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0047 SAMOSET ROAD - Health
17 Samoset Road Marstons Mills - - - A = 101 114 ,(S Date L� Physical Street Address-Check database to ensure it exists 1� Working Phone Number Actual Amounts -( ie. gas being used to fuel machines., thinner to clean brushes all count as hazardous materials-no blanks) Storage Information -location of storage, how long is storage for? If none, note that. AW Disposal Information -where and who? If none, note that. Applicant Signature - understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -give a vehicle washing policy and explain it Z_--Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. Jam..... RR-L--:-1-, l._.. _�_ -1-— — - _I_.. . _ _ _— __- YOU WISH TO OPEN A 13USINESS? For Your Information: Business certificates [cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by.M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE:tl 11,61 T Fill in pe: :1 APPLICANT'S. YOUR NAME/S: �' Fe- rye y,, l as BUSINESS �y Q YOUR HOME ADDRESS: �1 O yS Dyi S 7 _ c� TE PHONE # Home Telephone Number a6 NAME OF CORPORATION: NAME OF NEW BUSINESS a)/j t C' earl ��y1 Se v Li < <'S TYPE OF BUSINESS IS THIS A HOME OCCUPATION? _YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER — I [Assessing] 0.) 6 q p When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the.information you may need_ You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) .to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING�COM ,ISSION R'S OFFIC This individu I h e i fo m of a rmI requirements that pertain to this type of busine HOME O PATIO BUST COMPLY WITH CCU Autho •zad Sigpatur ULES AND REGULATIONS. FAILURE TO MMENT I 0j ry hul CONAPI.,Y MAY RESULT IN FINES. ll 1 2. BOARD OF ALTH This individual he info ad rm uirem hat pertain to this type of business, - Authorized gn ure** MUST COMKY WITH ALL COMMENTS: , WMDOVS MATERIALS REPUMONs 3. CONSUMER AFFAIRS (LICENSING AUTHORITY] Thio Individual has been informed of the licensing requir`arnants that pertain to this type of business. Authorized Signature** COMMENTS: - I Dater/lam llS TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: _dd r1 t, Cl edn-"n �r9' Se r BUSINESS LOCATION: S,�mN�Sc� ,-d r kn!; ./ ills 111ANVENTORY MAILING ADDRESS: P©. /�D.)G !a 2 TOTAL AMOUNT: TELEPHONE NUMBER: 41e 9 �1s a1 p CONTACT PERSON: >'�'✓/ EMERGENCY CONTAC TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: c a L7 /' n `Y= 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) &2 Miscellaneous Corrosive ❑ NEW ❑ USED Q Cesspool cleaners ® Automatic transmission fluid 0 Disinfectants Engine and radiator flushes 6�1 Road salts(Halite) C9 Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED e12 (insecticides, herbicides, rodenticides) �j Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - m Degreasers for engines and metal Printing ink 69 Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents C2 Leather dyes Car waxes and polishes ® Fertilizers Asphalt&roofing tar PCB's D Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners 12 (including carbon tetrachloride) D ❑ 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 Q Floor&furniture strippers v may be toxic or hazardous (please list): (� Metal polishes Q Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids a (dry cleaners) Q Other cleaning solvents 62 Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials TOWN OF BARNSTABLE LOCATION 417 J/9!y a S s/ D SEWAGE#p / � '%A VILLAGE M,e,rS7VW M,Ar ASSESSOR'S MAP&PARCEL /0s/ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /000 LEACHING FACILITY.(type) —,SOy X WAV� (size) 9,5—)C 13 NO.OF BEDROOMS --3o OWNER 0 D Eu dddRJ4.DP, PERMIT DATE: /S" COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)/ Feet FURNISHED BY t L3 _�=S7.2•. a CSack w ao' rrl • No. C?v�1 L4 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4plitation for Vslo8�Itl; tem Cunstrurtiun 3dermit role vim" G�Application for a Permit to Construct( ) Rtpair( )i Upgrade( ) Aandon( ) ❑Complete System ❑Individual Components OE Location Address or Lot No.y?s'F���OSC;T O Owner's Name,Ad,�1ress,,,annd Tel.No. Assessor's Ma /Parcel ,OW P In�staVa} e,Address a d Tel.No..f"48"�/2�-Q'-� D signer's Name _ r sand Tel.No. d ' 8/C,��sr�-�!l�!�i,�rsrol�s Dl�l� 9`3 9�l �h.Sr• ��isrvdT E'dp r''� .� rwf TI pe of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) `j�O gpd Design flow provided 33o gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) TO Date last inspected: t 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 Certificate of Compliance has been issued by this Board of Health. Si ned Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ) s Date Issued i No. CT'"�� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplitatlon for 33isposal*pstrin- Construction VPrmit Application for a Permit to Construct( ) Rpai »Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.' 7."S��/OS l;T o Owner's Name,Address,.and Tel.No. ,y/,yNSI`Up/5 l�L1i r�iOG'U /9Hf�/'sa1J/J Assessor's Map/Parcel 0/.//y Inn,sstaller's Name,Address,and Tel.NospB /fa-9�3 Drigner��ame Address and Tel No. OG JaSc/� U� rjvvU S f/ ovsa- qn� i�vG�i��-e/'iHr��.t/c. AvrT /t' �= �X Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures 2 Design Flow(min.required) 13 3Q gpd Design flow provided 330 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) fin// %,(�!$ L�iyGl�/i/� TD /1��jG pG k1Ti� r Date last inspected: 4 Agreement: q 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 Certificate of Compliance has been issued by this Board of Health. Si ed Date {1 Application Approved by Date 1� t Application Disapproved by Date for the following reasons Permit No. S '' Date Issued ` 1 THE COMMONWEALTH OF MASSACHUSETTS (BARNSTABLE,MASSACHUSETTS THIS IS TO CERTIFY,thatt the On-site See g U e Disposal system Constructed( ) Repaired( ) pgraded( ) Abandoned )by j�o�ef'� !/G ��o�/f'�S at z/7 J,�if>O_S�T /���.,�>.' T�/i?S y`/i��� has been constructed in accordance l l with the provisions of Title 5 and the for Disposal System Construction Permit No 15 "�Adated Installer i1✓.5elq� U-e. ��/'�S Designer Paawl C'�al //✓Gir7��s�i�/o T.U�, #bedrooms � Approved design flow `�30 .gpd The issuance o this permit shall not be construed as a guarantee that the system will nc n; design rO Inspector_A V`. J J_ _________________________________________________________________._-_-_____________.________________ a No.r9o � � ��� Fee 'THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal �6pstem Construction joermit /Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at �� ,56�ti'!D j/-=r and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction m t be co pleted within three years of the date of this p rmit. Date `fi a 11 Approved by FROM FAX NO. Jun. 13 2010 01:22PN P2 BgqrRislable Thomas s°n lala,Health D71 iAo'a �s ��� Fax: 508-790-63W, flfEi�o� 50F••&51-4��!