below inlet 6..'6.....--... Total leaching area_.`+_!y2 sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit-- �.......... Depth to ground water_____________.__�?� L� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ----------------------- --•---•-----------------•------------------------------------------ D Description of Soils-1 ... -/.. 2�2 [�.. ... U . .........,ti. ........._ ►9 6�- ----------------------------------------------------------------------------------------------------------------------------------------------------- W -•-------------------------------- /---------------------- ----------- UNatur of Repairs_or Alterations—Answer when applicable.....C.f�..�_.—r �'"______�_�.��..Y 32. ......_•. Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of'TT L- ;of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ....................................... ......�........... Date Application Approved By............... ...II...... ......... �J 7 Date Application Disapproved for the following reasons---------------••-------------------------•----•--------•----.....-----------•----------------••----------....._ -•-----•--•----------•---------------------------------•-•----------------------............------------•---•........---•-----•------••--------•-----•-•----•••----•--••••----•------------•--------•--- Date PermitNo-----�1. 2�.,o....................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C -t...............OF......./� . - Trrtifiratr of Tuntpliatta THIS IS TO C,�RTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ,04,} by..............CA.. �S,.Q,a..............--- •-• --•-• ............ _••--_---•--_--Installer , at -1/--L?-------•--- vie.: .....- ?� -------------------------------------------------------------- has been instailed in accordance with the provisions of T�"�IE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit NO._Y..7-....7..CJ0.......... dated_............................................. THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................t t-"._. ..?..-.. ........................... Inspector............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH �"�7 7/)/} - .........OF................. .. -� � ................ NO..V../...-1.vf/ FEE..,O.-I�f)........ Ehapja..1—�1 arks Tonotrn #uan amit Permission is hereby granted------.._�� .......t�4=2<t--,__ ---------------------------------------------------------------------- to Construct ) or Repair_(� an Individual Sewage Disposal System atNo.--------� ...�.r €-neE --------.---••----------•--------------------------------�------------------•--•------------------------•-------------.- street /I,, as shown on the application for Disposal Works Construction Permit No, ,_�.7-__ Dated.......................................... ................................�.....T,...'`r.. .`'-^=='. "1 Board of Health DATE.......... �' �' FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map` Parcel I Application F � Health Division Date Issued Conservation Division Application F e Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-O;<H Preservation/Hyannis Project Street Address 5 41 Village ILs D-2 4�( Owner Address SYLf Telephone W� Z \ Permit Request �2e.�I c ,l�Fan� �e F- w sec f/Lvo '• CA1-i, Lo [4,1[ ��,_���•.-e,�-f- n.6+�u-e r-�n,n�j� w �d.•.01�cs• �.ti�,�S#.ai 2s 6�' �2C Pc � 1�� �.sl/ � �2e Square feet: 1st floor:existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 6 Project Valuation .3«% Construction'Type Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. 1 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other �w v Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) xNumber of Baths: Full:existing new Half:existing new Number of Bedrooms: existing_new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new, size—Pool:❑existing ❑new size _ Barn:❑existing ❑new size_ <l X Attached garage:❑existing ❑new size_Shed:❑existing ❑new size — Other: vtl j Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) I Name t4, t/ Telephone Number -g5 Address License# LKJ- Home Improvement Contractor# I ` Worker's Compensation# i ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i I ro ya{TN[t0` •`� .'s The Town of Barnstable teu�r��rs MAIL Inspection Department eon i470 ��� ,yak►l 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner December 16, 1992 Benjamin E. Zehnder, Esquire Laraja, Ranaga and Bott, P.C. P. O. Box 236 Orleans, MA 02653 Re: Site Plan Review Number 4;1r92 r-DeV rek-Johast_o_n;�54`4�Rac_e,Lan_e, Marstons Mills, MA Assessors Number 126/001 Dear Attorney Zehnder: The above referenced site plan is conditionally approved based on the following requirement: 1. the location of the off-site compost system must be approved by the Health Department. Enclosed please find a certificate Of Review and a copy of the conditionally approved plan. Please be informed that you must comply with any requirements the Zoning Board of Appeals may impose in addition to the above. Should you have any questions, please feel free to call. Peace, oseph D. DaL z Building commissioner JDD/km cc All Site Plan Review staff enclosures (2) S921216B II LA.RAJA., KAxAGA Axn BOrr, xrrOMNEYS AT LAw RICRARD A.LMW,& 46 SOUTH OR'LEANS HOAR POST OFFICE.HO,�C R;jg EARNSTABLE.MASSACHUSETTS OFFICE: CHRISTOPHER W.KANA0A 3087 MAIN S RUIT(ROUTE GA) ANTHONY R.bOTT ORLEANS,MASSACHUSErtS 02653 (Sp$)362.4C00 BENJAMIN E.ZRUNDER OFC'mySEL• (*08)L55.5800 AM144TED WITH; MCHARD D.WALSE FAX(508)855-8844 SHANL tik PAULILLO. . NEWTON,MA$iA011u5ETT5 PEY TtNOTON,WMKINSOK UUM AP,GATEMAN ek CAMP,PA: TULARASSER.FLORMA December 9, 1992 Joseph D. DaLuz rlftC Building CommissionerTown of Barnstable 367 Main Street hnn Hyannis, MA 02601 Res Derek Johnston Site Plan Review No. 41-92 S44 Race Larne, Mars tons Mills, Massachusetts Dear Mr. DaLuz: This letter is in response to your correspondence of. Novembex 18, 1992 regarding. the below listed site Plan Review staff comments: , 1. Does the onsite sewage disposal system for the residence meet title V, of the state environmental code. Attached is the Board of Health Certificate of Compliance dated November 17, 1987 certifying that the system has been installed in accordance with, said Title v. 2. Where will the dog feces be disposed of? The Applicant's current practice in this regard involves mixing the dog feces with horse manure and delivering this mix to an offsite compost system. This practice both minimizes Oder and insures the, recycling of the waste for more beneficial uses., thereby reducing demand on the local landfill. 