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HomeMy WebLinkAbout0380 HOLLIDGE HILL LANE - Health 380 Holliclge Hill Lane oarstons Mills ---- LA = 081 012 r-----vim-v J a \ Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v P°rl .'� 380 Hollidge Hill Ln Property Address M Fred Curran Owner Owner's Name � information is . Marstons Mills Ma 02648 12/18/16 . required for every _--- _ ---� _ 6� 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 A. General Information filling out forms �j J t� on the computer, use only the tab 1. Inspector: key,to move your cursor-do not _Michael DiBuono use the return Name of Inspector key. _DiBuono Sewer and Drain Company Name 8 Johns path Company Address. S Yarmouth _ _ Ma 02664 City/Town State Zip Code 508-364-9587 S103522 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: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/21/16 Insp ctor's Signature Date 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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 L`67r . t Commonwealth of Massachusetts ' Q. Title, 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments -380 Hollidge Hill Ln Property Address ------- Fred Curran Owner Owrier's Name --- information is Marstons Mills _ _ M_a 02648 12/18/16 required for every _ _ p2ge. City/Town 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: ® 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 includes a 1,000 GI septic tank as well as a 1,000 GI pump chamber. The leaching consists of three chambers in stone. 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): l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills Ma 02648 _ 12/18/16 -- - - -- --- ------------- --------------- ---- page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official .Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln _ Property Address ---- --- Fred Curran Owner Owner's Name information is Marstons Mills Ma 02648 12/18/16 required for every _ page. City/Town 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. I . ❑ 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 Y, , p laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate ate 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts W Title 5 'Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln _ Property Address Fred Curran _ Owner Owner's Name information is Marstons Mills Ma 02648 12/18/16 required for every -- 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- 10,00ogpd. ❑ ® 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. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 S Commonwealth of Massachusetts w W Title. 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills Ma 02648 _ 12/18/16 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): 4 -- Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills _ Ma 02648 12/18/16 ' page. City/Town State Zip Code Date of Inspection D. System Information Description: System includes a 1,000 GI septic tank as well as a 1,000 GI pump chamber. The leaching consists of three chambers in stone. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 198 Gpd 9 ( Y 9 (gp ))� Detail Sump pump? ❑ Yes ❑ No Last date of occupancy: 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•3/13 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 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is Marstons Mills Ma 02648 12/18/16 required for every _— 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: 2014 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is Marstons Mills Ma _02648 12/18/16 required for every _ _- 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: Installed 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): System is vented at the field Septic Tank (locate on site plan): Depth below grade: 2.5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene, ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill_ Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/18/16 page. City/Town 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 24 - --- Scum thickness 3" — 42" Distance from top of scum to top of outlet tee or baffle --- -- Distance from bottom of scum to bottom of outlet tee or baffle 1" Sludge stick e Measure How were dimensions determined? Tap — Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): No evidence of Ieaking,Tees and or baffles in place at time of inspection. 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•3/13 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 .'" 380 Hollidge Hill Ln Property Address Fred Curran _ Owner Owner's Name information is Marstons Mills Ma 02648 12/188/16 required for every _ 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.): Tees are in place and levels are normal. Tight or Folding 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'. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �., 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/18/16 page. City/Town 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 Level and at normal level Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber is functioning properly * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner ---------------------------------------_Owner's Name Name information is Marstons Mills _ _ _ Ma_ 02648 12/18/16 required for every _ _ _ page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® - leaching chambers number. 