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HomeMy WebLinkAbout0190 PINQUICKSET COVE CIR - Health 190 Yinquickset Cove Ciri A=005-072 Cotuit I j - COTUIT BAY DESIGN, LLC r � ' tY: -- ARCHITECTURAL DESIGN Zi S STEVEN COOK 43 BREWSTER ROAD G f "Gi � �'� PH: 508-274-1166 MASHPEE, MA 02649 FAX:'508-539-9402 WWWGOTUITBAYDESIGN.GOM �`j0 rd41� STEVE@GOTUITBAYDESIGN.GOM I , : I 1 � I { I ;- I I i : I , I I I 6 I i i 3 V I. , 3 1 I I I : , S 1 ' I I , : I I i 1 I S , i 1 S I i I 3 - - -- i , i i I i I 1 i I i . l, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary;Assessments 190 Pinquickset Cove Circle, Cotuit MA 02635 ,y� y Property Address ®� 1 Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116;, July 7 2008 required for Cit /Town State Zip C ode Date of Inspection every page. Y C .. Inspection results must be submitted on this form. Inspection forms may riot be altered in any -way. Important: A. General Information When filling out forms on the computer,use 1, Inspector: !' only the tab key f to move your Patrick M. O'Connell I cursor-do not Name of Inspector use the return ? _ key. Septic Inspection Services Co. i Company Name ' rob 189 Cammett Road I r _ Company Address Marstons Mills MA I. , 02648 ,E4 State ' Zip Code renen Clty/TOwn I f a 508-428-1779 S1 12855 Telephone Number License Number f Il M k B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the:time of the inspection. The inspection was performed based on my.training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: } ; I . ® Passes ❑ Conditionally Passes ❑ Fails 4 ❑ Needs Further Evaluation by the Local Approving Autho jity 1___ _Uv� July 7 2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent tO.the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 08-'182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary.Assessments 190 Pinquickset Cove Circle Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7,2008 required for every page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are t indicated below. Comments: Tank is not in need of pumping at this time leaching system has no signs of hydraulic failure. ` 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. ❑ The septic tank is metal and over20 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 08-182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 r Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Pinquickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7 2008 required for .every page. City/Town State Zip Code , Date of Inspection B. Certification (cont.) I B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ 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: 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 has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.. 08-182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Pin uickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7 2008 required for State Zip Code Date of Inspection every page. Citylrown B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 to or bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal , less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded El or clogged SAS or cesspool ® Liquid depth in cesspool is less than 6" below invert or available volume is less than_day flow El 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. El Any portion of cesspool or privy is within 100 feet of a surface water supply or ® tributary to a surface water supply. 08-182 McParland.doc•08/06 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 4 of 15 i Commonwealth of Massachusetts RT Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for,Voluntary Assessments 190 Pinquickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116, July 7 2008 required for State Zip Code Date of Inspection every page. City/Town B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® , Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence. -of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. El ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be-considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the. questions in Section D. Yes No ❑ - ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area (Interim Wellhead Protection ❑ ❑ Area-IWPA) or a mapped Zone Il 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. . • Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 08-182 McParland.doc 08l06 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments w 190 Pinquickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7 2008 required for State - Zip Code Date of Inspection every page. CitylTown C. Checklist Check if the following have been done. You