�• ' a�arn.3T+orm . ! 01rffiIll `�fi`J �i.'� �e111��g°c1T�`tE� lot#4 Dun �4Qll pm DWI. -... was Is513Bd a petni-t fio ymfala a 4 ,-. based on a.des.ga drEONU by I ce,ttify t1r�i th,e:�e,Qti,c rya^�A1 Ti�fea:e�ce�L a:h�ie wwa..�ir.�cnlied "'�������'a�.y a��c��diY��'� t rlesz ,�n; cLi ifwliide z�ulr EL 0ved ChROE13s -MOLL ti3 lateF�] mLocaiio�othe 6L-ti iz t m box andl«x sVdr,tai*, C c rki y tL,^f'th� sup tic + tpm.rzf«enced above wap, iustalle�l.Zvi i}� Lr�ajor al�aug�s i.e. giet�tt:�tl�arl L�7' Laterall�lc�cxti0.�1 of1ho SAS or a�n;� ve�i,ca1rel,oc ,a�n of azy com�o,a�nt of ft 3Cp11 G 3Q3te�)b-o-in accoT&JL�F tivith'State1 Local P.egLil l7ons. 1�l r0`y:�ion.ar �— - celttfiad as-Molt by desigPez to f0JDw- KH OF Agp Ss9 0 DANIELA, / OJALA alle�'sign�t«e) �> CIVIL 4V ►vo.46502 Q s �jf y ' sS�ONpt ( es]y'.a's,yTO l t, - WR ,s,a0F,,T 1T�F '�,Tr-.- liFa�9,7LL�Pd. x_ 1'1-fl_C AAA ,•rQ-P 4.�T 'ri Ni�Q Bx..6 �u] 3� �,T 'A' D1�11( . .a , 05--262, TOWN OF BARNSTABLE I,6CATION 411" Sa FWa S e t --eeQd SEWAGE # AGEA r S tOY)S S `LASSESSOR'S MAP & LOT v,,S 41L Wc NAME / rV /N" 6Q ;L L, J a m,S SEPTIC TANK CAPACITY LEACHING FACILITY: (type) el a (size) NO. OF BEDROOMS .3 YQrf.� u ya,•,_ �OWNER N° PERMIT DATE: C«OLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to tie Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by I r TOWN OF BARNSTABLE LOCATION y; _5,*,W05e7— Al SEWAGE # Z,00.S= j`M.tA'GE ASSESSOR'S MAP &/LOT/D/-�//S/ INSTALLER'S NAME&PHONE NO. SOB-�120-973� f�oSei�h LZ C�lsNa,S � SEPTIC TANK CAPACITY /M9 LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leachino facility) Feet Furnished by S s f D�Gk j u Colic,All ' OG co ") . M ` No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZppYication for Migool bp5tem Construction Permit Application for a Permit to Construct( )-Repair(grade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's N7,e,Address and Tel.No. Assessor's Map/Parcel , _ n /* Installer's Name,Address,an ,f"Tel.No. 7q—e/2$— 779Y Designer's Name,Address and Tel.No./,�f06—,,y6!g— Type of Building: Dwelling No.of Bedrooms_Jr Lot Size sq.fr. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Na pf Repairs or Alterations(Answer when applicable) T,�t�� 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 B and of H alth. Signed Date Application Approved by Date Application Disapproved for the following reaso Permit No. n6e4ya Date Issued A5)0i;I--," C���—.� �F✓ Fee THE CL MMONWEALTH OF MASSACHUSETTS�_ `` ntered in computer: 44 . ; gi .. K Yes PUBLIC HEALTH DIVISION =TOWN OF BARNSTABLE, MASSACHUSETTS ZIppYication for Ztgoml 6pMem -Construction Permit Application fora Permit to Construct(4 *pair7'--�-pgrade( }Abandon( ) O Complete System ❑Individual Components Location Address or Lot No, L/ WW 0s r s�Own�Ter's N me rex dss d Tel o ���►`sro�s �,/ls 4 Assessor's Map/Parcel Inst. ler's Nam Add ss,an Tel.No. S �r ey 2 De igner's Name Address and 1.No. �Os �-e l�,�v.�a�' �'dc.�, ,�h Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ). Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets' Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nat f Rep/airs or Alterations((Answer when applicable) ZHST� �°*chic I^S GG.// Date last inspected: Agreement: b 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 beenjite'd by this B and of lth. Signed p - n. Date .- /r Application Approved by O �i��/ U Date l/ Application Disapproved for the following reaso s on 'A ..- / ; Permit No. Date Issued _ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS --�— (Eertificate of compliance THIS IS TO CERTIFY, that th�Ons�te� ge Di p al System Constructed(4�"Repatred (G- )'1Jpgraded ( ) Abandoned( )by �LJJ /d LL.��te at '0��S' has been constructed in accordance with the proyisions of itlf an e for Disposal System Construction Pe t No. C�uS z dated Installer ✓bS�/� "'`� ' -s Designer awH G69/d� L'61!9 i/9/=r�I!!� 1 A/C The issuance of this pennit shall not�b�j'construed as a guarantee that th se' y�ste�i31 wi"11 notion as deli-gy►ed. Date /j 1 Inspector Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mie;pogai 6pztem ctCon,5truction Permit Permission is hereby granted to Construct( Repair( Ugrade ba d p ( ) on( ) System located at y17 .51��lOS/ _ and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Cons - c o. f be completed within three years of the date of thi Date: Approved b - � � PP Y � _ FROM :down cape engineering inc FAX NO. :1508362geeo Oct. 13 2005 oe:10AM P1 Town of Barnstable Regulatory Services Thomas F. Geiler,Director M,,S& g Public Health Division aaso. �e so ' Thomas McKean, Director 200 Main Street,Hyannis, MA 02601 Fax: 508-790-6304 Office: 508-862-4644 Installer & Designer Certification Form Date: L011dos Sewage Permit#Q 00S~ JAIP14 Assessor's Map\Parcel v �f Designer: �. /!2 ee_c - Installer: �D e � c Address: �a 1 10\ ' Address: 7a4, /- �. aa67� r was issued a permit to install a J V L/ On /rG ate installe septic system at �''"��'� based on a design drawn by (address.) dated (designer) i certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. tGP`t'A of 1 4.4 SE (Installer's Signature) ARNE H OJALA CIVIL No.30792 / 4esigner stire) (A a tamp Here) PT.F.AS RETURN TO_, BARI�TAB'LE PUBLIC HEALTH Diva N. CE TIFI ATE OF ARE COMPLIANCE WILLNOT BE ISSUED U TIL BOT THISFORM AS-BUILT C RD RECEIVED BY THE BARNSTABLE PUBLIC HI ALTH DIVISION. THANK YOU, Q:Health/Septic0csigner Certification Form 3-26-04.doc Town of Barnstable j"IIE' Regulatory Services Thomas F. Geiler, Director '" � MAS& Public Health Division rat" Thomas McKean, Director _ 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 _ a f J T> Installer & Designer Certification Form ry - Date: AlIdas Sewage Permit#ad0�" 6 Assessor's MaplParcel n�41 Designer: t ► _ 2 inee.4,& Installer: L 0 2 L11f v`jL _& w Address: 939 �_(A. � � �' _ Address: On A oZ �� J D c/ ��G_was issued a permit to install a date installer septic system at ! `/a�I tt!'2 �/.0. based on a design drawn by (address) dated �`'�^-2- + Oa (designer) XI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State.