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HomeMy WebLinkAbout0030 VIOLA LANE - Health 30 VIOLA LANE, MARSTONS MILLS A = 043 006 i � TOWN OF BARNSTABLE LOCATION 3 0 L SEWAGE# 4013 391 VILLAGE XxrST�hS rK/4 ASSESSOR'S MAP&PARCEL /0.'/,S -00(o INSTALLER'S NAME&PHONE NO._S0B-Z/2o-973$ �DSrGi [tee �/i~{'rc7s ;SEPTIC TANK CAPACITY /000 LEACHING FACILITY:(type) �-500 NO.OF BEDROOMS -3 O OWNER 04Vlr,/ S'wS zEu/.yA / PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BYE . I /3-2= 3SG„ {q-3,so,� s j Town of B• Tastable Pit of � Department of Regulatory Services z Public Health Division BateKAM — ,6 y tee$ 200 Main Street,Hyannis MA 02601 �rf0 AM't� � '•, I 1 �R3,`Time Date Scheduled Fee Pd. i- i oil-Suitability Assessment for Sewage Disposal Performed B ! Witnessed By: i�° 1 i LOCATION & GENERAL INFORMATION Location Address . MCA-0� � Owner's Name � �/1 I,L V 1�/t/S I I Address / 5(�'✓✓� Assessor's Map/P$rcel: 0 lg l oo1p/002 I Engineer's Name -r NEW CONS11Z . ION REPAIR Telephone# 1 (�� Land Use Slopes(%) Surface Stones 00 Distances from: Open Water Body ft Possible Wet Area eft Drinking Water Well>�v ft i ptainageWay >100 ft Property Line >ly ft Other ft ,SKETCH:($treet name,dimcnsioos'of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) r o �1?a °Y s ! i i i i i Parent material(geologic) G G. t� I Depth to Bedrock n ---- Depth to GroundwaWr. Standing Water in Hole:' /' I Weeping from PIt Face Estimated Seasonal;High Groundwater DtTERMIN TION FOR SEASONAL HIGH WATER TALE Method Used: --In. Depth to sgll nlgttltCs: Itt. Depth l ibperved standing" obs.hole: ! in, Groundwater Adjuattrtent Depth toiweeping from side of obs.hole: Ac(I f'tetor, - Adl�Croundwater Levr1.,,�,e. index Well# _ Reading Date: Index Well leVt'1 I PERCOLATION TEST . D$tp-.----a T4HC • N . . Observation / Time flt 9 4 Hole# ' C 64" Time at 6" m Depth of Pere Time(9"-6') --- Start Pre-soak Time.C� ) 27 /! End Pre-soak Rite Minllnch Site Suitability Assessment: Site Passed >C Site Failed; Additional Testing Needed(YIN) Original:.Public k;e$Ith Division Observation Hole Data To Be Completed on Back-- i you must first notify the ***If percolafiit. test is to be conducted within 100' of wetland,; Barnstable C#01L vation Di*ision at least one (1)wedk prior to beginning. I DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel to 22''- 3It C eb• f D`l R� 33''--72? C111- PYR-713 , z DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) - Mottling (Structure,Stones,Boulders. Consistenc %Gravel) 01)—(,09 A o��-41 PJ WL fig" Sii-T- b4on tO-t f,713 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra 1 F • i Flood Insurance Rate May: V Above 500 year flood boundary No Ye Within 500 year boundary No Yes, Within 100 year flood boundary No `l Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring p r riouls material exist.in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on d 4 (date)I have passed the soil evaluator examination approved by the _ y Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 3,10 CMR 15.017. Signature ) Date Q:ISEPTICIPERCFORM.DOC No. o ' Fee (V - THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplication for Disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(ArUpgrade(4)--Xbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,30 Jf V1 A- W-*Y Owner's Name Address,end Tel.No. � p,pe, o-I nr,115 FogsZ6 W_57<I Assessor's Map/Parcel o z13ppG -©O $ ,41iJ5 Ins ller's N e Addr s,and Tel.No.s 08-y2 0-9'� Designer's Na ,Addre s,and Tel.No.,SbB-3(�2- ?cI2'L ,has�p fir_—'Yi=�'7 v Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) fAI511411 C!