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Home My WebLink About0046 TIMBER LANE - Health 46 Timber Lane, Marstons Mills A = 149 056 � .. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: `� I Fill in please: APPLICANT'S YOUR NAME:y/��b " - BUSINESS YOUR HOME ADDRESS: Pf SOf ' TELEPHONE # Home Telephone Number SD k J�a 0 a y3 6 NAME OF NEW BUSINESS. d �- u �- ��-1,-* 'I �QF< SINESS /�r �,� :�•c IS::THISA1 HOME OCCUPATION? YES NO Have you been given approval from the'buildmg division? YES NO L! SP ADDRESS OF:BUSINESS S2 MAPJPARCEL NUMBER 7 . ` 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 CO NER'S OFFICE This indivi ual h s eQ-i r of any permit requirements that pertain to this type of business. Aut e ignature**A , , OM ENTSiLA ein 2. BOARD OF HEALTH This individual has bee nformed oft e permit requirements that pertain to this type of business. Aut orized Signature** 1 COMMENTS: [XAXer '"7 arA tit, ty n&f-.'C a d" 4 r hl ,v2 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha �n inf of the li , r 'rements that pertain to this type of business. Authorized Signature COMMENTS:_,_n U Town of Barnstable Regulatory Services F tHE�p� tic Thomas F.Geller,Director s�AB *1 Building Division - - MASS. �►J Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 f www.town.barnstable.ma.us Office: 508-862-4038 Faa : 508-790-6230 Approve Fee: Permit#: HOME OCCUPATION REGISTRATION Date: Name: �l b P� /�+C/ C'o r/✓/ ' Phone#: .50� Address: /l---ie', L n Village: / If4Y S�o 4S me- 1��4 0v's& Name of Business: —oY it/ ��c,`�'�'' eF V4 Ted-Tr �"f-e, r / /b1 Type of Business: T�eit kt5 Map/Lot: /y� 06 A INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by.such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant. � Date. W/'z/0 c� Home'oc.doc Rev.5/30/03 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: Fill in please: - � . APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS:_�� ?. •� ,lP. TELEPHONE # Home Telephone Number SD k fa?O f,3� NAME OF NEW BUSINESS G syr IS THIS A HOMI`.:OCCUPMION7 YES NO Have you been given approval`from the building d►vision� YES NO ADDRESS;OF BUSINESS 5�<0m MAP/PARCEL NUMBER f When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this.type of business. Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual has bee informed of the permit requirements that pertain to this type of business. Aut orized Signature* COMMENTS: lXluhex �fr�-}�.S n� `7 a.rj&,S J,V K&f---t 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Date: TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: f/L i'¢i' ��r� �6�.011 �'j/P" e1041 "'P4eyt—��// BUSINESS LOCATION: Z ri , 1141-<Itln-s M, / M A 0.26 VENTORY MAILING ADDRESS: �� 23ax yCP TOTAL AMOUNT: TELEPHONE NUMBER: �� 5'; :Z2jo 003 S ®� CONTACT PERSON: A� -j- Ao EMERGENCY CONTACT TELEPHONE NUMBER: ��a' `/o?D-o? Y3 (o MSDS ON SITE? TYPE OF BUSINESS: ..v�, INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum 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 or hazardous (please list): Laundry soil & stain removers t2 �eS 120 Z AdZ�.yvS (including bleach) G 714s�f-e c��t , BC�:f-r�o-� �. Spot removers &cleaning fluids (dry cleaners) J Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS �J TOWN OF BARNSTABLE 2" d L�sJCATION 41 . //rn , L.rJ SEWAGE# S- �r VILLAGE 1�7 471�� ASSESSOR'S MAP&LOT !p" INSTALLER'S NAME&PHONE NO.&r61 i T`).2 6 SEPTIC TANK CAPACITY O e d 0-4 L LEACHING FACILITY: (type)i�.Zlec (size).?9 A NO.OF BEDROOMS 3- BUILDER OR OWNER C <dl19e PERMITDATE: l!'" 7-0 F,5---COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S 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 .6, ° y6 r • 1 3 � 1 f 1 - fit. No. �v� / y / �� Fee �d THE COMMONWEALTH OF MASSACHUSET tS 9 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 0[pplication for Migaal *pgtem Con5truction Permit Application is hereby made for a Permit to Construct( )or Repair(b4.an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. �16 %c,N1ja&LCh0EL Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. /11 "M I u.s j 444- . 0114 qf— e Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow roz.30 gallons per day. Calculated daily flow 33w•ss gallons. Plan Date !! 