3. The site play does not meet the requirements of Site Plan Review. Dimensions need to be included. The revised, site plan is attached showing the various dimensions requested verbally by the planning department. Jaseph D. Datuz December 9, 1992 Page 2 .Applicant acknowledges the requirements set forth in paragraphs 2, 3 and 4 of the staff comments. Applicant will comply with all relevant portions of the Barnstable Zoning By-law as well as all other pertinent ordinances. Attached is a Copy of correspondence dated October 24, 1992 from the Property owner Cathleen Hill to the applicant permitting and supporting the applicant's use of the premises for the subJect home occupation. The: garage shown on the site plan at the rear (northerly) side of the property will be used for the home occupation. Thank you for this opportunity to respond to the 'staff comments addressed above. Please do not hesitate to contact me should you require any further information. . Very truly yours, Se in B. Zehnder BEZ/rr. enclosure Cc: Derek Johnston October 24,1992 Derek Johnston 544 Race Lane Marstons Mills , MA. 02648 Dear Derek, I understand that you have requested a s ecial permi to operate your training business from the property in whichtyou rent from me at 544 Race Lane, Marstons Hi11s. I have absolutely no problem with this situation as long as i.t does not cause me any additional liability with the Town of Barnstable or Insurance. Any additional exposure would be at your expense. property do not see any reason in which the mown should object as ty h as been in my family for man been used in some manner or another .invol.vingears animals and homey$ and has the e based business activities . We operated our Kitchen and Bath business from this location since the early 801s . We had never had a problem brought to our attention as to the , neighbors having a. concern. At one point we had a complain regarding the use and storage of flammable adhesives. immediately and went to a non-flammableWe stopped using those product. Department, Building Department and Fire Departmenthwereaall involved and had no problems with the discontinue use of flammable adhesive property use only that we pr9ducts in quantity. Richard Seaman also used the property for his Dog Trainin Business while you were employed with him. We never received a complaints during the time he used the any business . property for his training The property is zoned for use as a HOME BASED BUSINESS. I do not see why the Town of Barnstable should not issue you a permit to operate your business within there can be of any further assistance please let meuknowineYou have m full support . y Respectfully yours , Cathleen i l l 3329 Fairhaven Road Davenport , Ia 52807 (319) 359-6763 7 F$s....... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......r . "... ..OF.....:..... . ..:... . Appliratinit for Disposal i9orks ( onstrurtin" Permit Application is hereby made for a Permit to Construct ( ) or Repair (,�) an Individual Se System at.: wage Disposal /V.i� ...• ........... ..................................... ..MM.M ..Location-Addr ss r ..••ot Lot. .• . :._...�......:_....�����{�� .:..fir.. l... ....... , .Y. . ..:!-�..t.�:��s :.�...���.� � - •• ..._ rrzA....... a Address, ,.. Owner.:..........». :..: /.? :11s9!!'1:. je :....................... ........01�.7. ..�i. :r....4 :Jt..t7.b�,t: . ...... Installer � Address. ..............•..................... T of Duildin Type g LtI Ua p Size Lot.... Sq. feet w Dwelling—No. of Bedrooms......... •••••..........................Expansion,t�ttic ( ) Garbage Grinder )Other--�Type of Building ............................ No. of persons.........1/................. Showers (f ) Other fixtures .....................................•--•.............................................................. Cafeteria ( ) WDesign Flow.......Z/0..........................ga Mons per person �}}11 y+. Total daily flow......3 .Q..........,.........gallons. Srptic Tank--Liquid•capacity/, g lions Length... .lx.... Width-5r.�....•. _ _ Disposal Trench—No Width Total leaching area - .. Diameter . Deptli.4i-G... .�.....--- Total Length... .. thing area.: q, 3 t. Seepage Pit No.....:�......... Diameter........... ... Depth below inlet./R!k,....... Total leaching area..�.t'r`.�.. sq. ft, Z Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by.................. ....._.............. .... Date.. � Test Pit.No. 1................minutes per inch Depth of 'Pest Pit.../..�......... Depth to ground water.. .. . .........�kJ I� + Test Pit No. 2................minutes per inch Depth of Test Pit..............._ . Depth to ground water..............:......... ... . .... x Desgription of Soil. - ..�........... ..... fJ..�.. . . .... .. ..... w. :... .1r: .1................................................._.............................................-----------••-- ..:.....................................................:.........................•...................... _�........................ ..... . V Natur of .Repairs or Alterations—•Answer when applicable..... .................... � � ���������� ...._ .V. `:.4 .? .7.)c�.:....... .1�.�r I�?...... .. �'"��"L►. ....:�) ' E�..... . - .-pl�2).................... Agreement: ._.. ....................... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accords the provisions of Tlxi. 5 of the State ' _ p y nee with Sanitary Code The undersigned further agrees not to pines the sstem in . operation until a Certificate of Compliance has been issued by the board of health. y Signed---- Application ... .... f Approved.By_.......... ...Z�: D . .. .**.�.----:s�,�..........................._ ............: a:�., _-.�` 7 Application Disapproved for the folio Date wing reasons:..............:. ..................... .............._...................................................... ................ Permit Na..__. �- p, Date \ ........, Q.G?...................., Issued................. THE COMMONW9ALTH OR MASSACHUSETTS BOARD OF. HEALTH `o .....1...� :L ..