/ —20 0-6 o X X-620 64 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date Application Disapproved by Date for the following reasons a Permit No. �1-7- � � Date Issued 3 R Fee No. �,, THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Misposal �bpstrm Construction 3pErmit Application for a Permit to Construct( ) Repair( Upgrade(G}%ICbandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ,?j O Vo D /p- Wj9 y Owner's Name,Address,and Tel.No. /ti.Oes>005 A011115 Assessor's Map/Parcel b - 006 -OD Installer's Name,Address,and Tel.No.S'a8-Y2 U-c773 F Designer's Namg,Address,and Tel.No.,ra8-_YG 2- 192`L r Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable)ZNWAII �//=!L -2�) -/3 a X �-5(O 6.4 Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the;system in operation until a Certificate of Compliance has been issued by this Board of Health. F Signed` Date Application Approved by Date ' r Application Disapproved by Date for the following reasons r Permit No. l�` 3 21 Date Issued 1S d-(3 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded Abandoned( )by at_� p�,rp r/�¢G1 l�J9�ar ���J�%/f has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 321 dated Installer,&,,d a,i--�,grea S Designer - ®mil #bedrooms Approved desi flow 3 3 y ) / gpd The issuance of-this permit shall no be construed a uarantee that the system*nction.as dee1gne . ! C SDate Ins ector `� --------- ----- . _ 1 - ___ _ - - -:---- - _ --- -- -- ------------------- No. a 0( / 3.1�f Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair Upgrade(tom— Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit/ 'J Date 0 (�j Approved by Town of Barnstable '"E'` i.� Regulatory Services Thomas F. Geiler, Director M&MABLL 9�A . � Public Health Division 71 Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: ��5 �) 3 Sewage Permit# &L "��/ Assessor A 's Ma \Parcel '� .� ®�j 00 r f Designer: Installer: U � 1 n Address: �X �� Address: ZP v��37 On N((da was issued a permit to install a �installer) septic system at IZ/dh,A L NO<< based on a design drawn by (address) Me i,1 Lo-/ �"`S �►� dated �� �' (designer) I certify that the septic system referenced above was installed substantially according to gn n the desi , which may include minor approved charges such as lateral reiocatio of tl�e distribution box an&or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or ariv vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MASS_ o D RR Y � (1 nstaller's Signature) �i " No 1140 .. '�EGISiE � SOI TAR��'� (Designer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARINST. BLE PUBLIC HEALTH DIVISION. CERTIFICATE OF CONIPL1ANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNST.ABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic,'Designer Certification Form 3-26-41doc i&® t/ TOWN OF BARNSTABLE LOCATION LW c'V VrolA SEWAGE # ?7 VILLAGE ASSESSOR'S MAP 6z LOT INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) ood NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER JyMc s S •f� DATE PERMIT ISSUED: DATE COUPLIANCE ISSUED: VARIANCE GRANTED: Yes No r - 3 .�y -f No..�7=6. .7 FEB ' THE F Ts BOARD OF HEALTH ty 3 l..cawt�...................OF...... ---------........................................... Applira#iou for Uhiposal Vorkg C> omitrurtiou Prrutit Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal System at: ....... /...1 .... . 7 :........................... ............ 4 ........---•----•-----------------•------------••---.............----••. Location-Address or Lot No. - M %M%. ....................•-------•---•----- �1.o�� � ......----•-•---....-•----..................---...........-••-•--- Owne - � i - Address pus 7-le Installer Address UType of Building Size Lot...../._..,/AO....Sq. feet Dwelling—No. of Bedrooms........1 !e:n<....................Expansion Attic ) Garbage Grinder (�) '44 4 Other—T e of Building No. of persons............................ Showers — Cafeteria 04 Other fixtures ----------------------------•--• . W Design Flow..................................... per person per day. Total daily flow................ -3-3®.........gallons. WSeptic Tank—Liquid"capacity.0_10.gallons Length__8._.le,...._. Width_.':71Q0.._. Diameter__- - ---- Depth�_14.!. x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area-____---------.._---sq. ft. Seepage Pit No.....c/7V.,....... Diameter.....ZO---•-_-- Depth below inlet...... 1........ Total leaching area._i9_97-•-sq. ft. Z Other Distribution box () ) Dosing tank ( ) Percolation Test Results Performed by...... ......................................... Date.......WIA9 sul............. Test Pit No. 1.....2.......minutes per inch Depth of Test Pit....../0.�..... Depth to ground water........... _-. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water... � .................................................................................................................................... ._........4. O Description of Soil-----o'Z..Tod---. 50.6.sa]....-----•-------•-------------------------------------------------------- STEPHEM `ice (4 -•--.......--•..................... `S ...r-IA -......-- ---------••--•-•-•--...-••-•-•---•-•---••---•--------••-----•-••---••--......--•--•--•---......• ALLYN eri WILSON a�No.30'?16 UNature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------- -•---., , ------•-----------•-----------••------•---•---•------------•---•----•---•-•----•--•-•.............................•------------•------•---•-----...---•-•..............._.•-• •• . IST Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in acc ce ervi�. 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 ......... ...-------- .... .. . � Dace Application Approved BY ........... ... .................................. si t.6;te ..-.. ."f Dare Application Disapproved for the following reasons- ------------------------------------------------------------ ---------------------------..-----------------. -- . --- -- ..................... -- ---------------------- Date Permit No. - . .;Z..7............... . Issued ------------------------ -- -- --......-------- ...... Uate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1..................OF...... ��°i.z.r�r> .................................................... Appliration for DWpaiial Works Tomitrnrtinn Vamit Application is hereby made for a Permit to Construct (K) or Repair ( ) an Individual Sewage Disposal System at: _ Location•Address or Lot No. .............. .�:t.._ ..-- �-�-�-"•- ---•-•-•........_.. -•---•Y•/ laCt9'tS'r..---------- - ----------••-•-----------••-----------•--•---- ownqi Address Installer Address Type of Building Size Lot....-� ,��-!4....Sq. feet U Dwelling—No. of Bedrooms......... .....................Expansion Attic (Au ) Garbage Grinder (410) `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures --- -•--•--••----•.....................................................------•-•------------------•--------------•--•--...........•------•--•••.•--•-- d W Design Flow...................................;;� ,gallons per person per day. Total daily flow.......,...............-tea----+3Q........gallons. r I WSeptic Tank—Liquid capacity.!;,7!:r5.gallons Len&th._�.:, .t.,.. WidthA'-'. 0.t... Diameter..._"'- Depth...1_�e.'_?. x Disposal Trench—No. .................... Width.................... Total Length...,................ Total leaching area....................sq. ft. Seepage Pit No.....i?KnA.--_-- Diameter....../0---.._. Depth below inlet..... ............ Total leaching area... .;;'_7...sq. ft. Z Other Distribution box ( %) Dosing tank ( ) Percolation Test Results Performed by......T .c cl 1......................................... Date------- ............. aTest Pit No. I.....:!�.......minutes per inch Depth of Test Pit......1d .... Depth to ground water.., ...... Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa `. ®F •-•--•-••----•-�--•---•--••-•------•-•••...............• •--•-................-.,,........ _---•-...•---- 1...... T--•-•................... O Description of Soil.....�?_'� TOO 1.n�,>� :50bspi)• --STEPHEN j.._... I x .. ``� .1 _ t..__....... ALLYN V ...-•--•-•..........--••--•....-•--•- , ---••-•.........•-•-- W ••-- ---------------- -•--•------•5_---/(�----�_.....t.�'�'zl�-------•--•--- V:-3 2-1- � U Nature of Repairs or Alterations—Answer when applicable............................................................. ��. PS`P����q► ..------••-•---------------------------------------•--••-•••------•-----•--••--•-----.......-•---....