& Local Regulations. Plan revision or certified as-built by designer to follow. X�H OF�4,,ysS C 9 (Installer's Signature) � ARNE H o OJALA CIVIL �1 No. 30792 1 G/S ERGO esigner s e) (A one tamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26-04.doc TOWN OF B ARN STAB L E Health Division— 200 Main Street - Hyannis, MA 02601 �� Date: �G FAX 4 snxivsr,►si y stags. Number of pages including cover sheet: i6g9 �0 QED MP'�A To 7Fromw: ARON CROCKER Town of Barnstable Health Division / 2 Mail to: 200 Main Street Phone �— � (P �n 3as Hyannis,MA 02601 Fax phone: /n Phone: 1-508-862-4642 CC: Fax phone: 1-508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment /s - ;206s A4- F7 c�2/� S o �j r a0i_17 i v �.. _ ° Fee No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I " Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYicatiou for loiopaal Opotem Comaruction VerMit Application for a Permit to Construct(4,yRepair(e-M-pgrade( )Abandon( ) ❑Complete System ❑Individual.Components Location Address or Lot No. C/;r Owner's Nam;Addrqss d Tel.No. Ow/re Assessor's Map/Parcel `Q/ , //,/ _ 7.� �/JA Installer's Name,Address,an Tel.No. Ss Pq—�/2 8— �7.3� Designer's Name Address and Tel.No., s'08/��/(�— 5,rw/ Oo� �.�p� F��•h,��-�--,may �'�e, Type of Building: Dwelling No.of Bedrooms _ Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Na f Repairs or Alterations(Answer when applicable)1L2' 'Ti4�/ o,& 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 issu by this B and of H alth. Signed Date Application Approved by Date Application Disapproved for the following reaso Permit No. '� Date Issued ._.�. -. IL THE'COMMONWEALTH OF MASSACHUSETS.. BARNSTABLE, MASSACHUSETTS .. Certificate of Compliance IS IS TO CERTIFY,that the On- to S a e Disposal System Constructed(`")'Repaired(.-, pgraded( ) THIS �s} �v g P Y Abandoned( )by,. OS ��s. at . ��� 7- AW A%AJ_1_0"J1 has been.construc ( ordance. . he pro isions of itl an e for Disposal System Construction Pe t No. dated, with t � yy InstallerPv�.S�/p ' -�fP Y Designer-719&/" . 64 f'. _f9 /�✓9/-" !''/d� LNG . The issuance of this permits of b construed as a guarantee that t syste w n tion as d ed. Date �1 t Inspect "r —— .. Fee �t✓c-' `�; No. ` 1 THE COMMONWEALTH OF MASSACHUSETTS . PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS ]h6po5a 6pttem cow5truction Permit Permission is hereby granted to Construct Rep r( grade( b don( ) System located at � o and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his,'/herduty to; comply with Title 5 and the following local provisions or special conditions. Provided: Cons c b pleted within three years of the date of thi e r ' (/ v Date: � Approved by �C/ �� `'L-0 C Al ION S E W A G E PERMIT NO. "ef VILLAGE INSTALLER'S NA E R UILDE R OR OWNER p k3-t eg- �9� DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED _ ! o . -1 No .....'j - ' Fss... `®................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Tovm Barnstable .-......-- OF.......................................................................................... 3 .1 lirtt i�au fur Utipnial Workii Tome ation Vrrmit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: Ylarstons Mills : l+' �;ot ;� 49 , Samoset Rd. , Capricorn R�Aft r Vftst 765 Falmouth Rdbdt,N°Hyannis ......................_.......................................................................... .............--•------•----•--••-•-•••----•-•••-••-•-------...............--•...................-- W Steve Lobel Owner Address Installer Address dType of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms__........................................Expansion Attic ( ) Garbage Grinder ( ) PL4 Other—Type of Building ranch . No. of persons............................ Showers (2 ) — Cafeteria ( ) Q, Other fixtures ------------------------•-----•. W Design Flow........ 5------------------{000..gallons per persq.�ge r day. Tot qi,flow....._.-33_----------.--..._._....paltons. Gd Septic Tank—Liquid capacityy...._....__gallons Lengt ................ Width................ Diameter---------_...... Depth:.............. W Disposal Trench—No.................... Widt _ Total Length...... _ Total leaching area..._ 6. sq. ft. Seepage Pit No..................... Diameter......_.._.......... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosintlagk larSdde Engineering 11-25-81 Percolation Test Results Performed by.......................................... .,. ------------------------- Date........................................ ,a1 Test Pit No. I.2• minutes per inch Depth of Test Pit_.._ G........... Depth to ground watepone eneounter— e C1 (i Test Pit No. ._A_..._._._nlinutes per inch Depth of Test PitiT1...A-........__. Depth to ground water......................... ......... -• •.. ......oam & tpso.l1 lDescription of Sail- ..._..0 irix 2Y..-- TUT..__..Iady .......... ------ ---------------- 10-,-..._--•1.2-,-------mec�:.....iHi e__saric�ftraces o�"..gravelfrio- water_--aIv_12 --------------------------- ------••--------------------...--------------------.....-=---------........--------------------------------------------------...-----....----•-------------•-••-•-------•-• UNature of Repairs or Alterations—Answer when applicable................................................................................................ ..............................................••••-----------------------------------•••-•...................--------•------•--------------•••-•••---------------------•---------------.......--•- Agreement: The undersigned agrees to install t�e afor scribed Individual Sewage Disposal System in accordance with the provisions :ITI,L 5 of the Stat5Aamt ode—The undersigned further agrees not to place the system in op nu a C sate o ompl' nc issued by th board of 1th. � .............Pres. �2 -.$3 ,. . Dat / PPlicion Approved By................. ----- ------••-------••................................................... .....-•-�f'.-a� ....... Date Application Disapproved for the ollo ng reasons:..........................................................-----------------•-••••---..................-•--•---• ......................................................•------...........--••------------....................-•-..................-------•---•---•--------------------... ....------------.....-•--._.._. Date PermitNo......................................................... Issued-........................................................ Date 1 Nogla..--r��-/__3.. ...Fss... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town Barnstable .........................................OF.......................................... .���lirtt�io�t fox �i��o�tti ork� C�oo��rttr�ion rxuti# Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System at: ot i 49 , Samoset Rd. , Ylarstons Mills 14A ..........................•---.....---•--.........-----•...------------•............•... ...--••-----....----•-..__.....------...........__._..._.....-----•------....------•........-•--•- Lo ti n-A ress or t N Capricorn Reae��V rust 765 Falmouth Road, �iyannis --.... ... ..... .... ............................ ........... ........•----------•••----..............---..................-- W Steve Lebel owner Address a --••-----------••...------•••---•-----•----••--......-•---•-••--•-•............................... ............•....•••--•.............................--•••_............_........-•---------•-••--- Installer Address Type of Building Size Lot............................Sq. feet U DwellingNo. of Bedrooms..3.......................................Ex ansion Attic— p ( ) Garbage Grinder ( ) aOther—Type of Building rot= l............... No. of persons............................ Showers (2 ) — Cafeteria ( ) dOther fixtures .......................................................................................................................................•......._...... W Design Flow.......5-5...............................gallons per person er day. Total daily flow........33.9...........................gallons. WSeptic Tank—Liquid capacitvl.000__gallons Length# ��....... Width'_'10 Diameter__ 8 it Depth------...... x Disposal Trench—No. .................... Widthi.................. Total Length..... . �.......... Total leaching area........ ._ sq. ft. Seepage Pit Not___________________ Diameter.._.6.._......_... Depth below inlet... ........._... Total leaching area..26b.__...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..�ldredgeEng.ineering Date1 .................. •.. Test Pit No. L 9._.....minutes per inch Depth of Test Pit.12..........._ Depth to ground watePone...encounter- // >> - -- d fX4 Test Pit No. NA---__----minutes per inch Depth of Test PiWA.............. Depth to ground water.Nl................. e P4 -•----•----•-••-------------•-•--------•----•-•-•-••----•---•.......-•--•---.........---------------......................................................... 0 Description of Soil.........9' 21 loam topsoil ----- --------- ----•----•------•--•-------------------- x 2' - 10' Medium yellow- sand w 10' - 12' med. white sand/traces of ravel�no water at 12' -------------------•----...-•----•-------------•---------------------------------------------....---•-•--------•--•-••-- e........•------•---••--•----.._.......... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------------------------------••......-----•--••-...._-----• -------------------•-•--••••••------••-•--••--------•-•--••--•--•-•---------•--------•-----• Agreement: The undersigned ag s to install the afo des c ' Individual Sewage Disposal System in accordance with the provisions of ITLL 5 of Sta anit y e The undersigned further agrees not to place the system in operation u1] k3 Cery' cat of Compl' n e e i by the board of health. ------- +� ....--------------------------------------------------•-......... ........... I ------ ate A licatio, A ved B --. �..... mil_.. s /2 ate Appli tion Disapproved for the o110 ' g reasons---------------------------------------------•---------------•--------------•---•-----...._...-•---•-------•---- ...............................................................----....................................................................................................................................... Date PermitNo......................-•.........--................................ Issued-....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........Town..................OF.......:�Kn.stable . .. .. .................................................................. Trrtif iratr of Tootpliaurr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (y, ) or Repaired ( ) bySt vo_.Lebel--•--••-------------•------........-----.........---........................----•-----...-•---••--•-•--......------. at_._._.... :c49!.._ amoset Rd. , InstallTgarstons Mills , f,A •-•-----•---------••.................•-•-- ...--•-----------------•-•-•••-------------------------ZARANT7E ........ ............... been installed in accordance with the provisions of TITLE 5 of The State Sanitary ed in the application for Disposal Works Construction Permit No... `1�,�...._....... dated_. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS ATH THE SYSTEM 1d111LL FUNCTIO SATI FACTORY. '6411t�A DATE................................ Z' G. g •---------..------ Inspector.....----------•-.•........................... f� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Town.........................OF....Barnst.?.`�i e r No .. FEE...� '........ liiyoiitt1 Workii Tonstrudiort rrutit Permission is hereby granted.................Steve Lebel . ............. to Cotistr,.uel .. r Re ' an ndividual Sewa e Disposal System j at N .....................................................................................................T o :-j ' iJ o�e)c tt • ' _ir tons yMills iA i ' .........................•........... ...............�� .---------------------- Z........................> !........._.y' - Street Dated�1'.� � as shown on�,the application for Disposal Works Construction Permit No... .__ �..`...r..,l:.�'.......... PP P , Board of Health DATE.......... ---•--•........................ ................. FORM 1255 A. M. SULKIN, INC., BOSTON �'` - h NOTE . ; • � FX/sTiNCr To/�v�i2tlP�� ��Przao Uc�o r�6„1 pl— rl DqT o vEc, 8, /97,8 8y i0 /9-9 XTC2 .9 N ye, Q s 2 5 -nn V �7 Ix 0,3 -0 GF MqS o� A U No.10951 O ` \� p FG/57IN E� ¢p LEGEND EXISTING SPOT ELEVATION OxO OF CERTIFIED PLOT PLAN /�,tw Mqs EXISTING CONTOUR --- O --- ES 127 FINISHED SPOT ELEVATION ROBERT / FINISHED CONTOUR 0 BRU E i EIDR[D N IN APPROVED , BOARD OF HEALTH U DATE AGENT SCALE, / _ 3 0 ' DATE ' VORE'DGE ENGINEERING Ca !N CLIENT T-�eA�cv : I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED 83 -7 " R OSED J09 N0. � BUILDIPf6 SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR IDR.BY' `�--- - OF BARNSTABLE, MAS . 712 MAIN STREET. CH. BY, 7z•I3.E ' ` HYANN I S, MASS. SHEET-L OF DATE REG. LAND SURVEYOR H 2O FT. M//V. /YO7"E /F EI THER THE.SEPT/C TA V A< OR L.E�FC.4�iivG '/T A.-tE /JORZ TN.I,,V IZ"0E401V f�/D /�7 M/N. GRA OEM fi 2Q"p/A M E T ER CONCRjFTE CODE.! SHALL &.F B APO&(Sr YT TO 6RA AEX7-.R/4 CONCRL7E MIA. P/TGN PVC P/Pd /'lE.4Vy CAST /IPO/Y Cod/,—R Sh�.4LL OE !