must indicate"yes"or"no" as to each of the following: Yes No- ❑ ® . -Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 08-182 McParland.doc•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form -{ Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 190 Pin uickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston _MA 02116 July 7 2008 required for State Zip Code . Date of Inspection every page. CitylTown D. System Information Residential Flow Conditions: 4 Number of bedrooms (design): 4 Number of bedrooms (actual): 440 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 0 Number of current residents: Does residence have a garbage.grinder? ❑ Yes ❑ No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ❑ No Seasonal use? ® Yes ❑ No 38,000 gal. = 52 Water meter readings, if available (last 2 years usage (gpd)): gpd, Sump pump? . ❑ Yes ® No Unknown Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): M Grease trap present? El Yes ❑ No Industrial waste holding tank present? El Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): 08-182 McParland.doc-08/06 .Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 • Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 190 Pinquickset Cove'Circle Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7, 2008 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: None Was'system pumped as part of the inspection? ❑.Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) El maintenance 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): Approximate age of all components, date installed.(if known).and source of information: 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No 08-182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments w 190 Pinquickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston _MA 02116 July 7 2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other.(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass [] polyethylene ❑ other(explain) If tank is metal, list age: years . Is age confirmed by a Certificate of Compliance? (attach a copy of'certificate) ❑ Yes ❑ No ---------------------------------------------------------------------------- ----------------------------------------------- 8.5' long x 5.2'wide- 1000 gal. Dimensions: 4„ Sludge depth: 26" Distance from top of sludge to bottom of outlet tee or baffle 2„ Scum thickness 611 Distance from top of scum to top of outlet tee or baffle 1.2 Distance from bottom of scum to bottom of outlet tee or baffle Measured How were dimensions determined? 08-182 McParland.doc•08I06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 190 Pin uickset Cove Circle, Cotuit MA 02635 Property Address - Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7, 2008 required for State Zip Code Date of Inspection every page. CityrTown D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage; etc.): - Liquid level was found at bottom of outlet invert, tees are intact. Tank is not in ned of pumping at this time. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee'or baffle condition, structural.integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 08-182 McParland.doc•08/06 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 10 of 15 F. Commonwealth of Massachusetts Title 5 Official Inspection Form: Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4„ 190 Pinquickset Cove Circle, Cotuit MA 02635 Property Address Stephen McFarland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7 2008 required for State Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Tight or Holding Tank (cont.) Dimensions: Capacity - gallons r Design Flow: 9 gallons per day Alarm present: '❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date ' Comments (condition of alarm and float switches, etc.): t *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No Distribution Box (if present must be opened) (locate on site plan): 0.. Depth of liquid level above outlet invert x 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.): No solids or high stains present Liquid level at bottom of both outlet pipes. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 08-182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 15 Commonwealth of Massachusetts 47) Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments k,M 190 Pin uickset Cove Circle, Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7 2008 required for State 'Zip Code Date of Inspection every page. City/Town D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: Two 46 pits. ® leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields - number, dimensions: overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching pit#1 had no standing water or sidewall stains. Leaching pit#2 was under fence &hedge and was not opened. 