3 ❑ 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.): 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•3/13 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 380 Hollidge Hill Ln _ Property Address { Fred Curran Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/18/16 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.): No ponding no break out 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts F Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills _ __ _ Ma 02648 12/18/16 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 attached separately 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name information is required for every Marstons Mills Ma 02648 12/18/16 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: 10+ ft feet 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: 2010 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: Test hole data on plan Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 TOWN OF BA]E3NSTABLE LOCATION SEWAGE#— ,t> Il VILLAGE ASSESSOR'S 1VW&PARCEL T/ / INSTALLER'S NAME&PHONE N0.✓L.. y/� � ;'•' `y ,, rd/�S'• �� SEPTIC TANK CAPACITY Z a+ LEACHING FACILITY:(type) 32b (size) i--J�.:V"`aC,;:p i NO. OF BEDROOMS I OWNER PERMIT DATE: � ? -Ia, 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) Edge of Wetland and Leaching Facility(If any wetlands exist within Feet 300 feet of leaching facility) Feet i FURNISHED BY C, 19 ti" I I .. I 1 r � ` � I I I w .jl•. Commonwealth of Massachusetts W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 380 Hollidge Hill Ln Property Address Fred Curran Owner Owner's Name --- information is required for every Marstons Mills _ _ _ Ma 02648 12/18/16 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 Y r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 1 12 Town ®f Barnstable P pyTfif P Dellartlrlcilt of Regulatory Services L BARNMHLJ� PublicHealth Divisioll gate AB& � 200 Main Street,Hyanuis MA 02601 7 ��PFD MA't a ` � O Fee Pd.��U� (It) Date Scheduled "1 Ito Tihle __ Foil Suitability Assessnielj' tfor SP.Wage D u rdsal 1'crfonned By: Witnessed By: Location Address 0 / e Owner's Name /-( �l Address \ Assessor's Map/Parcel: �l I°� Engineer's Name NEW CONSTRUCTION REPAIR Telephone It 36 1 Land Use. t- Slopcs(%) ��� Surface Stones r�jXqv� / t 1M Distances from: Open Water Body / 3Q ft Possible Wet.Arco )3d ft Drinking Water Well Al,� ft Drainage Way o.V/�__ft Property Line �Ft Other It T 6 . SKET CH.' (Street n e,dimensions of lot,exact locations of test holes Bc perc tests,locale wetlands lri pratintily to holes) {` �®-4 1plo 30 Parent material(geologic) ©✓��CiS� Depth 1p Budnick, 3-5); t�h 99 Depth to Groundwater: Standing Water in Hole: NdNS' Weeplltg Cron]Pit B11oe�T�r"� O Estimated Seasonal High Groundwater DICTERI UNA'I<'][ON FOR SEASONAL HIGH WATER TAB LE Method Used: ^ Depth Observed standing in obs.hole: A/ /T- _ _ _ In, Depth IU 5g11 Itlt�lll�4: T Itt, Depth to weeping from side of obs.holc: _ In. Uroundwater Adjustment e, fr. Index Well it Reading Date: Index Well level _ Adti,h.ketor A41.c)rtwtldwate'r Uvel PE Rtl.OLA A JIO,l V TEST ` DIJIU Mto' `)1 U1d 1 M Observation Hole Ilc fit "Cinle tit 4" Depth of Pere bt� Tinle atg6" a t 0'- Start Pre-soak Time @ '� oD _ Time(9"-6") 3� End Pre-soak Rate Min./inch 2.W Si Le Suitability Assessment: Site I'asseii_ Sitq'-Eailcci:. Additional Testing Nceded(Y/f!) Original: Public Health Division Observation Hole Data To Be Completed on Back---✓'----- ***If percolation test is to be conducted within 100' of weiland, you nl➢lst,'filrst Notify tile. Barnstable Conservation Divlsloll at least olle (I) week; prior to beg➢ll➢ ing. Q:\SEPTIC\PERCroRM.DOC , t Depth from Soil Horizon Surface(in.) Soil Texture Sdil Color. soil Other (Mansell) Mottling (Structure,Stones;Boulders. `v Con istenc % ravel -13 • w DEEP OpsER VATION HOLE LOG Depth from Soil Horizon I-role # Z Surface(in.) Soil Texture Soil Color (USDA Soil (Mansell) M Other ottling (Structure,Stones, Boulde /U Cons! ene rs, %Gravel • 3 ;y-y Ali ' s- �/� DE'E l P OBS]E)[g Wt�7[ION T-TOOL E LOG ' Depth from Soil florizon Surface(in.) Soil Texture Soil Color (USDA) Soil i Other (Mansell) Mottling (Structure,Stones,Boulders. _ Co si to e 0 vel 4 I ]DR E]P O-BSIERVAtTION HO •{ . Depth from �.� �, p Soil Horizon ®�" Hole* Soil Tcxn Surface(in.) 1fe Soil Color Soil(USDA) Other (Munsell) Mottling $ (Structure,Stones;Boulders, Consi ten o a F,100d Insaau•ance)[Pate Ma Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No Ye's Depth of Naturally! Oc-erring Pei vious Mater!al Does at least four feet of naturally occurring pervious material exist in all areas Observed throughout the area proposed for the soil absorption system? I&not, what is the depth of naturally occurring pervious mat®r In]I c>✓'e>ctn�cati°ems • g certify that on �. (date)I Inave,passed the soil evaluator examination approved by the Department of Environmental.PI•otection'and that the above analyt js,was performed by me consistent with the aegafired trai ing, eZf! is and x rienee•described in �1 0 CMR 15.017. Signature9,- c� Date U d /o , 16 Q,1SJ3PT1C\PEftCF'ORM.DOC TOWN OF BARNSTABLE LOCATION 71 Zi e A) SEWAGE#A ,6-11J_ .VILLAGE ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. i7,r.,,J,6 SEPTIC TANK CAPACITY ore 4r, F'r w 'rot LEACHING FACILITY:(type) f;Pr 41 (size) /,0 X j/tJ `X 9/ NO.OF BEDROOMS V. OWNER t PERMIT DATE: 4/a?