7 4;77-- Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q tJ77 ,9 t1 Gv LAC V Date last inspected: Agreement: The undersigned agrees to ensure the construction a f the afore described on-site sewage disposal system in accordance with the provisions of Title 5,#the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by t ' oar of Hea Signed aj;7� Date Application Approved by Application Disapproved for the following reasons Permit No. � ® Date Issued /� P • * ,+ry,...'tn. r �..st� •,� .. T /^' '')w.f". �9r"4 4 f "+1v / A 3 T`�.. ..- 'ti- � _M1 _ Ai+ ( l 7/ No. IG �CI / � Fee �d THE COMMONWEALTH OF MASSACHUSETTS '4. 44 PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE} MASSACHUSETTS ZIpplication for Migool *patent Con.5truction Permit j Application is hereby made for a Permit to Construct( )or Repair(b,")an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. .rat AjQ_S7-6t W W I L t,f , J�L4 /�£ G C _J!�cJ �J�.r +-i Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. �4�w CA y ��sw,a,cr6y /14 M ►tL,S 444- . G,)-G` F rvt , M I ti3 14 AA - . Type of Building: Dwelling No.of Bedrooms 3 Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeter,( �,)•'` Other Fixtures Design Flow St2o gallons per day. Calculated daily flow - 33�� gallons. Plan Date 7/�csa Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) /1JSi Ati- ,�• p C-$7 7 a 0-A, Date last inspected: , Agreement: The undersigned agrees to ensure the construction a f 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/)goard of HeaWQl� Signed V, Date /1 .3 71�k Application Approved by Application Disapproved for the following reasons Permit No. " �� Date Issued THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced m4)on b dV 0A:;r,%-6T1n CoN S' for -�C0 C A--/L:[.�+G Y � vl y!n / 44,d e4— &4-r-Je ,M , �1 r uS has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 9S' dated - Use of this system is conditioned on complian lth the provisions set forth w: G-+ r i No. - /a 7ay Fee -7U— THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS 'Wigpogar ,*patent Con!aructio l Permit Permission is hereby granted to 4: G/tv—U L_aT-)-) C0 r,)S7/-?-'Y U`e r,IJ to construct(, )repair an On-site Sewage System located at 444 l 1A S 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 m st be completed within two years of the date below. Date: �� a7�f'� Approved by A�J l ♦� CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) L �o i-�' '' hereby certify that the application for disposal works construction permit signed by me dated lee, I� , concerning the property located at ee— C44,' ,m «S meets all of the following criteria: "� • There are no wetlands within 300 feet of the / proposed septic system � • There are no private wells within 150 feet of the proposed septic system The observed groundwater table is 14 feet or greater below the bottom of the leaching facility There is no increase in flow and/or change in use proposed L --- There are no variances requested or needed. SIGNED: DATE: l/ �-7�yU LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. k �{ g 3-5.s rx .a E�t #:>'f45'ti �,� -9 :w`",-:.' `.*`� �aYt :._r _,V ;.-a '�y,.: f`#`uc r4 r ,,..,.'+a. � y>a„ µ k,:.., c t �• '' �s •`�" 5 ivs:. ..F.,�3- �,:: �' ..a:�;t �s. ..F`it r,b��,y.4.,r`a�..r ,i a r..�*ars-, .t.,tu�u. r�tw:n r.:s�*," E r,.;'�`g'" ..;k .•' .�}^t- _ �`v'�. ��'.,� .� ' A• v # �' ; .x_ a - r K <:..^. ';r' 2 _--` ., r t v •; .=-,sq 0 6-,, r vw �: tF .Two �, • w 'w r s'Y. F s rr a x y, 1, +. 'atr45' tx"'�I•"' v;�a CC r.. . r �.r; NT .€+.;'• ,s w ;'a.•.;u:, .,:ri!+ ' t> .� n .r; �k' ,:fir-R -..,.+a} a P.X`�' s'•� '` 4:xr�.o*,.: tyA ^ r-3`sh.,a i�`c..:- t b .`�" .dr +..� 'p•s `u a,� a ^'{.+.,. '°+r:ir.,4.7� e.p -..,. �... ra7sa #f s: +.:T tom,..., . k � .°.`�`-.✓t, x>'a'Ya �-1,.��. ,. .".,..p�r.BS."' r ,-.rw�.�^� .. ._ FS.. a+.� �#+.tee• r,�e sic",�..�'SCY�� r_� x -Fy..i,Y, iz ,��a t�,.,. f*a�,'� �� t.;?. >�,Y,� �, �� • �.�, t ,�, z �,.�,� A ;fit ,.A��• a�'"��"a�'=s� +'� ', -� [Lai f� � �:�^ r Y:� �` *�* � .� �^� F�'�, ��_ e �.y,r==u.s'� -;y�,Vic`_: ,�,� �',€,F+F,-�,,,•w..,',,'�a �,;� - .ur.�: .*�t,u?�� k 'a. � .,f„�w�,,y..� 4�. -��,�r` 'tf�t;�;,f+„'�'�7��: fi� C_" _� =�.,.= ...