08-182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15, i Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 190 Pinquickset Cove Circle Cotuit MA 02635 Property Address Stephen McParland Owner Owner's Name information is required for 1 Exeter Place, Boston MA 02116 July 7, 2008 every page. Cityr town State Zip Code Date of Inspection D. System Information (cont) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer ' Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): -Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 08-182 McParland.doc•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System°Page 13 of 15 Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 190 Pinquickset Cove Circle, Cotuit MA 02635 _._._.._..._---.._ ....--------._ Property Address ..---'-------— Stephen McParland Owner Owner's Name information is 1 Exeter Place, Boston MA 02116 July 7, 2008 required for --...------ ------- - -.— every page. City/Town state Zip,Code Date of Inspection D. System Information (cont.) 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. 20 1 h y�" • 34 3 ,• :v 4 30 4 40 I Commonwealth of Massachusetts Official Ins ection For , Title50 p , I � , . o Subsurface p y e Sewage Dis osal.S stem Form - Not for Voluntary Assessments, R 1Y 190 Pinquickset Cove Circle, Cotuit MA 02635 4' Property Address k Stephen McParlandI it Owner Owner's Name information is 1 Exeter Place, Boston MA 02116{ l July 7, 2008 required for State plZip Code Date of Inspectio every page. Cityfrown i� �I i�lli I, . tl D. System Information (cont.) ` } i I F1iii �� Site Exam: l I it ® Check Slope ® S urface water ® l Check cellar �. ® Shallow wellsio 3 1 , 51 Ul k�II{�e�_•I yfIl 7� t Estimated depth to ground water. feet Please indicate all methods used to determine the high ground`water elevation: � ❑ Obtained from system design plans on record i.al .a ra'4 �"iti r Ilea If checked, date of design plan reviewed-. . . Date ill' III "ail"r. ® Observed site (abutting property/observation hole within 150 feet of SAS) �ll ill " }4 explain:_ Checked with local Board of Health - • � t.:,la i �9 +a �1� local excavators; installers - (attach documentation) ; I �AIi ❑ Checked with i lilp i ❑ l Accessed USGS database-explain: I I 1 1 ' IF a I, r lift ai ,I I � You must describe how you established the high gr(DUnitwater'elevatlon. r►, High water mark at rear of propert is 5-6' lower that bottom of SAS frl !�� E it i II I i Ifkfk ( , 1 f.:- — I I i C I t ----it --— - it o.u.. .:,r.,:,i�e..,�, q Town of Barnstable OF THE 1pL Regulatory Services g Y BARNsrnsl.E. : Thomas F. Geiler,Director 9^ 1639. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would be listed on the "Disposal Works Construction Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic inspections.DOC: L, b � " TOWN OF BARNSTABLE L CATION j�® �/��' e IGSsi'��� �; SEWAGE# ASP VILLAGE � �� ASSESSOR'S MAP&PARCEL 'S NAME&PHONE NO.�eOr -k f �A & n",) SEPTIC TANK CAPACITY 16W LEACHING FACILITY.(ty e) , 1 (size) 06 NO.OF BEDROOMS .OWNER 5T-epk e1 M PERMIT DATE: ATE can `Z OE) 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 20.0 feet of leaching facility) feet Edge of Wetland and Leaching Facility(if any wetlands exist within 300 feet of leaching facility). feet FURNISHED BY 20 14 34 45 3 , ` 0 d 4 40 P \ 1 )Inv Y Nd-.:Z—91-91 . Fxs........................... �. THE COMMONWEALTH OF MASSACHUSETTS BOAR® F HEALTH OCUAJ iUs�L� OF........ ..._../...................... ........ ................. :. ................................. ............. bb� i Appliration for Bispniittl Works Tonstrurtinn ramit Application is hereby made for a Permit to Construct ,QC ) or Repair ( ) an Individual Sewage Disposal Loc n-Add ess40r.­.��._ O r Ad ss /�� a .......... .... ...... .................. ....... • ------.... ....... . ....----••............---------•--.&.2bl07�nInsta er AddressType of BuildingSize Lot.lB.�................ t DwellingL N of Bedrooms.............._.___.__._.___.._...._Expansion Attic (b)=.% Garbage Grinder (� a'4 Other—T e of Building No. of persons............................ Showers YP g ---------------------------- P ( ) — Cafeteria ( ) P4Other fixtures ----------•••-• ••-------------••-•-......----•-----•••-•-••-•--•------•----•---•---•--•-•------ W Design Flow.......................c�.S .......__..gallons per person per day. Total daily flow---- __�' ----------------•-------•-----gallons. WSeptic Tank—Liquid capacity. i�..._�.gallons Length................ Width................ Diameter________-___-_- Depth................ x Disposal Trench—No..................... Width....-1-------_____-- Total Length... ___.v _..�,_ Total leaching area..__.._----•-_ - ft. Seepage Pit No.-______oa._ ------- Diameter.....q.......... Depth below inlet.�'�__��..... Total leaching area-- _.._sq. ft. Z Other Distribution box ( ) Dosing ( ) e '-' Percolation Test Results Performed by......P_�-4�_r _._ _ ®_.�'� __._. Date.__v �...1 -- Test Pit No. L.0`. :.minutes per inch Depth of Test Pit----- Depth to ground water___cjue V'___i"- 44 Test Pit No. a 2.-•-•------Q••JJ••...mn utes er inch Depth of Test Pit................. Depth�ound water.................... �-�-�-- ----- /f5eb? � •.O Description of Soil----------- -------•-•----••-•------------------ ------. x W -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••--••--•- V Nature of Repairs or Alterations—Answer when applicable...__..............................................................................•............ ------------------------------------------ ----------------------------------------- ...------- •.............................................................................................. Agreement: The undersigned agrees to install the of ede ed n i ' ual S e Disposal System in accordance with the provisions of iITLI 5 of the State Sa h nd rsi ned f rther agrees not to place the system in operation until a Certificate of Compliance as e e of ealth. ' Signd--• -• ----- .. --- . .......-••-•----••-••------------- Date Application Approved BY ---- - --•••--•....................... �,t�--Z)q ........ ..ate Application Disapproved for the following reasons: � 1 -- --- -------------------------------•--------------- ----•--------- ----------------------------------------...........-----------------------...---•------------------------------------ --------•-•...-•- Date PermitNo......................................................... Issued_....................................................... Date cat'72. N0��W...��"1... Fss............._............. THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH § ^. /.... ...... .. ----------------OF........................................ .:..._.... AVVIirat.ion for Disposal Works Tomitrnrtiun amit { Application is hereby made for a Permit to Construct ) or Repair ( ) an Individual Sewage Disposal System-a • - - . . . ................•-•--. -•-•--• .................................. ............ -- - I���yy��//''��,�' Lo 'on Address . W er t A ress rWI Inst ler Address f UType of Building Size Lot............................�Sq--feet Dwelling�--No. of Bedrooms............................................Expansion Attic (b4:A Garbage Grinder aOther—Type of Building ............................ No, of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ..---------•---•-•---•-----•--••---------•----••••--••-•-••-•---------•--------•--------------- -- W Design Flow ...................asf....._...._.gallons per person per day. Total daily flow-__--_�:.`..=. ._._..................gallons. WSeptic Tank—Liquid ca.pacityt_.5r Mons Length................ Width................ Diameter................ Depth................ xDisposal Trench—No..................... Width.................... Total Length..� .... ... Total leaching area______ _.._...sq. ft. Seepage Pit No.......r,4........ Diameter.._.):._........ Depth below inlet... ?_. :.._... Total leaching area.`. . ....sq. ft. Z Other Distribution box ( ) Dosing Percolation Test Resu is Performed by... t 3 #w:t% F �?�.. . E. 5?� Date ••--•- Test Pit No. I.An.. ..minutes per inch Depth of Test Pit...... ........ Depth to ground water_. '':.....1!".._ f 44 Test Pit No. 2................minutes per inch Depth of Test Pit ..........__ D roue water. oDescription of Soil------•.. '�'"�..� '�'�1?� -----•-•---------------•----•-----•----- ...............................................................=............ �, UW ---•-•---•-----------------------------•-------•--••----•-••-•-----•-•-•-------•--•••--...---•---•-•---•-----••--------------•-••-------------•••---•----•-••-•--•-•-••••-•-----•------••-..._.......... Nature of Repairs or Alterations—Answer when applicable................................................................................................ ---------------------------------•--•---•------------------------------------------••--•--.........---------...------------------•------------•------------------••-•------------------.....-••-....••-• Agreement: The undersigned agrees to install the a red 'bed ivilual Sewage Disposal System in accordance with the provisions of TITL% 5 of the State Sa >; d h undersij(ne9 rther agrees not to place the system in operation until a Certificate of Complianc ha been •s ue he ea ofAealth. Sig -- - ----- .. . Date Application Approved By-••------- ---- ----------•-............