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HomeMy WebLinkAbout0185 TIMBER LANE - Health (2) 185-Tin-Ab-er Laner —- - Marstons A= 1.49 -0.4 i i I I i "r : - i-w Ca,.T , _ ;. z2 r : • _ i, q----- iy a. i I ` _ � I i TO ! -- „yI - ,..._.. -r T r I ' L_ I I I I I ! I - _ r T T ; T -r-tv �-v IV vA r i Tf i T T - - - - -- � - - _ -- -- _ - -- _ r I I I 1 r fi 1. .. SrtA VA , I I I I I I ' c� 1,7T PT Tl-ln _....I I r I i �p ! I i.. � I 1• � T _ ` .... i I ; T . { ; , � I I I I II 7 r 1 r f i {. t I I I �� p r , I I 1 t I r ( , r k` +' 1 -i l3 c^ I Massachusetts Smoke-free Workplace Law Common Questions for Establishments with Liquor Licenses The Massachusetts Smoke-free Workplace Law(M.G.L.270,chapter 22,"An Act to Improve the Public Health in the Commonwealth")prohibits smoking in workplaces to protect employees and the public from secondhand smoke.This law amends the 1988 Massachusetts Clean Indoor Air Law. For additional information,contact the Massachusetts Department of Public Health at 1-800-992-1895 or go to www.mass.gov/dph/mtcp. The Massachusetts Smoke-free Workplace Law went into effect July 5,2004. Is this the only law regarding smoking?No.The majority of cities and towns also have regulations,by-laws or ordinances on secondhand smoke.The state law permits cities and towns to pass stricter laws than the state law. If there is a difference between the state law and a local law,the stronger law prevails. Some cities and towns,for f example,have banned smoking in all private clubs. Are private clubs or membership associations exempt from the regulations? A not-for-profit entity that is established and operates for a charitable,.philanthropic,civic,social,benevolent,educational,religious, athletic, or similar purpose is exempt except when the membership association is open to the public. For example,a function must be smoke-free if. A rental fee is paid or Tickets are sold to the public or The public is invited to attend the function(examples: advertisements,signs, invitations,etc)or to ee or independent contractor is hired to perform a job(examples: e who is a temporary,contract employee P A person p ary, P Y P bartender,caterer,disc jockey,etc.). Can members of the membership association smoke while the facility is open to the public?Only if the membership association has an enclosed indoor space that is separate from the space open to the public and"the space is restricted by the association to admittance only of its members,the invited guest of a member,and the employees of the membership association"The association must ensure that members of the public do not enter the enclosed space where smoking is permitted. Caution:Admittance of the general public and sale of alcoholic beverages to the general public by a private membership association holding a"club"type of alcoholic beverages license violates the terms and conditions of that"club"type license and can result in suspension or revocation of that license by the local licensing authorities or the Alcoholic Beverages Control Commission. Can a restaurant or a bar have smoking on an outdoor patio or deck? If the area is open to the air at all time and cannot be enclosed,and the smoke does not migrate into the building, smoking is allowed. If smoke migrates into the workspace,the outdoor space will be considered an extension of the enclosed workspace and smoking is prohibited. The Department of Public Health is considering promulgating regulations to establish guidelines for outdoor spaces and enclosures. What are the penalties? The first offense for workplaces is$100,the second offense occurring within 2 years of the first offense is$200 and the third or subsequent offense occurring within 2 years of the second offense is$300. An individual smoker can be fined$100 for each offense. Municipalities may have local laws with stricter penalties. The full text of the law,fact sheets and no smoking signs are available at wwW.mass.gov/dP-h/�m—t-c2- -51 /.33, y D - -- •3 9 �/ - �t 4P&OF �� O - OC�U CRAIG r-' RAYN, �Sr O'y RT i t o - cn p oIa o N v No.27483 J °-'IONA6�'�Cy���� 0 7 t t 19- iGB. 00 �= yi8� yo 01-3 ' s t t 7-A//S P,c 151AI d O)F� IV O > ,4A,4G N<n Z f1.QO .Z d A.S .O k.C.. /,V sF fI>,c__,O r Zv i 7-R fI i CERTIFIED PLOT PLAN r 7 9• L O C A r i 0 Nt 1Y/9l'_-57"¢[ ?1V_5 _1 .L�.