�'�' �=�t�,�x"*.-3��1?_ t a�f-•+.'*� ,1}s��, r.+.+,i�`(y�� ,�"g�,�=1R.�'.`y� .: �N3,'�g.Q��. �.,�,-.i d5��t �'��' yja+�?• � ,x� .' x�. v`�� z. .f a '�-„�.... �- _ la-?�'�` � .�Sfi✓ yy.c. .�r ,r r, � r.r^'r.. ::a.. vy 'C.stf't �eN'f {fit ." .. �� 'ifi::�r�kp '"{?��"#aS, 'fS r.� is�a' .n•�fin`--,.'��$�$`.:�'i5 _r f � :-�:`+`s �, '�'� �� ✓�-.�,.�° �+: ��}�,�m � h';r,��a�.{,z.`,':�"a�"`�yv�.t"'+d} d �."a„r�'�kS�•liz^„��*`sr�''� + ��`y ,'m"�" .�„''�s,�,�+,�,��,�'"y ��+ .. .9 . ... l � \ Lam` 3 W e - %: COMMONWEALTH OF MASSACHUSETTS h8l EQ EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS cc AP DEPARTMENT OF ENVIRONMENTAL. PROTECTION tnR 2 9 1999 ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 70"OF S, it A B � 'XE (i (n Secretary ARGEO PAUL CELLUCC[ ` ��" DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 46 Timber Lane, Marston Mills, MA Name of Owner: Francis Carral Address of Owner: Date of Inspection: April 12, 199-9 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49. OyervUle, MA 02655-0049 Map: Telephone Number: (508)862-9400 Parcel: CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at thin address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ✓ Passes Conditionally Passe Needs Further Ev ion By the Local Approving Authority Fails Inspector's Signature: Date: April21. 1999 The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. NOTES AND COMMENTS revised 9%2/98 Page Iof11 Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: .�46 Timber Lane, Marston's Mills, MA Owner:�:.� 4 � � Francis Carral • A Date of Inspection: , April 12, 1999 a INSPECTION'SUMMARY: Check A, B, C, or D: , A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or"repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. _ The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached) indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank 'failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. _ Sewage backup or breakout or high siatic water level observed in the`distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) _ broken pipe(s) are replaced _ obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page of11 SUBSURFACE SURF CE SEWAGE DIS POSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA F Owner: Francis Carral Date of Inspection: April 12. 1999 ,.$ 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 the public health, safety and 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 THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet to a surface water supply or tributary-to a surface,water-supply: The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less_than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for colifotm bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9j 2/95 Page 3ofII l w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA Owner: Francis Carral Date of Inspection: April 12, 1999 D. SYSTEM FAILS: You must indicate either "Yes" or "No" as to each of the following: I have determined that one or more of the following failure conditions exist as,described in 310 CMR 15.303. The basis for this .. determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. J Yes No Backup of sewage into facility or system component due to an 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 '/a day flow. 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 Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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.•If the well has been analyzed to,be acceptable, attach copy of well water analysis for_ coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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 The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 'Page 4ofII ' 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 46 Timber Lane, Marston Mills, MA Owner: Francis Carral Date of Inspection: April 12, 1999 I Check if the following have been done: `You must indicate either "Yes" or "No" as to each of the following:' Yes No ✓ _ Pumping information was provided by the owner, occupant, or Board of Health. ✓ _ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ✓ _ As built plans have been obtained and