� ..............OF ............................. ..........................:.......... C91141iiratf of (a�rit�rlittnii'p by.•• ••THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or repaired ] at............ ,�..d .......` instaiia............... .............. has been instailed in accordance with the provisions of T 21E 5 of The State Sanitary Cede as described in the application for Disposal Works Construction Permit No.. ... ::... ;.0 .......... dated_.•...........:........:..:................:... THE ISSUANCE OF THIS CNRTIFICATE SHALL NOT of CONSTRUED AS A GUARANTEE THAT '1H1; SYSTEM WILL, FUNCTION SATISFACTORY. DATE...................... /.f..�:...�..7..-.. 2.7.........:................ Inspector............... THE -COMMONWEALTH OF MASSACHUSETTS - �y BOARD OF HEALTH 1\'0..R ........./.G k:.G,tk'.�........OF.......... f .... ...... ...... . ................... DiNt agal Works TH11.6tradjoll Permit Permission is hereby granted......... !:�{;;� - to ConstrucU ) or Repair•, an at �� Individual Sewage Disposal System ,....... ::c:�,................. ..........................................treet :.................................. Street ......................... as shown on tite application for Disposal Wrrks Construction Permit No ..:2, �.,.. Dated.....:......... ......... ............................... ...,.. t, .,,X� ..... DATE 7 ' ,.. ..............._ ....._ r ��++ Board of Health FORM 18p13 N00S8 er WARREN. INC.. pUmLI6"XA5 " DEC 09 192 14:43 LARAJA KANAGA & BOTT �r P.6i6 _ S� RA, acre N VI T 1 o n N a �i � N 4 � �•,^ • ' , .�,�`b Lv Ile ° 1 00 P.Ajj lu does 'V c t approval of th0 E 3rd�aire ,� pQ • yw C rc QUUV is BAR rrsrAcze s i CF D r. _b$ PLAN SEp;.1 ta57 01� LAN to w t,6 ae- 13A-,,,Q Ma�sroNs L :tECprt., As av� L.S. �ASSL �...... . DAVID � SCALE f IN=40 K sax • Ms�..cw �' ,,1 V 1.Y Z6,19b`7. sr+w�t Cs+.►rartv��a.a. seSuRvCYoiCl. 4 or►�M�° sa su� •. site 4,14 'vI � ` li ��r i4 t� ��y.-�rr.w>jp'Y� � .w,Q � �� r�Sh� ti'•� . , � °,f l sh���(r� i� f t "^1t " 't': hrhf!• tR �i�'f fy r: 1 ' 1 A I nAaA, KAxAGA Axr) Borr A•r OWNEYS AT LAw . RICHARD A.LARAjA 48 SOUTH ORLEANS"GOAD" CHRISTOl+SEH W.XANAGA POST OFFIG$I$OX a0e YiAItNS'rentr!,IaAssAcati,BTTS OFPiCB; 3CByMAINSMILIT(ROUTECA�, . ANTHONY R.bOTt QRLEAN$,bLAS$ACHIJSITT$OL'853 (spg)3g3.4L'00 7SENJAMIN E.ZRHNDER OFCOt1NSEL (508)355.5600 GUARD D.WALSR FFAX(508)255-8844 AFFILIATED WITH; SHANL&PAOLILLO NEVWN,MASSACIlusETTs• . - - PMWINGTON,wumm.sipN,DANLAP,WBJL N&GAXP,PA: TALLAKKSSBR.FIARMA December 9, 1992 Joseph D. DaLuz r Building commissioner Town of Barnstable 367 Main Street J)EC Hyannis, MA" 02601 TM a Res Derek Johnston Site Plan Review No. 41-92 S44 Race Lane, Marstons Mills, Massachusetts Dear Mr. DaLuz: This letter is in response to your correspondence of November 18, 1992 regarding. the below listed Site Plan Review staff comment$: . 1. Does the oneite sewage disposal system for the residence meet title V, Of the state environmental code. Attached is the Board of Health Certificate. Of Compliance dated November 17, 1987 certifying that the system has been installed in accordance with, said Title v. 2. Where will the dog feces be disposed of? The Applicants current practice in this regard involves mixing the dog feces with horse manure and delivering this mix to an offsite Compost system. This practice both minimizes oder and insures the. recycling of the waste for more beneficial uses, thereby reducing demand on the local landfill. 3. The site plan does not meet the requirements of Site Plan Review. Dimensions need to be included. The revised. site plan is attached showing the various dimensions requested verbally by the planning department. Joseph D. D"UZ Page 2 December 9, 1992 .Applicant acknowledges the requirements set. forth in paragraphs 2, 3 and 4 of the staff comments.I Applicant will comply with all relevant portions of the Barnstable Zoning By-law as well as all other pertinent ordinances. Attached is a copy of correspondence dated October 24, 1992 from the property owner Cathleen Hill to the applicant permitting and, supporting the applicant's use of the premises for the subject home occupation. The: garage shown on the site plan at the rear (northerly) side of the property will be used for the home occupation. Thank you for this opportunity to respond to the 'staff comments addressed above. Please do not hesitate to contact me should You require any further information. Very truly yours, c/ Be in E. Zehnder BEZ/rr. enclosure CCt Derek Johnston October 24,1992 Derek Johnston 544 Race Lane Marstons Mills , MA. 02648 Dear Derek, I understand that you have requested a s ecial permi to operate your training business from the property in whichtyou rent from me at 544 Race Lane, Marstons Mills . I have absolutely no problem with this. situation as long as it does not cause me any additional liability with the Town of Barnstable or Insurance. Any additional exposure would be at your expense. 1 do not see any reason in which the Town should and object as the property has been in my family for man y yas been used in some manner or another invol.vingears animals and homeys based business activities . We operated our Kitchen and Bath business from this location since the early 8015 , We had never had a problem brought to our attention as to the neighbors having a concern. At one point we had a complain regarding the use and storage of flammable adhesives. immediately and went to a non-flammable prod stopped using those Department, Building Department and Fire bepaxha involved and had no problems with the tment were all discontinue use of flammable adhesive products inequantity. Richard seaman also used the property for his Dog Trainin Business while you were employed business.complaints during th with him. We - never received an e time he used the property for. his trainingy The property is zoned for use as a HOME BASED BUSINESS.do not see why the Town of Barnstable should not issue 5' I permit to operate your business within there You a If can be of any further assistance please let meuknow, you have m full support . y a � \ Respectfully Yours, 1DEC 9 ! t' `: Cathleen Zll 3329 Fairhaven Road Davenport , Ia 52807 (319) 359-6763 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF......:......: . . :G........................ . App iratinit for Disposal Works (foustrurtiutt rnwi# Application is hereby made for a Permit to Construct ( } or Repair (X) an Individual Sewage Disposal System at .1.....- WI.... YN...1....:........................• ....t.........mN �•Locetion--Addy 9>,r ""'a Lvt•I�o. •• Owner r�:1.:.:...... 4e xAddress ........................ Installer ..............!,�,, ........... ......... Type of Buildin Address gW Ua D P94W Size Lot..................._.:...:..Sq. feet �• Dwelling-•••No. of Bedrooms......... ....Expansion;t�ttic �j/ ( ) Garbage Grinder ( ) a Other—Type of Building ............................ No. of persons._:........................ Showers (f ) Other fixtures ...................................... .................:.............................................. Cafeteria ( ) /� ....... W Design Flow....:..� q�,/.:..........................gallons per person Total Total daily flow... .. .. ..•.............gall Septic Tank Liquid capacity/j. gallons Length.....:. Width_5r.&4....... Diameter..:............. 17epth. ... 6•� Disposal Trench—No...................... Width.................... .rotal Length.................... Total leaching area.. sq. ft. 3 a .......�:. .... Seepage Pit No.: ......... Diameter....... .. Depth below inlet. .. ......... Total leaching area.. it. ft. Other Distribution box ( ) Dosing tank ( ) a Percolation Test Results Performed by............:......... .._. Date. Depth.o I'est•F'it...I�al/........... Depth to ground.w........,. .. .......... ............. Test Pit No. 1................minutes per inch pt � Test Pat................._. Depth to round water � Test Pit No. 2................minutes per inch Depth P g ater........................ .....-------------•--- x Desgription of Soil. �.�:1 ......:............ 621�t �• �� x.... fJ..�.. . . .... .......... .....r. ................. ::::.........' :.'` : :::::::::.....::................................._......I.., ........r :.......................---.._............................. I. U A. Natur of Repairs or Alterations Answer when applicable....�rA .1 -••��� .r :. ... . .. : " . ................... . x rim x--x.r�,.,� - ......67..............Agreenient: .......... The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of^IT 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signs I�.�P `• Application Approved.By............ . ,,.,�.....��..i .................. ...... D�1 . .__.. .�.�-�.----sue ..... AC Application Disapproved for the folloudt$g reasons:.........•...,;,,,,,,•,, DAte ............................^...................................................... .... .....•........._.._--.................................................... ............... Permit No..__ .� _. ..—.. ...............�__. Issued..............._.... .._.. .................... . . . Datee/,% THE COMMONWEALTH OF MASSACHUSETTS i BOARD OF HEALTH rQ ra,.�..�t.. ��r#i�irtt�r �rf (�utu�rlittrtr� THIS IS TO C RTIFY, That the Individual Sewage Di by.. „�. ............ sposal System constructed ( ) or repaired „� 1 •. ............•.... '.y am........r��:�..�.�... _ .. NO .Installer................................. at .-...__._..... ....^..�...... ...................... •••'• • ..........Al.......,(�, has been inst.t led in ascot' 5 of .................:.:........:...nd"'e'.a....-- •- _..............:.. asses with the provisirnt5 of "'iE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No..�j�..�:„••�� .... ..�,......_.- dated:..............:............................:... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE........^.......... �f.. ... _. .. .. .^�........................... Inspector...............L�� ,. ._. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........ ........OF__.............. FEs.. Disp alottl Works (9jangtrudin rprutit Permission is hereby granted.......... !:fit;; toConstruct ..t:.3...... :.2:.O.a...ax:../.er.N.M................................... or Repair•.,( an Individual Sewage Disposal System -sue........ ••�:�,.............................._..:.... as shown on tits application for Street........................................................I........•............ PP o Disposal Works Construction Permit ,No / , ,,, Dated............ ••JJ�� ��°° _t. ti,.�...,.. ._.................. ..�.�.......- .....P`.?9;....:..l.�.. .................. .»... ~Board of Health FORM 121l9 NOOIQB d WARREN, INC., PUOt.ISNLAQ DEC 09 192 14:43 LARAJA KANAGA & BOTT �a ro P.6i6 " E ���A�• �L'`4 H Imo..{ .' �, r• •M~..r 4'4 G7 M � � N cn h Quo ' v4'c� rt o a u ep - I I F''• to 0 a • ���' N Ike r ..A jj v Oro ►� < t This p� does not require ro c approval of the Board of S•• ca c o An OF VZ4r 0 CP DE_ s i IOU BAN OF? LAND�E'p;.11357 M IN t-e� ae- 13�.,Q At�srorvs MIS.`$, M ASa ZN sd Scat, I IN=40 Fr: x • Mss.�raN j V t.Y 4 �a sulet •. S��g f�� _... �. I I } h �, � r -; 3s 1(0.... .7:� ... �� F$x....: THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH od �Y..t!.ti............OF......:....... rrkr�.mr�7�.,!��It~. ...............;..... . Appitratinu for R.4pnutti igurks (Ionstrurfivo rumit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal system at: n:.,.....�.� its .... / .......:.................................................................�................. ....... ........... ...... 4./� ,+„location-Ad/dye,�/I (� L/ �� / .• for Lott /1;1 `�f .... :.[.. [.--•........................... .f. .l..../`.:: ...'�Y�..(.:.t. '`R. .�. !.. l�. ........... • Address ........ _4.. ...r..... .......... ................. Address Type of Duilding Oj U 0 D Size Lot............................. feet ••. Dwelling---No. of Bedrooms......... ................. ....Expansion�ttic ( ) Garbage Grinder64 124 ( ) Other—Type--Type of Building ............................ No. of persons........ ...........,.,,,, Showers (f ) — Cafeteria ( ) Otherfixtures ..................................... .................................................... ...................._:._..�....... Design Flow....:..,1 (l:..........................gallons per person y. Total daily flow.....-3.3.6..---..-.......... gallons... Septic Tank Liquid capacity gallons Length... .4 ��. ..... Width Diameter................ Depth-�6.__... Disposal Trench—No. .................... Width.................... Total Length......,.....,. Total leaching area.............. sq. ft. � s b .. Seepage Pit No....... Diameter....... Depth below tnlet. ..