/S4.D _•,•. COVERS �9�RFR� /F/N OR/VElIVA y :;o: 2'J• MiN. C'D/VCRLrTE cf Avt CO rER CLEAN .SA NO I.. Y 10 CA - - - L/QU/D LEVEL _ • �� IRON 2 LAYER P/PE i �'O t� G/1L. yo a o P QF /I8 -3�B MIA.P/TCN D/ST, o• • • • ` ` • b •Ao WASHED' 570) E /4 Pert /T. ,SEPTIC TANK • ti • • • • • • • o e a • BOX03 Ito c � o • � 8 • • • • • � . � o. • ° 0 0 6 • • • ' • o WASHED STONE �'� ''e• /��c'2.1 '47p e 4 0 �o 0 • a e r • • • • • . • • v D o �� , d. a i • . • • . • • • p , j, PRECAST SEEPAGE !NlieRT w4RVAT/O/VS P/T C-" 'A c/Ty a y . , • • . • • . • � ' a `o P/T OR EQU/V, /NY.ERT AT DU/LD/NG 6 3-S FT INLET S'EPT/C TANK 6 z FT, --0 FT. PIAM. C SEE TABULATION",• OUTLET SEPTIC TANK 6 I/VLET D/STR/BUT/ON BOX &0-0 FT. SECT-/ON OF GROUN0 WA'rE,"e TAQLE Ot/TLETD/STR/BUT/ON BOX -s9.W FT. INLET LEACAIIAfG O/T SS,C) F7 SEWAGE 01 SA0r5'A I- SYSTEM Ti1BULATl�/V LEACH/IVG P/T FT, DES/G/V CR/.TL=R/A TCAL.E %" _ /'_ o~ bJMENS/ON A�� NUMBER OF BEVROOMs 3 D/MENS/ON C �' FT. I""'•`/' GAReAGED/SPO.SAL UNIT SOIL LOG TOTAL EST/MATED FLOW 33 G.4L.1DAY SOIL. TEST At/ $O/L TEST#2 "/L TEST NUMBER OF LOACNINIT P/T,5 I �+FLEy 60,0 ELEy PATE OF SOIL TEST S/OE LEACH/NG PER P/T 1 g� SQ, RT. r 0 -- 4 RESULTS it//TNESSED 8Y RSe (JAca/3 1 90T'TOM LG4CH/NG PER P/T 6 $Q. A•r L�A ^7 i PERCOLAT/ON MATE�/ ass M/N�IINCH TOTAL LEACH/NG AREA SQ. FT. 5 v t3 S v i L AE/tCOLAT/pN RA7"E/f Z Z-/'/Ri✓ MJN.1INCH RESERVE LEACNI/VG AREA 210 6 SQ. FT. 2 v OF �k OF /'I Ic/�/ f�Al / ROBERT ' uc� LUT 49 -SAM US c--T Tzp. -IFA 70A45 M /L-Ls �1!o ELDRE rv'n C3MORSE No. 10951�Q ELOREDGE ENGINEERING CO,INC. ^� Y'�`• �,"s�=;1 �Oc FG/ST E L . 4 e,0 7/2 MAJN 9T.� ,tIYANNl9, MASS. onaLEN ® NO G�TOVND kV,4TCM ENCOUNTfREO CL/ENT: D,•fTE p / Q G/t0 U/VL7 W 4 TE>Q AT ELEV _ >�R ✓� : / 1 3 3 JOB No. 83 �— YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates (cost $30.00 for 4 years.) A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.I.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: APPLICANT'S NAME: i GL YOUR HO�\gMr�E AD D R E Sr]: — Y�Y 35 ���y�r+�-- T�Yr ITV• \� � ` BUSINESS TEL PHONE # .. --b 4 G HOME TELELPHONE 73 NAME OF CORPORATION: I� 1 0,1 P 00n I NAME OF NEW BUSINESS TYPE.OF BUSINESS C QC n I Y) rj IS THIS A HOME OCCUPATION? YES O ,� ADDRESS OF BUSINESS 6*ls A U, MAP/PARCEL NUMBE �.. 1. (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally opera a your usiness in town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature" COMMENTS: ` 2. BOARD OF HEALTH This individual has be nformed of ermit r irements that pertain to this type of business. Authorized Signature" F7'MUST WAPLYWITH COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been iriformed�_of the licensing requirements that pertain to this type of business. Authorized Signature" COMMENTS: Hszar ous Materials Inventory Sheet Checklist Date ysical Street Address-Check database to ensure it exists z orking Phone Number Actual Amounts—(i.e.gas being used to fuel machines,thinner to 4�lean brushes all count as hazardous materials) ltorage Information—location of storage,how long is storage for? If none,note that. &4Aisposal Information—where and who? If none,note that. AApplicant Signature—understand what is listed and noted. �S"taff Initial—any questions,know who to ask. Vehicle Washing/Rinsing?—provide a vehicle washing policy and explain it—note that it was given. Attach the Business Certificate with your sign-off and comments. "The Inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them Date:/0 /0b2 O TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 15 BUSINESS LOCATION: OJ69VNVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: 5 CQ 6 L MJr L I �3 CO'IVTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: 5 3 SDS ON SITE? I TYPE OF BUSINESS: INFORMATION/RECOMMENDATIO Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc, carbon tetrachloride) NEW USED Any other products with "poison" labels Paint & varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic Qr'hazardous (please list): i I.. 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 TROY WILLIAMS SEPTIC INSPECTIONS ' i � .,, ,, „ . L Certified by MA Department of Environmental Protection (rP�j2 (508) 385-1300 4 19 Hummel Drive AN 9: 48 FABLED ��SP South Dennis, MA 02660 k ,- ECTION COMMONWEALTH OF �1%$014 'F1'l i I'S EXECUTIVE OFFICE OF ENVIRONMENTAL,AFFAIRS DEPARTMENT OF ENVIRONMENTAL, PROTECTION "ITITE 5 OFFICIAL INSPECTION FORM - NO-T FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CER"I'IFICA'I'ION Property Address: 47 Samoset Road Marstons Mills,MA Owner's Name: Karla Sullivan Owner's Addres,: 47 Samoset Road Marston Mills,MA 02648 C� Date of Inspection:. April 21,2005 (( )J Name of Inspector: TroyM. Williams Company Name: Troy Williams Septic Inspections Mailing Address. 19 Hummel Drive Telephone Number: South Dennis,MA 02660 (508)385-1300 CERTIFICATION S"FATEMFN"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. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sv�tcm- Passes Conditionalh Passes Needs further Evaluation by the Local Approving Authority Fails Inspector's Signature: 'S,�s,, ��.J.� Qom.." Date: L//a i /oy 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. Notes and Comments Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,certification Is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. •*""This report only describes conditions at the time of inspection and under the conditions of use at that time. phis inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 mipr I of II Page 2 of I 1 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 47 Samoset Road Marston Mills,MA Owner: Karla Sullivan Date of Inspection: April 21,2005 Inspection Sunuuary: Check A,B,C,D or E/ALWA�S coptplete al)of Section D A. System Passes: 1 have not found any information whichthe failure criteria described in 310 CN1R 15.303 or in 310 CMIt I5-304 exist. Anyd are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the "Conditional Pass"section need to replaced or repaired. The syste m, upon completion of tile replacement or repair,as approved by the Boar of Health, will pass. Answer yes. nu nr not determined(Y,N,ND) in the for the following statement . f"not determined"please explain. the septic tank is metal and over 20 years old* or the septic tank(w ther metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is ' minent. System will pass inspection if the existing tank is replaced with a complying septic lank as approved by e Board of Health. •A metal septic tank will pass inspection if it is structurally sound of leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break on r high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or never distribution box. System will pass inspection if(with approval of Board of Health): bro pipe(s)arg replaced o truction is removed distribution box is leveled or replaced ND explain: The systen►r ired pumping n►ore than 4 times a year due to broken or ubstructed pipe(s). TI►e system will pass inspection if ith approval of the Board of Ilealth): broken pipes)are replaced _ obstruction is removed ND explain: i page 3 of I I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION(continued) Property Address: 47 Samoset Road