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0050 NYES POINT WAY - Health
1 NYES POINT WAY, CENTERVILLE A=233 015 CERTIFICATE OF ANALYSIS Page: 1 of 1 ±° M; Barnstable County Health Laboratory (M-MA009) " acHv Report Prepared For: Report Dated: 8/9/2013 Sally Desmond Desmond Well Drilling Order No.: G1376139 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 1376139-01 Description: Water-Drinking Water Sample#: Sample Location: 50 Nyes Point Way,Centerville,MA Collected: 08/08/2013 Collected by: Desmond Received: 08/08/2013 Routine_M ITEM RESULT UNITS RL MCL METHOD# TESTED Nitrate as Nitrogen 0.77 mg/L 0.10 10 EPA 300.0 8/8/2013 Iron 1.9 mg/L 0.10 0.3 SM 3111E 8/9/2013 Manganese 0.10 mg/L 0.10 SM 3111 B 8/9/2013 pH 6.2 PH AT 25C NA 6.5-8.5 SM 4500-H-13 8/8/2013 Sodium 21 mg/L 2.5 20 SM 3111 B 8/9/2013 Total Coliform Absent P/A 0 0 SM 9223 8/8/2013 Conductance 240 umohs/cm 2.0 EPA 120.1 8/8/2013 Sodium level is above the maximum contaminant level. Those on a low sodium diet may wish to consult a Physician. i The water may present aesthetic problems(taste, odor,staining)due to Iron. Note: -- proved By: Attached please find the laboratory certified parameter list. Approved (Lab Director) ® R L GO ,v �a re'i (Y yv. M ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 , • a Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 50 JNYESPOINTROAD Please specify well type: Building Lot#: Assessor's Map#: Assessor's Lot#: ZIP Code: Number Of Wells: 102632 City/rown: Well Location BARNSTABLE In public right-of-way: GPS iYes iq North: West: 141.67849 170.33450 Subdivision/Property/Description: F.� Mailing Address: click here if same as well location addres Property Owner: Street Number: Street Name: BRISTOL 1175 1 PO BOX City/town: State: (Engineering Firm: 1SWEYMOUTH MASSACHUSETTS ZIP Code: 02190 Board of health permit obtained: ji Yes ji Not Required Permit Number: Date Issued: 2013 014 — 1 7/26/2013 —� 1 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Ll ) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock (Auger 1 --Choose Bedrock-- WELL LOG OVERBURDEN LITHOLOGY From To(ft) Code Color Comment Drop In Extra fast or slow Loss or addition of (tt) drill stem drill rate fluid 0 20 Fine To Coarse Sand I 113rown Ye r j r Fast rjq Slow rya Loss 011,Addition 20 F2_5_7 Fine To Coarse Sand Brown ,Ye r)r Fast J1 Slow rj,i Loss n)a Addition 25 45 Fine To Coarse Sand Light Gray Ye jq Fast )A Siow rtjq Loss ��,;Addition 45 F5_07 IFine To Coarse Sand ILight Gray e Ye r_)a Fast J1 Slow .j i Loss rY Addition WELL LOG BEDROCK LITHOLOGY From Drop In Extra fast or slow Loss or addition of Visible Extra To(ft) Code Comment Rust Large (ft) drill stem drill rate fluid Staining Chips Choose Code c Ye r,1;t Fast Jj Slow r1�loss ),)Addition ry; Ye Ye ADDMONAL WELL INFORMATION Developed 1ji Yes ,.Ji No Disinfected ,fix Yes .E)T No Total Well Depth 150 Depth to Bedrock Fracture Surface Seal Type one Enhancement r� Yes ,fir No CASING I b Is Casing above ground. From: 11 — 1 To: 10 From To Type Thickness Diameter Drlveshoe 0� 47 Polyvinyl Chloride I Fchedule 40 SCREEN c No Scree From To Type Slot Size Diameter 47 50 Stainless Steel Well Point 0.012 u WATER-BEARING ZONES DRY WEL From To Yield(gpm) 50 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed � Pump Description Submersible Horsepower 1/2 w' 'pV Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) 4 Pump Intake Depth(ft) 146 1 Nominal Pump Capacity(gpm) 110 ANNULAR SEAL/FILTER PACK From To Material 1 Weight Material WelghtWater Batches Method Of Placement (ga1)Choose Material --] 1 Choose Material F7 = 1--Choose One----] -- WELL TEST DATA Time Pumping Time To Recovery (it Date Method Yield (gpm) Pumped Level (it Recover BGS) (HH:MM) BGS) (HH:MM) 8/9/2013 Constant Rate Pump -� 12 1:30 10 0:01 1 WATER LEVEL Date Measured Static Depth BGS (it) Flowing Rate (gpm) 81912013 19 COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete a knowledge. Driller V111LLIAM URQHART Registration# 1299 Monitoring[M] Supervising Drill Firm I DESMOND WELL DRiq Rig Permit# 1024 Date Job Compl NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. �.. , :: ^I: :L' ;;ys`•. .;..