-/K COMPLIANCE DATE: / d Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ¢ Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY o olie s �a� No. clto 1� Fee t/yv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:—� PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 4pfication for Disposal *pstem Construction Permit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System Individual Components Loocat�atign Addr� ss or Lot No. �� `� �O ` Owner's Nam ,Address,and Tel.No. AssBssor'sMaapZarcel � / �� Installer's Name,Address,and Tel.No. Desi ner's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms _Lot Size sq.ft. Garbage Grinder Wep Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures �J Design Flow(min.required ® gpd Design flow provided `Zy gpd Plan Date Number of sheets /!�[Revision Date Title 5 r B go o /z / S Size of Septic Tank//��''/$ / Type of S.A.S. n&I w2nn "P'- Description of Soil ®x X 2 Nature of Repairs or Alterations(Answer when applicable) 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 4ofHe Signed Date Z Application Approved by R41S Date �'�-� Application Disapproved by Date for the following reasons Permit No. oho f0 115 Date Issued q- -ei-y-L() No. do/0 S Fee 1 ( � r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes '`�. ► Rpplitation for 3Dlsposal 6pstrut Construction Ptrmit Application for a Permit to Construct( ) Repair V Upgrade( ) Abandon( ) ❑Complete System ZlIndividual Components Location Address or Lot No. �, f<l tOywrier,Js,�Nam ,Addreess,and Tel.No. l r'sM p�cel �Qf S�f���` / /5 / i A-I e4 e Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms_ Lot Size 2 1,162/01 sq.ft. Garbage Grinder(�)� Other Type of Building No.of Persons' Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ® gpd Design flow provided �yy gpd Plan Date Number of sheets _Revision Date r Title. ,; Size of Septic Tank ®0/��Q� X/S�l�9 /Type of S.A.S. Description of Soil /�iY 7 - r f Nature of Repairs or Alterations(Answer when applicable) ti 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 He th. Signed Date � Z �2 �---z Application Approved by 5 Date Application Disapproved by Date for the following reasons ) i k Permit No. 02 y 11 S Date Issued 9- a f y THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Ctrtifitatt of (Comphante THIS IS TOX07WXV/ On-site Sewage Disposal system Constructed( ) Repaired(� Upgraded( ) Abandoned( )by at �� /lq /f/ ( � , has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 020 J0-I -5 dated Ll—-?.L?_ V Installer / � �f% /^ Designer #bedrooms Approved desigrLflnow A gP yy d The issuance of this permit shall not be construed as a guarantee that the system will functio�a�designed. Date �� / Inspector ��1 ' JP S No. ,�U �d �IS -_-------=-=y--------------------•----------Fee =---Iov-------- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS misposal Opstem Construrtion Ptrmit Permission is hereby granted to Construct( ) Repair Upgrade , ) 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. �1 Date Z (�� Approved by FROM :down cape engineering inc FAX NO. :150,83629880 May. 24 2010 01:29PM P1 /0 "P.homns F. Geiler,JNrector iar$s. Jul Pablic Health DivhAon Thomas Mckewo,Director ()f ce: 508 862-4644 flox.: 509-740-6304 Iuis��,1R n• i.➢� an. �c�•R,uAifia:s.Aiaiu Form 11➢aa�e,:�� �� O1 L5 hc JC'e 1•t�m.At# U l �s8��601C'S)�!II�,�44 1 �� �"S. l[Dcsngdns r: O�n).. Add �32 .. On /4Q `v API—P /// �_Ca��!/"1J'I5 issued a pt iilt to histall a (clue)at ( (uisE�llvr) { septic s'ystein c�U ? ! )�h e. L t based ou a,design drawn by /1 / (ache ress) lLl . — alai P P �' datod. --- (dc. i certify Lhat the septic system referenced above was installed substantially according to the design, which may .include minor approved cba,n,ges such as lateral rclocatioli of the distrlbiltiou box audlor$cptic t.9r. .. _._ 1 certify that the septic system referenced above was installed with. ma}or charlue4 (1.e, greater than 10' lateral relocation of the SAS or any vcriiu-d relocation of tiny ccmpoutn"i of the se-jAie system) but isi accnrdunce wi.tli Stine &Local Rogulations. Plan revision.or certi fled us-built by desicney to fol..low. H Ur•Mgs�c�� _ DANIELA. s� (ln�ta . ; Siguan�re) — OJALA °1 CIVIL No,48502 l-� SAUNA(,Fa Pe.;ilgr.:&s Si-gilahu:e) T (Affix De,si" :r s ST.elYllp Here] LI.Egy ME Tt-s B&R.Nf�i'AIJLL :0j)iLlC HTAJ,'.0c C.07y YANCE. Will, NOT E d`'S'U-E D U?J;d'IL,ifi(�'. YA TIES i',+6;kRl" /4f�I,U_AS-.K0J 1' C'Al..Jk A1fi-$f', �81F�L+NIEID J➢X'1'Y_IB+',:C��12N�Tl41�L 4'�� T HfANK YOU. Q:iiraltbJ cpiiu/fAe:;i�n�cr C cititir..siion:'unn:�'tf-il•I.�liiC TRAI�TS. INTO,: CITY/TOWN: APPLICANT: �v� lD�v� �'�t • ° T Ai DESIGN]FLOW: �}�o gpd REVIEWED BY: DATE: N/A OK i dO 1'1 .,:i!Til;?'1:.'• i.. r .,Z ... ' 1�:� ? n _+''.$ ✓c M:Lr. Y i 4i,^1. ,t'a�.b1�aFL*YMf19RPJ:GfeE.',•l'•.Yi'�'t�T;a '?}:l. `i I f i� .i 1 fJ�v e Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] ✓ Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) v� [310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system (required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] V Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(1)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater (method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(ri)] Address Sheet 1 of 7 N/A O NO Location of every water supply, public and private, [310 CMR 15.220(4)(k)] withui 400 feet of the proposed system location in the case f of surface water supplies and gravel packed public water supply within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case of private water supply wells Location of all surface waters and wetlands located up to 100 ft. I . beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR 15.220(4)(m)] (if water line cross see 310 CMR 15.211(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor (required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? / [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? �• [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? [various sections of 310 CMR 15.0001 System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address Sheet 2 of 7 N/A OK NO � !!. t'f'c `x,`�M 7 et �4 .