Owner: Marstons Mills,MA Date of fospeetiorr: Karla Sullivan April 21,2005 C. Further Evaluation is Required by the Board of Healtb: 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 pass unless Board of Health determines in accordance with 310 Chill 15.303 (b)that the system is not functioning in a manner which will protect public health,safety. and the vironment; 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 rsh 2. System will fail unless the Board of health(and Public Water upplier,if any)determines that the system is functioning in a manner that protects the public heals ,safety and environment: The system has a septic tank and soil absorption sys rt(SAS)and the SAS is within 100 feet of a surface %%ater supple or tributary to a surface water su y. __.._ The system has a septic tank and SAS and e SAS is within a Zone I of a public water supply. The sN stein has a septic tank and SA ' nd the SAS is within 50 feet of a private water supply well. The system has a septic tank an AS and the SAS is less than 100 feet but 50 feet or more frortl a private water supply well**. Metl d used to determine distance "This system passes if the ell water analysis, perlortn;d at a DEP certified laboratory, for coliform bacteria and volatile org c compounds indicates that the well is free from pollution from that facility and the presence of ammo a nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are ggered. A copy of the analysis tntist be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A, CERTIFICATION(continued) 47 Samoset Road Property Address: Marstons Mills,MA Karla Sullivan Owner: April 21,2005 Date of Inspection: D. System Failure Criteria applicable to all systems: You mus indicate"yes"or"no"to each of die 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 -Z Static liquid level in the disuibution box above outlet invert due to an overloaded or clogged SAS or cesspool LL—L �} _ Liquid depth pi resspeal is less than 6"below invert or available volume is less than %day flow --v/ Required pumping more than 4 times in the last year NQT 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. i Any portion of cesspool or privy is wit P P Y with* 100 feet of a surface water supply or tribut ary o water supply. PP Y ry t a surface , Any portion of a cesspool or privy is within a Zone I of a public well. — Ai Ig Any portion of a cesspool or privy is within 50 feet of a private water supply well. �Z/a Any portion of a cesspool or privy is less tltati 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 DPP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well i; free from pollution from ilia( facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less loan 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis ntust be attached to this form.! .(Yes/No)"rbe system fails. I have determined that one or more of the above failure criteria exist as dce cribed in 310 CMR 15.30.3. therefore the system fails. The system ossmer should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered is large system the system must serve a facility with a desi now of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteri ove) yes no — _ the system is within 400 feet of a surface drinkin Ater supply — — die system is within 200 feet of a tribut o a surface"king water supply — the system is located in a nitro ge nsitive area(interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of o public water sup well if you have answered"yes"to a question in Section I✓the sys}em is considered a significant threat,or answered "yes"In Section P ahovg the ge system has failed.The owner or operator of any large systegt consid&red signi�}cant titre*under to{I lr or Itrilect µpdr�r Sectiptt p shag ppgrade the system in accordance wjth 310 trM(t 15.31.4.The system o Gr should contact the appropriate fC to}} i office of the Department. 4 Page 5 of I 1 OFFICIAL INSPECTION FORM - NOS' FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART B CIIECKLIST Property Address: 47 Samoset Road Marston Mills,MA Owner: Karla Sullivan Date of luspecuu►r: April 21,2005 Check if the following have been done. You must indicate"yes"or"no"as to each of the following-, Yes No information was provided by the owner; occupant, or Board of I lealti, _..... ✓_ Were any of the system components pumped out in the previous two weeks ? lids the system received nornal 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 exanined?(if they were not available note as N/A) g inspected for signs of sewage back up Was the facility or dwellin '? .._.__ Was the site inspected for signs of break out 14'crc all system components, excluding the SAS, located on site ? - WOLS 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 dif el—ent frtmn owner)provided with information on the proper maintenance of subsurface sewage disposal systems? Tile size and location of the Soil Absorption System (SAS)on.the site has been determined based on: Yes no ✓ _ Existing information. For example,a plan at the Board of l lealth. v' _ Detennined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)13 10 CMR 15.302(3)(b)] r, 51�- Page 6 of 1 I OFFICIAL INSPECTION.FORM-NOT FAR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE A1SPOS4 .$YSTEM INSPECTION FORM PART f SYSTEM INFORMATION Property Address: 47 Samoset Road Marstons Mills,MA Owner: Karla Sullivan Date of inspection:April 21,2005 RESIDENTIAL FLOW CONDITIONS Number of bedrooms(design):- Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x k of bedrooms): 3 3 0 Number of currCut rCsidCnts: 0- -- Does residence have a garbage grinder(yes or no): Ato Is laundn un a xparate scwdge system (yes or n,i) .vo jil yes separate inspection required) Laundry systen► inspected(yes or no):dcL3 Seasonal use: (yes or no): nio Water meter readings,if available(last 2 years'lsagC(gpd)): Uy ; 98 don �u((o,�) v 3-S 9;oov Sump pump(Yes or no): Ali) Last date of occupancy: COMM ERCIAIJINDUSTRIAL. Type of establislunent: Design flow(based on 310 CMR 15.203): g Basis of design flow(seats/persons/s►1ti,Ctc.): )rC4SC[rap pl'eSelll(yes Of.110):_ Industrial wasic llolding tank present(yes or no): Non-sanitary waste discharged to the Title 5 sy nl (yes or no): _ Water n1C►er readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL. INFORMATION Pumping Records somc'e 01 information. //o_��r..r)..y_3..1._.!