----•--•--•----------•-••,----...................................... --•------------••--•--------•---••-•. Agreement: �Ceap'f The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with �,,-A 81 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 heal. Signed ------........(.;� --- : ------------- -------- / ��..." Dare A hcation Approved B `t ' PP pP Y ........... . ---- ---..c:�,�p-.--� /...-.... .. f5 ..............................................................'------- Date ..-, Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------- . .................... ........... . . ................................. . .. / Date PermitNo. ... ............�-;Z-7------------_----- Issued ----------------------- -------------------------------- Date f THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C9erttftrate of Compliance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (41- or Repaired ( ) by ......7.�� ", ", 7 . .. .................... ..------ - ,,r Installervj d at ! �''.-, `F.`.j* ------..k�e�oy..'�"'."�� .. ^',_,`'.'-_- .......��. ?;r: ..S'.r?" .. ..-------e!':. ..��.. ......................... .. 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. ....... f. "�__2...... dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE .----- .................. .... ............................. ..............I.....--- Inspector ...............................................................---------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .................................... No.. ? '" Bisp�as�� nrk� n� �rnti� Permission is hereby granted........_, - ..............•... • ... ......•• ..............•..•••-- or Disposal Syste rlri (y to .. ._..... _ _� .. .. ......................: .. L�%f..�,. `..s1� at No.Construct�-- -•-�'-- Repair a�;3a:�-�1��l Sewage...---�-------•-•----------•----------•-------•------ -------------------------------------------•-- Street as shown on the application for Disposal Works Construction Permit D ted.......................................... ...................- .-•. •-•---•-•..............._ 7 � Boa of Health DATE---••-.` Q..0-------------------•---•----------------.- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ..� i-. L44 : O.c�7Q D4% 'cz:0 W //O X 3 _ l 3 6. .. 3 7�-Lt/l� - X ./ � Usk' /oaaa a,44. . /79 -77 tom17 7aT.ClL ,DES/�.a/ SZ� 7?�T,4• D4/1-V Xzo w 330 e tA Of STEPHEN � B ��+ RICNARC ALLYN K3., 2 2 Q • WILSON No.30216 No.24048V/ �fCISTfaE� D to O S � .. ._ . .. .. �' • � I 70�� f3-25-g8 IA16r,4LL 4X�i.YL tie &- J_.4CC� Fj/ w/r- A/ z7-89 �85,o f'l, > 85,• o •• FG .. �'v5.s ��., Ta�F,Yd� ��o i rb P 'P m ' . . ,. ,•� i ,o Sv�3 sole 2 0 ,/�`r3 o,L •• o/sr, l v sdo) .Kc.) f • All, BOX ///K <5AI , Sew G Lqy ;-4h'AG/<t i . — cc a • , G•Z Z 5. T/LL 4LL •�-�/l� �'1,.4TC.2i.¢•C_�vZ /a•41.L- �c1 � �z!� ' �.4T�' /�-�/-f'� vp GE.C�r/�Y Tf/QT TiS�E Fcl,�/p��Sf�DW.t% IqAAI yE,�Eov co.�l��ys 1�/ram 7h'�'Sid��i�� B,dxr�.e .4iS/D.SETI//�Gv .��QU/�'EkIENrS o,` 7;V4 Tox%s� 0'` 4�2✓SraBCE �t v� /S .voT 1 ,eE6isr z4A 0.sveV,5 E s G ocdr�.o GV/7;Y/1,Y T.y.E XW"04 XI I-r AVpT h�E.eE4N.S,�a!/G p�pT QE Tv ES.T.�L/.Sy LoT-.G/NEs; USEQ : . ►� 0� / X3 %5�'sdL PI r--U�'��) l000 �.L. ;t- y N `°•�' d, 475. orrz�y 7ZMAL ,DEsi�/ : .� 5zy a.1�0. 7b72V- Z)41(y Fv-ow = 330 er...P.p_ Z' Mi.✓.Of STEPHEN a� F ICHARD ALLYN c 'A WILSON " :BAX' R N0.30216 No.24048 `er ` oo o��� �STf����' '��N� fCrStEaE �.,�;• r y pN MLA T�17-AlI-E 70 t19 6-25-gg IA16r Z-I- o4.G 4X7-1Wj tow/r ,//2 �F� ' �S.O 'FG•r� BS'o ,.. FG � Q�5.5 ;i;i Ta•�F.Yo� c��a i ro Sv/35o/L Z,o 5���'oiL ., o/sr. `Jr'.c(EVS�) .ciL.) s • /.sib g> p Xw- ✓(� GLQ L `,gck ZO• CJZlo SEPn.GZ 4s �' y T/LL .4L-L- ".. 0Z L . G E.GT/F/EO PLOT p�-:Iv Mom. ,gt�v�✓o ,b 7l0,0 . , }-- c" �. L oC,GT/oti n'I�51'a,�✓S �I/4.t� j ,S'GeL�' .� M•4T��i¢L.Fta2 /a•4tL a� A.4T.E - /-�'� D.D. �4745:z._ Ap W47E,fe- pprry� Z-0 F _�..GE•erXiC•Y T.�/.4T"T/�/E �J�o4 S//aW.cV l- -4A. 778 �6, cgs j :dtiD.fE'TI�AGY_ .2�4V/,e�'N1�i�/rS of 714 •vYE /.vim. TOWiV aF .C�.E6isrE.P.�=.O.G�.ci�.slie,iE�j,�S ��/�S�BLE• QiS/I� /S i{/OT"' G�ST�.GYfGL..E �. . j !