•---------.......---- .......... Date Application Disapproved for the-following reasons:................................................................................................................ ......................................................................................................................................................................... Date PermitNo.......................................................- Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF...................................................................................... Tntifiratr ,af Tomptianre TJIJS IS TO CERTIFY, That the n ividual Sewage Disposal System constructed ( ) or Repaired ( ) Ins •_. at....--•�-- :•-----�----- ---- ------ has been installed in accordance with e provisions of TI T Lr 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.'�'�..'`�-:~'y____________________ dated.__..LsaJ �/.�__.___.___..__.__..__. THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE...................................... -• �� .:.. Inspector............ '°'� THE COMMONWEALTH OF MASSACHUSETTS ` BOARD OF HEALTH �S y 9544 ..........................................OF..................................................................................... 64 No. ...................... FEE. ............. i �r 1� nrk inn ' n Permit N Permissiyni, hereby granted. 1�= ' •--------• ---•----• ----•--•..... ..... .to Constructor Repair ( ) an dividual Sera isp- System - Oat No. " � M .� - . �. . Street as shown on the application for Disposal Works Construction Permit No. ,.T' y.... Dated.......................................... DATE.................................. / Board of Health F FORM 1255 A. M. SULKIN, INC., BOSTON �� `` ,. 91SEfl oLO CkT'I615' S I W A G,E PERMIT NO. VILLAG E I N S T A LLER'S NAME ' ADDRESS" g U I L D E R OR OWNER d ^ 'b DATE PERMIT ISSUED ^L. y" DATE COMPLIANCE ISSUED �� r a p 5b r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I A m / IL DATA e Log`-Number: '` ' Bottle # - '"' Date: �t 04 BA�sa BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR`COURT HOUSE V BARNSTABLE, MASSACHUSETTS 02630 ABA DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2511 EXT. 331 Cl.ient: -,.Peter Sil.odeau Collector: Leslie H. Feist Mailing Address:-, , : •11e0o pr .ny r. -Affiliation' .; ', >; Ptt an is Weli Urlinnq ..Time,& Date of -Collection: 10/15/84, .2:00 p., . Telephone: Loo-iL1 Type of .Supply: we � ►•aat r Sample Location: ;-I ncIu l c;cse VL KO. Well -Depth i ���' Date`of Analysis': 1u 5 b " PARAMETER S MPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100. ml 0 H J,J Conductivity micromhos/cm 72. 500.0 Iron m - <0.05 0.3 Nitrate-Nitrogen m 0.05 10.0 Sodium m - -- 20.0 I . - ^ Water sample meets the recommended limits for drinking of all above tested parameters. II. Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present the problems checked below: A. Water sample has higher than average levels of Nitrate. Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste, odor, ,staining) due to D. Water sample has high levels 'of:sodium. * Persons on low sodium diets should consult their doctor. - Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: Laboratory Director - � 7/17/84 t a 1 01 �,.. c f 4 Massachusetts.Water Resources Commission/Division of Water Resources WATER-WELL COMPLETION REPORT t WELL LOCATION Address .t/0., C SR tFA n'-- City/Town G.S.Quadrangle Map _.....:__. .__..... Grid Location Owner �L.-Hc:® �6 r 0J eCXA L. Address f -11—= arl irk WELL USE, CONSOLIDATED WELL' Domestic® Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) Cable ❑ 2) From To Other 3) From To 4) From To CASING . Depth to Bedrock !f. Length ��.I Diameter Type �?�+rG UNCONSOLIDATED WELL STATIC WATER LEVEL Water=bearing.Materials Feet below land surface Sand: fine❑ medium C9 coarse❑ Date measured 10/ q I.�L4 Gravel: fine❑ medium❑ coarse[] Screen: GRAVEL PACK WELL / Slot#� .length�from�tolL Yes ❑ No.[� Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Sloto length from to Chemical rV Biological Depth To Bedrock PUMP TEST f Drawdown feet after pumping days hours at. 3 GPM. How measured Wi K- L4 v e Recovery feet after hours. LOG of FORMATIONS COMMENTS:(On well or water) } pM�aterials From To - �i w�. SYr�✓1 �3'� `D DRILLER l y Firm Ah-A-Nirl•C U►CIP� ()rQ) I=iiUr� �. Address�gAIO O Pit- Vd \ City Registration No. Operator s Signature ease print firmly 10M•8/81.164843 Massachusetts Water Resources Commission/Division of Water Resources r WATER WELL COMPLETION REPORT WELL LOCATION Address City/Town r �7— G.S.Quadrangle Map Grid Location Owner 4, f Address/ ? lit, !