� G> — ��U'= I Y, S C :T L E: DATE' REF E R E N C E E"/,VGr 71' z2 ,yam 0 G<l/t O t A T E i i HEREBY CERTIFY THAT THE BU1 L D I NG _ ¢a � t' L, A N D S U R V O R !$ H0WI4 ON THIS PLAN IS LOCATED ON --- - -4 THE toPOUND AS SHOWN HEREON -AND llhl�t_l AAA: � THAT IT ' _S CONE0RM TO THE �S�i9�t3F� L . ZONING BY - LAWS OF T' HE TOVYIN OF %11 ko W H E NC O N 5 TR U C T E 0 . JOSEPH M. •i� JR. -1 1�.. 1rtONAHAN, `n` mot."_ e? 13660 f REGISTERED EN1iir'� EEf2S i L AN SURV , .0p $ s `:�`'e MID -CAPE OEF1Cf BUILDING - ! 2G5 40 U .TE 2F) :1 - COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION v1 pis'. ,A TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY gNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM 's• PART A CERTIFICATION /o; — 13 �. Property Address: 185 TIMBER LN MARSTONS MILLS ��--� Owners Name: �Jcccc I Owner's Address: Date of Inspection:6/9/06 Name of Inspector: (please print) Douglas A.Brown Company Name: Douglas A.Brown Septic Inspections Mailing Address:P.0 Box 145 - Centerville,MA 02632 Telephone Number: 508-420-4534 i CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: X Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: ,.� Date: 6/9/06 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 SYSTEM MEETS MINIMUM PASSING REQUIIZMENTS AT THIS TIME.SYSTEM OLD AND SHOWS SIGNS OF AGE BUT DOES MEET MINIMUM REQUMMENTS ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different Conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000 Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 185 TUVIBER LN MARSTONS MILLS 4 Owner's Name: ''ii. ,c c.t Owner's Address: Date of Inspection: 6/9/06 inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM MEETS MINIMUM PASSING REQUIRMENTS AT THIS TIME.SYSTEM OLD AND SHOWS SIGNS OF AGE B. System Conditionally Passes: one or more system components as described in the"Conditional Pase'section need to be replaced or repaired. The system,upon completion of the replacement or repair, as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health, *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 185 TIMBER LANE MARSTONS MILLS Owner's blame: �, t Owner's Address: Date of Inspection: 6/9/06 C.Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.3030)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ the system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone I of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 185 TIMBER LANE MARSTONS MILLS Owner's Name: C, c,l Owner's Address: Date of Inspection:6/9/06 D.System Failure Criteria applicable to all systems: You must indicate"yes or no to each of the following for all inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number — of times pumped X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 3 10 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure, E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or no to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply — _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered yei m Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 185 TIMBER LANE MARSTONS MILLS Owner: `Bac c%i Date of Inspection: 6/9/06 Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No, X Pumping information was provided by the owner, occupant, or Board of Health X Were any of the system components pumped out in the previous two weeks ? X Has the system received normal flows in the previous two week period? X _ Have large volumes of water been introduced to the system recently or as part of this inspection? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding,the SAS,located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _ X Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X _ Existing information. For example, a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3 ))(b)] • li 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 185 TIMBER LANE MARSTONS MILLS Owner's Name: `I3c�rc� Owner's Address: Date of Inspection. 6/9/06 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NA Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NA Seasonal use: (yes or no): _ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): NO Last date of occupancy: COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): _ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components, date installed(if known)and source of information: 1977 ARCH CONST Were sewage odors detected when arriving at the site (yes or no)? NO Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 185 TIMBER LANE MARSTONS MILLS Owner's Name: Bcoe,c i Owner's Address: Date of Inspection: 6/9/06 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_ (locate on site plan) Depth below grade: 36" Material of construction: X concrete_metal_fiberglass _polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of certificate) Dimensions: 1000 gal Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness: 5" 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: 12" How were dimensions determined: WOODEN POLE Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.)- TANK LOOKS STRUCTUALLY SOUND AT THIS TIME.OUT LET IS UNDER DECK DECK IS GOING TO BE REMOVED. TANK COULD USE PUMPING GREASE TRAP:_(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(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 185 TERMER LANE MARSTONS MILLS Owner's Name: j?x,�c e 't Owner's Address: Date of Inspection: 6/9/06 TIGHT or HOLDING TANK (tank must be pumped at time of inspection) (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: y�(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 185 TAMER LANE MARSTONS MILLS Owner's Name: l&CC 1 Owner's Address: Date of Inspection: 6/9/06 SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required) If SAS not located explain why: Type X leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): I DUG WITH AN EXCAVATOR BESIDE PIT, SAW NO SIGNS OF HYD FAILURE,DUE TO DEPTH I COULD NOT FIND LEVEL OF PONDING CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): i Page 10 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 185 TDaERLANE MARSTONS MILLS Owner's Name: T-2,cz C c l Owner's Address: Date of Inspection: 6/9/06 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 supp y enters the building. I.Jc at 14 0"S-e Old SecFto--� O 5� Page 11 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM ] INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 185 T&IBER LANE MARSTONS MILLS Owner's Name: -C�cxC CA Owner's Address: Date of Inspection: 6/9/06 SITE EXAM Slope: Surface water: Check cellar: Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) _ Accessed USGS database-explain: You must describe how you established the high ground water elevation: CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Resort Prepared For: Report Dated: 5/11/2006 , Raymond D. Carlozzi, Jr. Order No.: G0635257 P O Box 1 Osterville, MA 02655 Laboratory ID#• 0635257-01 Description: Water-Drinking Water Sample 9: Sampling Location '185� Timber Ln.:Marstons Mills,MA Collected by: R.Carlozzi �—�-- Collected: 5/2/2006 Received: 5/2/2006 Routine ITEM RESULT UNITS RL MCL