^C�__�•v�.. ►c.b►a . Was system pumped as part of the inspection(yes or no): ,vu If yes, volume p►nnped:^ 941101►s -- I low was quantity pumped determined? Reason for pumping: —_--- "TYPE OF SYSTFM _✓Septic tank,distribution box, soil absorption systetu 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) —Tight tank _Attach a copy of the DEP approval —Other(describe):._ Approximate age of all components.date installed(if known)and source of information: N s-4--y�'t -2 /Z. ids 0 C-S- Were sewage Odors detected when atTiving at the site(yes or 110): Ala ` 6 `' Page 7 of 1 I OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISf OSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 47 Samoset Road Marston Mills,MA Owner: Karla Sullivan Date of Inspection: April 21,2005 BUILDING SEWER (locate on site plan) Depth belo�% grade:—Li I.+ Materials of construction: _cast iron ✓40 PVC other(explain): Distance fine: hri%ate water supply well or suction line: --- Comments(on condition of joints, venting, evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 3.3 ` ( ✓r S" {b Material of construction:.✓concrete Tmetal fiberglass —�olyetttylene _other(explain)__— __ -- If tank is metal list age: ___ Is age confirmed by a Certificate of Compliance(yes or no): ce (attach a copy of rtificate) Dimensions: 5 Sludge depth: Distance fiom top of sludge to bottom of outlet tee or baflle: 2 Scum Distance from top of scum to top of outlet tee or baflle: G Distance front bottom of scum to bottom of outlet tee or ball7e: How were dimensions determined: Comments(on pumping recommendations, inlet and outle t tee or bafle condition, stntctwal integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): J / 1. S—. .c✓_ - -\--_v�,=.� A 4_. �.�_w Y°►�.!�� t7i _v�c. G GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_—concrete_—metal_-_fiberglass— yethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or ba Distance from bottom of scum to bottom of outl ee or baffle: _ Date of last pumping: Comments(on pumping recommendatio ,mlet and outlet tee or baflle condition,structural integrity, liquid levels as related to outlet invert,evidence of akage,etc.): Page 8 of'1 I OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 47 Samoset Road Owner: Marstons Mills,MA Date of Inspection: Karla Sullivan April 21,2005 TIGHT or HOLDING "TANK: (tank must be pumped at time Ulf' Spec tion)(locate on site plan) Depth below grade: _ Material of construction: _concrete metal__ __fibergi s-__polyethylene other(explain): Capacity: _ __—gallons Design flue. — — -- lons/day Alarm present(yes or no): _ _ Alarm level: _ — Alarm in working er(yes or no): Date of last pumping: -- Comments(condition of alarm and oat switches,etc.): DISTRIBUTION BOX:Z(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.): —12 PUMP CHAMBER: _ (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,eonditi of pumps and appurtenances,etc.): rt yg rage 9 of l l OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SIJ13S URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PA RT C SYSTEM INFORMATION (continued) Property Address: 47 Samoset Road Owner: Marston Mills,MA Date of Inspection: Karla Sullivan April 21,2005 SOIL.ABSORPTION SYSTEM (SAS): (locate on site plan,exceation not required) If SAS not located explain H•h). 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 Type/name of technology: Comments(lute condition of soil, signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Gu'NJ /�^ t•� ._.r h.�L vim._ S`�s �h c-(p c S 6 i,wV YI . ti • J / /� CESSPOOLS: —_ (cesspool must be pumped as part of inspection) Cate an site plan) Number and configuration: — Depth-top of liquid to inlet invert: Depth of solids layer:_ --..----------- Depth of scum la.\er. Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or Comments(note condition of soil,si of hydraulic failtue, 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 hydrautI ilure, level of ponding,condition of vegetation,etc.): 9 Page 10 of 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE ]DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 47 Samoset Road Property Address: Marstons Mills,MA Karla Sullivan Owner: April 21,2005 Date of 111spectuui: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. locate all wells within 100 feet. Locate where public water supply enters the building. t I i� 267 2-9 0 ' r. Page I 1 of 11 OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 47 Samoset Road Marstons Mills,MA Owner: Karla Sullivan Date of Inspection: April 21,2005 SITE EXAM Slope ✓ Surface water Check cellar ✓ Shallow wells Estimated depth to ground water 10�' feet Adjusted high ground water elevation " feel Please indicate(check)all methods used to determine the high ground %cater elevation: --- ✓ Obtained from system design plans on record - If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) - __Checked with local Board of Ilcalth-explain: ._____ Checked with local excavators, installers-(attach documentation) Accessed US(;S database-ex 1)lain: 76��7 j 2auL Q gip, �/ G You must /describe how you established the high ground water elevation: A ` /' - - ......' __�A..Q1 Y_ .. .'O c.✓N).J4�(�_...f.hJwg I rz, } la•s F J c( ' IV This report has beet)prepared and the system inspected as of the date of Inspection. This report 14 nQt a warranty or guaranty that the system will function properly In the futyre There have beep no wariWJ4 or guarantees, either expressed,written or Implied, relating to the system,the inspection and/or this'(eport. z. II Id Bea-CM)AA ' A& M- D�N�1VC� Kil'Che�l b elk y L ce TO 86D 0 rwlk L . tit r Ga �OlulGrc rH OL 05 L i AT EL. 72.2' SYSTEM PROFILE TOP FNDN. ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ACCESS iCOVER 'WATERTIGHT) TO 6" OF FINISH GRADE ( TEST HDLEL LAGS MINIMUM .75' OF COVER OVER PRECAST WITHIN 6°' OF FIN• GRADE 2� SLOPE REQUIRED OVER SYSTEM 62.0' NOTE: PRovIDE AccEss TD - ELDREDGE ENGINEERING ' < INLET THROUGH DECK 2" DOUBLE WASHED PEASTONE ENGINEER: RUN PIPE LEVEL ES pR � J. CONLON Mos FOR FIRST 2'' 3' MAX. WITNESS: Q F�aR EXISTING 10DBASEMENT SLAB GALLON SEPTIC 63.0f* 59.0' DATE: 11/25/81 Locus o EL. 65.0' TANK (H- 10 ) GASo '.