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0181 PUTNAM AVENUE - Health
T f. } • 3 k 135,Putna avenue - ISO LULL AAA= 0-16" 040; '11 4, �[yO� I j� it S I i 1 1 �1 i 4 i 1 No. ✓ 613 Fee __�_5 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Application for Disposal 6pstem Construction permit �^ Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon Oa ❑Complete System ❑Individual Components Location Address or Lot No.P%S (7J j dA k Ave. Owner's Name,Address,and Tel.No. -J OC'a phi CO ',Jf-7' tJA• on63t 020AE3 a`JI Assessor's Map/Parcel Jas4ai4w's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. J nos '2;yat�-At�I 7/3_s-/-�7ft Type of Building: Dwelling No.of Bedrooms Lot Size ���z ®0 O sq.ft. Garbage Grinder( ) Other Type of Building (4 O al F_ No.of Persons Showers( 1 ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. • Description of Soil Nature of Repairs or Alterations(Answer when applicable) 1Z 9 k O V E/1=I L e Ir AS 0 ad L F 0 2 IS-IF ILI d, Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Z b a IF Application Approved by Date Application Disapproved by Date for the following reasons Permit No. ✓ Ad-3 Date Issued TW No.AL9), /V'� Fee 5 4 r THE COMiMONWEALTH,OF.MASSACHUSETTS Entered in computer l.Ye PUBLIC HEALTH DIVISION,•="TOWN OF BARNSTABLE, MASSACHUSETTS 0[pplitatlon for Zj.s loid 6pstem Construction Permit ►��?, Application for a Permit to Construct( ) Repair f Upgrade( ) Abandon( ❑Complete System ❑Individual Components n Location Address or Lot No. S ("7J'NA M .'-'Owner's Name,Address,and Tel.No. *J 06'V Pry 4PO LO Yi r— -rjr i1 1AA,- 0763r Ci2o pc-3 rAeo-i)9)oP 16Da&GAS AA. . 7X Assessor's MaplParcel S a y a1 4 39 S- � -A ! JnsWlor'.s Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. {' a Type of Building: _y Dwelling No.of Bedrooms Lot Size S'0..7 r 60 O sq.ft. Garbage Grinder( ) Other Type of Building (,(� No.of Persons Showers( � ). Cafeteria( �) Other Fixtures ` Design Flow(min.required) gpd Design flow provided gd` r Plan Date r Number of sheets Revision Date j Title L' r _ r � � Size of Septic Tank Type of S.A.S. Description of Soil f Nature of Repairs or Alterations(Answer when applicable) E 0 r I L L. l., e r,.S S P D A L ' P_0 R 15 M o. Date last inspected: Agreement:' The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system-in,, accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until`a Certificate of ' Compliance has been issued by this Board of Health. Signed Date ��[6/ate I; Application Approved by Date Application Disapproved by E, Date for the following reasons ! �- j • Permit No. ,.•�' Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS. Certificate of Compliance THIS IS TO-CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned)4 by at 135 -•` u I#-%a,4 '1 Ca 4o i has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. _ dated , r Installer Designer ' #bedrooms Approved design flow gpd The issuance,of this permit sh 'l1'not eccoonstrued as a guarantee that the systemrill function as designed. Date Inspector�`" � No. Fee x `, "�✓ ,THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS t , r. r-k 'bisposol �&pstem Construction Vermit Permission is hereby•granted.to Construct((,r)x`x Repair(' ) Upgrade( ) Abandon System located at i" )t 5 Vi An Q t"r"`� t� o4 t1\ � aiid as described in the above Application for Disposal System Construction Permit. The.applic t recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be comply led within three years of the date of this permit. Date, Approved by 4. , `��. T LOC&.TION SEWOC;E PERMIT t\10 x: VILLAGE -77 a �QTE P E R 4 7 Nt UEp G' l IT= - D &,TE COMPLI &MCE` ISSUE } Fy 17 t I � y` TOWN OF BARNSTAHLLf i -`LOCATIUIV Lncl SE WAGS # V ILL.tGEUn}$-� s n f r .SSESSOR'S 1NS TALLHR'S NAME ''PHONE N0: l.S ' •-� �. z "` SEPTIC TANK.CAPACITY LEACHI NG FACILITX (type}1' }� < . a.. NO.. OF-BEDROOMS y PRIVATE WELL O PU LI„ R B C WATER t3I7ER Olt OWNER UIL ATE PERMIT ISSUED . ' 4s y rVila, DATE ,ya COZIPI IANCE ISSUED ,i li h 't t 1 ��.z Y ,jY' : �„ .e ., M1:• } }'S �'Y� �C [i 1 p V. 'RIANCE GRANTED k yy Yes No V � 17 / : +-.;,. { yE,i..r`e n ,..,t r - "4• tit y;�`3. nG �. 7^r� �., a" C aq t � � a s � y Y�.��"~w c, r 44.+;.c < v ti _ �- ;. �TTti Town of Barnstable Inspectional Services BAMSTABM MASS. i639. Public Health Division 10�' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL47015 1730 0001 4987 8029 September 28, 2020 ROPES FARM LLC 9002 DOUGLAS AVENUE DALLAS, TX 75225 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 135 Putnam Avenue, Cotuit, MA was inspected on 09/15/2020 by Frank Nunes III, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passes" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Single Cesspool. Must abandon the single cesspool. You are ordered to replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas ea , R.S., CHO ent o oard of Health Q:\SEPTIC\Title V Inspection Report Letters Mai ling\Conditionally Passes Letters\135 Putnam Avenue Cotuit.doc INF ram. Town of Barnstable BARNWABL6, ' 63 ,�� Inspectional Services Department prFD MA'S A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded.or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). T O 2 YEAR DEADLINE CRITERIA Single Cesspool ❑' Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h), OTHER ❑ v 5 S C v v fn. ddA reair eadline: 4 0 i. Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address t•a Popolo Owner rrye information is Owner's Na ✓ ` required for every Cotuit MA 02635 9/15/20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information �'(# �� , Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and=mplete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes �I M I 2. ❑ Conditionally Passes M w; I H J 1 S i 3. ❑ Needs Further Evaluation by the Local Approving Authority �1- 4. ® Fails 9/15/20 Inspecfsr.d 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: There is a single cesspool which serves the kitchen/laundry. Barnstable does not allow single cesspools. The other system which serves the rest of the home is compliant. It is comprised of a septic tank, d-box, and leach pit 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner Owner's Name information is required for every Cotuit MA 02635 9/15/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc-rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 135 Putnam Ave. Property Address Popolo Owner Owner's Name information is required for every Cotuit MA 02635 9/15/20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. ❑ 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 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 must be attached to this form. c. Other: 4) 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts �. (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner Owner's Name information is required for every COtuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No - ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ID Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow El Z Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:- El ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool-or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ® ❑ 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. 5) 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 CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �a 135 Putnam Ave. Property Address Popolo Owner information is owners Name required for every COtuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: 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)) t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): n/a Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a Description: There were 2 permits in the file, the one from 1976 is for 1 bedroom the other permit was from1989 and the number of bedrooms is not filled out. The 1989 drawing matches what i found in the field Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ® Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: The home has been vacated for a while, per the caretaker there is no running water, it used to be on a shared well but that has been abandoned Sump pump? ❑ Yes ® No Last date of occupancy: unk Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9115/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ 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 below): 3. Pumping Records: Source of information: Unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form (- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u° 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ® Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Cesspool pre 1970, main house sytem 1989 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: no water to property feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts �e Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner Owner's Name information is required for every Cotuit MA 02635 9/15/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound, it is about 1/2 full at this time presumeably due to evaporation If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: trace Distance from top of sludge to bottom of outlet tee or baffle >12 Scum thickness trace >211 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle >2" 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.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 r Commonwealth of Massachusetts iip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments v 135 Putnam Ave. Property Address Popolo Owner Owner's Name information is required for every Cotuit MA 02635 9/15/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. 