`�x` .}u .k.?�`��� '�'4l �•S �y,.'4'k, .� t h .n .F Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (irdet and outlet must be 20" or greater) - middle access at least 8" (by 7/07) [310 CMR 15.228(2)] Access to within 6 " of grade - one port for systems<1000gpd, two for systems>1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR 15.228(2)] > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15.221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] x -�' 7y` .w'A^%bncmn,ukir,:xdzm;ry •iM'� yev s �' �is:J§h*. ,.�Y,r'4''2an���{'��� {-Id''�rf ,�fi;{w. Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15.223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and (3)] "U" pipe through or over baffle, outlet of each compartment with gas baffle or approved filter [310 CMR 15.224(4)] Address Sheet 3 of 7 N/A OK NO :���1���LA�Gm�2'l�'SL�CS.��������✓.�G�A�I:l'(a'V3 r., ��,,�la"3�.ikl�vy ��*'�"�a73��r��4�Sfl:. a:aYh '.` _ t �' 1 a Located at least ten feet from any waterline? [310 CMR 15.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided.? [310 CMR 15.222(8)1 Thrust blocks specified in force mails? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"M 0.02 preferable [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/ (leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMM 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) n,p} Stable compacted base [310 CMM 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMM 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.2U(2)(b)] Minimum sump 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency storage above working=design flow)? [310 CMM 231(2)] # (Lv P, Proper setbacks [310 CMR.15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode- [310 CMM i5.231(6) and(e)] Stable Compacted Base [310 C1V1R 15.221(2)] Buoyancy calculations needed? Provided? [310 CN1M 15-221(8}] Address Sheet 4 of 7 N/A OK NO , ) ��1�r 1 " T�w;�:: � ��Y`'.. . . "�,��AXMIT ¢, x Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] V Inspection parts specified and within 3"final grade? [310 CMR 15240(13)] - Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[41 and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet / every 20 ft. [310 CMR 15.253(6)] V Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] `JCskf30 ( P,, 1k52S a Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet -maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater (3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] 'T"!sG:s'F;7k7e' ^w.ur. Kam.. Y ;G;. er .F,... f:• minimum 2 distribution lines [310 CMR„15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] _ T_ Maximum separation between lines and outside of:bed 4' [310 CMR 15252(2)(e)] Aggregate depth-below discharge pipes 6" minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(f)] Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A .. O3rfK NO + 1M. MFrT6.t@Y-' 'rir Pressure Dosed Systein ? Provided pump and piping calculations as required [310 CMR 15.220(4)(1)] Pressure dosing required on all systems>2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system-make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year (systems<2000 gpd) or quarterly ✓'' (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Y Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by designer [310 CMR 15.255(2)(b)] Retaining wall must be designed by Registered Professional Engineer [310 CMR 15.255(2)(a)] Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. fiom impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] �G a e`lle'"ssz'l' tetra,f 1� '11i I M� 17 ..e te!S` c Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface A n � r•+,. Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CMR 15.220 / (4)(q)J / RLS Stamp necessary on plan if a component is within'five ✓ feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 MIR 15.414] Address Sheet 6 of 7 N/A Ox NO Is the system in a Designated Nitrogen Sensitive Area (Zone 1:1 for a public supply well)? [3 10 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such -existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [3 10 CMR 15.216(l)] ............ Pumping to septic tank? 310 CMR 15.229] Shared System [310 CNM 15.290] Address Sheet 7 of 7 `t Hartlwood;Floo�� f, y-UIZ Fonseca • Installation -Repair 508-360-24036 , • Finish/Refinish i I Hazardous Materials Inventory,Sheet Checklist i G Date = `- Physical Street Address-Check database to ensiire.it exists A-- Working Phone Number Actual Amounts -( ie. gas being used to fuel machines,thinner to clean brushes all count as hazardous materials) �G Storage Information -location of storage, how long is storage for? If none, note that. ,e_�Disposal Information -where and who? If none, note that. Applicant Signature -understand what is listed and noted Staff Initial -any questions, know who to ask Vehicle Washing/Rinsing? -provide a vehicle washing policy and explain it - note that it was given _4,,---Attach the Business Certificate with your sign off and