�:4�..�,�,".-;m'.'",--'".%.,-.,.-..:'-,;M-"-"".-..,.m��.::.�..'--...-�.,:�.m'm'.�.�'�.,.'.v 7."-.*..-.-_-"-%�.j.M.-��'..M.-,:''I.,-4.�-Q::'�.m,*.�....-.",::-�..TlI;:!-;*.'�m.."�"-.:,.�'m,-.".I::;....�....-.".-,�-...�I;:..-.�f,,..."-;").I--,�- -I'...-'."f..M m."""M�.-:.:'.."..�,---'--'-',''I.�1..:...4..-.,-.',.;�. • J" jT tY rV _ i- a '-� .t RNEBSEC' Y H %; .: �:i' !' < `' v F 1\. - y, 'f- a P EiiC: Ei ATE- .LET' t :._. TF..•• ' a. IM�CFI~' IN.nN etl -v J.r„. ,. S..: F vY j,a ;:A- 'f :{':: _ 1": y' �+ �: (.:}, i }.: :' :r _y. �'' C ..fl, t"'J1: :1 :. D - �} .. .s ,. l :i• :, °x: b. -A: y .. •t+'C •TS•. 1 `•J' ':1j'.:.;'. :�,: r nr•_ G.: ti. `9 ; . 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", L..'f ..-... _..... < .....:... .. .. .. ,.. , •r. , .P.c-: a.......Lf.iC.....a. �` .._. .w'i+.tt-!>��:.�.. _ - .. ,., ... , ... \. .. , )r10 G i — 0( Lj Fee BOARD OF HEALTH TOWN OF BARNSTABLE 01ppYication -for Vern Cottgtruction Permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: So %Agl Po*\40jj ,(\ Akjt. -22-?j o 15 Location-Adtddr ss Assessors Map and Parcel 1' R �Q.`MQS �e�1 AC2Y1 11 t r S ,A ZZ O er Address SNCI,"\00& \hL. tsF, 21R3 ,Sj(�uw NSA 02653 Installer-Driller_� Address Type of Building Dwelling Other-'1Type of Building No. of Persons Type of Well "Its SCk�yO p�L Capacity__ Purpose of Well ?0�OAL Agreement: The undersigned agrees to install the afore described 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 Cert'ficate of Compliance has been issued by the Board of Health. Signed 25 13 / Date Application Approved Byry .,� Date Application Disapproved for the following reasons: p' Date Permit No�/�� �1" Issued__ c Date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired by Installer at has been installed in accordance 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 SATISFACTORILY. Date Inspector `j9'�Q 3 ' O Li Fee < < •---� BOARD OF HEALTH TOWN OF BARNSTABLE 2pprication jfor Yell Conotruction Permit Application is hereby made for a permit to Construct(✓), Alter( ), or Repair( ) an individual well at: �o %as 4A\P- Z3310o 5 Location-Addr ss Assessors Map and Parcel Sa.�me s ;Vf O "\ '� c+ siol 221 Ro-\ON Tc"\b�S ,S, ZQ W\oj�' .% OZIq') Omer Address ( 6-'r"&\k \o& fvv I\YnL. �.0•'Q Qk 2Da3 . C>c\kanS MA 02.653 Installer-Driller Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 4" SCHAqu ���-- � Capacity I O't rzjp,., Purpose of Well ?O�4\'k- 1 Agreement: The undersigned agrees to install the afore described 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'�Ao 75113 Date Application Approved By xh ,� Ve "L(-,4,' Date Application Disapproved for the following reasons: r Date Permit NO Z- 0 4— Issued Date BOARD OF HEALTH /// TOWN OF BARNSTABLE certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed'( Altered( ), or Repaired(L)---- by y14. Installer at ' has been installed in accordance 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 SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Verntongtruction Permit No. (c) o V�i�7 �\fJ` Fee Permission is hereby granted to d � Installer to Construct l�l, Alter( ), or Repair(/ an individual well at: No. Street as,shown on the application for a Well Construction Permit N4.A 6 f�� f�Dated —7 1I_ � Date �� Approved By V'*Y\ VV--r � r ` 3261 Main Street Route 6A , Barnstable Village MA 02630 C_ September 6 , 1985 Barnstable Board of Health Town Hall 617 362 8133 367 Main Street Hyannis, MA 02601 RE: Septic System Repair Lot 2, Nyes Neck Road Bearse Pond, Centerville Our File No. 03-1498. 