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): Dimensions: Capacity: gallons Design Flow: gallons per day t5insP.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 I . Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments •� 135 Putnam Ave. Property Address Popolo inform Owneration is Owner's Name required for every Cotuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert n/a 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.): D-box is dry due to evaporation F t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every COtuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* { Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts (P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every COtuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): H-20 pit is in the driveway, it is dry at this time, it has a 32"cover 2' below grade, stain line is 4' below the invert, sidewalls are clean above the stain line 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 1 Depth—top of liquid to inlet invert dry at this time Depth of solids layer Depth of scum layer Dimensions of cesspool 6x6 Materials of construction Block Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Cesspool has a 32"cover 12" below grade, it appears to serve the kitchen sink and laundry t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 f , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •�; 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. CityrFown State Zip Code Date'of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately � a Q yt©c'z_ C 0O'L- � II AID UN t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: >12 feet, Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: n/a Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4' seperation per 1989 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping shows the site at 30'msl and nearby surface water at 2'msi You must describe how you established the high ground water elevation: See above Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts ii-p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 135 Putnam Ave. Property Address Popolo Owner information is Owner's Name required for every Cotuit MA 02635 9/15/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2pplicatiou _for Velf Cougtructfou Permit Application is hereby/made for a permit to Construct 00, Alter( ), or Repair( ) an individual well at: evAmAyn Location-Address' Assessors Map and Parcel oOQ.s ;gcrn LLC 9�01Z Qau ctkap Aqg,a�1«tTX -15225 bwer '% — IQAddress n Installer-Driller J Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well a (AAgU-i?4 Capacity 15 °��ih• Purpose of Well i�c °kA1-b-y' 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 Certi cate of Compliance has been issued by the Board of Health. Signed ' ZfD7.L1 Date Application Approved By A in I Date Application Disapproved for the following reasons: (�]�rj � W L 10 L (J Van 514(, A-� L���i1 Date S Permit No. Issued Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed W, Altered( ), or Repaired( ) Installer at 135 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 No. IA)�� r'� � Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zippricatiou if or Vern Con5tructiou Permit Application is hereby made for a permit to. Construct O, Alter( ), or Repair( an individual well'at: Location-Address, % Assessors Map and Parcel.. ►2.4�.�_���._�„Y-, g�,�,z a��,tA���� A,� - �����.-�x t Own 1.1ri1\er ``tt 11 Address C Cent.r� V� P1\ Clc -., 1?.0-(-,x Z_Pa� 0c� g-A"c 1U1 n2AS3. y Installer-Driller J ' r L y Address Type of Building .Dwelling Other-Type of Building No. of Persons Type of Will 4o' apaclty.,_� ± �1?Yr. = -• __ _ - - - t V� Purpose of Well y' Agreement: The undersigned agrees to install the afore described individual well in accordance with the provisions of the r 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 1Date Fx. Application Approved ByNu "it/ I YU .41 ' , Dale 1 Application Disapproved for the following reasons: i\Al. IA11/4-1A 0AM1111 j_ 3 ffi r+�. '�I �t l �n `—� R �, ,!to^v Ai /��1\ <7 `,P, N r.1-J1 N+�'1'�A �A l -t' �,I 1� , 1. e•ar-..�w�,:•. i "bate Permit No. Wc�(�a --UI Issued Date ------------------------------------------- BOARD OF HEALTH .TOWN OF BARNSTABLE 'Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed'(, Altered( ), or Repaired( ) by V'*I)Q tin, ��-.a ���R t � Installer ^ 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 _ - y _ - - � ��_ _ _ _ __ '_� _ -�.. �. - �. _ '_ .. - - ".....�-.��� �e���o ems. _ �� � �•����,�_T ���_.. i4 BOARD OF HEALTH TOWN OF BARNSTABLE Very ctCow6tructiou Permit No.1,1 Fee .i' Permission is hereby,granted Installer.m r to Construct , ;` Alter( ), or Repair O an individual well at: Y 1 Street as shown on the application for a Well Construction Permit No. V� ��(7,�(}-fi,� Dated L Date Approved By f G i Q�- otc ' h LOT 3 41 I 0- Q� 'NIF \ Ropes ',Form LLC 0 I J�, DESMOND WELL DRILLING t ? 