�P......... Total leaching area.,��.-, �q. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Perform Test Pit No. I................minutes per inch Depth of "Pest 1'it...,l ....... Depth to Date.........ground water ..... er.. .. . .........f.V.�?k/� Test Pit No. 2................minutes per inch Depth of Test Pit.................. Depth to ground water.................. 0. Description of Soil.f�.-�.�_1�?1.Q�..�:..���:..�.�li��..�1.!.�...��d.I.� �.�Z.r.'�,..1:�.�:.�.��.���!�._' W. .. ...0:R / u - .k .............................................•-•-....._._................... .........................................................................:............•.......................�r�_ _ u Naturg of Repairs or Alterations--Answer when applicable. 1 t :, ,C .-�f,_(32.). ........................_......._.................-1.................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of-TITIZE, 5 of the State Sanitary Code—The undersigned further agrees not to place the System in operation until a Certificate of Compliance has been issued by the board of health. Signs .. ... - ......... ..l ' Application Approved B ..............y. , , .,, .......... 7 Application Disapproved for the follouring reason.sr........................................................... opt` .,-------------------•--. .................................. ................ • Datc Permi t _.7.-..2a-a.............._...... Issued i ..................... .............. . . ...� ...... •� r ' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF, HEALTH Q Tutifi.cau of Tour rlialtrr.......................... � THiS IS TO C RTIFY, That the Individual Sew1 ge Disposal System constructed ( ) or Repaired � ....... 2*4* .... .............. _.........................--- -••-.............. .............y�....:....r��:�..� .----- ,t,�...... *,�: .__ __ __ _________ has been installed in accordance with the provisions of T "'ice .��.�S of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.. ...Z....7.490........_. dated................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................Lr..:�...�..�.. ........................... Inspector..............�,. .......................... ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........OF...................� _ Permission is hereby granted.........C Sri{; { - to Constructs G) or Repair,_4�) an Individual ............................... ............ t• - ttal Sewage Disposal System Street ...................... ....... as shown oil the application for Disposal Works Construction Permit No Dated l,� ,.;2, \ ••. 1111111 onrd of Health FORM 12115 WARREN, INC., PU®LISHtxg$ - lit _ w e. r _ 1 ( -4, e : 1 li .............. .. T-1 i I .................... hl { ICi Ii � I I .S , � � i I � � I -11'!-'L1 (,ATiuN iuk SITE ELAN REVIEW FUR Ufr'ICE USE ONLY s' DATE RECEIVED ACTION DUE BY LOCATION Legal Description: Assessor's Map 126, Parcel 001 Planning Board Subdivision Number: N/A Assessor's Map and Parcel Numberr 126/001 Property Address: 544 Race Lane, Marstons Mills MA 02643 OWNER OF PROPERTY APPLICANT Name: Cathleen J. Hill Namer Derek Johnston 4ddress: 3329 Fairhaven Road Address: 544 Race Lane Davenport, IA 52807 Marstons Mills MA 02648 Phone: (319)• 359-6763 Phone: (508) 420-3509 ENGINEER AGENT(1xxkerA=kxxmMerAVrr applicant) vame: N/A Name: Benjamin E. Zehnder, Escq 4ddress: AddreSSr Laraia, Kanaaa and Bott P.C. 46 South Orleans Road PO Box 236 Orleans MA 02653 Phone: Phoney (508) 255-5500 YI51I�1�: pr�,�, r,-P'SE� OTILIiI£S ZONING CLASSIFICATION(S) D fever District: RF Number: Htlxi er': N/A Public_ Flood Hazard: iiZe' Size: Private X - Title v Groundwater Overlay: GP Above Ground:— Above Ground:_ Fire District:Marstons Underground: Dater: —Rills LOT AREA: 51,470 sq. ft. Content,:: Contents: Public X Private:_ NUMBER OF BUILDINGS Fire Protection:_ Existing: 3 aT}.;Nl� FAAt;c.� Cr� B CilTS Proposed: N/A =egeclrel: _ Existing: N/A Electrical: Demolition: N/A rov1ded: 5 _ Proposed: Arial: X )r: Site: 5 To Close: Underground: TOTAL FLOOR AREA (in sq.ft. ) rf cjte: _ Total- comas: Residential:_2790 Natural: X Office: N_ii15T!? IC_AL f�IS'TF'I CT:(yes)_ i1), j X Propane:_ Medical Office: 1:N AREA OF CRi 7ICAL ENf IRnNttENTAL Commercial: (specify use)_ CONCERN (E_O.£.A. ► : (Lies)__ (no) X r 03EC? (dITHIN 100' OFlIETLAND RESOURCE AREA: (yes) Wholesale _ (no)_� Institutional: ePICCEIVEC .: . �-�.;. , ,w.. Industrial: Garage Proposed Area of Use 400 SITE PUC r W07 RJfcD" `+ A 2 rLn:,,3 The Site Plan shall Include one or more appropriately scaled. maps or drawings of the Property, drawn to an engineer's scale, clearly and accurately Indicating such elements of the following Information as are pertinent to the development activity proposed: 1) Legal description, Planning Board Subdivision Number (If applicable). Assessors' Map and Parcel number and address (If applicable) of the property. © 2) Name, address and phone number of the property owners and applicant If different than the property owner. ® 3) Name, address, and phone number of the developer, contractor, engineer, other design professional and agent or legal representltfve. ® 4) Complete property dimensions, area and zoning classification of property. N/A ❑ 5) Existing and proposed topographical contours of the property taken at two-foot (2') contour Intervals by a registered engineer or registered land surveyor. ® 6) The nature, location and size of all significant existing natural land features, Including. but not limited to, tree, shrub, or brush masses. all Individual trees over ten Inches (10") in caliper, grassed areas, large surface rock in excess of six feet (6') in diameter and soil features. N/A ❑ 7) Location of all wetlands or waterbodies on the property and within one hundred feet (100') of the perimeter of the development activity. ® 8) The location, grade and dimensions of all present and/or proposed streets. ways and easements and any other paved surfaces. N/A ❑ 9) Engineering cross-sections of proposed new curbs and pavements, and vision triangles measured in feet from any proposed curb cut along the street on which access is proposed. ® 10) Location, height, elevation, interior and exterior dimensions and uses of