00 Members of the Board: This letter is to inform you that the repair at the above referenced location has been constructed in substantial compliance with the plans. Two minor field changes did happen. A small portion of the retaining wall was deleted and the piping from the house to the septic tank was changed to eliminate the need to tear up the existing concrete sidewalk. If there are any questions or comments, please do not hesitate to contact me. Very truly yours, BSC/CAPE COD SURVEY CONSULTANTS Engineers Surveyors Stephen A. Wilson, P.E. Project Manager Health Dept. n� Scientists D Town of Barnstable Architects Enclosure [;���(s Landscape cc: R.M. Shields, Jr. Architects Planners %EP, 9 '1985 Cape Cod Survey Consultants COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ^. F DEPARTMENT OF ENVIRONMENTAL PROTECTION r C RECEIVED Wt i� ye JUL 19 2001 TITLE 5 TOWN OF BARNSTABLE DEPT. OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 50 NYES POINT WAY CENTERVILLE, MA 02632 Owner's Name: MICHAEL COCOMAZZI Owner's Address: 25 BUFFUM ROAD,HANOVER,MA.02339 Date of Inspection: 6/28/01 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 an&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: t . X Passes _ Conditionally P se _ Needs Furt r valuation by the Local Approving Authority Fails Inspector's Signature: { Date: 6/28/01 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 now of 10,000 gpd or greater,the inspector and the system owner shall submit.the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to.the buyer, if applicable,and the approving authority. Notes and Comments C' SYSTEM PASSES TITLE V INSPECTION.;RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address howlthe system.will perform in the future under the same or different conditions of use. i Page 2 of 11 i OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 NYES POINT WAY CENTERVILLE, MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 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 INSPECTION. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL 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. 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: 50 NYES POINT WAY CENTERVILLE,MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 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(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil,absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a p ivate 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 4 Z Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 50 NYES POINT WAY CENTERVILLE,MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than ''/2 day flow _ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped 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—1 W PA)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 "yr,s" in Sution D about,the larg@ sysMn'has failr d:Tht:own@r or opmtor of any iprg@ sy:`tgm Fonsitlr'rr tl a significutt 11imt 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. d Page 5 of 11 F OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 50 NYES POINT WAY CENTERVILLE,MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 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 water been introduced to the system recently or as part of this inspection '? X 'r 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)] 5 Page 6 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 50 NYES POINT WAY CENTERVILLE, MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 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): YES Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.2Q3): 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 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 e. Approximate age of all components,date installed(if known)and source of information: 1975 Were sewage odors detected when arriving at the site(yes or no): NO r, Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 NYES POINT WAY CENTERVILLE, MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 BUILDING SEWER(locate on site plan) Depth below grade: 10" 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.): WELL WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 6" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explam)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" W 4' 10"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: n/a Scum thickness: 1" 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: n/a 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 ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S 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 Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 