Method# LAB: Tested Inorganics Nitrate as Nitrogen 1.1 m /L 0.10 g 10 EPA 300.0 5/2/2006 LAB: Metals Copper 0.31 m /L 0.10 g 1.3 SM 3111B 5/11/2006 Iron BRL mg/L 0.10 0.3 SM 311]B 5/11/2006 Sodium 18 mg/L 1.0 20 SM 3111B 5/11/2006 LAB: Microbiology Total Coliform Absent P/A 0 0 309 5/2/2006 LAB: Physical Chemistry Conductance 150 umohs/cm 2.0 EPA 120.1 5/2/2006 pH 6.9 pH-units 0 EPA 150.1 5/2/2006 Water master ple meets`the recommendetl`limits for drinking water of-all the above tested parameters Approved By: (Lab re orl ZZ 3 y- 5., Co j RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A- , -- M 7-�-C&-,L DATA CENTERVILLE-OSTERVILLE--MARSTONS MILLS FIRE DISTRICT 1875 ROUTE 28 CENTERVILLE, MA 02632 (508) 790-2380/FAXO(508) 790-2385 OIL/HAZARDOUS MATERIAL RELEASE FORM F.A.# 1^ I— LOCATION: ADDRESS OF RELEASE: DATE OF RELEASE: In PRODUCT RELEASED ESTIMATED QUANTITY:;'_A CORRECTIVE ACTION TAk6A P'PESPONSIBLE PARTY: - ..I NOTIFICATIONS: FIRE DEPARTMENT: YES(,,,..)-'`NO( ) DATE: l:5,� Q-� TIME: az?s•T NATIONAL RESPONSE CENTER YES( ) NO( ) ` DATE: TIME: ' DEPT. OF ENVIRONMENTAL PROTECTION YES( ) NO( ) DATE:-TIME' OIL SPILL COORDINATOR: YES( ) NO( ) DATE TIME: TOWN BOARD OF HEALTH: YES( ) NO( ) DATE' TIME: TOWN HARBORMASTER: YES( ) NO( ) DATE: TIME: OTHER AGENCIES: COMMENTS: e e aif s�J' r e �I m ah' rs v' C re x1 F r��k frrldi� J t �.. ' � L `../•-. '-i v Pam- .. . t ze f+—ems••—�i i t r*—F'v 9,e P R r`a f , a ti s,--�� e t IF, , sv 11••- �-r� iO`' / . I l .I'"c'r! v\ lV.v/if`•— f / ✓v•L�rtl f fL�-Pr+ U11 r�� ,P/ �a � i P• `• f`�! e�a s ,I 6 fe a ,f!1 r•--v'a•—,/ram¢�.�y f,� { L.c,c(�/ t �...-- �, r't� t� .ice- - t � r - r-�.. - r •1�. - 1V '1 L.P 1. t t.`�✓ . I.�ly ..:.1•�../, • ... v 1.�./ t �./ I�..0.II ll!v�r f • - t - b ,•r .. F =�,—t {' /•—r-� r•1'•'P7f 1 1 7I���1, f 1f `� REPORTED EY: � , fy4vaa a DATE: WHITE COPY-FIRE DEPARTMENT YELLOW COPY-D.E.P. PINK COPY-BOARD OF HEALT C-O-MM FORM #58 r L ©%CATION �� SEWJ GE PERMIT NO. - � . vi «Ac E /���crYr _� � s INSTA LLER'S NAME & ADDRESS B UI'LDE R OR OWNER Ys T DATE PERMIT ISSUED DATE COMPLIANCE ISSUED al, 3_ 77 II � �D �,`� � � �� r 1 N0__1_ -_/_ ........ Fps.-. ......................... THE ®OO'1R®ALT �F TS H�/'1�TN 1 ...._... - .OF.....�17` !✓.��- �r _....................... ApplirFa#inai -fox Biiiposttl Morks Towstrurtioai 13nnii$ Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: � ELLS) ----- Location- ess or t No. 49 1 �� Owner -- ddress W = ` s --- - ....................------- ---_----- Ak'p!IL /! — a � In Address , UType of Building Size Lot. --)..'/5P-------Sq. feet Dwelling—No. of Bedrooms-----__-.c2..............................Expansion Attic ( ) Garbage Grinder ( ) Gam, Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- - - - W g gallons per person e�r��y. Total dai�yl�w--__-_-� ®--_-_--_-- - g Design Flow ® 6 - --------gallons. WSeptic Tank—Liquid capacity/Q�Q0_gallons Length__ _---__-----__ Width_.4.-'__.._ Diameter-----..--.------ Depth.-.,_----_. x Disposal Trench—No..................... Width_---. . Total Length-----�_- - --/ . Total leaching area....---_-_____--_-sq. ft. Seepage Pit No..-._--_�._.-_.-_.. Di eter_-_-72 ----- Depth below inlet--Z �� ,otal leaching area---2 -----sq. ft. z Other Distribution box ( `;' Dosing tank ( ) �— Percolation Test Results FX@e4o wd by_----------------------------------------------- vlz6y-------- Date...-.7/9-174 Test Pit No. I................minutes per inch Depth of "Pest Pit.................... Depth to ground water........-------_--..___. Test Pit No. 2----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water--_------_-----_------_. •--- -----8�--------- -•-----------------------------------------.......................................................... Description of Soil �dLx r �dnZ-!