/�lEiY1-'ea'e EY�fit/O Tf/E��/iY.ST.Q- or s YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the 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'' FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. t w. DATE: ) O �r Fill in please: , r APPLICANT'S YOUR NAME: C �i� 1-QS�I,a Ki BUSINESS YOUR HOME ADD ESS: �� �f� tc L-n 356r5+0 rt5 1 l l l 5 YYt TELEPHONE # Home Telephone Number: P NAME OF NEW BUSINESS C0-0+cvN15 TYPE OF BUSINESS Cleavl��`I COrn04a��� IS THIS A HOME OCCUPATION? L YES NO Have you been given approval from the building division? YES NO �� 2 , /�� ADDRESS OF BUSINESS_ -30 V',1Oh 6n. Jy\avS�OnS )A4 Ll s MAP/PARCEL NUMBER J V 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 MUSTCOMPLYWITHALL This individual s been inf med of er i r irements that pertain to this type of business. HAZARDOUS MATERIALS REGULATIONS Authorized Si ature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has. en informed the licensi g requirements that pertain to this type of business. A thorized Signature** COMMENTS: r f _ Date: o_ TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: �11s Clay, 41 BUSINESS LOCATION: A 11`6L LVI, KLAAs M;I�S � � 0ZI INVENTORY MAILING ADDRESS: TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: C4LLk� -N 'FcvzcwsK� EMERGENCY CONTACT TELEPHONE NUMBER: T nl J`al- 8356 MSDS ON SITE? TYPE OF BUSINESS: Atce c1eo_wn4 INFORMATION/RECOMMENDATIONS: Fire District: L5*ko )4yM oJ- w ch clean;4 4ok+51�t — WPKd ex 4-6dr+ cleane,- Waste Transportation: Last shipment of hazardous.waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) _._ Misc. Corrosive NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil NEW USED Misc. petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways &garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor &furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers (including bleach) Spot removers & cleaning fluids (dry cleaners) Other cleaning solvents twXC�c Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS s DEPARTMENT OF ENVIRONMENTAL PROTECTION Z � . n r I a 1 C I A IY I A I yQ IA yey TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner's Name: JIM ROSE Owner's Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Date of Inspection: 9/29/01 6 d o (o DO Name of Inspector: (please print) JOHN GRACI �{ Company Name: SEPTIC INSPECTIONS / Mailing Address: P.O.BOX 2119 TEATICKET,MA.02536 Telephone Number: 508-564-6813 FAX 508-564-7270 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 15.346 of Title 5(310 CMR 15.000). The system: a X PasseSY a _ Conditionally Passes _ Needs Fu Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: 9/29101 The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspe ion. 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. Tile original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL LIFE. ****'Phis 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. .Id Tiflr 5 Incnrrtinn rnrm 6./1 S/N)nfl. Page 2 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 VIOLA"LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 „F 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 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: SYSTEM PASSES TITLE V RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL LIFE. 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. ..E . Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. n/a 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: n/a n/a 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 ND explain: n/a n/a 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 ND explain: n/a Page 3 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 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 2. System will fail unless the Board of Health(and Public Water Supplier,if an determines that the PP Y) 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 n/a "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: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 D. System Failure Criteria applicable to all systems: You muss indicate"yes"or"no"to each of the following for alLinspections: 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 ''/z 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 nLa. 