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Home My WebLink About0064 TURTLEBACK ROAD - Health 64 Turtleback Road Marstons Mills s A= 047-085 ,1 1 t YOU WISH TO OPEN A BUSINESS? 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: $ �� r— Fill in please: APPLICANT'S YOUR NAME/S: � 1 s- �-, �v''� a US NESS YOUR HOME ADDRESS: — S TELEPHONE # Home Telephone Number n-evi-I — NAME OF CORPORATION :NAME-OF.NEW BUSINESS .' 1 `l a . TYPE OF BUSINESS' f/t:e. � Y h s 15THIS A HOME OCCUPATION YES:. NO q ADDRESS OF BU5INESS 2= g MAP/PARCEL.NUMBER � '._V�S [Assessing)`; 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 ha$ be"�arr�e�l of the permit requirements that pertain to this type of business. MUST S,OMPLY WITH ALL. l� VI(/I 'A'2ARDOUS MATERIALS REG[!I-AT! ).M11 Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: / �►I� TOWN OF BARNSTABLE Date:26/ ,(o TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: OL7�,4c,,,r ��')-( h.� BUSINESS LOCATION: INVENTORY MAILING ADDRESS: - Ice r Ce �� ,� -g5 TOTAL AMOUNT: TELEPHONE NUMBER: t( — CONTACT PERSON: nXyi EMERGENCY CONTACT TELEPk4 NUMB F : /—�g�°—72 '/ MSDS ON SITE? TYPE OF BUSINESS: k-roles I� e�/ 0-md--'u INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) 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 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 Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staffs Initials f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information f\ on the computer, I I U use only the tab 1. Inspector: Lo key to move your cursor-do not Ricky L. Wright use the return Name of Inspector key. B& B Excavation, Inc. ,-y Company Name 14 Teaberry Lane Company Address Sandwich MA 02563 Cityrrown State Zip Code 508-477-0653 S 14595 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ,r4 ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9/16/11 Inspector's Signature Date `ram r n The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. p if t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewag.,Msp.sal System•Page 1 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): I t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments p Y °M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): . 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: i Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d n/a 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 2007 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road M Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: tank 1985/pit 1992 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >20feet Comments(on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good shape no signs of leakage or blockage. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 5.8x5.8x10.6 Sludge depth: 6" t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness no scum Distance from top of scum to top of outlet tee or baffle no scum Distance from bottom of scum to bottom of outlet tee or baffle no scum How were dimensions determined? scour stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection tank appeared to be in good shape tees present no sign of back up. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appeared to be in working order. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ 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.): At time of inspection leaching appeared to be in good shape no sign of staining or hydraulic failure.Leaching was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attachedseparately O DOT Lt-1 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: >12feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 64Turtleback Road Property Address Veni Lemos Owner Owner's Name information is required for every Marston Mills Ma 02648 9/16/11 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE v LOCATION��` � Qd o SEWAGE # VILLAGE;;V��i_4& _;�lrcZZ ASSESSOR'S MAP & LOT 6 Ll 1.- 0-S INSTALLER'S NAME & PHONE NO.Qj '�' �" ?09BP Poo 1 SEPTIC TANK CAPACITY /j-®® LEACHING FACILITY:(type) e.441- (size) f®oo NO. OF BEDROOMS .I PRIVATE WELL OR PUBLIC WATER Oj BUILDER OR OWNER DATE PERMIT ISSUED: 42, DATE COMPLIANCE ISSUED: -a- VARIANCE GRANTED: Yes No I, r � 1 �� s � � \ - - - '?'° , r� -�� . � � -� �� o� _ <. 