-!t7---- F.. ,� U -------------------------------------cry "- �, �' `PJ w g -- �I►-6� ------------------------------------------------------------------- W UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------........................... Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b ar of health. Sig /Z Date Application Approved B -- A -_ ---- -- ---- - -°' ,��-/- -- --- - -------------- ---��� r7 --------- PP PP Y efiv Date• Application Disapproved for the following reasons----------------------- ---------------------------------------------•.---..._.._..-._-----_..-.-------_-__--___ ------------------------------------------------------------------------------------------------------------•-••-••---------.---._..-----------------------------.. .---------------------------- --- to Permit No. Issued. 7� - --=------ • Date No..... _r......... Fss....l. ............._ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD �OF HEALTH �G i✓l �✓ .. . ... --- ..OF......,",.!?, ✓1/' �G...............................-------------- Applirtttion -for :11ovoottl Mvrko Tutuitrurtion Vrrmft Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys at: / 1 ...................r ------- ....... ................................................................................................. Location-A ss r^ or Lot No. / �/ L ��r✓TtJ1`' C C;'��• �� cJiiJ `J.L !J- t/7�a/ Owner ddress Installer Address U Type of Dwelling Building Size Lot_No. of Bedrooms.___._._._______________________________Expansion Attic ( ) G.�bage Grinder feet( a4 Other—Type of Building ---------------------------- No. of persons.--------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures ------------------------------------------------------ W Design Flow----------> ------------------••-•_-•-gallons per person tper�a�. Total d iilyA 9w........ � -----------------_-._-.-gall s. P4Septic Tank—Liquid capacity/Ua�_gallons Length--- Width_.-__-.-'.'_.. Diameter___---_--.-____ Depth._4�_ W Disposal Trench—No..................... «1idtli-------------------- Total Length-----_-•--- ..._.- Total leaching area-.-.----_--_..._---_sq. ft. Seepage Pit No.._.._---�__-__-___ Di eter_--_,---2- '_._. Depth below inlet_- __ " Total leaching area.__ -----___sq. ft. Z Other Distribution box (�4� Dosing tank ( ) ,� 7- z '�' Percolation Test Results �d by........................... .G.�v........�i�_._...._._ W -- ----------- � Date------���---��------------.... Test Pit No. I................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------------....... (� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ ----------------------------------------------o Description of Sotl_._.._ ... k/_2-Y. _. ------ ------••-----•--------•-•------------------••-----.--------_---_----•----- W ------------------------------------- ----------------------------------------------------------------------------------------------=----------------•-------------------------------------------------- UNature of Repairs or Alterations—Answer when applicable................................................................................................ -------------------------------------------------------------------------------------------•---•-------------------------------------------------------------------------------•----------------------.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been-' ued e b and of health. ,/' Sign T. =/ -, - �..-•--•-•--••-•------•-•------•-•. �Z j'7.......... Date- Application 1� / 7.�.7 .. A Approved BY-._..... ... .:.................... ....._.--. ------- Date Application Disapproved for the following reasons_______________________ ....__ •-•-•---••------•-------•---•.............................. --•---........ --------------------------------•-------------------------...-----...