examined. Note if they are riot available with N/A. ✓ _ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ All system components, excluding the Soil Absorption System,have been located on the site. ✓ e The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction, dimensions,depth of.liquid,depth of sludge, depth of scum.. The size and location of the Soil Absorption System on the site has been detern-iined based on: ✓ _ Existing information. For example, Plan at'B.O.H`i ✓ Deteimined in the field(if any of the'failure criteria related'to Part C is at issue, approximation of distance is unacceptable) (15.302(3)(b)]. ✓ _ The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 Timber Lane, Marstons Mills, MA Francis Carral n Owner: Date of Inspection: April 12, 1999 t: •. .. s ", FLOW CONDITIONS RESIDENTIAL Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 4 Garbage grinder(yes or no): No Laundry(separate system) (yes or no): No If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two yearg;usage(gpd): Private well Sump Pump(yes or no): No _ Last date of occupancy: Currently occupied COMMERCIALANDUSTRIAL: Type of establishment: Design flow: Qpd(Based on 15.203) Basis of design flow Grease trap present: (yes or no) _ Industrial Waste Holding Tank present: (yes or no) _ Non-sanitary waste discharged to the Title 5 system: (yes or no) Water meter readings, if available: Last date of occupancy: _ ix. OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION„ - PUMPING RECORDS and source of information: Pumped when cultecs were installed on Nov 27195-per owner. System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,.date installed(if known)and source of information: Nov. 27195-per as built card. Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Nge6oflr SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA Owner: Francis Carral Date of Inspection: April 12, 1999 BUILDING-SEWER: (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: ✓ (locate on site plan) ` Depth below grade: 12" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: 8'6" x 4'6" x 5' (IOOOgal.) Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 25" Scum thickness:- 7" 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: 10" How dimensions were determined-.. Measuring-stick.---.-- '' Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) The tees were present. The liquid level was even with the outlet invert. There were no signs of leakage. Recommend pumping of system. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene '=other:(explain) " Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA Owner: Francis Carral Date of Inspection: April 12, 1999 TIGHT OR HOLDING TANK: None (Tank[trust be pumped prior to, or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present: o _ Alarm level: Alarm in working order: Yes No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: ✓ (locate on site plan) Depth of liquid level above outlet invert: 0" • P Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) The box was level and there were no signs of solids. PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) r Alarms in working order: (Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) revised 9/2/98 Page 8ofll f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA Owner: Francis Carral Date of Inspection: April 12, 1999 - SOIL ABSORPTION SYSTEM (SAS): ✓ (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located, explain: Type: leaching pits, number: leaching chambers, number: leaching galleries,number: leaching trenches, number, length: leaching fields,number,,dimensions: 4 cultecs-34' x 8.25' x 2' (see design plans) overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.) The leach field was not dug up and there were no signs of failure in the D-box. CESSPOOLS: None (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(cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (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.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA Owner: Francis Carral Date of Inspection:. April 12, 1999 , SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) O wce / �o 1 SAS 3 q 1 - I$ ° tea - aa.