0 Fss.....3 22......:..._ THE COMMONWEALTH OF MASSACHUSETTS APPR BOAR® OF HEALTH 6,,,,sjdoieG0ner TOWN OF BARNSTABLE A,pVtiration for Disposal Works Tonstrur#irr rmi c' `Application is hereby made _�for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Syst 60J,.. . "' ------------- ...................................... A- Lo n-Address or Lot No. de - ---------------------------------------------- ............-•-_............... Owner -..•.-•-•-•.-Address Installer Address Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) `4 Other—T e of Building No. of persons............................ Showers a YP g -------------•-•------------ P ( )--- Cafeteria-(----)- dOther fixtures -----------------------------------------------------------------•------------------------------------------------. W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter.........--..... Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-_------------------ Diameter.............--...-- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) � Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water.--..................... 01, Test Pit No. 2................minutes per inch Depth of.Test Pit............--...... Depth to ground water.--.................---. a .---•------------------------------•----.....--------------------------....-----------•••-•••...----......................................................... 0 Description of Soil............................................................................... --------------------------------------•---------------------------......--•-------.----- x U w ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••------- V 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 TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complla has been issued'by the board of health. Signed .. ! z...-- o �- ---------- ---- 2-_"'-�.�.". �-- Dare ApplicationApproved By ------ O c w, ------------------------------------------------------------------------ --------- Application Disapproved for the following reasons: .............. ----- -- ---------------------------------------------------...............----........ ------------------- --------------------------- --------------. --............------. -- .......I..... ----........ -- ------------------- ......-----...-------------------------.................................. ------------.---- ------------------- / Date Permit No. ...........7.1.. .... -6.�---- ----------------- Issued ----------................ -------------........-- -- ---------- Date If Fits.... 34/,2......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appfiration for Biopaaaaal Workii Tnnaitrnrtuin rumit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ....... ......._....... �a�_...... = ..f.JA .......................------ Lo t' n-Address or Lot No. ....._ (J � ---------------------------------- ..-- -----.-----------------.--------------.--................-..---..---------....._............. a / � Owner Address Installer Address Q Type of Building Size Lot...........................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) 14 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ................:........... W Design Flow............................................gallons per person per day. Total,daily flow_...........................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) IH Percolation Test Results Performed by.......................................................................... Date........................................ 1 Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �Ll Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 •-•-----.....••-------------•--------•-•------•---•-•-•--•-•---•----•----•.........--•--•-•----•-•-•......................................................... 0 Description of Soil........................................................................................................................................................................ x V ............................................................-------••-••--•----•-----•••••---•--•--•-•-••-••-•-•---------•------•--------------•-------------------------------•---•....-•-•--......••. W ------------------- -----------------------------------------------------------....----------- --------------------------------------------------------------------------------------••-•..-•-.