------------------------------------•••-----------•-----------••---•--•-------------•-•---•-•---. •-•-----------•-•-•-•----•---•--- .�. Permit No..................................-----•---------------- Issued----- . ---- ............. ----•--. .•-•--.. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD qF HEAL{TH 17 ........OF.-.... ...... -- f—.. ........................... /// 0.rdifirttfr of-Toutphaurr T 0 TIFY, That t, dividua ewage Disposal System constructed ( or,-Repaired ( ) by....•-•• --- ---.•-- -•-- •. ---- - - _.----- -----•--. / r �/ ..... .... O? has been installed in accordance with the provisions of Article XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ ..7r..Q................... dated.....1.2-.-.277-4................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS GUARANTEE THAT THE SYSTEM WILD FUNCTION SATISFACTORY. DATE--------•-�_ - : - �P 7 Inspector----- --•-------------------�-------------------------•------------ r�.r THE COMMONWEALTH OF MASSACHUSETTS J BOARD F HEATH r�"r�.........OF..... �,�r2sa,. ............... No.---.. .._ FEE..//—) t rk,� �n�#rur�ioat �rrutif Permission by granted----------- -- -- --- --•----------------------------------- ... ---------------------•--------.. to CoXtr t 2 2 orVell �' n Individ tl"Sewa��isp4q ` System [�at No ---- i�`� ' `----- — : Street as shown on the application for Disposal Works Construction - .r it No... ......... ,a ed... ...... - ..__ ............. B and of ealth DATE............................................................................... FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS *. - - i CL { - - /,33. - - •3 �� - - ` _ ��tW OF CRAIG O/.fir /od0 G�� o R YM SHORT /30X , �FPv eG 7-�gNfS c 6i1'h�AN" �.�� y,Jl'� r_-• �No. 27483 v, � A/,oAT/ old �'o ' -/sTEf i F�- /GB o0 /�= •y183 yo r/d/6 �.�•9i✓ J O S n/ o Y LW,4L- uJ/ rf1/;✓ A �•oEC/A� F,�.00r.� NoT� /�'✓ ���'r" Ar.' .ZOAl0' A.S AFL/V FATa0 /2A6,4//.vim' 7W 150"p,tJ ,9 W,9>41 0 Ts!E C O^7 V7 0 J/7- 7-R AtF A. 6- t3 Y Ts/F" f / CERTIFIED PLOT PLAN 7 B- 74, L O C A T t O N s SCALE'- /"= h�Q 4 DATE' //7-a O - 7'L GD" /3Z 6,-9.i],L) t � CFEnENCE- .&,E-1A,7 /L07 . 0e A .S -5/�/0 WA,) oAl 19.J ,0r00/1' 2 +'7 ��4 G► r' S 9 1-f E G 09 7- A?-�,�o 7-.,9.$L ff- �'i ern/,-f% 7-IT Y OE�eO 5 S I HER�lE13Y CERTIFY THAT THE BUILDIN EG. LAND SURYE OR SC40VVN ON THIS PLAN IS LOCATED ON THIZ GROUND AS SHOWN HEREON AND ®� � THAT I f 70'F--7 CONFORM TO THE KOMING © Y - LAWS OF THE TOWN OF v JOSEPH M. Fey CONSTRUCTED . MONAHAN, 1R. v 13660 C S ASSOCIATES. INC . RIZGISTEREO ENGI [ilEER3 b LAND SURVEYORS MID -CAPE OFFICE BUILDING - 12GS ROUTE 28 76 5? SOUTH YARM O UTHJ MASS. 02GG 4 04 THE COMMONWEALTH OF MASSACHUSETTS BOARD R HEALTH �L9fi�it.�...-.. ......0 F..... ... /tOC.7- �� Appfiration -for Diiip iial Works Cnutudrurtion 13rrulit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: i 8S Z �> Loc -Address `or of NoJ -.Address --•----•-•---- -----•.............. ..... - '---•----- �ST.-7� ---`!�r,_d �1�A----- --- - � -------- -- -- ='gyp- -- --- Owner j Address W - Insta er Address U Type of Building Size Lot__Z J ...........Sq. feet Dwelling—No. of Bedrooms.__----.�------------------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -----------------------------------------------------= W Design Flow----------1 d............................gallons per person er ,ay. Total daily flow-:.-.-Z_?®-------------------_--- -g gallons. WSeptic Tank—Liquid capacity)Qa�.gallons Length-. .-...6..... Width..tf.......... Diameter_............. Depth. -. ._... x Disposal Trench—No' .................... ��Tidth...'�-.-_-__ Total Length............ Total leaching area--------.-----------sq. ft. 31_.�, Seepage Pit No........f-.------... lameter...-.'7........-. Depth below inlet.... 4... Total leaching area.., ------sq. it. z Other Distribution box (t e 6,R Dosing tank ( ) � ~' Percolation Test Results �by....