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HomeMy WebLinkAbout0166 SAINT FRANCIS CIRCLE - Health 166 Saint Francis Circle Hyannis F A = 291 226 ° r ° ° f't3arnstable Assessing Search Results Page 1 of 2 F. Home: Departments:Assessors Division: Property Assessment Search Results 166 SAINq T FRANCIS CIRCL Owner: BARNSTABLE,TOWN OF (MUN) Property Sketch Legend Map/Parcel/Parcel Extension �'V O No sketch is availabl for this pal 291 /226/ Mailing Address BARNSTABLE,TOWN OF (MUN) C, C)� 367 MAIN ST HYANNIS, MA.02601 2005 Assessed Values: Appraised Value Assessed Value Building Value: $0 $0 Extra Features: $0 $0 Outbuildings: $0 $0 Land Value: $46,600 $46,600 Interactive Property Map:Ma requires Plug in` Totals:$46,600 $46,600 1 have visited the maps before Fir: Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: WEIGERT, BARRY C&MARGARET 7/15/1985 4610/236 $68,400 DALEY, SEAN F 3255/86 $0 BARNSTABLE,TOWN OF(MUN) 7/19/2001 14054/ 160 $ 125,000 Tax Information: Tax information is currently not available for this parcel Land and Building Information I Land Building Lot Size(Acres) 0.34 Year Built 0 Appraised Value $46,600 Living Area 0 Assessed Value $46,600 Replacement Cost$0 Depreciation 0 Building Value 0 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 Barnstable Assessing Search Results Page 2 of 2 >. Q .,A Construction Details Style Vacant Land Interior Floors Model Vacant Interior Walls Grade Heat Fuel Stories Heat Type Exterior Walls AC Type Roof Structure Bedrooms Roof Cover Bathrooms Total Rooms Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area(Finished)_ GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished.Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper.2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) . r http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/A... 2/2/2005 Septic Inspection Information DatEtry Date 6/26/2 pectNo 1 Assessors Maps 291 1226 0.616 RUPEE tJumber 166 M�ss Saint Francis Circle 1%ulag�e:,, Hyannis L-lnspecto James M. Ford „ System Status" %inspect date: 4/23/2001 ��,. ,� I F .=Comment; "Permit#�" Repair i?ate ` - Notif,�cation,�Date BEng/lnsta ler, Repai��®eadlirDate � � COMMONWEALTH OF MASSACHUSETTS a EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR DEPARTMENT OF ENVIRONMENTAL PROTECT ON 4PR 2 FQ ro yFOP �1041 �CTy�AST�etF TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 166 Saint Francis Circle �p Hyannis AM Owner's Name: Barry WeiQert Owner's Address: Same Date of Inspection: April 16 2001 Map: 291 Parcel: 226 Name of Inspector:(Pie nfe f Lot: 20 Company Name:... "anterm. fora- Mailing'Address:., P.O. Box 49 Osterville,•MA±'02655-0049 ;_. Telephone Number: (508) 862-9400 r, �'• ;". CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Np4s Further Evaluation by the Local Approving Authority ✓ ils Inspector's Signature: Date: April23, 2001 The system inspector shall su 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. _. . MNotes and Comments t ,• - ****This.report only describes conditions'at:the time of inspection and under the conditions of use at that time. This inspection does not,address how the system will perform in the future under the same or different conditions of use.' ` Title 5 Inspection Form 6/15/2000 page 1 M J Page 2 of 11 , OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ' PART A CERTIFICATION (continued) ' Property Address: 166 Saint Francis Circle _ } f Hyannis, AM Owner:' Barry Weikert ..