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.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. 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 _ X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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 largo system has failed.The owner or operator of oily large system considered.a significant threat under Section E or failed unde'�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. 4 n. Page 5 of 11 t OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 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 watefa 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)] sr . S Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM y" PART C SYSTEM INFORMATION Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 FLOW CONDITIONS RESIDENTIAL 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 Number of current residents:2 Does residence have a garbage grinder(yes or no):NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] - Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a .. � I COMMERCIAL/INDUSTRIAL , Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a Reason for pumping: n/a A 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): n/a v.l Approximate age of all components;date installed(if known)and source of information: 1990 Were sewage odors detected when arriving at the site(yes or no): NO i Page 7of11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction:_cast iron X40 PVC_other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 8" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 1000G L 8'6" H 5' 7,'3 W 4' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:33" Scum thickness: 0" 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: 18" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE SEPTIC TANK AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S X USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage;etc.): n/a c 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE 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.): DISTRIBUTION BOX APPEARS TO BE STRUCTURALLY SOUND AND APPEARS TO BE FUNCTIONING PROPERLY. PUMP CHAMBER: _(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a 1 Q I Page 9 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a 3 innovative/alternative system Type/name of technology: n/a r Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE PIT APPEARS TO BE FUNCTIONING PROPERLY. NEVER MORE THAN 2 FEET IN PIT.BOTTOM IS AT 7 FEET CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a n Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 60A B DcCk- o A C °g Al a� olg 5 AC y� � 3�y Page I 1 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 30 VIOLA LANE MARSTONS MILLS,MA 02648 Owner: JIM ROSE Date of Inspection: 9/29/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database,explain: n/a You must describe how you established the high ground water elevation: NO GROUND WATER FOUND BY AUGER AT 12 PLUS FEET cOtC� 1 f� MARSTONS MILLS LEGEND Foie �/ —1 PROPOSED CONTOUR A _ ® PROPOSED SPOT GRADE �FMFti \ SS T --gg -- EXISTING CONTOUR + 96.52 EXISTING SPOT GRADE = WAKEBY W— EXISTING WATER SERVICE ��� 04z) TEST PIT WATER GATE \66.4g � _eft CO i a LOT T 4 GAS ter_ LOCUS 86 AREA = 131 -0 sf +— �, a� 30 VIOLA LANE ASSR MAP 43 PC 6-8 � SEPTIC TANK LOCUS MAP -a v z OUTLET INVERT �^ < EL = 83.73 + LOCUS INFORMATION 0 - m TITLE REF: BK 14448 PG 026 PARCEL ID: MAP 043 PAR. 006-008 L 86 0 �� w SEPTIC SYSTEM �� REPAIR PLAN LOCATED AT: G �( 30 VIOLA LANE \O , N MARSTONS MILLS, MA. D��pF FN�N �i PREPARED FOR 86, E� — FASZEWSKI i 0 EXIST. 1 ,000 GAL AUGUST 18, 2013 SEPTIC TANK 85 - EXIST. 