--.._ .........PAV'L....l'-1-V_Rat�j........ Date-.--.?.�.�.�.�.('__--..__.._... a Test Pit No. 1_-------------minutes per inch Depth of Test Pit..-.------.--------- Depth to ground water._..-..__.--. -----__-- f� Test Pit No. 2................minutes per inch Depth of Test Pit...--------..------. Depth to ground water------------------------ ------ } Description of Soil ®"'. _ .�/._:.. !X-.._.�.- v l7-- ---------------------------------------------------------------------------------------- V ------------------------------------��{t-�D._......... !-_ .... . ------------ - - -- -- U Nature of Repairs or Alterations—Answer when applicable.............--------------------------------------------------------------------.:------------- -------------------- --- ----- ----------------------------------- -- Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code he u rsigned further agrees not to place the system in operation until a Certificate of Compliance has beenji,&< Doa of health. Sigd. ....... ------------- -------- ------------------------------------------ ---�` '� � ------ Date - , -7 Application Approved B _ Date Application Disapproved for the following reasons:...............•------- ---------------- ------------------------------------------ ---------- ................ ..----------••---•------------------------•--•------••------------------•-•--•---•-•--------•---•--..................------------------------------------------------------------....................... Date PermitNo......................................................... Issued....................... ....................-............. Date ----------------------------- - No. '�l __. F�s...���................. { x THE C MONWEALTH OF MASSACHUSETTS ARD�OF HEALTH ..... - OF.... i i��'.T 7r�t ............................................ ' .. AvAirtttion -for Riivoiittl Vorks ( owitrurtion Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: _ (� ------------------_._... =---•-- --...-----•------. -----------...----••----------------•-------------------------•-•------ �•" _ Loc 'on-Address ------------ 'T ��;cu7 !-? Owner Address -----------------------•--- .......................................................... ------•---------------------...--••-----•---------------------�----- -•------- Installer Address Type of Building Size Lot_-e_CI ___________Sq. feet V Dwelling—No. of Bedrooms-------- ....................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures ____________________________ Q W Design Flow________%U____________________________gallons per person per day. Total daily flow______��'n__.______________._._....._gallons. WSeptic Tank—Liquid capacitv_! :'..gallons Length____: _j�_ Width._,# ,.-r... Diameter................ Depth_4------------- Disposal Trench—No_ ____________________ Width__ - --------- Total Length_______.___.___ _._ Total leaching area-------------.------sq. it. -_-__ Diameter_____ Z---_-_ Depth below inlet_._ ��_=.J Total leaching area._ ?=' 1. "3 Seepage Pit No--------- p _____sc ft. z Other Distribution box (✓ 3� 6 Dosing tank ( ) r1 ~' Percolation Test Results +'erferrxer�-b J' ✓_L_.__` .����_�_ _ .__.____ Date.....�_�_ __ _�C y--------- --------------- --------------------.. Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water..------------------- f� Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water__--_.__-__-._-.-_____-- a - ------------------------ --------------------------------------•••-------._.....-------------------------------------------------- Description of Soil--.-- --- _.____C.LA_Y_____S___.__UP 0t, -- ----------..•---•••-•..................•-•-----------------------.........