- Date of Inspection: April 16, 2001 V 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: 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; io`or not determined'(Y;N,ND)in the.,- for-the following statements.,_ If"not :determined",please explain. r The septic tank-is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup-or break out-or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year.due.to.broken_or obstructed pipes). The system will — - pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 Saint Francis Circle Hyannis, MA Owner: Barry Weigert Date of Inspection: April 16, 2001 C. Further Evaluation is Required by the Board of.Health Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless"the Board of Health(and Public Water:Supplier;if any)determines that.the, system is functioning in a manner that protects the public health,safety and environment: The system tins a septic tank'and soil absorption systeni.(SAS).and.the'SAS is-within,l00,feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is.flee 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: I 3 Page 4 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 166 Saint Francis Circle t Hyannis MA ti t Owner: Barry Weikert Date of Inspection: April 16, 2001 D. System Failure Criteria applicable to all systems: You must indicate either"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 '/z day flow ✓ 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",ces'spool or privy is'withiri 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`' oo0 feet buvgreater-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 colifor'm-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 (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 System: - .r . . ._. To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either`yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "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. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B -°.CHECKLIST Property Address: 166 Saint Francis Circle Hyannis, AM Owner: Barry Weikert Date of Inspection: April 16, 2001 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:?;, sw° ✓ -,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 iocation of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ _ 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(3)(b)]. 5 Page 6 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 166 Saint Francis'Circle Hyannis, MA , Owner: Barry Weigert Date of Inspection: April 16, 2001 Y_ FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 2� DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: n/a Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no):_n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): n/a Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: _ Design flow(based on 310 CMR-15.203): gpd 7 Basis of design flow.(seats/persoris/sgfft,etc.). - i Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no):__ ._..._....__._.__ Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped on May 4194 and Mar. 24198-per treatment plant Was system pumped as part of the inspection(yes or no): 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) Tight Tan_k Attach a copy of the DEP approval Other(describe): :. Approximate age of all components,date installed(if known)and source of information: Nov 15, 1984 per as built-card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C `.' 'SYSTEM,INFORMATION (continued) Property Address: 166 Saint Francis Circle Hyannis, AM Owner: Barry Weikert Date of Inspection: April 16, 2001 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: —cast iron 40 PVC other(explain): Distance from privatevater supply well onsuction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 16" Material of construction: ✓ concrete metal fiberglass __polyethylene other(explain) If tank is metal list age:"_ Is age confirmed by a Certificat6 of Compliance,(yes or no):. (attacl�a�copy of certificate) Dimensions: 1000 zal. Sludge depth: I Distance from to of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 2" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 15" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): The tees were present. The liquid level was above the outlet invert and backing-up from the leach pit. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass _polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top,of.outlet tee or.baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle conditibri,structural integrity,liquid levels I as related to outl�ilnveii,evidence-of leakage;etc:): 7 Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM"INFORMATION (continued) Property Address: 166 Saint Francis Circle Hyannis, AM Owner: Barry Weigert Date of Inspection: April 16, 2001 ' TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete _metal fiberglass _polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): r. DISTRIBUTION BOX: 4"` if oresent.must be opened)(locate on site plan) } r Depth of liquid level above outlet invert: Up to the cover 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.): The liquid in the D-box was up to the cover, backint;-up from the leach pit The D-box was 32"below-orade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): � i 8 Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM•INFORMATION (continued) ZL Property Address: 166 Saint Francis Circle._ Hyannis, MA :._. •'.;.:: ;=`. Owner: Barry Weigert _ Date of Inspection: April 16, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I-4'x 6'w/2'stone-per septic plans leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: _._,. ...._... overflow cesspool,number:... . Innovative/alternative.system._...Type(name.of technology:,_ Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The liquid in the leach pit was'6"'above:the top of the pit`and into the riser.,"'The scum line was.1'above,the liquid. The bottom to grade was approximately 7' CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: . Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of pondin&condition of vegetation,etc.): PRIVY: None (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.): 9 s Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .1. . :SYSTEM INFORMATION (continued) Property Address: 166 Saint Francis Circle Hyannis, MA Owner: Barry Weigert Date of Inspection: April 16,2001 Map: 291 Parcel: 226 SKETCH OF SEWAGE DISPOSAL SYSTEM Lot: 20 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. Pond S 5 [31 - C2 B Aa- ace' �•, � u A37 '0 �. r33- `00 10 ro AI nT I(ob of 3 L + y 10 Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 166 Saint Francis Circle Hyannis, MA Owner: Barry Weikert Date of Inspection: April 16, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic map Checked with local excavators,installers (attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 7' Using the Barnstable GIS topographic map, the elevation at the top of the pit is approximately 37 A pond in"the back yard is at an elevation of 33. The pit is in the groundwater elevation. I This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed,written or implied,relating to the system, the inspection and/or this report. I1 Massachusetts Department=of Conservation andAecreation Office of Water Resources 148401 TYPE OR PRINT ONLY - Well Completion Report {, TO 1.-WELL LOCA ` 0 . . Address at Weli Location: S*.�Caw1 S Grc l Property.Owner/Client: ^1"w r' -4k 604 Subdivision Name Mailing Address-. City/Town: E � \S. City�fown: : v�v�\3 �I� (5'Z60 - m Assessors Map rAssessors Lot#: NOTE: Assessors Map and Lot# mandatory if no-,street,address available_: Board of Health permit obtained: Yes ❑ Not Required:LU ; Permit Number Date:,lss ed 2.WORK PERFORMED 3_WELL,TYPE .4. DRILLING METHOD,'" : 6.aCASING -[K ' Overburden Bedrock- From (ft) To (ft) TypgV,p Thickness. Diameter Fifl ' N Fol[41 ff IF-] L�g El A El S.WELL LOG OVERBURDEN . Extra- Water Loss or Drop in LITIIOLOGY Bearing Addition Drill Fast or ❑❑❑ From(ft) To(ft) ,Code Color Comment Zone- of Fluid Stem D Slow 7 Rate . SCREEN S From($) T,o`(ft)'��'` Type � Siot Size Diameter (� t-S ✓ Y / N Y /'N F / _3. ) ®M❑ , -0 1 0 S 2' Y / N Y / N F / S ❑❑❑ = — — Y'/ N Y.'