• �" j i}t .wc. /K t'� l} ,u rutrC.il WELL USE CONSOLIDATED WELL Domestic Q Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) Cable ❑ 2) From To Other f ! = 3) From To 4) From To CASING �l Depth to Bedrock Length I Diameter Type P-4 s f- UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface t Sand: fine❑ medium r❑ coarse❑ Date measured f 1 ! f Gravel: fine❑ medium❑ coarse Screen: GRAVEL PACK WELL Slot# f` length from � 1 tO 12 Yes ❑ No Q Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical Q Biological`© Depth To Bedrock PUMP TEST Drawdown / feet after pumping days hours at GPM. How measured' 11 Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 DRILLER y Firm 1 L r9) l C Lie1k-i.l. f irti 14.LR,�+ f Address",-,A'- City �, L . S 'i•',T)^1 n.4 Registration No. Operator's Signat Please print firmly 10M,8�R+-•�-- Massachusetts Water Resources Commission/Division of Water Resources WATER WELL COMPLETION`REPORT WELL LOCATION Address �i n t ;e a'r r<'_S H fl A- ;—r. r Ciiy/Town -� G.S.Quadrangle Map Grid Location' Owner d L i r-R"" 4 !i Cat s +. ix Address J' + ."(-1 r xl.r t N'u ran C•r .i i ta4 r t j WELL USE CONSOLIDATED WELL Domestic Q Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 11 From To - -Rotary(type) Cable ❑ 2) From To Other 3) From To 4) From To CASING /l Depth to Bedrock Length ; I Diameter c� Type + •' UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface � Sand: fine❑ medium❑Q coarse❑ Date measured-1 t ! Gravel: fine❑ medium❑ coarse❑ Screen: 1 GRAVEL PACK WELL Slot#r j length 7 from 3 t to i Yes ❑ No Q Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot length from to Chemical Q Biological Q .: Depth To Bedrock _ PUMP TEST Drawdown feet after pumping days hours at GPM. How measured I' `• ! 'e Recovery feet after hours. r. w LOG of FORMATIONS COMMENTS: (On well or water) Materials From To. Cb Cz DRILLER Firm Art a qt i t 4yc,k-t NI1-{ptriq °a Address'sffl City--\L, Registration No. Operator s Signature .; ease print rrm y 1OM-8/81-164843 l I t c-7 NO,POSTAGE. NECESSARY IF MAILED 1N THE UNITED STATES BUSINESS REPLY MAIL . FIRST CLASS PERMIT NO.37716 BOSTON,MA POSTAGE WILL BE PAID BY ADDRESSEE MASSACHUSETTS WATER RESOURCES COMMISSION, DIVISION of WATER RESOURCES, LEVERETTSALTONSTALL BUILDING, 100 CAMBRIDGE STREET, BOSTON, MASS.02202 WALL/DEMO LEGEND .y°'-.. N m N DE REMOVED N 'V . • ^ O I�� w EXI5TIN6."fALLS TO L REMAIN ~ U fn NEW WP115 `U• fu t UU .1 DEMO NOTES v L EX 5nNG DASHED WINDOWS 1 W L5 ` TO BE REMOVED AV PATUED A5 NEEDED OR REPLACED A5 NOTED. M uO� t0 • � id \ E L y O 51TT[NG -----------i --------- C CD ---------------- i a DINING �v], w cc o % KITCHEN j ----- 1 HALL G� — ® - LIVING DINING Fry (/) U c6 PAMRl ----- ------ BATH ------- j ---�• -------'__�;�"> MASTER LAUNDRY BEDROOM •-- ---------------------------- „ 0 o HALL r-"-r o m. ------------ y= r�o CLOSE ------------ T FQ'i'ER PDR. DN. x�' x•>•-�'-"o I ��1 _— � ON. - rho e9'rcc�^ `K 1 OFFICE CD (n Izo x Iz-a PORCH 19-5 x T-O - U U ai C > = c N -- ----------------------- ----------------'------- - o L cu U (4 —�— N ----------------------------------------- -------------- Q O • GARAGE - w V a: N C W� 0 �U ----------------------------------------------------------------- job no.: Iln date 22 AUGUST 2015 r SCa[e : A5 NOTED FIRST FLOOR P L A N drav;n SCALE: 1/4" 1'-O" rev. rev. o A-2 r n ISSUED FOR REVIEW snt 2 of 5 { t E WALL/DEMO LEGEND o W O C W N N -------------------_- WALLS AND ITEMS TO v UO @ Be RENOVED y U EX 5TINa WALLS TO N REMAIN U N n • � IOW WALLS �• M U DEMO 10TE5 v N " - EXISTING DA5 EP WINDOWS 1 WALLS C U TO BE REMOVED AND PATCHED AS 2 NEEDED OR REPLACED AS NOTED. Y N N _p E 8 ++ U � N C Ip U ------------- --------------------------------------- -- W W o BEDROOM 3 day Vo 3 u `GPEN TO BELOW ly I cc --------------- • J BATH2 -----------.---------------------------------- UPPER 11-------------------------j HALL BATH 3 ti BEDROOM 2 OPEN TO BELOW - - ______________..____-_q_--______________ , i J ncUa`or en�oe9 BEDROOM 4 lih ------------------------------------------ �c m5an n� nm—m V/ >= a -- OPTIONAL -0 U U O NIP ^ LL ----- - ---- ---- - N U N W60 0) Job no.: nn date 21 AVcUST 2 13 ?I wale AS NOTED SECOND FLOOR F L A N SCALE: I/4" --------------------------------------------------------------------- I'-O" drawn: jLw rev. rev. T, 6r r ,, -3 h j ISSUED FOR REVIEW ant 3 Of 5 i 1 oo" D \ _ Q `F CrT 30, cil"-,n may: V G� �� � ,R r7,0 mti To -------------- �t K4' PLi .---) (,;-I 4- I.-Pi., USE_ J�S CY! C?TY7� 4 , VEEP d5T t- T 7 Zl%s IP T'HE Rkf rof j, i o r-- 'j-1 A T-o\Aj u e5 T- lofm it., r. Inc T� 0D 6