all buildings or structures, both proposed and existing; location, number and area of floors; number and type of dwelling units; location of emergency exits. retaining . walls. existing and proposed signs. II) Location of all existing and proposed utilities and storage facilities including sewer connections, septic systems and any storage tanks, noting applicable approvals If received. ❑ 12) Proposed surface treatment of paved areas and the location and design of drainage systems with drainage calculations prepared by a registered civil engineer. ® 13) Complete parking and traffic circulation plan. If applicable, showing location and dimensions of parking stalls, dividers, bumper stops, required buffer areas and planting beds. ❑ 14) Lighting plan showing the location. direction and intensity of existing and Proposed external light fixtures. ® 15) A landscaping plan showing the location, name. number and size of plant types. and the locations and elevation and/or height of planting beds, fences, walls, steps and paths. ® 16) A location map or other drawing at appropriate scale showing the general location and' relation of the property to surrounding areas including. where relevant, the zoning and land use Pattern or adjacent propertles, the exl5ting street 5y5tem In the area and location of nearby public facilities. N/A ❑ 17) Location within an Historical District and any other designation as an Historically Significant property, and the age and type of each existing building and structure on the site which is more than fifty (50) years old. ® 18) Location of site with regard to Zones of Contribution for public supply wells as determined in a report entitled "Groundwater and Water Resource Protection Plan. Barnstable. Massachusetts" prepared by SEA Inc., Boston, MA, dated September, 1985, which is on file with the Town Clerk. N/A ❑ 19) Location of site with regard to Flood Areas regulated by Section.3-5.1 herein. N/A ❑ 20) Location of site with regard to Areas of Critical Environmental Concern as designated by the Commonwealth of Massachusetts. Executive Office of Environmental Affairs. S : . _rc_kL_v1EWfL/ t'' -It Ih,__t -) iLoIM, t_ tit,M1 _t,io".c_i. : Zoning District RF Old King' s Highway District NO or Listed in National and/or State Register of Historic Places NO Perimeter set backs: Front Side Rear _ Lot Coverage Tupe or Use ( zoning) RF Flood Plain Zone N/A Elevation - Number Of Floors Two_ Floor Area: lst 1110. . Znd 864 - Basement Other (specify) N/A Parking Requirements: Required Discretionary Provided 5 Handicapped Spaces Are there accessory buildings? Yes Accessory Buildings Floor Area @ 1216 ftz PLEASE PROVIDE A BRIEF, NARRATIVE DESCRIPTION OF YOUR PROPOSED PROJECT. Applicant proposes to use premises, in conjuction with two other locations in Falmouth and Eastham, for the training of dogs and their owners. Owners will drop off the dogs or, sometimes, Applicant will conduct small training classes on the premises. Animal feces will be disposed of in accordance with Health Department suggestions. 1 assert that I have completed (or- caused to be completed) this page, the Site Plan Review Application and the checklist on the back of the application and that, to the best of my knowledge, the information submitted here is true. ` (signature) (date) Benjami E. Zehnder 6 Division of Land YES NO Is thisv a division of fifty (50) acres or more of land which was In I I IX common ownerslill) as of 1/1/8R? Is this a division of fifteen 05) acres or nnore of land which was in common ownership as of 1/1/88 and which was the result of an earlier I I Ix subdivision within tine last seven (7) years? is this a development which proposes to divide land In commloin I i Ix ownership Into thirty (30) or morc resldcntial dwellinng units? Is this n development which proposes to divide land in common I I Ix ownership Into ten (10) or more business, office or industrial premises? Creation of more than 30 dwelling units Is tills a developnieill, lnehaIillg the expansion of misting developments, that Is planned to create or accomnioclate more than I I I 30 dwelling units? Commcrclal Construction • Will the development create retail or wholesale business; office or Industrial dcvclot,nicrit: private, health, recreational, or educallonal dcvclopmcnt with a Boor area as follows: 1) New construcllon greater than 10,000 square feet? I I Ix I 2) Addition or auxiliary buildings greater thait 5.0w s( uarc feet? ( I IX 1 3) Outdoor commercial space greater then 40,000 square feet? ( I IX I 4) Use changes wlnlch Niue a fluor area greater th;ui 1p,000 square; feet? I ) Ix! Facllltics for Transportation to or from Barnstable County Will tlic devclul„ncnt construct or expacici -flittt far transportation to or froiu Danistablc Conroy? I i IXI Access To The Coast Or A Great Pond is tliis devcloprinent a bridge. road or driveway providing dirm velileular access to tile: co;tst or;i great ponc)T I I IxI Historic Structures Will (lie development deneollsh or sul)st;intially alter an IIlslorle structure listed with (lie National or Massachusetts Register of Historic I I Ixi i'laces, outsldc a neuniclpal historic district or outsicle tine Old ICings Highway Illsloric District? (Note: Repairs. upgrades, changes. alterations or extensions to n single family honk arc exempt from Commission review unless the proposed repair, upgrade, change, 11tcl-Mlon. or extension Is greater than 25% of the floor area of the existing dwelling.) P '7 ADDRESS: 544 Race Lane, Marstons Mills BUILDING COVER: 5.25% LEGAL DESCRIPTION: Assessor's Map 126, Parcel 001 NUMBER OF FLOORS: 2 ZONING: RF PARKING SPACES PROVIDED: 5 USE: Home Occupation/Dog Training LOT SIZE: 51,470 ft2 BUILDING SIZE: 2,704 ft2 c°.V3 i b tiA b U„ „0 h In a y„ n b M y i 4w 'kb P4 o 'y •� �'`; J J } L9 0 d ri 'S ,b yh� ..�,,L 0 IL = d = > Cj o a all Ix All J Q Z- 11 v J ►l V toSL = .ri Z i N Ir Lai in • 0 j � � ' QCo v rj ^ wl -- [. ASSESSORS , 6/ 1 �t t � .37 nP3 1 cos I 14. R A -C E a7O.a 3q L(. � 69 /30 .. 5.01 aL e71 ISO O 7o ISO /.00'W. . 7j (�." ISO _ 0' to�4a) too me ® fe z 75 77 72 I.Oi K. I.Soac O Roos 73 51 aO 0.00 Ar- 7G Lol A �`. 1.00 AC. ® .76 C'41h 4.LT\ 4 ' K 4 N /•08 1 O a� �� o , RHoo` S`' a ® O 8i r31 '4 ad e 1.01 Ar tV I.OL K CI 01 95 ssa D e f� I.00 cc e 89 Io i r °.4 ^' s 90 i4 �1 9') Q I.co.r 1.