comments **The inventory form should explain what the business consists of and the procedures they are doing. Notes need to be left to explain what you discussed with them. YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00-jor 4.years. A Business Certificate ONLY REGISTERS THE BUSINESS 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, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Fill in please: Date: st, APPLICANT'S NAME: /Z 5 --,Ad�"� 9urq SCC� ' YOUR - OME DDRESS: G Z ' BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION: NAME OF NEW BUSINESS rnPzoak TYPE OF BUSINESS IS THIS A HOME OCCUPATION? NO OAS 01 a- ADDRESS OF BUSINESS 3 (St&15 I lS ZI MAP/PARCEL NUMBE (Assessing) When starting a new business there are several things you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining th e he information you may need. You M g y y UST 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 usiness in town. 1. BUILDING CO ISS NER'S O FICE _ This individ al h s en info d f any per it requirements that pertain to this type of business. r — MLISI COMPLY WITH ME OCCUPATION Aut rized S' at RULES AND REGULATIONS. FAILURE TO COMMENT ( %/' COMPLY MAY RESULT IN FINES. 2. BOARD OF HEALTH This individual een inf r d f the p rmit re i ments that pertain to this type of business. Authorize gnature** '".. ., KWCOWLYMALL COMMENTS: fKQARWW IMATOWS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual beery i formed of the licensing requirements that pertain to this type of business. w- A1 7 Authorized Signature` COMMENTS: ;.,,• , Date:c�S/&// ' TOWN OF BARNSTABLE TOXIC AND HAy/ �1`ZhARDO S MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: � FT �/9(92 BUSINESS LOCATION: INVENTORY MAILING ADDRESS: 390 1& I T© lu TOTAL AMOUNT: TELEPHONE NUMBER: a �✓ CONTACT PERSON: CC EMERGENCY CONTACT P, PRY- INFORMATION/RECOMMENDATIONS:HONENUMBER• MSDS ON SITE? CTTYPE OF BUSINESS: 4 lP �Cl Fire District: Waste Transportation* E rl 1 C 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 F�_d�ood 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 removersolc4rzwr1b (including bleach) i - S S ITS fi ,/ Spot removers &cleaning fluids (dry cleaners) Other,cleaning solvents Bug and tar removers Windshield wash '� WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS r No.-- 0( 0 Fee---qs-- -- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell (Cootruction3permit Application is hereby made for a ermit to Construct ( ), Alter ( ), or Repair ( �andividual Well at: CAation — Address — Assessors Map and Parcel r—f "Z — _— Owner Address --------------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling---� —--— — Other - Type of Building------------.-------- No. of Persons_------------------------- Type of Well YP �. --- Capacity------------------____—_._—_ Purpose of Well-- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate.of Compliance has been issued by the Board of Health. Signed __--- ____— ___— —__—_-- i--da�e Application Approved By date Application Disapproved for the following reasons: ------- --------- date - Permit No. t"J 'ZOO L— U -- Issued--- - ?- - ---- —_— __ -- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate Of Compliance THIS IS TO CERTIFY, That the`Individuall Well C�on�st cted ( ), Altered ( ), or Repaired nstal at 1-14 has been installed in accord a with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----—------------Dated THE ISSUANCE ISSUANCE OF THIS CERTIFICATE SHALL NOT-BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE— ____ — - - --_ Inspector------------------------------------------------ ----- --— - f t• � � � - � -t. L. . 7 ..Ri f No.--IL -0.� 1 Fee---- ----- BOARD OF HEALTH- . TOWN OF BARNSTABLE ZippCicat ion-for Veil Con.5truction3Permit Application is hereby made fora permit to Construct ( ), Alter ( ), or Repair ( an individual Well at: Cdcation — Address Assessors Map and Parcel --- ------------------------------------------------------------------ Owner ! Address Installer — Driller Address Type of Building Dwelling Othei - Type of Building--------_—_____________ No. of Persons-------------------------__—___________ Type of Well y If e= ----- Capacity-- - - - ---------- Purpose of Well----- t2�.E?�_--- ------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Signed -r-- ------ — --_-- ---- date Application Approved BY __ —_ -—-— �:---------- date Application Disapproved for the following reasons:---------------__------ —_________—_______—____ - -------------------------------- - ,..�� date Permit No. w Ou �_ ___ ----- Issued-------v�- -� -__ -- ------------- date ___..____..________..______________..__________________________.._______--------------------_------------- BOARD OF HEALTH TOWN OF BARNSTABLE Y Certificate Of Compliance THIS IS TO CERTIFY, That the/Individual Well Constructed ( ), Altered ( ), or Repaired U._ � eveY nstale at has been installed in accordaA with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- --- -- - --_ Inspector------------------------------------------ - ih BOARD OF HEALTH TOWN OF BARNSTABLE Veil Con!9truct ion permit No. Fee- Permission is hereby granted-- ' �A �f3/L to Construct ( ), Alter ), or Repair ( an Individual Well at: No. -- e Street as shown on the application for a Well Construction Permit Dated -- ----- --- -- - -� ----- DATE Board of Health , ------ ----- 1ICy t 3 t 5oZ-4R Sr..PR i �G' 1 a►yK a If 200 % BAcL !