NYES POINT WAY CENTERVILLE,MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 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 IS 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 u 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: 50 NYES POINT WAY CENTERVILLE,MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a I leaching fields, number: LEACH FIELD n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH FIELD APPEARS TO BE FUNCTIONING PROPERLY.THE FIELD SHOW NO SIGNS OF HYDRAULIC FAILURE 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 Page 10 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 NYES POINT WAY CENTERVILLE,MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 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. ,1 �e b c 4A Aa 31 A� `f1` � ati in Page I 1 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 50 NYES POINT WAY.CENTERVILLE, MA 02632 Owner: MICHAEL COCOMAZZI Date of Inspection: 6/28/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 7+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 NO 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: GROUND WATER FOUND BY AUGER I1 a Commonwealth of Massachusetts Executive Office of Enviromiental Affairs Dept. of Environmental Protection IN One winter Street,Boston,Ma. 02108 Jolui Grad D.E.P. Title V Septic Inspector P.O. BOX 2119 Teaticket, MA 02536 WILLIAM F.WELD (50 -6813 Governor 8 ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR vEOCEPART A (ON RTIFICATION3.1Y13 l9Property Address: 50 NYES Nt's6St POINT t�.CENTERV LEMAP233PAR15 AddressofOwner: Date of Inspection: 10/2/98 (If different) �BAIiHSTABLE Name of Inspector: JOHN GRACI DELUCAALTfIOEPT I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name, Address and Telephone Number: 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on crlterla defined In Title V Conditionally Passes code 310 CMR 16.303.My findings are of how the system is performing at the time of the inspection.My inspection does NeedsiForther Evaluation By the Local Approving Authority not Imply any warranty or guarantee ofthe longevityofthe Fai septic system and any of Its components useful life. Inspector's Signature: , Date: 1owu The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: Al SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B1 SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes, no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exhitration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012199 _ Sew.ane backuQ or.hreakout or high static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health. safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012199 D] SYSTEM FAILS(continued) Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012198 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _X_ — Pumping information was requested of the owner, occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _X— — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System, have been located on the site. x The septic tank manholes were uncovered, opened,and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is unacceptable)[15.302(3)(b)) (revised 04127S7) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Pfopefty Address: 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012199 FLOW CONDITIONS RESIDENTIAL: Design flow: 3w g•p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 2 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings, if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: nIa COMMERCIAL/INDUSTRIAL: Type of establishment: nIa Design flow:0 gallons/day 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: n1a Last date of occupancy: nfa OTHER:(Describe) rda Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)Na If yes,volume pumped:8 gallons Reason for pumping: nla TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components, date installed(if known)and source Information: 1986 NEW SYSTEM WAS INSTALLED Sewage odors detected when arriving at the site:(yes or no) No (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 NYES NECK POINT RD.CENTERVILLE NAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012199 SEPTIC TANK: x (locate on site plan) Depth below grade: 4' Material of construction:x concreate metal FRP_Polyethylene_other(explain) If tank is metal, list age aia . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'e"H5'7^w4'10" Sludge depth:2" Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness:1" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 17" How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING EVERYTwO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: Na Material of construction: _concrete_metal_FRP_Polyethylene_other(explain) Dimensions: Na Scum thickness:Na Distance from top of scum to top of outlet tee or baffle:Na Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping;,,, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Na BUILDING SEWER: (Locate on site plan) Depth below grade: 4•e'- Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction IineTOWN Diameter: Ala_ gv,!mments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Capacity: rda gallons Design flow: rda gallonstday Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert: LIQUID LEVEL wmi8OTTOMOFPIPE Comments: (note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)—Yes Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda L(wde.dC412P97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 Owner: DELUCA Date of Inspection:1012198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan,if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: nfa Type: leaching pits, number: rda leaching chambers, number:We leaching galleries,number: nla leaching trenches, number,length: rVa leaching fields,number, dimensions:ONE40'LONG overflow cesspool, number:nra Alternate system: nra Name of Technology:_nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH TRENCH APPEARS TO BE FUNCTIONING PROPERLY. CESSPOOLS:_ (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: nra Depth of solids layer: nra Depth of scum layer: nra Dimensions of cesspool: rda Materials of construction: rda Indication of groundwater: rda inflow(cesspool must be pumped as part of inspection) nra Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: rda Dimensions: rda Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nra (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 DELUCA 1012198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) �q33 10f) C (revised04127197) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 50 NYES NECK POINT RD.CENTERVILLE MAP 233 PAR 15 DELUCA 1012199 Depth of groundwater 7 Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data 4 Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) GROUNDWATER DETERMINED BY HAND AUGER AT 7' (revised04l2719T) page 10 of 10 NO.Z..�. �P..f� ��jd ✓Z y - Fizz..`� ..-...... �(�� THE COMMONWEALTH.OF MASSACHUSETTS !S BOAR® OF HEALTH I 3 _-�....OW...................O F.... �,.GS e. a3 Appliration for Disposal Works Tonstrurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (A an Individual Sewage Disposal System at: ................_........_...................................................................... ................4 P .e................................................................. Locati�o�nf-Address /� or Lot Nor ri....�V..2,ykfelHaS...�F.................................. .......... .r ../Y W Owner Address C.a�t � P&! ..9-S---------------------------- ------------------------------- Installer Address MType of Building Size Lot...J4300.t.._.Sq. feet Dwelling=No. of Bedrooms..............�3-------•--•-____..___-_-•Expansion Attic (Alb) Garbage Grinder (gip) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures •.... ------••-••-•---------•---•-•---•--••----••--•-.•-••-------•-------••-•-----•---•-•--•---------•-•-•---••----••......-•--------•...........••-- W Design Flow................................... per person per day. Total daily flow.............................3_?z.0-__gallons. WSeptic Tpk—Liquid capacity/0010.gallons Length.S 6 ._. Width.Y./R.a. Diameter.....:.......... Depth.�._�_/_}.��.. x Disposal No........,/.......... Width...... b........ Total Length....:'..._.Total leaching area__ ----- ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box V,) Dosing tank ( ) aPercolation Test Results Performed by_. ..0 t� _.0 s � � ....... Datea O�--1z,!e75 ........ a Test Pit No. 1................minutes per inch Depth of Test-R./W.'..... Depth to ground water..61&.er _..__.:___. f� Test Pit'No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water......................... •---•----•--•--•----------•----•------c------------•-----.....T--•-.•-•--•.-.-...._...--•-u------...---.......----.-.-...---•------r�-•--1-.-4--•:..®._..._.�-•--•--.•�.-•.•.-�----•�••.O Description of Soil--- ---? � Z - t-,-- rt ff ------- ma! E..- ....-- - ----------------•---------------------...--------........------------------------------------•-------------------•-----.......---------------•--------------. U Nature of Repairs or Alterations—Answer when applicable__-__ ..Alwa................. ....e f5e 'e'o r.................. .....•----------------•-•-------• Agreement: The undersigned agrees to install the aforedescribgd, IndivrlSewwage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary C tkrFf agrees not to place the s to in operation until a Certificate of Compliance has be ssu by e boa f health. ( � Signed ..... '--•--- Date/ Application Approved BY = ---...... ........... tl-46.......-- Date Application Disapproved for.the following reasons:------•-----•--•-•----------••------•--------•------•-••--••----------•-----•--••--------------••----••-----.... -----------------------------•------•--....--•--•------.....---------.........---•--------------...---------....-••-----•---------•------••---•--•------------•-•-•----•--------•-..................... Date Permit No....�..�`�......�-r--r................. Issued........................................................ Date Ec;;e /Yl vim' 13 c= �r2� ro _D''2lN� :Z7ruSrAt_4L.Ft--rt cyJ E FSS......:::'`. . ........-. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF` HEALTH N OF........'. I- ........... r ............................................. Appliratiun for Bistruoal Works Tomitrurtion ramit Application is hereby made for a Permit to Construct ( ) or Repair ( an Individual Sewage Disposal System at: ................--......_...................................................................... ................... - ._......- Location-Address or Lot No. .fb{,4.. t a ____________-_---______________----_---- Owner / Address W a Type of Building Installer ............-•--•-••------•----•..................SizderLot----1:)--?fpb.f..Sq. feet Dwelling—No. of Bedrooms_______________ 3.............._.------_Expansion Attic ( / Gar Grander (A4 a`4 Other—T e of Buildin yp g ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) 04 Other fixtures .•••-•--•-•---•••---------------•----••••--••-------••.•-••----•-•-•••••••••-••...------------------------•-•---------••-•...•----•----._.........__.. W Design Flow......................................; - gallons per person per day. Total daily flow...............................-vimgallons. 9 •Septic Tank—Liquid*capacity__,4v6,ogallons Length__ !.!'.: Width____ ,Id."Diameter________________ Depth___ Disposal `f�No...........`________ Width........f,!5_':_.. Total Length........ Total leaching area_._._.�t�__sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( ) '-' Percolation Test Results Performed by.___,e,�x � Test Pit No. 1________________minutes per inch II,�.epth of Test Pi _____/zQ_"___ Depth to ground water____,�t.te...... r, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water....................... fy Description of Soil...... a. as !' /y" �{ ' + 3�- '.:✓��. '` Es�isr j �� ��p ii , ._. J W r ` �-- -•• .... U Nature of Repairs"or Alterations—Answer when applicable....... ErY<y_ _ ------- .............. l r-ccY;+r- i-c/ * ` ,str G+�yir,v-ec;� je�9r/r1Ei.�x ............-...................................... Agreement The undersigned agrees to install the aforedescribe ndivid Sewage Disposal System in accordance wit the provisions of TITTL 5 of the State Sanitary Co h er g grees not to place the Sys in n operation until a Certificate of Compliance has been a by b of health r'.