� Ba - a6 &„ A3 ' 3� 8 3Aq - " as y9 � revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Timber Lane, Marstons Mills, MA Owner: Francis Carral Date of Inspection: April 12, 1999 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 30+/- Feet Please indicate all the methods used to deterrnine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property, observation hole,basement sump etc.) ✓ Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Using the Barnstable Topographic and Water Table Contours maps, the maps were showing approximately 30' +/- to groundwater. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Page 11 of 11 f LOCATION SEWAGE PERMIT NO. VILLAGE INSTA LLER'S NA E $ ADDRESS 21 BUILDER OR OWNER DA T E P EXINIT ISSUED � � dY DAT E COMPLIANCE. ISSUED ! • Jc/- 7k P, > -1 I G �G a� THE COMMONWEALTH OF MA4SACHUSETTS V ~- '_--'~�// BOARD OF HEALTH -'��--'A_e v'---- —�-�` .°�� x� � ��ppliratxou� pm« l Works TomitrurtKon ramit L/ , . Application is hereby made for u Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at, Lo' �--------^Wj C ....................................................... ...................................................... ' Location Address or Lot. '�� .� ___--------------_-'---____ ��'��_��-- -- '-__'_'------_-_' . -- --' �_--___'-------___' v°"= . � ins dress Type of Dwelling�� c6 8c6r000m_-~��'_.--_-_-----'Expansion Attic Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons'---_------ Showers ( ) -- Cufeteria ( ) ^-4 Other fixtures --------'-.-.-'-------_-.'_--___-_-.-'---'-_'--_--'-----___'' Design ..guDoou per person per day. Total daily flow. | Septic Tank—Liquid* .guDuuu Lcocth---.-..-' Diameter---------------- Depth................ Iota Z Other Distribution box / Dosing -77 -~ Percolation Teat Results Performed by-. ................. atc-,t' Test Pit No. l---'�--min utes Depth of Test Pit--V��----- vr D�ot6tou�nuo� uterl.kof��f��~- Test Pit No. 2................minutes per inch Depth of Tent Pit.................... Depth toground water........................ --.. 0 � S�__ _��-�- ��. .................. | ---------------------------- -------------------- --------------------------- ........ ------------------------------- -------------------------------------------- ----------------------- ---- ------------_---__---__--.---_-----__--.__--.-----'----'-.------_.----'----.._____ U ��o� � Repairs or Al�cruo�oou—Answer when upyucaoue.-.......................................................... ................................ � -----'--'--''-'--------------'------------'---'''-----'---'''--------'---'------- Agreement:� . The undersigned agrees to install theuforedescri6ed Individual Sewage Disposal System in accordance with the provisions ofTLlITIE 5of the State Sanitary Code--The undersigned further ugrcrx not to place the system in operation until u Certificate of Compliance has been issued bythe board o6health. Signed- - ----------' ............-................ 4� Application Approved Bv-''�� - _. -'--- --/!:�Z/ .......-'--- (� Date Application Disapproved for the following reasons:.............................................................................................................. _-_-'_-.-___-_-----_'_.--__'_--_---'-'---'----_-------------.----''----_-----------.-------- o"te ` Permit . Date No................_....... Fzcs.............. THE COMMONWEALTH OF MASSACHUSETTS ' -•,WARD 04jog.ALTH ...........................................O F...................................... Apphration for Biiivao al Work Tmitratrtion Prrmit Application is hereby made for a Permit to Construct (.. ) or Repair ( ) an Individual Sewage Disposal System at: �o� 33i1M�t2 LAME _7A, HAP A11/3 6 ................__....._..: •-• -- - ........ - -----------------• -•-•_..... . ----- --•--••--•---•--------•-----_---•••---•---•--- Location-Address or Lot No. K :J �fpv> Z Owner Addre a Y C°OA..I-! l'./1•-yu.�....../ i4•i'L�v /�L tr Installer Address Type of Building Size Lot.__-�__�_.IL:G ......Sq. feet Dwelling-)�No. of Bedrooms._.____................................Expansion Attic ( ) kp Garbage Grinder ( ) Other—Type e of Building No. of ersons____________________________ Showers P� YP g --------•----•-•---.._._.