� Id4CL I SCO GAL II rr ��►Pa�aL PIT Vur. Icoo Al LOT SS6, IF eaTTOM MUM 13 .5 F 4s7T. Pic oL..AT I as.j At _TOP Fwtti-'141 ti 77 61 F&, a EMT fil. • s>�vn�' t9�TrAtTJ7�T� T''G ' `% e M 4.Ara � Ova � _ 25vgotc.. ,¢"�,v6 p�T uec IQdL. �c ••: wv• `S o L IIAd Z3o�. � t'd� Sc�eL 64.4 TA►d!i LC-%CLA Loeb Pt T 4A&A> WATT STCN6 ` 5$,o Miry E PL-OZ- PL-A w - P'g0 Fr L r Pow - wr�Ou , l U Awo�i Gt3241R'{ . T"T T'tr1�. luau ND AT(o!J �541awU DL-A. GAJCf— a¢a,o.-4 c AAPL-Y,9 T"M 4D 4=-WALK TWQ6 ��+�tTt�Q q I�AYCa 16.bC, q14 Play 14 LOT �!sSED orJ Au l�►YBOMQMT t�Tc�v�t„Lb ,trtls�y. ZVMY A TbAG op"ar; -5WW%rm NOT Ja1s L). tO'p ' VQTe3LGw16J& %. -r ✓ � ���Lis. - OF U WILLIAM yG. arE M .y Itp. 19334 T �E Q� G • v WELL ! P 1 3 ' ►T Lp COIrk. }r 3 to BED L 4T64� }EKP I_ r C.). V� . 10 ion°F P 1 t--o T l Co 1 i -v e 4 ��1 h n OF HAR,y:. o� 3r CERTIFICATE OF ANALYSI Page: 1 RECEIVED Barnstable County Health Laboratory .,-rAcrtus�' — Report Dated: 5/28/2004 JUN 0 7 2004 Report Prepared For: MAP Order No.: G 42OWN OF BARNSTABLE Ann McAlear PARCEL, � �' � HEALTH DEFT. 380 Hollidge Hill Ln. LOT , Marstons Mills, MA 02648 Laboratory ID#: 0425235-01 Description: Water-Drinking Water Sample#: 25235 Sampling Location 380 Hollidge Hill Ln Marstons Mills MA Collected: 5/24/2004 Collected by: E McAlear Received: 5/24/2004 Test Parameters - ! ITEM RESULT UNITS RL MCL Method# Tested GAB: Microbiology I ' Total Coliform Absent CFU/100mL 0 0 309 5/24/2004 Water sample meets the recommended limits for drinking water of all the above tested parameters.4 Approved By: — ( Director) Superior Court House, PO. Box 427, Barnstable, MA .02630 Ph: 508-375-6605 fit aF 60 Page: 1 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory �SgCHUS�. Report Dated: 6/10/2004 _ Report Prepared For: Order No.: G0425219 Ann McAlear 380 Hollidge Hill Ln. Marstons Mills, MA 02648 Laboratory ID#: 0425219-01 Description: Water-Drinking Water i Sample#: 25219 Sampling Location 380 Hollidge Hill Ln Marstons Mills MA Collected: 5/20/2004 i Collected by: D Hayward Received: 5/20/2004 Routine ITEM RESULT UNITS RL MCL Method# Tested LAB: IC Lab 1 Nitrates BRL mg/L 0.1 10 EPA 300.0 5/20/2004 LAB: Metals Copper BRL mg/L 0.1 1.3 SM 3111B 5/20/2004 Iron 3.0 mg/L 0.1 0.3 SM 311113 5/20/2004 Sodium 8.8 mg/L 1.0 20 SM 311113 5/20/2004 i LAB: Microbiology Total Coliform _ Present P/A 0 Absent 309 5/20/2004 LAB: Physical Chemistry Conductance 90 umohs/cm I EPA 120.1 5/20/2004 i pH 6.3 pH-units 0 EPA 150.1 5/20/2004 ,Recommended maximum contamination level exceeded due to Coliform Bacteria.Retesting is recommended Approved By: r� Director) FU ECEIVED N 1 7 2004 TOWN OF BARNSTA13LE HEALTH DEPT. RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 L'O CATION SEWAGE PERMIT NO. VILLAGE 174.,4R S1� $U-5 I N S T A LL,pER'S NAME g ADDRESS BIJUDER OR OWNER "J . DATE PERMIT I S S U t D -77 DAT E COMPLIANCE ISSUED &G r . ® , -�,� THE COMMONWEALTH OF MASSACHUSETTS Application is hereby made for a Permit to Construct (1-<Or Repair an Individual Sewage Disposal System at: L,6� & ................................................. _94.. .... ------- ------------ Alt Addres Type of Building Size Lot------ ---Sq. feet Other Distribution box Dosing t�r� Percolation Test Results Performed by_ V ........... Date---,e, YYj17_,q!-------- ........ ..... -------- &. ....4-- -------------------------------------------------------------------------- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XIof the State Sanitary Code The in operation until a Certificate of Compliance has been issupd by athe eK_ Jf healt". Approved _'--'�r--`=_=-�-'.�-'---'-'_-Application -.--_----- --_---_-- -----.. ' »�-" _ ` Application Disapproved for he following reasons:................................................................................................................. ` -_-------'_'_------- � --' ` Permit No - �� Date _, No.------... _... .............................. THE,COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH /� Appliration for Riiposal Works Tomlrurtion Prruti# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 0 A9 � Z/l �131/f i/f -----...---•--..........----•-•-------- -------------------•-------...------------ --------------------------.............................................. _ Location-Address or Lot No. '�iL, �,✓ .., . ......r , .., r s'a, -----•--•-----------------------------------------------o ... -----....... ..... . Address; j��/ Installer Address Type of Building Size Lot------ ....Sq. feet'*r U Dwelling o. of Bedrooms-_..... ............................... Expansion Attic ( ) Garbage Grinder Other—T e of Building No. of persons............................ Showers 4afeteria Otherfix ---------------•---•---•-----------------------------------------------•----•------------------------- ..5 ................................ WDesign Flow.............. ........=......gallons per person per day. Total daily flow..........................-__.-__________-__gallons. WSeptic Tank J Liquid capacityt�R__gallons Length................ Width---------------- Diameter................ DewLL_- ---------- x Disposal Trench—No. .................... Width_ ....._......... Total Length._...._._ Total leaching area...... _M-....___rf--.sq. ft. Seepage Pit No..................... Diameter....... ' :.----- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing nk ( ) �( _ ~' Percolation Test Results Performed by ` ._. -......�:T_r. _e.4.. Date... minutes per inch Depth of�Test Pit____________________ Depth to ground water_________-_-__--_._-_--. Test Pit No. 1... Gzl Test Pit No. 2................minutes per inch;.