52653 ,INC. RtaAO,C30X 2783 LOT 4 S,o-iooMA � (Soel 2a0 o I o 0 D,{� `p Legend: I O Iron Pipe Fnd Stake & Tack Set O C8/DH FND Top Of 8orik o SB/DH FND i — _Meon Hi h Water Mean Low Woter Cotuit Bay . ` 025 5075 1.00 150 200 FEET Ca eSUI r V Sheet Title: DwgStokin92 p Plan Showing Lot Line As Staked 23 West Bay Rd, Suite G Scglg Osterville MA 02655 1 =100, (508)420-3994 (508)420-3995 fax D to capesurvOcopecod.net �4/JUN/i 9 ` -- --................. - . .. i 1 y °...- TOWN OF BARNSTABLE J LC �'A`IICN - �/1'i�MIfG. SEWAGE # / VILLAGE �� /y/irk _ ASSESSOR'S MAP LOT iNSTALLER'S NAME PHONE NO. , 12 01A SEPTIC TANK CAPACITYllC'1 t _ LEACHING FACILITY:(type) (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I� j G� I I i. -- 1 19 � � �,� ;, ���,�� ��� t9� �� ; '! �`- � � l 1 i ;� � rz9'� �� �i ''� a '� y 3` o. 'f_ �.1� 20.00......... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ..---Town .. ...-.....OF....Barnstable Applir�a#ion f for Dispos al 10ork.6 Tomitrurtinn ramit Application is-hereby made for a Permit to Construct ( ) or Repair OM an Individual Sewage Disposal System at: -1-3TPutnat Ave Cotuit ................--..._--•... ............•---•...-••---..................--•••-•---•---.••.... Location-Address or Lot No. J. Barzum -- - ......................•-•-----...................•-•--........._.... J.P.Maeomher JroWner. Address a .............................................. ,- ........ Installer Address Type of Buildiii� Size Lot............................Sq. feet Dwelling X-No, of Bedrooms.._:....._............•....................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) C4 Other fixtures .----------•--------------------------------•-----._•. Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................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........................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O I as r. tion of Soil............................. ....---........ x W •-••------------------------------•-••-•-•-•--•-------••••----•••-----•-•---•---•-•-------••-•-•••-----•--••-•-••-•--•---••-••-•---••--••-••--•••---•-----•------............--------------.._..••------ U Nature of s r All do —Answ hen icabl 1— d6 ga g ls1d 1-1 0� ,a�' on e_Leaching Pik; - --------------------------------------------------------------------------------------------------------------------------------------------------------------•••---•-----•------............---•-•----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT,11, 5 of the State Sanitary Code— The undersigned further a ees not to place the system in operation until a Certificate of Compliance has been issued y Ae bo rd of h lth. Signed-- Y.'•._ r.. 8 118�.-•-----•-- Date Application Approved By..................... • •-•----- --e- ........................... --•- 'S e{------. Date Application Disapproved for the following reasons:------•-------••-----•--........-•--•------------------•----•-----•---------•--••----------•----•-•-•-•--------- ----------------•---••---•-••----••••-•--.....•-•---------•......--------•••-••---------•.......•--- Date ,4 Permit No...... ----�..J`.--v------------------ Issued--•-------................................................................................... x 1 Date FEs..Lf�.z:��.......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH tI'Of''ln........................OF..... n s to t le .....-•------......-----------------------------•-•..........--------- Appliration for Diapsal Works Tonarttrtion rrutit Application is hereby made for a Permit to Construct ( ) or Repair (Y) an Individual Sewage Disposal System at: 1? Putnam Ave Co;uit ...........::..................................................•--•-•---------................... .......------•••••-••---...-------••----------•-•-••-•--•----.......•---••------.............•-•-- Location-Address or Lot No. J. Bar?u : ......................-.......................................................................... ........•-•------------•---------•---.........._......--------..........._............--------.... Owner Address w J.P.Va:onl'�,er - r. ,-] ---------------•---_......._........---• •-•..............------••-•------... ................................_...••---•-•-•------•---•--------.............................---- Installer Address UType of Building Size Lot............................Sq. feet Dwelling 1—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building .. No. of persons............................ Showers — Cafeteria aOther fixtures ..............•-----......--•••...................................................................................................................... W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.........