-- 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 TITLE 5 of the State Environmental 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. Signed ------- .....Icy 0.4— --.....�.../. .... ..................................................... ........... Date Application Approved B --------------------------------------------------------_--_--------- -------- --Datf/��s � PP PP Y ................ -�-+�^�--�-�.e^^"„'^"� a � Application Disapproved for the following reasons- ---------------------------------------------------------------------------------------------------------------------------------------- .................................................... . .. .. ....... .. ..................... .... ............................................................. .......................... ........................................ Date L Permit.No. c Ifi; ...._--- --------------- Issued ........--------------------------------------------.------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cer#ifi ate of Comyltttnee THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ............ .-.: -------------------------------------------------------------------------------------------------------------------------------------------- Installer at ------------- `7 ......: ---------i zf4..-has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .......max.......lfll.e ................ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................... �.....�1.... Inspector ...-... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No....9.�-:--v(� FEE.-- C�- Utopaasal Work.5 Tnno#r inn amit Permission is hereby granted............. ....... . ...........(a gC�I -E •--•••-•--•---•..................•.............._..--•- k to Construct ( ) or Repair A( an Indivi ual Se'nwa, e Disposal System 1 at No.................��-...._ �.Ql�........ �.---------�-s-- ---- Street q / as shown on the application for Disposal Works Construction Permit No._/-"�:'�--____ Dated.......................................... l ..................................��Board of Health ----------------••----•-----•-•--•-•---.......--•. DATE................................................................................ FORM 36506 HOBBS♦}WARREN,INC..PUBLISHERS L O CAT ION SEWAGE PERMIT NO. kot o3 my '3�,c 83. 23J VILLAGE 7- d�S INSTA LLER'S NAME i ADDRESS . �(cS►fV�L� - U I L D E R -OR OWNER _ h-wrn ®S DATE PERMIT ISSUED L DATE COMPLIANCE ISSUED �� 3y�\ S�� f3 �� s , ................ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ........................OF....:. .( � � Nam- --------------------_._.--------_------- Appliration for Mipavia1 Vorkg Tnnit`urtion Frrutit _. Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at:. ... }........TS�� M � ---- ..... ! Q.?1 .......M it ....................................... Loca' n-A ress. or t No. y�}�� ,,LLLLgg pe Owner a Address------------------------------------••••- ----------'-------- •• -•-..• � nstaller Address Type of Building Size Lot. 0 ....Sq. feet U Dwelling—No.No. of Bedrooms...___ __________________ __ Expansion Attic ( ) Garbage Grinder ( ) a -------- — p, Other—Type of Building GY-Ar eS A..... No. of persons------- Showers (3..) Cafeteria ( ) PaOther fixtures --------------- --------------------------------- W Design Flow.............�J®.......................gallons per person per day. Total daily flow------A3 D.--...._............_....gallons. WSeptic Tank—Liquid capacity.le94..gallons Length-----0 ----- Width.....4p.*..... Diameter------- Depth................ x Disposal Trench—No. .................... Width---_--------------- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No----_-------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) / ~' Percolation Test Results Performed by._._ _____ ��._!_�................................... Date..y-.l--!_`E Z 3.........._. aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--__--__________-_--___. GT., Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+' -----------------------------------------------------------=------------------------•--•-•------•-••......................................................... 0 Description of Soil......................................................................=............................................. ................................................... 