-Depth of Test Pit.................,.. Depth to ground water--_----_________-___-_-- o ---------- t x W---- ------ 44440 P �... Descri Description of Soil.... --+ �` "" 6 f�2 ......................................... ---- ------------ --- - -- --------- '� . ---•-- ------. •--- --------------------------- W - - '1, :_ :: •------------------------------ U Nature of Repairs or Alterations—Answer when applicable----. ---.-1__________________________________________________________________________________- U P ------------------------------------------------------------------------ ------------------------•----------------------.........----------------------------------......-••-------•------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code-The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the:,board,of health. , eig. ------- -� ---' 1.- ----.-_ J.��' --------Date /APP-lication Approved BY------ ---- - == d 'f / Date Application Disapproved for the following reasons-------------------------------------------------------------------------------------------------------------•--- Date PermitNo......................................................... Issued........................................................ Date R- L THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT L0 Tntifiratr of Tootphattrr - T�,S IS ff0 C TIFY, That the Indio' ual $ewage Disposal System constructed ( ) or Repaired ( ) (�, (� -------- - --- --- T `+ In tall .n d by • ' at __ - � -----_--._ �J has been installed in accordance with the provisions of Artic I of The State Sanitary Co a descr' ed in the application for Disposal Works Construction Permit No.'......Kt._/__?_.�___-___- dated-______)4-27�.... ......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. I DATE .................................. 19-��1----- -- ---------•---- Inspector--------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH NO. ...../--!... FEE........................ Bia roo ki orts#rurtion roti# at No.. .T V ..- ........ Permission}'s ereby granted 1 . -------- ------- .....j kA—.7 C;�, to Construct. '"Ar.ReP it 1 ) an Indio' u 1 ewa-e os ' em -- -----.-./----. ------A---------- -----.4 �n ------_-(----.-.-..--..-- Street p 4} as shown on the application for Disposal Works Construction P � __._�� No._ __..,_ Dated--- Board of Healt ---------------------- DATE.............................----------------------------------------- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS 4 - 200 n G� G> `�_ .� t`t P[. A U ohl SAC N I :' ' saL a+7 �3 y1'oi r [� � o�..L�Dlo� ♦� O�/Au- AIR SA ' ZZG I P L 40' C3a�o� 2ZG KZ y'. SL.S GPp BAR f T'bTAL D��6N � III G•�� _- . 4.74 S.P > c Go�.AT ION Bd�Li t��l�! Z AC J O$.LF - -- - -- - - µ Ink 4 /� TOP FNb•-74 3 7'M-OT 6l(shq ` FG'L7 a 7TJRv7JQsi Tf�a77�CrA*WV.z G �117� ski, 64 4 au 94 Gd 4 �Q+aiG P1 T 17A$A> WIT" �6Z0 Fri �' Poa� C T 1 FI Eaa -oT PI-AN I � �JO 5�0� a►�'10e.d �0 k/ArEQ / MAfZKOIJS C GR4�Fey TNAT TFIe,, I�o u I,i D A T 1 p N St �D 4 PAa"D�ceL g w�rH T� SIDFa.1Nc, �c �Ey.IGe_ f,. 64v�R�AoIT$ OR TLICs iDT �(� atn.i OF4LJ '6 =h.r A4 ce Pie I#r T1.16 ��T�S� OfJ AU �T�AA@IJT �T�RVI g� 'gµOVLA LJOT $6 US@.p v` ���. �s Dt�T�R.�ti&.11� �T LIIJ�. APFLIGANT 1 D T r. EL �� I nn i ol i41W 1 ! `} `\ WllLIAld � arE ' `D p NO. 19334 O O� 'V o � WELL � +1 1! P 09 . i f RwR ' tT t t o&" L 4 TJ4� 'I Ei(P 'ham ++' AzeA �3' IF ti r� L—T ( (c t uI L_ L.. _ 3-V ' 4���� ►.oki to,) c a. i SYSTEM DESIGN: _ SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES LEGEND PROVIDE MIN 20" DIAMETER WATERTIGHT MARKED WITH MAGNETIC TAPE OR (NOT TO SCALE) COMPARABLE MEANS FOR FUTURE LOCATION. GARBAGE DISPOSER IS NOT ALLOWED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE 1. DATUM IS APPROX. NGVD (GIS SPOT) Mystic Loke 99 -- EXISTING CONTOUR (OR TO GRADE WHERE UNDER DRIVEWAY) CONCRETE COVERS TO WITHIN 3" GRADE X 99.1 EXIST. SPOT ELEV. DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD TOP FOUND. EL. 77.6' 2" PEASTONE OR GEOTEXTILE (OR TO GRADE WHEN UNDER DRIVEWAY) 2. MUNICIPAL WATER IS EXISTING USE A 440 GPD DESIGN FLOW \ FILTER FABRIC OVER STONE 99 PROPOSED CONTOUR MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 76.0' 3. MINIMUM PIPE PITCH TO BE 1/8° PER FOOT. 4"sCH40 PVC 4. DESIGN LOADING FOR ALL PROPOSED PRECAST UNITS �o I 198.4 PROPOSED SPOT EL = •: PRECAST H-10 PROP. TEE TO BE AASHO H-LQ Locus 1 SEPTIC TANK: 440 GPD (2) 880 RISERS (TYP.) 4 OSCH40 PVC BLOCKS OR TH1 y 2'0 PIPES LEVEL 1ST 2' PRECAST RISERS 5. PIPE JOINTS TO BE MADE WATERTIGHT. Middle Pond RE-USE EXIST SEPTIC TANK** MORTAR ALL TEST HOLE ADD 1000 GAL.' H-20 PUMP CHAMBER COMPONENTS H-2o INV'S •L. 72.0' EXISTING (nP•) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH o 10" 14" 73.0 310 CMR 15.000 (TITLE V.) cQ 2% SLOPE OF GROUND y TEE 10DO GAL H-10 TEE *, - o0000000' °�°^ °' o°=a° ;00000 LEACHING: �SEPTIC TANK 67.9E c °0000aoaoo° aOa " o 0 0 0 o o °°8�R00Ro8 000000 0 w O O O O O O O 6 MIN. SUMP o 0 0 0 ��aa �Oa� 0°0°0°00°0 ���� -U��O� ;00000000 (RE-USE) O O O ° O ° ° a o ° ° ° ®®®0�0�0�0 0 0 0 o ap ap�p p� ��0�0� ,0°g°0°g° 7, THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO p� UTILITY POLE SIDES: 2 (40 + 10) 2 (.74) = 148 GPD �' SLAB O 69.1' GAS BAFFLE o o°o°o°o°o°o° °a o 0 0 0 0' 0tl0b°Ono C7 „o„o o„o„o 0 0„12' MIN. TNT. DIM. :o ;°0°0°0°0 a®oa000�aao ogo0000000 ®®®®LJ��O�00 '0000000o BE USED FOR LOT LINE STAKING OR ANY OTHER 4o X 10 74\ = 29s GPD 72.3 72.15' " �o�o�o�o aaaaaao�ao� o ,000000 om®®aammm= ;0000000000 ° PURPOSE. FIRE HYDRANT BOTTOM ( ) . ., ... . .. °o 0 0 0 0 0 0 0 070.0' 0 0 0°0 :.o o ° 00 0 ° o00 p��.JQ .: ) O O O O O�O�0000 0 .