/ N F / S g.ANNULAR.SEAL/FILTER PACK/ABANDONMENT MTL . Y / N Y / N F /,S.-, From(ft) To (ft) Material Description Purpose Y / N Y / N F / S_f' ❑❑ ❑❑ Y./ N Y / N F� /.�5 ❑❑ _ ❑❑ Y / N Y / N. �F hS � ❑❑ ❑❑ Y / N Y / N~ �F��,S ❑❑ ❑❑ WELL LOG, BEDROCK Extrd . Water.Drop in Extra visible' Loss or #of 9'SITE SKETCH. - F LITHOLOGY Bearing Drill Large 'Fast- jRust Addition Fracture Zone Stem Chi psri Slow Staining of Fluid per.foot From(ft) To (ft) Code Comment , brill Rate Y / NY`% N_ F�/ S Y / N Y / N Y / N,Y./-NF / S Y./ N Y / N Y,,/ NY"/-N F / S Y / N Y / N N,Y / N F / S Y / N Y / N _. j' YtaNY / N F / S Y / N .Y / N ^. YjNY / N F / S Y / NY / N Y7NY / N F / S Y / N Y / N . Y / N Y / N F / S Y / N Y / N ` ;1JV Y / NY / N F / S Y / N Y / N C "} Y / N.Y N F,./ S Y / N Y / N 16.WELL TEST DATA(ALL SECTIONS MANDATORY FOR PRODU:G'TJOt tWELL�} 11.`STATIC''WATER LEVEL(ALL"''WELLS) Yield Time Pumped v Pumping Level Tir f 0eco 3 k'i—'A covery Depth, Below Date Method (GPM)- (hrs&min) (Ft. BGS) (hrs&min) (Ft. BGS) Date Measured Ground Surface (ft) 12. PERMANENT PUMP(IF AVAILABLE) . .. %. 13.ADDITIONALWELLINFORMATION Pump Description . Q`0 ❑ ❑ Horsepower Developed Y / Ih)Fracture Enhancement Y / Pump Intake Depth r. �' (ft) Nominal Pump Capacity (gpm).` Disinfected Y / Surface Seal Type 14.COMMENTS Total Well Depth�Depth to Bedrock 15.WELL DRILLER'S STATEMENT This well was drilled,altered, and/or abandoned under my supervision,-according to applicable rules and regulations, and this report is complete and corroOt to the best of my knowledge. Driller: �' _ n� Supervising Driller Signature: Registration #:I A1:I �I Firm: to t Date Complete: Rig Permit#: I I I *24 � I NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion: ; " ' r BOARD OF HEALTH COPY y, }(: , ►`: n Well Completion Report Codes Section 2 Section 3 Section 4 Work • Well — Drilling Work Performed Type Method Performed Code Well Type Code Drilling Method Code Decommission DC Cathodic-Protection CTPR Air Hammer AH Deepen DP Domestic DMST Air Rotary AR Hydrofracture HF Geoconstruction GCON Auger AG New Well NW Geothermal Closed Loop -GTCL Cable Tool CT Repair RP Geothermal Open Loop GTOL Casing Advancement CA Replacement RE Industrial INDS Core CR Injection INJC Direct Push DP Irrigation IRRG Drive and Wash DW_ i Monitoring MONT Dug DG Public Water Supply PBWS Mud Rotary MR • - Recovery RCVR Reverse Rotary RR Test Wells TSTW Sonic SN Section 5 Section 6 Overburden Casing ' Lithology Overburden Overburden Overburden Bedrock Type Thickness Name (OB)Code Color Color Code. Bedrock Name (BR Code) Casing Type Code Thickness (NO CODE) Artificial Fill AF Black BL Amphibolite AM Certa-Lok CTL Schedule 5 Boulders B Bluish Gray BG Basalt BS Fiberglass FBG Schedule 10 # Clay CL Brown BR Conglomerate/Breccia CG/BR Galvanized Pipe GLP Schedule 40 j Coarse Sand CS Dark Gray DG Diorite DI HDPE HDP Schedule 80 I Cobbles C Greenish Gray GG Gabbro GB NSF Coated Steel NCS Schedule 160 t Fine Sand FS Light Gray LG Gneiss GN PVC PVC SDR 13.5 Fine to Coarse.Sand FCS Reddish Brown RB Granite GR Stainless Steel SST SDR 17 1 Gravel G Yellowish Brown YB Limestone LS Steel STL SDR 21 t Medium Sand MS Marble MA SDR 26 Organics 0 Quartzite QZ SDR 32.5 Sand&Gravel SG. Rhyolite RH SDR 40 Silt SI Sandstone SS '17# Silty Clay SICL Schist SC 19# Silty Sand SIS Shale SH Silty Sand&Gravel SISG Slate/Phyllite SL/PH Till T Pegmatite PM Section 7 Section 8 Section 10 Annular Seal/Filter Screen Annular Seal/Filter Pack/Abandonment Purpose Method Screen Type Code Pack/Abandonment Material Code Purpose Code Method Code Carbon Steel CST s Bentonite Chips/Pellets BC Fill FL Air.Blow with Drill Stem AB Continuous Wire PVC CWP Bentonite Grout BG Filter FT Air Lift AL Galvanized Wire Wrapped GWW Cement/Bentonite Grout CB Seal AS Bailing BL Perforated Pipe PFP Concrete.._..