--------•--------------- U -------------- - -------------C)- fj n,�? "(Zfi�t�- -;-•----•••--•_- . W �.te r--------------_�• .............. P<�0 - SF!r� --------dnueL------------------------------------------------------------- --------------------------------------- - - ----------- U Nature of Repairs or Alterations—Answer when applicable---------------------------------------------------------------- ----------------------------------------------------------------------------------------------•-----------------------------------------------•-------------------------------------------------=-----.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The and rsigned further agrees not to place the system in operation until a Certificate of Compliance has been ' u by a, of health. Sig d ---•-•---• •--•----••- ✓' ,a ,r_.�i----•- Date Application Approved. BY - � / �� �.-J--��-- Date Application Disapproved for the following reasons________________________________________________________________________________________________________________ ._._..-•----.._..-•...............••--••-----•-•------•-----------------...-••••••-•••-------••--------...._---•----•--.__---•--•-•••....•--•••-•--_.....-•••-•----------------------•---•--------------- Permit No. Issued ---•----- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD,OF HEALTH �....."`'. ...................OF...........a.. �.. <3 ,....................................... Tntif irttte of Tilutplittna THI� L�TO CERTIFY, That the Individual Sewage Disposal System constructed (L-- or Repaired ( ) �V�� v(� . by............. --- ------------------- ••-••-••••------------------ -------------------------------------------------------------------•-------•--•----•_- f L Instal at........................................ .............................. ---------------------- has been installed in accordance with the provisions of . tl XI of The State Sanitary Code as described in the application for Disposal Works Construction Permit N .. .. . - ���______._-__ dated..._./.. .�__7_.-__7. ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM VVILL FUNCTION SATISFACTORY. , DATE----_--- �r Inspector..... C. . ---1/�THE COMMONWEALTH OF MASSACHUSETTS L-7� ,/ BOARD OF HEALTH r' ...........17'... ..........OF....a.... . ......._.R_�tc �- No..---.....- 'X?/ FEE- ............... - utt ti�at rruti Permission i hereby granted- --•--• • ••--•••--= ------ --- ... --- - -- ---------------------------------•-•------•- to Constru �}--�Re air ( ) an Individ al Se age Dispo a System �}f y at No. ---- ! . e ,� as shown on the application for Disposal Works Constructioge �itetNo. ;-- <=' Dated.__ _ _.'__ ..`--.�-� ---- -------------=- -----------•..._ Boar of Health _ DATE-- ------------------------------------------------ FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ' l 7 l!/�S d 10rJP' J O _jkk OF If CRAIG y i '0" % RAYMOND G .box , h7loo 011 o SHORT `� /OG�Gfgc, No. 27483 ti FSS/OUAtE��' �8 r'r N oT 03 10V vVnr- 7 I rU / jIF 4144'0u-1 Cit/4 y", Ti' =y/83'110 A =32 4/z f� = /�9 .s"8 /P� .3z77 7 8 7-/yE' ,C3 v/,c V 1 Al G, 7W 1,5 P4-.9A'1 ,DD,E's .Vo7— 4 W/TN/N iy �Pt=G/AG FG O fJ,O ,A11V Z 1 CERTI P I E D PLOT PLAN T g 4�� L0 C A r 1 0 Nj 12. r7 L--� 'ill s o'=.s� --cL�V� ::F�'<s- /-�30- 7G 5l/' a ' — i✓1E-,0 45,1luc? A19'It-4SCALE: �/��� �Q � DATE: � 9p"-32' --GG1�-�.SC• 6i9aJJ fGi�i9(/f=L PCFCsRENCE: ,60//L; .� 07" Z3 fIS '::�W o u/,v o,v I<VA .4,%J /0/9 a Ac_ 8 z />'k G.b/r.,O i9 7> I HEREBY CERTIFY THAT THE BUILDING �R�G• LAND SURVE ' OR k SHOWN ON THIS PLAN IS LOCATED ON THC GROUND AS SHOWN HEREON AND THAT ITS. —s CONFORM TO THE ZOP4ING VY — LAWS OF THE TOWN OF � � f��sJF�t e�MA-�,5 rAM&E WHEN CONSTRUCTED . JOSEPH M. �a ' E n MONAHAN,JR. 13660 C S ASSOCIATES, INC . REGISTERED ENGIQIEERS 8 LAND SURVEYORS MID -CAPE OFFICE OVILDING - 1265 ROUTE 28 ���✓esS�������� � 7�_9 SOUTH YARM O UTH., MASS. 02664 `