°°°O°O°° H-20 D BOX NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING 444 GPD No TOTAL. 60o S.F. � - 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. .. . of ADD TUF-T IL EF-4 H-20 500 GAL. LEACHING CHAMBER BY ACME PRECAST OR EQUAL. EFFLUENT FILTER 3/4"-1-1/2" DOUBLE WASHED STONE 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED USE (3) 500 GAL. LEACHING CHAMBERS (ACME OR EQUAL) (OR EQUAL) ED GAS 6" CRUSHED STONE OR MECHANICAL (3) UNITS REQUIRED WITHOUT INSPECTION BY BOARD OF HEALTH AND I WITH 2.25' STONE AT ENDS 5' BETWEEN UNITS AND 2.6' DEFLECTOR COMPACTION. (15.221 (21) o1:ERALL DIMENSIONS TO OUTSIDE OF STONE: 40.0' X 10' PERMISSION OBTAINED FROM BOARD OF HEALTH. *THE INSTALLER SHALL VERIFY THE AT SIDES OF ALL UTILITIES AND ALL �N'• 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING LOCATIONS DIGSAFE (1-888-344-7233) AND VERIFYING THE BUILDING SEWER OUTLETS AND ( 1 % slol=�E) ( 1 % SLOPE): . . LOCUS MAP �LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES ELEVATIONS PRIOR TO INSTALLING ANY PRIOR To COMMENCEMENT of WORK. NOT TO SCALE PORTION OF SEPTIC SYSTEM 6:5.8' BOTTOM TH-1 11• ANY UNSUITABLE MATERIAL ENCOUNTERED SHALL BE MA FOUNDATION EXIST. SEPTIC TANK PUMP MO GROUNDWATER FOUND LEACHING REMOVED 5' BENEATH AND AROUND THE PROPOSED I APPROVED DATE BOARD OF HEALTH 6' 65' D' BOX 17' FACILITY ASSESSORS MAP 81 PARCEL 12 CHAMBER G-W ELEV. AT POND ELEV. LEACHING FACILITY. (>20' BELOW BASE OF SAS) 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND - - REMOVED OR PUMPED AND FILLED WITH CLEAN SAND. 13. CONTRACTOR TO DETERMINE IF ELECTRICAL SYSTEM IS SUITABLE FOR PUMP INSTALLATION. **INSTALLER SHALL CONFIRM MINIMUM SEPTIC TANK SIZE AT 1000 GALLONS AND ITS SUITABILITY FOR RE-USE. REPLACE #7 MIDDLE WITH 1500 GALLON H-10 SEPTIC TANK IF NOT SUITABLE. ,/�? POND I D i �I #8 ••/•• •`'•4% 30 � . •�•.• #5 �•.s3.10 ALARM AND CONTROL PANEL ACCESS COVER TO GRADE TO BE INSTALLED INSIDE / •.��pF `• BUILDING. ALARM TO BE ON �( F, SEPARATE CIRCUIT FROM PUMP #9 •/' °G `''. �;,, �,,�, ,; ELEV�72.0 ,\\, TEST HOLE LOGS /'' ••.� INV. IN 67.8' ENGINEER: ARNE H. OJALA, PE, SE /' #q 1000 GAL. H-20 S T 2" PRESSURE LINE ' 50.21 ALARM ON 500 GAL.+ SLOPE TO DRAIN BACK TO PC #11 #10/ FLOAT SWITCH RESERVE 0.25" WEEP HOLE WITNESS: DAVID W. STANTON, RS f �••-•••-•••-+•50.62 •' SETTINGS: PUMP ON CHECK VALVE DATE: 4/1/10 FO`• 4" WORKING RANGE MYERS SRM 4 PERC. RATE < 2 MIN INCH '`O\„ �" SUBMERSIBLE 4/10 HP PUMP ��`•• PUMP OFF 8 SYSTEM (OR EQUAL) CLASS I SOILS P# _12872 yyo` oo�0000 c�-�0000 00 0 0000 PUMP' CHAMBER-- ELEV. ELEV. ((NOT TO SCALE) _ 0" � 75.8' 0" 75.8' #3 WATERPROOF/WATERTIGHT " _ •, 6 CRUSHED STONE OR MECHANICAL A A COMPACTION. (15.221 [21) 65.22 50.53 LS LS $ 12" 12" 85.74 v ' I � • B B EXG WELL 28 166.40 •,` LS LS NOT USED PER OWNER 2 6 4 7.14 �.,. 2.5Y 6/4 � 2.5Y 6/4 9:14 sa11 •�•,'• 36 72.8 36 72.8' ,� \.• 1.09 6 9 • 7. IST. .••�. 1 i�� 6 PROP. 1000 2 7.93 ��67. # GAL. PUMP C C ' ��` �� 6CHAMBER 1+50.45 PERC WELL EXISTING � •: � `% ./ HOUSE •/••'/••' DWELLING 76 6.07 5.9 " \\ Op \ SM TREE 248" N ./•• TOP FND. 1 >� SAVE CS CS .• ELEV. = 77.6 �/ cs, 78. �. ` " �2 BASEMENT SLAB .75. \ \+�70.91 `•' N ••/•'' �8 1 ELEV. = 69.1' _3 ••/• 85.67 76.76 6.06 5 �� ' ' 2.5Y 7/4 2.5Y 7/4 1 +/76 6'56 7 . 7 1 / \ LOT 16 /• DECK 30•. I L� '75,o0 74.6+74. 49,000 SFf #1 77.61 ASS. �.64 \ %5.42 +7�49 \ 4.9.15 \ }50.82 I 1�0, �9�-69 76.65 7 $••' +75.7 k- �74.31 ti -\ 120" 65.8' 120" 65.8' - .32 �/C 8 *7�- .1$ �7453 UNIT e 76/ \ 72.98 7 4 -I--�q�70 7 .65 EC. ,+ 35 10 \74.69 7d.61 NO GROUNDWATER ENCOUNTERED 6.79 6.14 M GARAGE � / •. - `7�62� , -�73. 3 + p DOORSTEP 1.88 i'1 .60 75.991 �A .1 ELEV. = 77.0' /+75.87 73.16 7 SIOb 4,73.4 l6, / + Cy.07 +7 8 + 76.56 TITLE SITE ALAN 73.63 \ �� 1 \ 7 1 . \+76.72 TH / �TM 2 VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE 1 \ � •'• IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR OF 75. 76. 5.9 \ 4176.55 \ •� BY HEALTH INSPECTOR L �. }76.83 + 3.89 STONE / PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED S2 L� /� 76.21 \ 7 5gg r� DRIVE /� BY THE BOARD OF HEALTH REVISED DURING A PUBLIC 380 HOLLLIDGE HILL ROAD \ 1 76.37 +75.39 \F� � � 6.49\ T � HEARING HELD ON AUG. 4, 2009 �F 7,6.68 76.50 MARSTONS MILLS 76.s1 4) FAILED SYSTEMS ONLY : SEPTIC TANK OR PUMP CHAMBER 7 .00 �� ?,r. 7g PROPOSED TO BE LOCATfED LESS THAN 100 FEET BUT MORE THAN 75 FEET AWAY FR{OM WETLANDS OR A WATER COURSE. PREPARED FOR j \ � �76.9 76.28 f 76.53 ���ccc 6.47 76.83 'F7&-5 76.56 -8o ESTATE OF T. McLEARN 76.83 PROP.. VENT WITH CHARCOAL FILTER i AND BUGSCREEN (FINAL PLACEMENT BY tlTl_ITY CONTRACTOR WITH HOMEOWNER 76.91 CONSULTATION) f 1 -Ckl1STER CATV, TEL, ELEC. _ APRIL 5, 2010 _ +76.51 / 76.68 5.80 �76.98 ��jN oP MgSs _ 60 �r+OF ��' qcy Scale: 1"= 20' _--+ EDGE� 5P5 9.05 w " `�� MAssq o DANIEL G� • G s J�' DANIELA. oy � OJALA N A. -K76.86 6.14 JALA c�+ -+ No.409 0 10 20 30 40 50 FEET \\ \No,46502 0 0�0 -- HOWDGE HILL ROAD \\7 .56 ssq off 508-362-4541 75.53 0� yG DANIEL oyGN fax 508-362-9880 DA ILA. N A. dowrncape.com cS �{ 0 •1� OJALA � � ,,,,// No.46502 �No,40980� W0wO Cope engineering, ift. �0 F�l STE ° °FF civil engineers �s3 NAL E���` ` \ Np 5V land surveyors I '-�-5- ID 939 Main Street ( R to 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 10-06 > 10-061 McLEARN.DWG(SBO) ; I r - I - _ ---- - -