- ,z.CT . Constant Rate Pump CR Pre-pack PVC PPP Sand t l "1 (rt;5S% Variable Rate Pump VR Pre-pack Stainless PPS Native,MaterP� �_____+ _- Slug SG Slotted PVC SLP tW,013y I -•,voosFt of s,,;' Stainless Steel Vee Wire SSV Stainless Steel Well Point SSP , Section 12 Section 13 - Pump Description Well Seal Pump Description Code Horsepower Surface Seal Type Type Code 2 Wire Constant Speed Submersible 2WSS 1/2 20 Cement CM 3 Wire Constant Speed Submersible 3WSS 3/4 25 Cement/Bentonite CB Constant Speed Submersible Turbine CSST, 1 30 Concrete CT . Variable Speed Submersible Turbine VSST 1 1/2 40 None NO Jet JET 2 50 Line Shaft Turbine LST 3 60 ' Centrifical CENT. 5 75 7 1/2 100 -- f4a»: 1.Q4K U"ll25 �.� set. tk .a ssg fis !3t:I'% TOWN OF BARNSTABLE LOCATION RAP Ff AAC 1.5 SEWAGE # AGE_ 14"JAAA iS ASSESSOR'S MAP& LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /O D GAL } LEACHING FACILITY: (type) size) yx G C7 ST n� NO.OF BEDROOMS A' BUILDER OR OWNER IN PECTION PERMITDATE: --COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 leachingfacility d Feet Furnished byrdn . �arL,l �11�(91�� M � C► � "'rc co O J- i W) i 0 a- O Ca -U -- TC1 C.0 Q L O C AT 10 --,� SEWAGE PERMIT NO. ' VILLAGE Cam- � I STA LER'S. NAME i ADDRESS BUILDER OR OWN ER e�-' DATE PERMIT ISSUED DATE COMPLIANCE ISSUED T 9 � e J� j Nohl :71Y.4n. F ........................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Z 0 HEAL F.................. ..........0 (_ * _1 ,f- .................. Appliration for Uhipasal Workii Tongtrurtilln Vrrutit Application is hereby made for a Permit to Construct �or Repair an Individual Sewage Disposal System at: ---9 T.o.c.a...6. ...T. j;r.e. Address .... .L.V . .... .. . A....... ........... .................... ........----------------- C - .........e-I--.-.----�----....--..-..-e,.-.-.-, Owner Adress . ......... ............ . .. ----- Inst .-.-.-.-.-.- .-.- ler Address Type of Building Size Lot../5, ----Sq. feet ... . U Dwelling—No. of Bedrooms................ ............Expansion Attic Gar 7age Grinder 1� ok Other—Type of Building A/0.0D---FkAtX,No. of persons............................ .Showers Cafeteria Otherfixtures ...................................................................................................................................................... Design Flow..........//.0.....................gallons per person per,day. Total daily flow........ 0..............gallons. Ix Septic Tank—Liquid capacity/oi 0..gallons Length .._F..�...... Width.1'.4of, Diameter................ Depth.ff.."10." Disposal Trench—No. .................... Width . ....... Total Length.......... ._ .. Total leaching area....................sq. ft. 4 > meter...Seepage Pit No........ I........ Dia ... Depth below inlet......3 ...... Total leaching area..................sq. ft. Z Other Distribution box Dosing t k Percolation Test Results Performed by...... CZ.....4.S........... Date... 17 Test Pit No. I... Pit.I.O.Ye... Depth to ground water.... . .. *....... -I?, .....minutes per inch Depth of Test Test Pit No. 2................minutes per inch Depth of Test Pit................_... Depth to ground water_.._._..........:_.._._. ...... ...................... .... ............ ";.......... z?.Description of G .. .....n. .�Vv� 0 ........ ..... L.. ..... a. t. ..... �4 V.............. U .......�4... ... ............................................................................................................................... .........................................................................................................................................................................................;.­" U Nature of Repairs or Alterations—Answer when applicable_.... }. ...