--- P ( ) — Cafeteria ( ) a' Other fixtures __________________________________ _•- ._- W Design Flow................... ?__4`. per person per day. Total daily flow........7_3..P_....................gallons. WSeptic Tank—Liquid*capacity-I 00-gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No Width_____ _____________ Total tlt ___ _ t In area....................sq. ft. Seepage Pit No pag �___._,..................... Width __)Dept o ml � '` of eaching�r�t'ea� ,tb� Z Other Distribution box ( ) Dosing qffit u Percolation Test Reslts Performed by__________________________________________________________________________ Date_._._ . a ..•••. 7 ,.a Test Pit No. 1_______ _______minutes per inch Depth of Test Pit.......!Z-______ Depth to ground water._ _ Gz, Test Pit`No. 2___............minutes.per inch Depth of Test Pit......... _ epth ound w er_- _____._______.._____. x - ;t� st - ... ______------ O Description of Soil__---� f___j *-«-v -Q.,--_ ---�� __________•_____-- U ---------•-•---------------•-•---_'._......----... •-•---_. --•-•----__ ----------- ------- ------------------------------- ---------------- •----------------------------- •-----_-•--------- W ---------------------------------------------------------------------------------------•-••--•--t------------------------------------------------------------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable.. ______________________________________________________________________ •--•_._...----••--••-••••••-•••••-•---•-•----••-•---•---••-•--•-•_._.._..--•••-•••••--•-----.....•••-•...._...••--••--•-•-•••-••••••-I-••=-••-••--•-----•-•-••••---.._...-••-••-----••...---•-•......_:. Agreement: The undersigned agrees to install the aforedescribed :Individual Sewage Disposal System in accordance with the provisions of TITI.- 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. ___-_ /"� 1+ '; Application Approved BY...........................................................................--------............... ....................Date.............. Date Application Disapproved for the following reasons---------------••----•---.._..-------•--•---------------•-----------------------•••••••-••---••••••--•••-_-•..._ -•.._._....•--•----•-•--••........•••-----•-•-•----••-••-•....................•---••--......----•--•••••'•-•---•••-••-•-••-•--•••---••-•-•-•••-----._.-•---•-------------•._.. Date ,.--- ---••...•••--- ePermitNo................•---•........_--•••-•----••--•-----..... Issued....................................................... r Date THE COMMONWEALTH OF MASSACHUSETTS _ BOAR-D�OF HEALTH. (..o<cl (J �!�rUST/ Jc.E.............................. ..................................O F................ .. ..... . Tatifiratr of TontpliFanrr TA T.Of osjQZjTe�,�uc ed A,� ' by-- 7 � er''" t , .. -------------------------- -a ---•------•----•----------------...---.....---........-------- i� Instal r at. �,, has been installed in accordance with the provisions of TI F 5 of The State Sanitary Cods d `fibed in the application for Disposal Works Construction Permit No......................................... dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS y� BOARD OF HEALTH .....!..U..:v............................OF....��.�.:�at15TA 3G 6 .................................... No......................... / FEE. S.__...�� wtion unfit Per si l n is granted. -------------------------------------- to Cons�ct ( �) lrh2�ividtlevpys��em 1�l atNo............------•-----------•--...---•--•--------••----•..........:......:.......••-•-•-----...-----••----_Y�d ..------•-•-•• � +�' .............. as shown on the application for Disposal Works Construction i c �. � --- --------•-----••----•-•••- f . ... Board of Health DATE------- - 7............................................... FORM 1255 HOBBS & WARREN, INC., PUBLISHERS - �i i 1! : 1: i I I:i I I 7 I�-- ,I .��--, �,.I I I 9-1-,, , I 1-1.—1,,m 1. I 11 , . - I---"-�1111____—- ___-"---l-1-11 I I t, __ , 9 19..1 9 � I I 11.9. I � I I . * , - ��. I I I . " I i I I I __ 1 �*11119 11 -6 1 1.I I-9I' ,,-6,11 "I�1111 I :I;. O;IWI",.14,:,9,. � "� ,,- ,� �....... 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