°°AC. P/t. 91 a6 � a� I.OI.� 9 l 6 9 CJ b 5°� I�Oo �J PREPARED UNDER THE DIRECTION BARNSTABLE BOARD OF AS THE 9t ti SESSORS--�-">s h 1.0. .o o AVIS AIRMAP IVf s. SCALE MA-15AC"JS ETT3 PROPERTY ADDRESS I I ZONING I DISTRICT CODE 'SP-DISTS.I DATE PRINTED I CLASS I pCS I NBHD 1544 RACE LANE 03 RF 300 03CO 03/28/92 1LAS 00 2QAC R126 001. KEY NO. LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS 68483 1nO Bj'�D•'• S'•D'^•^•iee r UNIT ADJ'D.UNIT L Y M A N• R O N A L D D b H E L E N M b M AP- CD FF� 1NAcrn OC.fYR. PEC.CLAS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE D. pton 10 1BLDG.SIT 1 X 1 =10 110 39999_9 39999.99 #LAND 1 41.600 CARDS IN ACCOUNT - L 1.00 40000 #BLD6(S)-CARD-1 1 82.600 01 OF 01 A 11 1RESIDUAL' I X =100 130 800D.00 8000.00 .20 1600 #OTHER FEATURE 1 10.000 N p 3ATHS 1.0: U X C= 1]0 #PL 544 RACE LANE MM ARKET 69400 3500.00 3500.D0 1.00. 3500 B #DL LOT 3. 4 b UNMB NCOME 40T TUB U X' C= 110 1.00 2700.00 1.09 2700 B #RR 1344 0205 0 i A R61 DETGAR S 18 X' 40 197 C= 78 16.22 12.65 720 9100 F *40481215 3/84 SE SHED S 12 X' 8 1970 .0 78 12.00, 9.36 96 900 PPRAISED VALUE A 134P200 T S ARCEL' SUMMARY A T AND 41600 LDGS 82600 E -IMPS 10000 F E OTAL, 134200 E N - CNST A T DEED REFERENC TTq DATE R I O R YEAR VALUE T S Boa Pew '"" MO. vr. so"PNo. A N D 41600 u 5684/279t I 4/87 A 1 LDGS 92600 R 3611/317.' I-11182 0 40000 OTAL 134200 I t E I t 1 S BIJILDIN(i PERMIT 6 A R-4 0% COMP LAND ' LAND-ADJ , INCO E SE SP-BLDS FEATURES BLD-ADJS UNITS Nt.lb« Dal. Typ. A"�y /88___.........41600: 10000 - 6200 100% COMP 1189 C1e.a °on" T«� Base Ae ve„R„n _ 31335 10/87 AD 10000 . SHED ATT-TO R61. Urob Urote 1.Rate A Age Dw. Good. CND. Loo. qe Rep.Coal N" Aq.Rep.Valm Shin ••_•......._.•_ 1 C 000 10D.100• 74.50 74.50 50. 70.21 i 78 105 .95. 95 4 R.G.72:8 ` " "°°�' R«' e""' �� PeRy../F.o 113474: 82600:1.D. 5 2 1.0 . 4.0 . Dex p- Rat. Spears Feel Rep.Cost _ MKT.INDEX: 1•OO ' IMP.BYIDATE: M 2/8 S � 1 I O D.49 B A D:10 0, 4.5 0: 8 6 4: 6 4 3 6 8 SCALE: ELEMENTS E coNSTRucTXN1 DETAIL S FWD 85 8 '50 198 1683 T FWD 85 8.50 912 7752 29- *` STYLE 03 ANCH 0.0 R .. ..FWD ! ESTGN-AWJ`RT- -00 ---------------- U 615 72 3.64: 624 33471 � - --Tr=0 . ! ' RT .pA1TS-- 01 DiI6-FRI(ME-------II_-0 . EATIAC-TTPE- -04 I-:-------------- T ! *-8-* ! - RTFK:FINISR- -00 -------------- U ! 6 6_*-r--24=- -* NTyWw'1AY60T- -02 ----------- Zr."0 R *-:-----36---18--*-8-*:45 ! -------U:O A - RTFA:9UAl_TT- 02 A?fE-AT-ERTFfI.---II=O ! - � - - CDUR-STRUCT- 00 --------------- L E Total A-._ 1110- 864. 2;_ ! ! - ! E CODY-CDVER-- -00 ----------------- e85e- BASE 24-. 26 _ ____ _ -U.-O BUILDING DIMENSIONS 26 DDF TTPF' QO �_O T � � CETTRIt-IL'--- -Q0 _ -------------- -------- A AS W22 FWD �S09. E22 N09 W22 �- � -------- �_0 , ! - G15 ! OUMfAT2 6N--- 00 ----------------- AS W14 N24 E36`FWD W18 N24-E29 � - �_9 ! ' --------------- --- ---------------------- 65 615 E24 N26.W24 S26 ._ FWD *=-14=-*----22---X=r11-a►----24----*. L 303 W11 N24 E08 N06 W08 S06 PTEIbIfgOR 00 27AC-T+fARSTDTIS'1K7CC 9 3AS S24 _, � - FWD 9` LAND TOTAL! MARKET PARCEL' 41600 134200 *=---22---* AREA 2503 VARIANCE +0 +5260 S STANDARD 25 TDPOGRAPHY '1 LEVEL * TOPOGRAPHY *"UTILITIES 2 PUB WATER * UTILITIES 6 SEPTIC ST FEATURE. 1 PAVED * ST FEATURE * UTILITIES * ST FEATURE * DWELL LOC. 2 MTODLE * LOCATION ST_ COND. * TRAFFIC ' 2- MEDIUM * AMENITIES * AMENITIES • NUISANCES * * NUISANCES * * YOU WISH TO OPEN A-,BUSINESS? For Your Information: Business certificates (cost$30.00 for.4 Years]. YOU must do by M.G.L.-it does not give you permission too operate.) A business certificate ONLY REGISTERS YOUR NAME in town Main Street, Hyannis, MA 02601 (Town Hal(] p ) Business Certificates are available at the Town Cle ---------------- rk's Office 1•� F (which L., 367 fim� r @g, Wi 1 � �`a„ '�F 21' APPLICANT'S DATE: L YOUR NAME S: + Fill in lease: BUSINESS H• 1 p P 2X#A ,. �� YOUR HOME ADDRESS: k s 30-IM, r TELEPHON # Home Telephone Number NAME`OF CORPORATION: .NAME OF.NEW.QUSINEERS IS THIS.A HOME I�CCUPATfON �r ADORE SS.OF BUSINE59 � YES NO TYPE OF B 51NE 5 (( N1 GG�i . ��` Q ,. When starting anew business there are several things you must do MAP/PARCEL NUMBERi (Assessing) Barnstable. This form is inintendedsthe o assist you in obtaining the information ou in order to be in compliance with the rules and regulations of the Town of Rd. & Main Stre,et]. to make sure you have the appropriate permits and licenses required to legally operate'your business in this town. I. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any per requirements that pertain to this type of business. .COMMENTS: Authorized Signature** 2. BOARD OF HEALTH This individual has be n in�J m/�t d�p�fhe permit requirements that pertain to this I �I V I V I type of business. Authorized Signature** :.,.` :...T` MUST COMPLY WITH ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3, CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this e of type business. COMMENTS: Authorized Signature** + A L� Date: 3/ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: i< �r� c4(-2 BUSINESS LOCATION: 5ALA lvjMqr-. .115 M9 626 a INVENTORY MAILING ADDRESS: 0� ICK M�r,5 a/s 1 <<s VyI� 11� TOTAL AMOUNT: TELEPHONE NUMBER: 36o b CONTACT PERSON: N �)v EMERGENCY CONTAC TEL PH NE N MB R: k�� 3S "6 MSDS ON SITE? TYPE OF BUSINESS: C cqe- 4NoSc INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils p Pesticides ❑ NEW El USED 5 (insecticides, herbicides, rodenticides) \Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) 'j"3lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for drive ways eways&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/CANARY COPY-BUSINESS A licant's Sig ature Staff's Initial 1•`'. . �, The Town of Barnstable i fA1VILSO, A : Inspection Department r6 71. %��� 6i.Y'. 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D. DaLuz Building Commissioner November 18, 1992 Mr. Derek Johnston 544 Race Lane Marstons Mills, MA 02648 Re: site Plan Review No. 41-92 544 Race Lane, Marstons Mills, MA Proposed home occupation, dog training Assessor's Number. 