__ 110-0 1/ ww. 9 ....................................................................................................................................................................................................... Agreement: The undersigned a&ees to install the afo d �Criibed. Individual Sewage Disposal.'System in accordance with e e� the provisions of TL III LE 5 of the State Sanitary 0 e The undersigned further agrees not to place the system in operation until a Certificate of Compliance has sued " �e board of Sigig ....... ......X....%.................................V_:.......................... ................... ale ApplicationAppro .... ........... ......................................................................... .. .................. Date Application Disapprovi fo he Kfollowing reasons:........................................................................................... .................... ......................................................................................................................................................................................................... Date PermitNo......................................................... Issued........................................................ Date --------------------------——------- ------------ ---------- No.4,2...-/_1l6- --_ . ` ' FHB `Q...............••. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ..........OF........ ............. 8 ,���lirtt#ion fnr �i��n�ttl nrk,� C�on��rttr#ion rrmi# Application is hereby made for a, Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ........ ......................... ................ .... ....___................... ..... .._.--- --•--------• *rt ..No Owner, Address W 4".QIJS.. v y '- staler_.. ` . -- Address d Type of Building `' r Size Lot../,5- �,' 00----Sq. feet V Dwelling-No. of Bedrooms...,............... ..........Expansion Attic ( ) Gar age Grinder ( ) p Other—T Buildin{ Type of g J/QO.j?---�'y.)91M�, No. of persons____________________________ Showers ( ) — Cafeteria ( ) 04 Other fixtures -------------------------------------------•------••--....._._............---•------------------.........----....---•-----....-•--•--------•••--•----- W Design Flow......._ fe.. .......... .......gallons per person per day. Total daily flow......... ..............gallons. _• �.'; ri: Septic Tank—Liquid capacitYA44 -gallons Lengt Total 9Len Length g' 0!' Diameter tal leaching area._Depth-:$/6 t xW ;Disposal Trench—No_.................... Depth below inlet �.�..:... Total leaching area ................. q ft. ?See a e Pit No.. .___ DiametWldth��++ '' a ea". q. ` { Other Distribution box Dosin tank w a- Percolation Test Pit,Noest Rl suits Performed nutes p inch Depth of Test Depth to grounw�te _� 8 .. �`�}��- �4 �z Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ ._a -- • •--•- 0 Description of Soil--------i/ 3/� [�.�� ...:.. Eux ... ll V ram- +at ,a fF ✓ i x Nature of Repairs or Alterations=Answer,when a hcable_._� ,�..,..__._.. -_ " k;U P PP ��.�-�.....:!hp_s ..a. ,�,. .✓..�Ga!7/L -----•...............................................................•--------------•--•---------•---------......----------..-....._..........---------•-- .......................................... Agreement: The undersigned,lagcees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE'. 5 of the State Sanitary qd_e The undersigned further agrees not to place the system in operation until a Certificate of Compliance has �• ed b t e board of h Sig -X- ------------------ - :' .. Date +� ' Application APpro � ..o 6 .......gDate Application Disappr;d fo the fowing reasons____________________________________________________________ ________________ .. ........................._ .......••-•-•---•••-•--•-••--•................••-•••---..................••----••----•------•------...•--•--•-•-•-•---------...__.... _......•-•••----......_ ...... .. Date PermitNo---------------------------------•----------------------. Issued._..._.