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 TITI.L 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. d- ----- - --------------....'_-_ 1n------------------------------ 4 , -- -to -....--- ApplicationApproved By.... ..............................--------------------------•--------------------------------- ---- ... ----------•--- Date Application Disapproved or the following reasons------------------------•----------------...--------------------------------------------------------------•....._ .......................................-------------------------•-------•-----------------•--------•--•-..-------------••---------------------------------------------------------------------.......... Date PermitNo......................................................... Issued....................................................... Date 4 ! Na. .. FE °�l..................... LTH THE BOARD AOF OF MASSACHUSETTSTs OF... rb� -..-........ Applir�ation for Diipnu�al Worka Cnomitrartinu Frrutit Application is hereby made for a Permit to Construct K) or Repair ( ) an Individual Sewage Disposal System at: 1-;O - # -403 fi � a n Nt'c 11 .;.�................•- Lo C ress No. ..............._.... --- - ------...... ... . -----.....-• ••-•----..........---...-•----------------------------------.......... Owner Address ................................................:... ...................................•...........••••....................._..... Installer Address �^�r�/�"► d Type of Building Size Lot..:.-:.1...................Sq. feet Dwelling—No. of Bedrooms..... ..................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building( Ak T.SOh No. of persons....4................... Showers Cafeteria ( ) P4 Other tures Design Flow............................................gallons per person e day. Total ai flow.._...-:_..__.:...... gallons. W ..00 �� «fir �e.......--••••••••- WSeptic Tank—Liquid capaclty�._-_.._....gallons Length................ Width................ Diameter-_---_-.--_-.-_. Depth..............-- W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date---•---•-•---------------------------- -. ,aa Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ Gz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •--•-•-••-•---------------------••-••--•••-•--••-•••----•----•-••-•---••...........•-----•---•--•............•--•-•-••......................•............... ODescription of.Soil........................................................................................................................................................................ x U ------------•-------------•--------------- ------------ ..._...------------------•-------------------- -----------------------•-------...------------- 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 TITL% 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operati6h until a Certificate of Compliance has been issued by the board of health. to Application Approved By`._ ----------------------------------•----•--..........---•---•----...---... .... !`g -- ............... Date Application Disapproved r he following reasons:................................................................................................................ .....................................•--..............---•----------------•-----••---------•--------------•••-••••••.....-••- --••••----•••••---••-------------••--•----•-•---••-•••-•--------••......-- Date PermitNo......................................................... Issued---------------------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF..................................................................................... (In if iratr of Tuutplitttta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) rby---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installer at............................................................................................................................................................................ . ..... :••----•••-•. has been installed in accordance with the provisions of TITLE E 5 of The State Sanitary Code a d ed. in the application for Disposal Works Construction Permit No.-__ ............. dated-...-__--- -.r� . THE ISS AN PE OF THIS CERTIFICATE SHALT. NOT BE CONSTRII AS A GUJARAN EE THAT THE SYSTEM V!I I. NOTION SATISFACTORY. DATE--.f�.. -_•---. Inspector---- ••. ----•••---•---•---•••••--•••••-••••---•••----••---•-•-•...:.