126.001 Dear Mr. Johnston: In reviewing the above referenced site plan, the attached comments and requirements have been submitted by the Site Plan Review staff. Any additional or revised material should be submitted as soon as possible to allow adequate time for staff review. should you have any questions, please feel free to call. Peace, Joseph D. DaLuz Building Commissioner JDD/km cc: All site Plan Review staff enclosure-s ) SITE PLAN REVIEW STAFF COMMENTS SP-41-92 Planning Department See Enclosure 2 Health_ Department 1. Does the onsite sewage disposal system for the residence meet Title V, the State Environmental code? 2. where will the dog feces be disposed of? It is suggested that the feces be placed in odor-proof receptacles prior to proper disposal at the landfill. enclosure 1 Town of Barnstable Planning Department TO: Joseph Daluz, Building Commissioner FM: Robert Sche=nig , Director Anna Brigham, Associate Plannerr RE: Comments on Site Plan Review #41-92 , Johnston Home Occupation, Marstons Mills November 6, 1992 q 1 . The site plan does not meet -the requirements of Site Plan Review. Dimensions need to be included. See Section 4-7 for further requirements , 2. All requirements of Section 3-1 . 4 RF District 3) Conditional Uses A) must be complied with. This proposal will require a Special Permit from the Zoning Board of Appeals . It is recommended that the applicant do whatever he can to minimize the possible neighborhood objections to this home occupation ( see e) . Some possible solutions are heavy exterior screening and special interior soundproofing etc . 3. Please note this proposal is in two Groundwater Protection Overlay Districts - GP and AP. 4 . It appears that there is an accessory use of horses on the premises . All requirements under 3-1 . 1 (2 ) (B) must also be complied with. 5 . We recommend a letter from the owner to allow this proposal on the property. 6 . It appears that the site plan shows two garages on the premises . Which one will be used for the Home occupation? .. CAPE CO� f' LWORT LOCUS o f �o. ` y yC PAU G� � A. No. I !� IST 0 Q�k� " POND a n Sob;?4 ' » 86. 48 MARSTONS MILLS ti \ �10. pp LOCUS MAP o � o C.B `sue Rl 9 P pROpO / �� PLAN REF.- 1.2034D SH.2 RES. ZONE 'RF FLOOD �, VAILABLE LOT 6 \ ",VI ?� JOHN ASSESSORS LOT 133 �ti` O liT OL �`� �� LANDERS• LEY 5 _ / ' � CAU �. 43 661S.F. c IL O N . 101 00 14 51 �0� ry ti0 10 PROJECT L O A T10AI 13 ,.. 3�o ASSESSORS LOT #133 RACE LANE T� T,gNx� o MARSTONS MILLS, MA. i 99.8p 007 21 HAMPDEN DRIVE LOT 7 ��S' �� f' i SOUTH EASTON 11IA. 02375 \� ASSESSORS LOT 134 YA NKE E SUR VE Y CONSUL TA N l S P. O. BOX 255 UNIT 5, 40H INDUS7R Y ROAD C�� � MARSTONS MILLS, MA. 02548 PH. (508)428-0055 - FAX(508)420-555J GRAPHIC SCALE �s 30 0 15 30 60 720 / SCA L E'I"=30` ILDA TE. o4/2s/96 i .: ,• ,,,,..: .. ;, / ON HYDRANTBOLT RE V.- 5130196 . REV. ( IN FEET ) ELEV.=102. 74' (ASSUMED) 1 inch = 30 ft. / JOB NO. 50822 SHEET I OF 2 F.F. ELEV.=101.5 PROPOSED 1 0'min. ELEV.=VARIES t I 4" CAST IRON OR ELEV.=99.5f ' SCHEDULE 40 P.V.C_. �CONCRETE COVERS 4" DIA. SCHEDULE 40 PERFORATED PLASTIC PIPE 4" CAST IRON OR `ir SCHEDULE 40 P.V.C. END CAPS ON ALL PIPES I 5' ON CE ER A 3" LAYER OF DIST.=14.5' SLP.= 0.02 SLP.=0.005 12 min 1/9"-1/2" — INVERT DIST.=11_9' CONCRETE COVER DIST.=1E_— WASHED STONE ELEV.= 97.6 4 FLOW LINE _ SLP.=0.02 96 69 °�0�0�08 O, 0 0, 0.0 0.0.0. 0. 0 0 0 0. 0 0 0 °.° °„°"° o, o.,o,0.,0,°.° o o.° 0 --- ELEV.= 97_35 — INVERT ELEV =—_ o 0 0 ° ° o ° o ° ° ° ° ° ° ° ° ° o 0 0 0 ° o ° o 0 0 0 0 0 ° ° o ° ° c 10" MIN. -- o 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 19" _o_o_o_0 o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_o_0_0_0_ _0_0_0_0_0_0_o_0_0_0_ ELEV.= 97.10 ELEV.= 96.8 ENV = 96.69 0 0% s" LAYER OF O . /4" TO 1-1/2" 4" CAST IRON OR -- 00 0u0u0v0v000 0 0000 - 0 - C, 00000 o00 0 V 00p00. WASHED STONE SCHEDULE 40 P.V.c. DISTRIBUTION BOX n ,0,0 0 0 0 0 0 o O�o�o�o� � o„o o_o 0 0„0„0, IF MORE THAN 4' OF COVER, ELEV.=96_5 A USE H-20 LOADING USE STONE I 1500 GALLON SEPTIC TANK TO BE WET TESTED IF TO LEVEL THE MORE THAN ONE OUTLET. 8.0 TO BE PLACED ON BED AS NEEDED. 6" OF STONE OR TO BE PLACED ON MECHANICALLY COMPACTED SOIL. 6" OF STONE OR — — — — — — _ USE A TANK WITH THREE COVERS. MECHANICALLY COMPACTED SOIL. BOTTOM OF TEST HOLE OR USGS PROBABLE WATER TABLE ELEV =88.5 USE H-20 LOADING SOIL TEST DONE BY: J.E. LANDERS-CAULEY P.E. IF MORE THAN 4' OF COVER. WITNESSED BY: J. DUNNING --------- PERCOLATION RATE: __2---MIN/INCH P# 8582 ynx,oF 3' TEST HOLE 1 DATE: ELEV._99_5 ___ �o�o�o�o�o°0 00�0�0�0�0�0� assrorrs PROFILE OF 00000 oo®o°o DEPTH HORIZON TEXTURE COLOR MOTT. OTHER SEWAGE DISPOSAL SYSTEM 3 PERFORATED PIP S NOT TO SCALE 0"-3" 0 SECTION OF 3"-9" BTv LOAMY SAN o JOFIN �yG GENERAL NOTES: _ LarvDERscAutEY , 9"-32" B LOAMY SAN U No CIVIL.01 ti o '�E 1. THIS PLAN IS FOR THE CONSTRUCTION OF A NEW SEWAGE DISPOSAL SYSTEM. PERK AT 2. PLAN REFERENCE 12034 D LOT 6 BARNSTABLE REG. OF DEEDS. 32"-132 C YVED. SAND 36 3. THIS PLAN IS FOR THE INSTALLATION /REPAIR OF SEPTIC SYSTEM NO WATER AND NOT TO BE USED FOR SURVEYING AND ZONING PURPOSES. ENC'T DESIGN DATA: 4. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. NUMBER OF BEDROOMS IBREE.-(3)_-- 5. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN TEST HOLE 2 DATE: 10�0�95 ELEV._ NUMBER 12" OF THE FINISHED GRADE. GARBAGE DISPOSAL _II91�IE_(9�_____ DEPTH HORIZON TEXTURE COLOR MOTT. OTHER 6. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE TOTAL ESTIMATED FLOW -33Q----- GPD SAME, UNLESS NOTED BY FINAL CONTOURS. 7. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE 0 - 0 ( 11(L__ GAL/BR./DAY X �____ BR. ) OF WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR 3"-9" ByV LOAMY SA1V SEPTIC TANK CAPACITYQ2�9L__ WITHIN 10' OF DRIVES OR PARKING AREAS. H-20 LOADING SHALL BE USED UNDER OR WITHIN 10' OF DRIVES OR PARKING LEACHING AREA REQUIREMENTS AREAS UNLESS NOTED. 9"-32" B OAMY SAND 8, ANY MASONARY UNITS USED TO BRING COVERS TO GRADE SHALL SIDEWALL AREA 0-___ GAL./S.F. BE MORTARED IN PLACE. 9. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 32"-132" C MED. SAND BOTTOM AREA _45_2 GAL./S.F. DEEDED OR ZONING REGULATIONS. OWNER/APPLICANT IS TO EWALL&BOT. SID OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. NO WATER LEACHING CAP. )_333 333 GAL. 10. THE EXCAVATOR/CONTRACTOR SHALL VERIFY THE LOCATION OF ENC'T ALL UNDERGROUND UTILITIES PRIOR TO ANY EXCAVATION. RESERVE LEACHING CAPACITY _33_3 GAL. tw APPLICANT: CHARLES & RITA RE DATE: MAY 6, 1996 REVISED: MAY 30, 1996 SHEET 2 OF 2 IJOB # 50822