---........ Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.------............. Depth to ground water.---.................... Test Pit No. 2................minutes per inch Depth of Test Pit---................. Depth to ground water.--.------•----•.-.----- ----•---------------------------------•-..........--------------------•-•--------------•------...............----------•---------------._.........-•••....... Descrition of Soil........................................................................................................................................................................ x Sancti v •-•--••-•-•-••---•••••-•-••-••••---••-•-------------------------------------------------------------------------------------------------------- W ----------------- -----••----•--------••--•------•-•-••••••-••••••••••-•---••--•-------••-••--••--- --••••••••-----------------------•-----•--••-••-•--•.....---••--••---•••--...........-----------•-- U Nature of Repairs or Alterations—Answer when applicable............................................................................................... .� :.i 'a'11cf, n-io. ?.i_1G1 lE?i: ci1J -) pit. .......................................................-........•....................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.................1 r.� : fi t/,t y'!J `--------------- ---*1,- :...... ----.---.- i `s. V ! ✓' Date Application Approved B 1' ? f_-__ __.._..-_ Date Application Disapproved for the following reasons:---------•----------------------------------------------------------•--••----------•--.................•---•---- ----••-••--------•..........--•-•••-•-••••----•........•................•-----............•--•-••-•-......-----••••----•--•--••-•--•....••---••---••---------------•••--.....-•-•------•-••-••••--....... Date Permit No....... ra Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH h.....tt...................OF........R? "�:xtcI-. :.......... ............................................................. %lun ifiratp of Toutpliunrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (�X) by .JeP•.1`;...__.c�l;,er ...r. Installer 1� Fez", a-, � Co;,u l at •....-•--••.....='.................................•--•----------------------------------------------------------•--•-------------------------•---------------- ` has been installed in accordance with the provisions of T-{"1Z 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.... ...... dated--..--.---_---------_......................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED S A GUARANTEE THAT THE SYSTEM WILL FU TISFACTORY. DATE ...... Inspecto -9.........--•--...--•---_..... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH C No. --=--.. ._ C/ FEE....:........::....�...... Disposal orko Tyonotrttrtion rrutit Permission is hereby granted...........................Lt ',_"!_ -' - '<"-A1-ar...Jr......................................................................... to Construct ( ) or Repair (Xlj an Individual Sewage Disposal System at No __ Street . as shown on the application for Disposal Works Construction Permi o. . _ Dated.......................................... .......................•-.-- -•--- ----------- ................................................. DATE.... ............................................... Board of Health FORM 1255 HOBBS & WARREN. INC., PUBLISHERS ftMassachusetts Department of Environmental Protection Bureau of Resource Protection ` Well Completion Reports Well Driller Please specify work performed: Address at well location: � l Lew.- Street Number: Street Name: ,135 PUTNAM Please specify well type: Building Lot#: Assessor's Map#: »° Irrigation p1{o 036 Assessor's Lot#: ZIP Code: Number Of Wells: 001 02635 City/rown: Well Location BARNSTABLE In public right-of-way: GPS r.,Yes r No I North: West: 41.62264 70.04902 Subdivision/Property/Description: Mailing Address: click here if same as well location address .....W._...._._........._._.............._.._.._.........._.._....._._........._.................._........._.__. Property Owner: Street Number: Street Name: JOE POPOLO 9002 DOUGLAS AVENUE City/rown: State: Engineering Firm: DALLAS TEXAS ZIP Code: 75225 Board of health permit obtained: to Yes f"Not Required Permit Number: Date Issued: W2020029 109/09/2020 .................................................................................... S Massachusetts Department of Environmental Protection ' Bureau of Resource Protection-Well Driller Program ,Well Completicn Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock !Auger Choose Bedrock-- „ WELL LOG OVERBURDEN LITHOLOGY Drop in drill i Extra fast or slow Loss or addition From(ft) i To(ft) Code !Color Comment i I I stem 1 drill rate of fluid ; 0 20 Fine To Coarse S i !'Brown" i Fast Slow I ( YES NO 1i; Loss Addition 20 40 l Fine To Coarse S i Brown ('Fast t'"Slow YES NO !I Loss Addition i t _�._— r j ._ ( (: 40 45 fine To Coarse S II Brown ( Fast(�Slow " rr._. . -AIL ... _ t..._......