-- Signed•-••-• _ - ...........- -- ....... . Application Approved By--•-•--••----•-----•••=-=---==:_2...... = X....---- •------------------------- ----------- Date •J Date Application Disapproved for the following reasons-------------------------------------••--•---:•----------•-•-•--•-----•------•-•----------•-•------------_...._ --•..............•-----------•---._._.....---------••----------•-•--------------...--------------•-------------••----•--•---•-••-•-----------------••-•----------•----••---------••••••-----------_-=--- Date Permit No...: a.:: .... ------ Issued-•--------•-------------------------------------------- �_,ti. � �--� ..�- Date -....�.-+lC.,i�tn..%<.. I\�. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................._.._....._.......................... Tnrtifirate of Tompiiane THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( )-or Repaired ( ) b y -••._... -..................................................................................................... Installer at........... :• +� .......,,1 J-�C�---------k- E r i =e!✓ --------- has been installed in accordance with the provisions of TITLE, j of The State Sanitary Code as described'in the %application for Disposal Works Construction Permit No.....- ,....... . dated_....... ---------- ------------------ TIME ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CO U N'YRUE® AS A G �R74 TEE_THAT THE SYSTEM WILL FUNCTION SATISFACTORY. V SSAbC DATE....................... .—.1g�l....----•---•-------•-----..._.. Inspector.:...... THE COMMONWEALTH OF MASSACHUSETTS (I,<v'BOARD(bOF:'HBA :.TF-I , Yv Ir;/ �1 ,r; Diu .1 ;rtL C�}�,1 y� r_ J f —�{.L• Nc r :- =i= FEE._ � Disposal Vo&a TonStrnrtiou .ermit Permission is hereby granted.or R v .. to Construct Repair an Individual wage Disposal ( ) p ( ) Sisposal System ... Street as shown on the application for Disposal W -___Works Construction 'Permit No._�'_ � �/`l Dated.__ =-✓.=------- f ::........... ................................ Board`of Health DATE----•------:------•--- - r------•---- FORM 1255 HOE -& WA 17 EN INC., PUBLISHERS T WN O STABL" "1Lo, iTON" pyos l SEWAGE # j LLAG — k"ll� ASSESSOR'S MAP & a73— 15 � IINSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 00 LEACHING FACILITY: ( ) ever 1 (size) NO.OF BEDROOMS BUILDER OR OWNER PERMITDATE: 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(Ifs ���ds exist within 300 feet of leaching facility) &0,C.( Feet Furnished by AA*�) M �� 49 � C 5� IV/I Pia 3�3 , , L'O C A'T ION �^� '/� E,W A G E PERMIT- NO. °t e r� -1VILLAGE IN 1A LL R'S NA-ME ADDRESS R U 1 DE R OR OWNER DATE PERMIT ISSUED 7 DATE: COMPLIANCE ISSUED q'9 -?-5 i. i icon �" 57 P;Pe � 1 P L O CATION � N SEW A G E PE RMIT- NO. VILLAGE `P INSTALL R'S NAME & ADDRESS A S ,� k- RUKDER OR OWNER DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �. � I Pcoo �' Sf pipe : SOIL TEST PIT DATA: �A,�a �P d T� C)ETA�..: DISTRIBUTION BOX DETAIL LEACHING I�ELI� DETAIL: REVISIONS; MEfSC. --- �OtMOD r NOT TO SCALE NOT TO SCALE NO_ 4 I/�- T'EiT 814Cd+. YWA3'�.P NOT TO SCALE - �;NiSMEG GRADE TP TP TP TP I40TES I SEPTIC TAW SMALL K STEEL ♦ NkET &FLIES OUTLET TEES TO 9E CAST MN, / _�v NO. OF OUTLETS. � � _ L _ 1_ __ � 1� c�/, ; ,;/ 77, REINFORCED COW-*4TE Sit 49G PW OA r' -ti1-VIJ f CITE TEES --__ �'+L ANL MCA !1 I v0F LN NOTES ORD. EL._ _ GRO. EL. __ GRO. EL.____-- GRD. EL. �� yaE p IrA«Ma� covE� --�_- - ; , t . w/pEw GW. EL. GW- EL. —r_� GW. EL__ _ GW. EL.____.._._..._- 2 SEPTIC TANK TO IIftTIt5TA1rD M-ICJ 1. D�lIL 9 - - L DIST BOX TO WITHSTAND H-10 LOADING, 4 PERFJRA' . Pv. A ' _ PIPE LOCES.^•' djl_ /"�<�v TRAVELEDD WAYS,WHEREIN t UNCIEft PAVEMENT, -20 LIDAD IG I t ___ -._ _ __ �_ . . __ ___ _ __. _ `.____ ----' UNLESS rN�QER PAVEMENT, DRIVES OR "+ c r a"}Cr SHALL APPLY. j ��. i F- TRAVELEDLL WAYS WHEREIN H-20 LOADING J LY, EVE: gB0''QM a rd �_ '.= T" ,G17` � '" rV` tl PRECAST r t' �° O $ > 5 3 ALL. PIPE CONNECTKMS AND CONCRETE wwws�.