` (RE USE) BAFFLE 58.45' ' ja\58.28' 00 O 0 PERC. RATE _ < 2 MIN/I' CH x �� 6' MIN. SUMP o 58.17' [] 0 0 C7 I� 0 {� 0 4 AROUND CLASS I SOILS i i 6" CRUSHED STONE OR MECHANICAL 12' MIN. INT, DIM. 8o C) 0 (� �80 0 � 0 � 0 � 0 � COMPACTION. � SLOPE)5.221 [2]) ( 1 o000 2 56.17 3 4" TO 1 1 .2" ,bOUBLE WASHED STONE 'ELEV. DEPTH OF FLOW = 4 ( ) % SLOPE) / / 0" 61 .5' TEE SIZES: INLET DEPTH = 10" LOAM LOCATION MAP NTS & j OUTLET DEPTH = 14" SUBSOIL LEACHING 2 59.5' ASSESSORS MAP 101 PARCEL 114 FOUNDATION EXIST. SEPTIC TANK 86' D' BOX - 13 FACILITY. _ 5.67' *THE INSTALLER SHALL VERIFY RIFY THE **INSTALLER SHALL CONFIRM MINIMUM SEPTIC NOTES . LOCATIONS OF ALL UTILITIES AND ALL TANK SIZE AT 1000 GALLONS AND ITS BUILDING SEWER OUTLETS AND ELEVATIONS SUITABILITY FOR RE-USE. REPLACE-WITH 1500 MED. YELLOW 1. DATUM #S NAVD88 PRIOR TO INSTALLING ANY PORTION OF GALLON SEPTIC TANK APPROPRIATE TO SITE SAND 2. MUNICIPAL WATER IS EXISTING SEPTIC SYSTEM CONDITIONS IF NOT SUITABLE 50.5 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS D 10' TO BE AASHO H-10 51 .5 1? / D MO XIS N 5. PIPE JOINTS TO BE MADE WATERTIGHT. p PAVE DR VE o MED. WHITE SAND 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 129,57' 310 CMR 15.000 (TITLE 5.) ELOCATED SA �� D TR. GRAVEL 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER 0 12' 49.5' PURPOSE. " � NGWE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 0 6 O PREP pP a 0 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED 'JV!TNOUT INSPECTION BY BOARD- OF .HEALTH AND > i a .. ;I � f m �, � �_ �1 � _ _ PEERMISSION OBTAINEDFROM BOARD- 0•r HEALTH. 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE (1-888-344-7233) AND VERIFYING THE o N SSE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES p D G PRIOR TO COMMENCEMENT OF WORK. � S 1 BNC MAR - GONER POL y' , ON PAT E = 3.6 p 62. 11. ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE REMOVED 5' BENEATH AND AROUND THE PROPOSED LEACHING FACILITY. °�o EX as O� F� 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND p BPE�.gas / PP v OaX• �12� a REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. ZONING RF SETBACKS 30'-15'-15' PROPOSED RET ININ aR� 13. POOL FENCE SHALL HAVE SELF-CLOSING �� SELF-LATCHING GATES, SIZE AND MATERIALS TO MEET WALL WITH ENCE LOCAL AND STATE BUILDING CODE, ALL DWELLING TOW = 64.5 �'sz i (DESIGN BY OTHERS) `� sXPSICG DECK DOORS OPENING TO POOL SHALL BE ALARMED TO CODE q * O O TITLE 5 SITE PLAN L, RAF G� OF SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT Al I OWED DESIGN FLOW: _3 BEDROOMS ( 110 GPD) = 330 GPD G �o �� #4.7 SAMOSET ROAD USE A 330 GPD DESIGN FLOW � _ � MARSTONS MILLS, MA SEPTIC TANK: 330 GPD (?) = 660 N PREPARED FOR USE A 1a0D_ GALLON SEPTIC TANK (RE-USE EXISTING)** LEACHING: SN D TADEU ANDRADE 2(25 + 12.83) 2 (.74) = 112 , SIDES: _ .83 .74 - DATE: SEPT. 15, 2015 25 x 12 BOTTOM: ( ) --- - 237 L � "oFM Lj ASS SNIpF M qN 0, MA 1 �� ssgc DANIEL) yes � ; �s�� TOTAL: 472 S.F. 349 GPD I "©F-MA �G OJALA �° o DANIEL �� DANIEL r s USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR �o DANIEL, sm o �� IA. A. 1 off 508-362-4541 EQUAL) WITH 4' STONE ALL AROUND ° 0 cIVIL r a OJAI.A CJALA �� r' 17 .�4 r fax 508-362-9880 r CIVIL No.46502 d No 41 9'a downca e.com **PROVIDE ACCESS TO INLET COVER OF SEPTIC TANK No.46502 � Po �� ti� L 1 N1 40980� `� (� o / P THROUGH DECK AS PER RECOMMENDATION OF SEPTIC �o �� ������`` figs c/sTE� G� SS` INSPECTION REPORT OTHERWISE, REPLACE WITH 1500 �F �'s,e SroNALe�� �qNF ��o� 9�rQ�S cape e/18'/flee/'/!1�► /I1c. ( SS/ONAL D U �> �➢ a GALLON TANK BEYOND DECK) Scale: 1"= 20' civil engineers land surveyors 0 10 20 30 40 50 FEET • -+�- 939 Main Street ( Rte 6A) 9 DATE DANIEL A. OJALA, PA-., P.L.S. YARMOUTHPORT MA 02675 D CE #05- >2 J 05-123 SULLIVAN-SP.DWG TOP FNDN. AT EL. 73.2' SYSTEM PROFILE TEST HOLE LOGS ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE) PROVIDE INSPECTION PORT WITHIN ELDREDGE ENGINEERING ACCESS COVER (WATERTIGHT)TO 6" OF FINISH GRADE ENGINEER: MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 65.0'- 65.5' WITNESS: J. CONLON NOTE: PROVIDE ACCESS TO INLET THROUGH DECK 2` DOUBLE WASHED PEAS ONE DATE: 1 1/25/81 ? RUN PIPE LEVEL � pR- Ll �FOR FIRST 2' 3' MAX. PERC. RATE _ < 2 MIN/INCH os fNR `� rp EXISTING 1000 BASEMENT SLAB GALLON SEPTIC 64.0't* 62.5' CLASS I SOILS L0C1S 66.0' TANK (H- 10 ) GAS RE-USE BAFFLE 61jl '--- EL 61.78' 0 0 a L7 0 CI !� -- - 0 61.67 (� 0 00 4 AROUND CJO � CI a a � a' 0 Q ELEV. 6" CRUSHED STONE OR MECHANICAL so 2' a 0 CO 0 a ED'Q E� O COMPACTION. (15.221 [21) $ 0 59.67' ��� 62.5' DEPTH OF FLOW = 4' (3.3 % SLOPE) ( 1 % SLOPE) 3/4" TO 1 1/2" DOUBLE WASHED STONE LOAM & TEE SIZES: 2' SUBSOIL INLET DEPTH = lost o" 60.5' LOCATION MAP NTS OUTLET DEPTH - 14" FOUNDATION LEAC�-IING EXIST. SEPTIC TANK 61' D' BOX 13, FACILITY ASSESSORS MAP 101 PARCEL 114 9.17' MED. YELLOW *THE INSTALLER SHALL VERIFY THE - SAND LOCATIONS OF ALL UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS N + PRIOR TO INSTALLING ANY PORTION OF °' rn SEPTIC SYSTEM + 64.0 / n� + 66.6 6 MED. WHITE co SAND 62 9 5 BENCH MARK - CORNER + CO CONC PATIO EL. = 66.0 TR. GRAVEL 6 6 Lo + 6s 2 c (o o) 12' 50.5' TM + .4 NGWE a � 3 + 4 Q I NOTES: SEPTIC DESIGN: (GARBAGE DISPOSER IS NnT AlI nWEr) ) +^ 6.7 co 2 J I . APPROX. NGVD 110 GPD) 330 GPD 1 DATUM IS rnc� 65.3 Co �- DESIGN FLOW: --! ,BEDROOMS ( ) _ , 66 O �0 3.3 USE A 330 GPD DESIGN FLOW 2. MUNICIPAL WATER IS EXISTING + 66d46, o / ^ 74.0 SEPTIC, TANK: 330 GPD 2 = 660 3. MINIMUM PIPE PITCH TO BE 1/8" PER FO'CT. CP �o 58 w 0) h ** 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10 65. -1 75.2 USE A -JOD GALLON SEPTIC TANK (RE-USE EXISTING) 5. PIPE JOINTS TO BE MADE WATERTIGHT. x fib1%9 LEACHING: 6. CONSTRUCTION (DETAILS TO BE IN ACCORDANCE WITH MASS. 1 RET. SIDES: 2(25 + 12.83) 2 (.74) = 112 ENVIRONMENTAL CODE TITLE V. LAWN AREA�p- 66.0 WA 76.6 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT 5 .0 4.9 772.0 .5 BOTTOM: 25 x 12.83 (.74) = 9 A 7 TO BE USED FOR ANY OTHER PURPOSE. ..-� � ,0 73.2 S TOTAL: 472 S.F. 349 GPD 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. o '` 1 G 74.1 762 6 �4�yjOS USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT CONC. �/ EQUAL) WITH 4' STONE ALL AROUND INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED x PATIO 741`s 76.4 '4� FROM BOARD OF HEALTH. 4.8 EXIST. DWELL 6.0 5 **PROVIDE ACCESS TO INLET COVER OF SEPTIC TANK 10. PUMP & REMOVE (OR FILL W/CLEAN SAND) FAILED LEACH PIT + 72.8 � THROUGH DECK AS PER RECOMMENDATION OF SEPTIC 3 0 BASE. SLAB � ^ - 7s.3 7 _ INSPECTION REPORT (OTHERWISE, REPLACE WITH 1500 ELEV. 66.0' 2 2.9 3.3 62 - ",79.8 GALLON TANK BEYOND DECK) N x _ \. ;$0.4 LEGEND TITLE 5 SITE PLAN w 8 DECK GRAVEL DRIVE O 01 LOT 49 81.6 100.0 PROPOSED SPOT ELEVATION OF 60. P w 74.1 20,412f SQ. FT. 47 SAMOSET ROAD 100x0 EXISTING SPOT ELEVATION 2.3 ^°` IN THE TOWN OF: 7 .6 Q, 71.0 0- 10�p PROPOSED CONTOUR ( MARSTONS MILLS) BARNSTABLE EXISTING SEPTIC TANK** + 68. ^� 100 EXISTING CONTOUR PREPARED FOR: MITCHELL 8c KARLA SULLIVAN � + 71.7 + 72.5 2.8 � 73 1. oD rn LAWN AREA i e 20 0 20 40 60 6 9 BOARD OF HEALTH O `' 61+ 75.8 . MA SCALE: 1" = 20' DATE: JUNE 22, 2005 71.2 N + 72.3 7 APPROVED DATE - N off 508-362-4541 W fox 508 362-9880 (o + 72.5 �o I �^ down cape engineering, inc, H OF,t7gss �ZH OF MqS 71 CIVIL ENGINEERS o�� ARNE 9cyGm ARNE H.�9cy�N ^ ^+ 7 75.o LAND SURVEYORS � H � �ivl�i' � Q� 6 jz� 05- 123 939 main st. yarrlouth, ma 02675 �q�FF OJA j o �No. 30792 \ DATE '� '�fM-S NAL