_�__.......-.__ I - YES NO Loss Addition !: I : —__..._............. ._ ...... ...... ....... ......._.. ._.... 45 E 55 Medium Sand ? j Brown ? I. (.-Fast r Slow I .................................__ _ ... _.. _. ..._... EYES NO i' Loss Addition _..._._.._ -- ! .._.... .._.... -_ TT -::::_::: ................................._.......... -.-_........_:_::_::::::::_.:_....................:::_:_' WELL LOG BEDROCK LITHOLOGY _.._..............._.........__._............................................__....._-_......__.._..............._..............,....................................................................................._...., 3 ! Loss or Extra ! Drop in Extra fast or Visible Rust From(ft) i To(ft) Code Comment addition of I Large drill stem slow drill rate !Staining !i fluid I Chips I LJ (1 (°° iYES NO I Slow Loss Addition ii: ! € € I ADDITIONAL WELL INFORMATION Developed 6Yes f"No Disinfected t:Yes(.No Total Well Depth 55 Depth to Bedrock Surface Seal Type None � racture Enhancement 'Yes CASING Is Casing above ground?1 From To Type Thickness Diameter Driveshoe �0 �51 _ Polyvinyl Chloride [Schedule 40 �4 Yes 1 ............_..................._ SCREEN i 'No Screen From To €Type Slot Size 1 Diameter 51 rr55 ! Stainless Steel Well Point !0.010---ry 14 ........... i �.... ...............1 :........... WATER-BEARING ZONES `DRY WELLI .............._..__._.............. From To Yield(gpm) 36 55 12 PERMANENT PUMP(IF AVAILABLE) 2 Wire Constant Speed Pump Description Horsepower Submersible 1/2 Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) Pump Intake Depth(ft) 36 Nominal Pump Capacity(gpm) 25 ANNULAR SEAL/FILTER PACK ....__.......................-_..___..______........_....__._.._........____..__......_.._________..___..______----------______....__----_---- ___..__....---------_________.._.._.._.._.._....______.._.......I...................._�_..__..__..__......... Water IBatches Method Of j From To Material 1 Weight Material 2 Weight (gal) ;(count) Placement ,Choose Material � (..77, 1 Choose Material } i -- __._._I ............--............. ......... .......... ------ ----------------- ------------- --------.._.__.._..__.................. ......_..__...... WELL TEST DATA I Date Method Yield(gpm) Time Pumped I Pumping Level(ft i Time To Recover Recovery(ft (HH:MM) I BGS) (HH:MM) BGS) 09/02/2020 Constant Rate Pump 12 01:30 €i38 i00:01 36 ' WATER LEVEL i i Date Static Depth BGS(ft) Flowing Rate(gpm) Measured i 09/02/2020 36 _ _=1 12 � 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 and accurate to the best of my knowledge. WILLIAM Monitoring[M] Supervising Driller DESMOND, DrillerURQUHART Registration# 299 Signature THOMAS,E DESMOND WELL Firm DRILLING,INC. Rig Permit# 0551 Date Job Complete j09/30no20 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ENMOTECH LABORATORIES,INC. MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandiviclt,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name: Desmond Well Drilling Location: Address: PO Box 2783 135 Putnam Ave Orleans, MA Cotuit,MA 02653 Lab Number: DW-203529 Collected By: DWD Date Received: 09/22/20 Sample Type: Well Well Specs: Irrigation 50738' . � }�Locnitoie Soitrce'�:a s Dnte Collected � Ttnte collected ' 1.f-.:?i �� .0 A.�, 5�,. '.`� .—a >.:3 ,:,OJIL�I�O 4:'^ � . i:] Y��.�S^ �•i'+ . � �' 4 ," �i�....-,�k � F # Z { .A .a a V' }' .Y.,' ..fit c 'r.�i•%.e:f �-t,i. �: Analysis Requested Units Recommended Limits Analysis Resrtlt Method Date Ana/yzed Annlyzed By Total Coliform CFU/100mL 0 0 SM9222B 09/23/2020 RL @1430 PH pH units 6.5-8.5 6.47 SM 4500-H-B 09/21/2020 SD Specific Conductances umhos/cm _ _ 500 -- _ _ 61 EPA 120.1 09/21/2020 SD Nitrite-N mg/L 1.00 ND EPA 300.0 09/23/2020 SD Nitrate-N mg/L 10.0 0.051 EPA 300.0 09/23/2020 SD Sodium mg/L 20.0 6.6 EPA 200.7 09/23/2020 KB Total Iron mg/L 0.3 .<0.01 EPA 200.7 09/23/2020 KB Manganese mg/L 0.05 0.005 EPA 200.7 09/23/2020 KB Comments: pH is below recommended limit and may have corrosive characteristics. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. Water meets EPA standards and is suitable for drinking for parameters tested. Date 9/23/2020 Ronald J.Saari -_— Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 oCeriificalion is not available for this analyte for potable ivater samples... ENVIROTECH LABORATORIES,INC, MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Nante: Desmond Well Drilling Location Address: PO Box 2783 135 Putnam Ave Orleans, MA Cotuit,MA 02653 Lab Number: DW-203529 Collected By: DWD Date Received: 09/22/20 Sample Type: Well Well Specs: Irrigation 50738' Locator:Source R Date Collected Tinte Collected Y 3x 'CQmmenls , � Analysis Requested Units Recommended Limits Analysis Result Method jDateAnalyzedl Analyzed By Total Coliform CFU/100mL 0 0 SM92226 09/23/2020 RL @1430 pH pH units 6.5-8.5 6.47 SM 4500-H-B 09/21/2020 SD Specific Conductances umhos/cm_ 500 61 EPA 120.1 09/21/2020 SD Nitrite-N mg/L 1.00 ND EPA 300.0 09/23/2020 SD Nitrate-N mg/L 10.0 0.051 EPA 300.0 09/23/2020 SD Sodium mg/L 20.0 6.6 EPA 200.7 09/23/202 KKB Total Iron mg/L 0.3 <0.01 EPA 200.7 09/23/2020 KB Manganese mg/L 0. 55 0.005 EPA 200.7 09/23/2020 KB Comments: pH is below recommended limit and may have corrosive characteristics. All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results, We certify that the following results are true and accurate to the best of our knowledge. Water meets EPA standards and is suitable for drinking forparamefers,tested. Date + 9/23/2020 Ronald J.Saari Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 oCertlfrcation is not available for this onalyte for potable water samples.. LOC&.TION ' 5EWQC,E PERMIT UO. -�V74-,W77 �/ILLAGE �/35 _ viti.�� WSTQ LERS WE 6 . ADDR S5 BUIL R 5 &-M Q ORE.55 DATE PERMIT ISSUED D ATE COMPLI Q ACE ISSUED .V�&J r � t 0 No........................ FR$...��1...................... THEOCOMMONWEALTH OFH EACHU u TS BOARD - f 1_l oOF .............. tV Appliratinu -for 43iipustt1 Morkfi Tuu,itrurtinu Vrrutit pplication is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: N.......AVE........-_..-.QTn-n_...... ----- ------ atio Addr ss or Lot No. ._... i' rl+l----------------------------- 11 � fr.�li�' P a caner Address a 1 -v. 11 ................ I er Address Q Type of Building / Size Lot............................Sq. feet Dwelling�No. of Bedrooms______ ___________________________________Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtur jF_._. W Design Flow. _................. gallons per person per day. Total daily flow----------- __-- _-_�___-..gallons. WSeptic Tank Liquid,capacit/_.gallons Length---------------- Width................ Diameter---------------- Depth.-_.__.__------. x Disposal Trench—No. .................... Width----------- . o al ngt _ Total leaching area..------------.-----sq. ft. Seepage Pit No......../----------- Diameter._ _. epth bow�mlet .. ..__.................... Total leaching area.....______._____sq. it. -' z Other Distribution box ( ) Dosing tank ( ) 11 aPercolation Test Results Performed by.......................................................................... Date----•-------------------------------.... Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water...---_----_----- ---. r3:4 Test Pit No. 2---------_......minutes per inc Depth of Test Pi ................... Depth to ground water.........= __-_.-. -- -------- . •. •• --;;................................................................................. 0 Description of SoiL�----------___ U --------------------------------------...................................................................................................----------------------------------- ---------------------------------------------- -------------------------------------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable._------- .. iG ..... .--.S_.� _____.: /� ; -------------------------------------------------------- .............................................................. --------------------- -------- .- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe ----------- •-----------------•--------•-------•---•-•------------•--------------• -----------------------=•---...- --Date Application Approved BY f :..._ /2 Date Application Disapproved for the following reasons:-----------•-----------•------•-•----•-•---•---....-•-•---------•............................................... .........---•----•-•..............•--•--•---------------•-••--------•--•--•-----•-----------•-...--•-----...•--•.-•••------------•----•-----------...---...----------•---••--------.._.....----••-•.----- Date PermitNo.--...................................................... Issued.................................................... Date ------------------------------------------------ ^ .......4;)............. Fizz ..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD 9f HEALTH Appliration -fur Ui,spufiat Works Tonstrurtion Vrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal v System at: �---A JI =-------- O T! !-l----------- -----•-------•---•-------•---------------------•------....--•-•-•-•-•-.._._...-------------- lymatio •Address or t No. W caner l (� Address __ -----------------•-----•------•--------__-_ ---------- - ---------• -- --•- e----------..__.--ill I a er Address UTy,'pe of Building Size Lot-----------------------_....Sq. feet Dwelling�No. of Bedrooms............. ..........................--- Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures -_-------•---------••---------------•--.__-•----------------------__--------•------------------------------ -------- d - W Design Flow...:..........s�____.--._.______ __jgallons per person per day. Total daily flow...__._...._ -____.........___......_..gallons. Septic Tank Liquid capacity- v`�gallons Length---------------- Width................ Diameter------.--------- Deptli...--.----...._ f` Disposal Trench—No_____________________ Width......... ._. _ o �1 ngth ...... _ Total leaching area....................sq. ft. e.. Seepage Pit No.__.... -_____ Diameter..__/_ �.._ e th b ow inlet____________________ Total leaching area..__-_-------_____sc ft. -�---- � (- ---- P a t 1- "? �- z Other Distribution box ( ) ' Dosing tank ( ) aPercolation Test Results Performed bY-------------------------------------------------------------------------- Date......................... -------------- Test Pit No. I________________minutes per inch Depth of Test Pit-.-______________--_ Depth to ground water-.._--..._.....__.-_--- (� Test Pit No. Z................minutes per inch Depth of Test Pit .................. Depth to ground water__._.-_-.__-_-_-___. --- P; Description of Soil`--------------- ../... ��� - 5 x -' UW ------------------------------------------------------------- ------------------------------------------------------------ = ---------------------------- Nature of Repairs or Alterations—Answer when applicable. _ ...C( ---- ------ .S-_-( �✓ --- �/�X /..... --- Agreement: ' The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe ....../�/, ---------------••--•---•-----------------------------------------• ----- ---.._._._._....._------ Date Application Approved By........ -'Z. ............. -- ------- Date Application Disapproved for the following reasons:----•--•---•-----------••-----•-------•---•...............•-•----------•-•----......_------•••----------•------ --•-••---•--•----•-•---•-•••----••-----•---------------------------------•--•-•------------•------•-•------••--••••-------------•--•------------•---------•----------------------------------...._•-•--- 1' Date PermitNo.........................V=............................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT ..........OF............. .................................. V tr Qkprtifiratr of 0.11mVlianre TH S IS TOXERTI Y Tl t the Individual Sewage Disposal System constructed ( ) or Repaired by---"�.-- ----------- ------- ...... �- ----=--- ---- ------•�'�- --- --- --,d���� ----------------------------------------------------•---------------•--- Installer at -•--- --------�-----.. ..__ . -- has een installed in accordance with t e provisions of Ar i� XI of The State Sanitary Code as dew}fb d in the application for Disposal Works Construction Permit No.___ __.___Z 2._U_______________ dated.... ............... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. � DATE Lam ..._.. - __-- ._. Inspector -•-•-••-- -•-------- ............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH 7Ga2lJ d' i.......OF.. ........ ... .............No......................... FEE.....-----•-............ �i��u� � urk,� uu riirtiu$i �rriitit Permission •s hereby grante ------ -----------� --------�-Lf-=•-----------•--• ---�-----------__._---•---------.__--•---- .............................. to Construct _ r Repair ( an Indi7vidual w isposa yst as shown on the application for Disposal Works Construction P myr No..____ __ '.,, ated--- - --`---�- ......•-•---... /��1. A ________________ + / Board of Health DATE----------------------------- ------------------------------------------------ FORM 1255 HOBBS & WARREN. INC.. 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E ]E ]E ]E JE J DATE , ��t A VXAH /v PLEASE PROVIDE. A. SKETCH; SHOWING THE -TANK .LOCATION.'ON THE -BACK. OF THIS CARD .« f � .DAMES LOWELL BARZUN, M. D. NASHOBA MEDICAL OFFICE BUILDING GROTON ROAD , AYER,MASS.01432 THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY OIBIGINAL (S) A- �C&' - DATA ^.'^"'r!• �r ,(,... T 1 �•� J ..i , YJ - -n.' _ r : .-.. s .'.. _S r-• tir, s.m -. 1..� (Jffff r -TOWN OF BARNSTABLE — UNDERGROUND FUEL/ AND CHEMICAL STORAGE REGISTRATION OWNER AND INSTALLER INFORMATION t ADDRESS: I A'o ,Lr,t'•✓ MAP NO. PARCEL NO. OWNER NAME: Ertl' x,),I t 1^c'n is t _ .�. .1 it VILLAGE: 7--�s 7- INSTALLATION DATE:. rUv '",;c: - BY: . f1 rr� �rj t, , c A- ADDRESS-: CERT." NO. a -7`?`" TANK INFORMATION LOCATION OF TANK: 1 CAPACITY .�-0 0 - r ,cTYPE S / � , L AGE ??FUEL/CHEM I CAL r) TESTING CERTIFICATICON C ]�PAS.S) C I FAIL DATE S- CHECK IF- N/A TYPE/BRAND LEAK DETECTION E4 ZONE OF 'CONTRIBUTION C I YES C /] NO DATE TO!BE REMOVED FIRE DEPT. 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