[ :rev[w DIST i / Y. CONSTRUCTION TO BE WATER''18MrT TO irwsb- s+•sac'--, i eox I 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE OF I INLET PIPE EXCEEDS O.08FT/FT• OR IN 3 '�r.A>t✓.y �_ l PUMPED SYSTEM, r L_-_. L__ QRat^,�_E� GENERAL NOTE 4Gs � � rr i �„ ��' 3 FIRST TWO FEET OF PIPE OUT OF DIST i.._..-.._�� _-- � -- —•' .- �^r a —t - - 80X TO BE LAID LEVEL . PLAN vtEw 1. THIS PLAN IS FOR DESIGN AND RE MOYE AOL E COVER - CONSTRUCTION OF THE SEWAGE 77-7 PR;7vIrrE co,y � DISPOSAL FACILITY ONLY. ISLA- 'E t �RECAaT - �s 1 TS t ._� _ _:___':-.: ._ - _ _. - d s►5lracrM ALL CONSTRUCTION METHODS AND } , ' T �-._ -- — C T IDIV a f` lit a ., s .4a'' +EN! O+u T L E T ' � �; _ J"l !f E --�- ! fEgT1[ r d q a+c *� —'--. 'EE oTE 2 /, i , p 16" ►w. t+rF '�G�-" MATERIAL SHALL. CONFORM ORN� TO (.54y"pic `i`n"*cro) + TAX% � _1NLE1 � 1 �'- r.. .I 4 Ui1TLET t �, _ __,_ s►,G,,.,,a MASS C7.E.C�nE, TITLE AND t_OCAL. I BOARD OF HEALTH REGULATIONS, t r 1 BOTTOM ON o , 1,s,r,� . ' _�` •c--w :a _s.i_ iTasm_c *A SW mV,s —� z p• �F�L S'iAot F 3. ALL PIPES SHALL BE SCHEDULE 40 �r. CROSS-SSECTtON EASE OR EQUAL- DATE: DATE: DATE: DATE: INVERT ELEVATIONS: TEST BY: TEST BY: TEST BY' TEST BY: " 4 INVERT AT BUILDING WITNESSED BY: WITNESSED BY: WITNESSED BY: WITNESSED BY: 4" INVERT AT SEPTIC TANK(in) 1. . _ •4" INVERT Al SEPTIC TANK(out) _41.,<.W PERC_ RATE; PERC. RATE: PERC. RATE: PERC. RATE: �,� \�, �� ~� ; 4" INVERT AT IJIST. BOX(in) _4.0.,SZ1:�_ .____._...._—.MIN./INCH MIN_/INCH MMIJINCH _.___-MINI./INCH ' !' ti 4" INVERT AT DIST. BOX(out) __4_0.73- CONSTRUCTION NOTES: At t s. 1 R6rriovG /it VA1� rr7E�r',t �I1YiT$G.fi =:a1.• ` INVERTS AT LE r aHING F.ACILITY (, �' `•-_ "-.. �� � 1 �„� / � k '^_'• � � A+�'!�.��'„'.RI ('!rr..'y r. � iJ f�!"' /!!-/Ie�'�!t'r/1c'✓d'l�l...�" A PC.�n6 4" LEACHING BEGINNING FIELD am.}- it �fI.JE'AR f+`1 �k INVERT I. _ _ _ ._.._--- ��, ._.•... _: ,�, J .�_�� 9`�" .-- '�'// • ` ... �' .. � OF LEA ti�l G F -� r F 3 a«ws p, r ,--t -� .� E � . .�>>.~ _ •. _ =� 9�,�� � -y ILEACH Nt LIEDLD r�- BOTTOM „: „, .�e..:. j ,_ , � . ,�"- � ""� •�r�.°'' � •�r^...�„_ OF ELEVATION FIELD EVATI ✓A# 10A (�1~ �.. .,� l� •'.,. ....� `� �- �,._. � ,;> ,��;�.,� / �- ., =3�. �¢ � � �� ��-y OBSERVED GRC.�t�I�0Vti1ATER `� '�. ELEVATION 7 S .. �, .>'r •r r J F. .�' mot. _, • ""'..++� �� .."'� j��'�_., - y� /C/ttn.,! crCfST/.M� !-La,y +r1r ..w N .�e --------------- 'I DE IGN CRITERIA: i 1�5 L)VSI N FLOW: r , __. BEDROOMS ATa ...G.P.B./D= _UPS G.P.D. �R.-�f /�U� ..__.._._._._.._. —._�._/_...._—.__..__•/_��_.__���{_�n.,.�—__..._p��_�—...�_�_./_._J..__-+_-_ +,—_t •.—._...__—n. _._..r ...__...,_n_.._..—...-_-._.n...+......n - ._.....__.-....,_ aEu�7le « CAPE COD SURVEY , r~ r��,�, e ,.••we � e REQUIR ED TIC TANK , SEPTIC • CONSULTANTS eFr,tr. �. � v >� � x_1; _'. --- 9-q - _ GAL. 'rE „ A r.'' r' _ 3261 MAIN ST.'RQUTE 6A r� r SEPTIC TANK PROVIDED: -- _ �. < _ GAL. BARNSTABLE VILLAGE, MA 02630 4� „ SIZE OF LEACHING FACILITY REQUIRED: I yrr DESIGN PERC. RATE: f K.^ r ,:i MINJINCHDIVISION OF T N S P JECONSULTANTS g�J'� 7rss .E' • I - _.__-__ -___- _- ENG EE • SJRVEYrNG ° IIN '' • PLAN�NiNG TITLE C�. SEWAGE DISPOSAL SIZE OF LEACHING FACILITY PROVIDED: .4 SYSTEM DESIGN /^q ...... �� ��J "`+�-_.•.. `�.,,r" .e ..aft, } {t,,,� } r --.....,�..-�i'�'. c,+`;h''1}E� j / '"®-...,,��,,,,,/ \ „� � ::!:.. �.k,_.7C .,.1, V.: :yi+1w",�.t�5►F` _._.. �:5��_..�.f- .�._ ^_ „ 1 i n f-- �/7 v. LOCUS PLAN. 1 _.,. •-�, r � r r -` r ys`rK. C, /r�Cri,91l�`1`IIiiR' -"`~.. tOR C•-%d".!E'G T r,.V�r"",� ��4+'►t.r••>µ, ,,. . ..._ ` � � r 1 � ,., --,�'-�•�1► _._._ ---•-�- � .�'",._ PREPARED FOR ,� � r I :„ � • • i r `4. Z)6-,,4,,4,f A_Are AC .. �. .:-- ... R ti I t,4" *.. 1 a u r ' ' �, , rtE/r7c•rJ� '%Z'i,i?'.5A/L { ,`� '...,,,, 'y _'y �'• 4.} `- -- __--.___—.._ ,/ �.....__--._____ DATE, 1} ' %} f` p rr x a L s,1Jyt c;;vvtl ,. .;. .�i..n.<+,a.�w-r. -,.,.,.,..�..• �' d."_'c3A1 _-0,f 7 '• `d._ \yam r.' "e'' .r� v e' '1 COMP,/DESIGN. 1 f' (V..e�ri✓,�.`ai+.• rru:_ r.. ,. -_....mot.,. C' ,n''•w ='.,E• :..,," .a ..r-h:.',.n- _R ,} DRAWN �° I �_ _ ' - �4 -.- - -{ ok. PLAN VIEW _ ` G:`�'TdrJ{t% rB!" CJf1d 1.. �(. �-'/��Q 1' •-y •. t�'�=�i�_ � � FIELD. t SCALE, i ' is FILE NO: DWG, NO: ,- JOB NO: v3 14�� O� 0 ,- r� FEET SHEET / OF: /