1 ,000 PIT ���`� OF Mq l H 1 / (see Note 10) N M yGn r y � o. 1140 \ '�fGIsl BENCH MARK �aMITAR�a PAINT SPOT ON 2 BULKHEAD CORNER* 01� 25.00'--1 ELEVATION = 86.50 29• _ BARNSTABLE GIs DATU I o MEYER & SONS, INC. 85 102.00 ft P.O. BOX 981 PLAN EAST SANDWICH, MA. 02537 SCALE: 1 in = 20 ft 20 (508)362-2922 O 40 O 10 20 SHEET 1 OF 2 J 1491 ELEV. TOP FOUNDATION NOTE: METAL RINGS AND COVERS TO GRADE OVER ALL COMPONENTS (Existing) FINISHED GRADE (85.50) = 87.49� F.G.EL: 86.5 F.G.EL: 86.0 F.G. EL: 85.50 •a � MAINTAIN 2% MIN SLOPE OVER LEACHING AREA A' :v 2" OF 3/8" DOUBLE WASHED F.G.EL: 83.30 1 3/4" - 1-1/2- DOUBLE ,• . STONE OR FILTER FABRIC DOUBLE WASHED STONE A 77777 6 1 4" SCH 40 PVC 31 1o"I 14' 6' 0III 1% (MIN. ®®®®®®®®®®® A' TEE'S ARE TO BE INV.81 .85 ®®®®®®®®®®® M 4" SCH 4o PVC 2 E F. DEPTH ®®®®®®®®®®® INV.82.0 V.81 .65 GAS _ 4' 2 X 8.5' 4' PROPOSED DB 3 EXISTING OUTLET BAFFLE DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 82.25 `� AM AA INV. ELEV.= 81 .50 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON ��~``� �F Rlxr,04 BREAKOUT OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL oa DARKEN M. �, TOP CONC. ELEV.= 82.50 ELEV.= 82.50 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ' I Y 1 11 0 INV. ELEV.= 81 .50 MEU313 E3E3PIPE INVERTS PRIOR TO CONSTRUCTION ®®®®®®2) D-BOX SHALL B£ SET LEVEL AND TRUE TOE/$TER� ®®®®®®GRADE ON A MECHANICALLY COMPACTED SIX SANR�a� BOTTOM EL.= 79.50 ®®®®® INCH CRUSHED STONE BASE, AS SPECIFIED IN 3.75' 5 FT. 3.75' 310 CMR 15.2 fg I j EFFECTIVE WIDTH = 12.5' 3) REPLACE EXISTING ING 1 1,000 GALLON SEPTIC TANK SEPARATION 5.00 FT. WITH 1500 GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE 0 FI LE31. DAMAGED, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 74.50 _ (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON (H20) LEACH CHAMBER) GENERAL NOTES: SOIL LOGS DESIGN CRITERIA 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL #= P 14097 NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: AUGUST 6, 2013 OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS. SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR WITNESS: MARYBETH MCKENZIE, BARNSTABLE B.O.H. DAILY FLOW: 110 G.P.D. X 3 BR DESIGN FLOW: 330 G.P.D. = TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. GARBAGE GRINDER: NO (not designed for garbage grinder) 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN Elev. TP-1 Depth Elev. T P-2 Depth ENGINEER BEFORE CONSTRUCTION CONTINUES. LOAMY SAND LOAMY SAND LEACHING AREA REQUIRED: 330 85.10 A0 85.60 A o" ( ) = 445.94 S.F. 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 84.27 10YR 4/2 10" 85.10 tOYR 4/2 6" .74 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. B YR 5/8 B SANDY LOAM USE TWO (2) 500 GALLON (H20) PRECAST LEACH CHAMBERS W/ 4' 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 83.27 22" 10YR 5/8 STONE ON SIDES & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D C 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED C MEDIUM SAND 84.10 18" 10YR 6/6 SILT LOAM TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. BOTTOM AREA: 25 x 12.5= 312.5 SF 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 82.35 33" 10YR 7/3 SIDE AREA: (25 + 12.5 X 2 X 2 = 150 SF THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING C2 SILT LOAM 81.60 48" ) CONSTRUCTION. C2 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. 10YR 7/3 79 10 72" SE PERC O EL. 8027 DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5 SPECIFICATIONS. C3 MEDIUM 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION MEDIUM 2.5Y 6/4 PROPOSED SEPTIC SYSTEM UPGRADE P LA N 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 74 10 2.5Y 6/4 132" 126" AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 75.10 30 VIOLA LANE, M. MILLS, MA 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. PERC RATE <2 MIN/IN. ("C2' HORIZON) Prepared for: Faszewski 15. ALL PIPING TO BE 4' SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN I, Darren M. Meyer. R.S., CSE, hereby certify that I am current a MEYER&SONS,INC. Eco Tech Mar. N.T.S. DMM ey fy y approved by MADEP pursuant to 310 CMR 15.017 to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX98f (508) 375-0735 DATE CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that 1 have passed the Soil Eval. Exam in October, 1999. EAST SANDWICH,A4A 02537 508-3s22M 08/18/13 DMM 2 of 2