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH I ...........................................O F...---•--........._...-.............................................................. l� No... ':-. '.�f FEE....:................... Disposal Workii 01. uuitrudiott 'grunt Permission is hereby granted...............................................-•••••----...........----•---•---•••-••-•-•-••------•••-•..............-•-...........---...... to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No....................................................................................................................................................... .... .. ............ as shown on he a`plication for Disposal Works Construction Permit Street ..................... D _--•_----------_.----- B rd of ealth DATE............................................................................... FORM 1255 HOBBS & WARREN. INC., PUBLISHERS 20 FT. MIN. /1l07E /F,E/TNER TNE.SEPTIC TAN OR �. _E�i.GtliivG 'P/T .4RE /`MORE T 119.�'/, /2:11BELOJN.. �Z. !D -r. /M/N. rRAOE�i4 24 O/AM ETER C•ONC.F�-TE COVER /2,0 „ SHALL eF QROV6,g7 7'0 " :;RA IOE. �.• ,v EXT,?A 4 PYL' P/PE CONCRL7E 1iy C^_ST /RO/!; CO,{iER SN�4 t.L "13E,G/SE1� COYERS M /TCN IF /N OR/VE1�t/A Y ••. 0MiN. CONGR�TE . . ADE CC) CGEAiV .SANG *'CAST 2 L 4YER /IRON P/PE o e v . -JV8 ~;b M/N. P/TCN GAL. • a 1 • • . . . • �. . > •4� WASHED 57-ONAC %4'Rom -r. SEPTIC TA/VK D/ST, .� t , . . • . • a', �O/�T7�s�4�-) rp • 1 •EFFECT/VGA i r • •r 314'_: ��2 • ° • • DEP7'N • • • •� m l4%45h'ED STDiYE : :� tt • .• � a .. • • ppo /S�•5 K 2.S =. '�f'7/ GAD ' • • • • • • p ► v PREC45T SEEPAGE" 7g.SY �.a _. �g a•►•� • • • •. •. • •:� o • v QR EQU/✓. INl�w T CLEkIA77ONS . .a /NYERT AT BYJ/LD/NG //10 Fr5y� GPa 6 Jm D/AM FT. D/AM• C SEE TABULATJON> OUTLET SEPTIC TANK � r. 1 /NLET SEPT/C TANK I6 8 FT FT, � /NLET D/STR/AVT10N BOX l0 `( FT GROUND WATE/�t TABLE O(/TLET D/STR/BUT/ON BOX 101,z _FT SECT/ON.�F //YL6T LEACN/NG PIT is •o FT .SEN/AGE .OISIoOrSA.L .SYSTEM LEACHING °PIT TABULATION SCA4LE %.~:� D/HENS/ON A. ESIGN CR/TER/A �•O FT D . D/tfENS/ON 8 el NIJ/NBER OF BEDROOMS 3 : D/HENS/ON C V. CAROAGED/SP0.5.9L UNIT �'� SOIL LOG SOIL TEST TOTAL EST/NlATEO FLOrV G.4L..1DAY SO/L TEST Af/ SO,/L 7—'=S7-#2 NUMBER OF LEAC//ING P/TS_ ELEK //O ELEY, l y�g3 p/_ A(_ . ,DATE OF SO/L TES7- y . S/DE LEACH/NG PER P/T ESQ PT. a- o Z; RFSUtTS h//TNESSED BY E a jAw / BOTTOM LrACH/NG PER PIT 'S SQ. FT. 5Ue35eac. PtRC0L.4T/0N /cRTg ,Ef -L 2-- MjJV1JNCN_ TOTAL LEACH//YG AREA _SQ. FT. �` FfxCOLAT/ON RATE RESERViE1EACN/IV6AREA Z61-2 549. FT. - 6QAOFL t SR D SN OF RI' Gt �eg� 77/ 7Z .r�Cl a ROBERT yGn v �'•/A T BRUCE { LfloE r " a 3 �E y No.10951�o�Q EL DREDGE FNGI NEER/NCs:CO,/NC H G E GISTS-P . �. Et�3/.58.0 7/2 MA//Y S.T..• Al Y.4NN1S. .M.� SS E�� NO GRO.f1ND yY�4TER-l�NCOUNTER�D. CL/EJvT: rST O i o � ScrONAL J�r.�Q^•'' DATE � S< /'.Sr �...� Gm UND PVATER AT ELEi/ - . .JOB MD,• ��ce'6 P SHEET�--OF �-= d. -T. A.EC JM� F1<71,'.S )! r—! s )I !C i..: AP--r T� g. r / Q 'r y ♦�O 1_%_!_ L., IJOI (AL l t. ;: l 40 3 l s ' I n\ 3 .cp � Nv, �1 .. P o Q EXIST, c IT � i\�.Asa ,�'�i1 ".� c� � yx. �`. t�� C' \\\:rGq°} \\ ` �•� li,S ��. �J j � ,� ; .S (1'. ,� p, � �.. � '4'°�,,G �� L o,�•, ,\ '.�,�R gib,, , -0 F CQAI6-b WlNV-RE_d .* O \ ' IV7a 6- \g \ Q a x Zt A "c. op obi �/F CDkI � ! G. Lac- Y �b�yi � .�// v�� . .�, O 01 / ! AsaumE WELL of l - (�`' I ��r / (� FoUNDATIOAA I.J ft.SEDTIG G,QISfArl tLL PA�-n4 !!+E.: i'i C. C Il 1 �/. SISTEM LOC,-noo I PER. It_1 - 2E-AQ .1�+� / �8�.�,JRGE n�a�A 1,/p21a&)cc; Grp y��83 11�N F M�ea C T?s}2,.�ST. raaa� OF HE4'1-7K y LEGEND AL R . EXISTING SPOT ELEVATION —OAO i�-� CERTIFIED PLOT PLAN ai RSE CollEXI STING CONTOUR --- 0 _ v 7 ' 3 0 3 -t-ur;TcE 13A c:K M lj . 0.10951. O FINISHED SPOT ELEVATION [Q ] � % 4 r'5 T y/V•S /9 / L L-$' FINISHED CONTOUR 0 - 11 o a\ ��' A- APPROVEDBOARD OF HEALTH ,, IN 1 ` ` 1 DATE AGENT SCALE= 4o DATE 4 5 �--3 i�SN OF� � LOREDGE ENGINEER/NG CQ IN m a K eo/v i CLIENT I CERTIFY THAT THE PROPOSED H EGISTERE REGISTERED JOB NO. 03� BUILDING SHOWN ON THIS PLAN n a CIVIL LAND t CONFORMS TO THE ZONING LAWS ENGINEER R E . OI .BY _.LL:—L OF BARNSTABLE MASS.�� Ho suR��y 712 MAIN STREET CH. BY J HYANN I St MASS _ 1 4s SHEET OF _ DATE G. LAND SURVEYOR