__..._..._ ' ' Date THE COMMONWEALTH OF MASSACHUSETTS BOAR F HEALTH . ...OF................... a C9rdif iratr of Tbutphanrr 0 IS I TO RTIFY, That the.Individual Sewage Disposal System constructed or Repaired b6�-�• --... . _ -•-----•----•--•----•------ ... y stauer at. -Q-••• t f� PIL, :"- --•-••• .•.....................••-...••--- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in'the s t . application for Disposal Works Construction Permit No , ..+ ��................. dated_ _____-__................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE -b Inspector........... -•.................................................................. THE COMMONWEALTH OF MASSACHUSETTS E BOARD OF HEALTH Nn} " �� ........................................OF............-...................--------............---•--. FE. . ................. Ui ipog.. orkii Tontrur#ion rrrmit Permission i eby grante ..-- ...................... ••--•-- ••••••----•-•-------..._.........•-----..........=---•-•........................ ` to Construct r Repair ( nd> ual Se la > o al" ystem atNO.._ .. ... .... ... : Q�?.... 'E;E,�,t� - .........................--- •---............. Stree as shown on the application for Disposal Works Construction Permit No....... __ Dated..........:............................... ..............�.-•a •••----•••--------•-----•-••.......-•-•...................•-------- Board of Health DATE--------------------------- 1.: ...... -------•-•-----• FORM 1255 A. M. SULKIN, INC., BOSTON j - 1 - � DOYLE -ENGINEERING ASSOCIATES, I� 47 MORIN AVENUE FALMOUTH,MASSACHUSETTS 02536 TELEPHONE 617-540-4411 JOHN P.DOYLE,R.L.S. JOHN P.DOYLE III STEPHEN J.DOYLE June 13, 1985 William Lieberman 235 Timberlane Drive. Marstons Mills, Ma 02648 T6 Barnstable Board Of Health 367 Main Street. Barnstable , Ma 02601 Dear Board Members; This is to certify that lots 11 & 20 St. Francis Circle have had sub-surface Sewagw Systems installed in accordance.with the respected site plans approved by your Board Of Health an Barnstable Conservation Commission. Thank You, William Lieberman WL:ers i SOIL LOG NO. 1 v F NO. 2 S- ITE PLAN_ TQ� ©tom 3� I� - 3, 4 � TOP OF FOUNDATION EL.: ` r s,o;+.ic� _ 3 sX 5 • IL I1.lITiAL W°•TPIZ, c IN.EL. •e. V A4,T E rZ v 10 IN.EI. '�n,3 4i I;:..F» fD12 -- - - - 11 4 ::• IN.EI. IN.EL S 8 STowe I . • O/B W/ 6"SUMP lti �`" a° � `� c � ---- 3�„� ��,r �/•d.� ��� sTraiJE. 13 4 LIQUID LEVEL 14 15 PERC TEST RESULTS PRECAST SEPTIC TANK WITH PERC RATE: CAST I PLACE INLET AND r ;cam 3G, 5 -�` LT e -r - °l a =' __ WHITNESSED BY: 17- OUTLET T "S PER TITLE Y - ter BUBB If HEALTH. SIZE : 100c) C �.�.�► - ,,; SI - < < r t � s,� � BATE: 1991 C TLC v..011 r : __ IN, r r k ` zD PROFILE OF PROPOSED SEWAGE SYSTEM :r c SYSTEM DES16NED BY THE TOWN OF REGULATIONS AND STATE TITLE I FOR SUBSURFACE DISPOSAL OF SEWAGE . SCALE : 1/4*1= 1 ' 0 " �1 — a,L i N . B , 1. ALL PIPES SHALL BE SCHE®OLE 40 P.V.C. SEWER PIPE 2. ALL PIPES SHALL BE SLOPED 1/4 •' PER FOOT EXCEPT FOR ' HE FIRST 2 FEET OUT OF THE DIB WHICH SMALL BE LEVELJ. DESIGN FLOW BEAR1111S AT 110 GALDAY PER BA. GAL/DAY Lcl,- SEPTIC TANK SIZE lI _ ___ __. 6AL . USE GAL. Nil_.-_._ BARBA&E DISSPAAAL LEACHING SYSTEM: USE �_q ` 1,4 1 ,a�- rit x _la r_- FF - . __�� _ _ B { �- T I9 •�=' -`"'T i--� `�-�'� 1 ' �F �Tc:�� �. .i=��.1.. .�;�..E:a:J�.a c �5� � P�.�'x.. �"�?�t� •�.Cam- - t 3 � �. EFFECTIVE AREA: SIDE . 82 t _ za Y BOTTOM . 76 ::�,•,'c:./1�,'°3' `!' _..._.. _..._ _- 1 _ � tom ��' T�?-,N., '' -tZ.,t� TOTAL FLOW 6 �, , ,,,_ TOTAL REQ'D FLOWX _ / . GARBAGE DISPOSAL RESERVE FLAW 60 LLD GAL/DAY_ 61ZIG, 10A1_ L�2AQ� ? ( cam _ r lu E E RENCE PLANS : _ r , IN APPROVED BY : BOARD OF HEALTH PLC N s .- Li E BATE PROPERTY OWNER , _ SITE AND SEWAGE PLAN 1012- J j RAF �c_>c %1_ ► = - Of FOR : �� ,� + AJM BEDROOM SINGLE FAMILY DWELLING � Palm N LOT : c:-lkL LE DATE . �.�< zz, 1 �Ev 1014 /,g3�vl i k DOYLE ASSOCIATES FALMOUTH , MASS . ` S T 2� y