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Home My WebLink About0160 VINEYARD ROAD - Health " lfiO,VINE.YgiP RAW.,COTUIT .. 015.003 1 1 gay 03 1510:43p p.1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.&Daniel Flanagan Owner Owner's Flame information is required for every CotUlt :� MA 02635 4-30-15 Page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, Ib1g6s y 1. Inspector. f Q - _ s S. use only the tab l ��3� • I S. key to move your g O; G JAM ES cursor-do not :m use the return James D.Sears key, Name of Inspector Capewide Enterprises,LLCCompany Name 153 Commercial Street , ,51 iNSP;'G�°�O� Company Address Mashy_ ___ MA 02649 City1rown State Zip Code 508-477-8877 S1623 Telephone Number License Plumber 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 trai61g and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-1-15 I ectors 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, 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 peirt6rm in the future under the same or different conditions of use. s- /'�ns (Qet5ins•3113 Title 5D1rda on Form:,Subtsurtam Seirage.Disposal,Syslem•Pagel el 17 1 May 03 1510:43p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.&Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. Cityrrown 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 indicated below. Comments: The system is a 1500 Gal. Tank D Box and five pipe field B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined'(Y, N, ND)for the following statements. If"not determined," please explain.. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3013 TiUe 5 Offidal lrepwion farts:Sulnurfam Sewage Disposal Syslem•page 2 0117 May 03 1510:44p . p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form ' l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,",vw 160 Vineyard Road Property Address John Jr.&Daniel Flanagan Owner Owners(Name information is required for every Cotut MA 02635 4-30-15 page. Cityfrown state Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumpslalarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes (cont.): [] Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): i ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ' ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines In accordance with 310 CMR 15.303(1)(b)thatthe system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Oftidal Inspection Fame Subsurface Sew2ge Disposal System•Page 3 of 17 May 03 1510:44p p.4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property AJdress John Jr.B Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. Cityfrown state Zip Code Dale of Inspection B. Certificallon (cunt.) 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 ❑ 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 theanalysis 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 ❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in empapoW is less than 6°below invert or available volume is less than day flow A t5rns-3113 Title 5 Official Inspection Fore subsurface sewage Disposal system•Page 4 of 17 May 03 1510:44p p.5 Commonwealth of Massachusetts - Title 5 Official Inspection Form HDOW Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t wtj 160 Vineyard Road Property Address John Jr.& Daniel Flanagan Owner Owner's Name inquired on a Cotuit MA 02635 4-30-15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 1100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd- For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes' in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department fsns.3r13 Title 5 Orfidai InspeLlim Fomc Submz am Sewage Disposal Systern.Page 5 of 17 May 03 1510:45p p.6 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 160 Vineyard Road Property Address John Jr.B Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02535 4-30-15 page. Cityrrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner,occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(If they were not available note as NIA) 0 ❑ 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? 0 ❑ 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. 11 ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)1310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 5 Number of bedrooms (actual): 5 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 550 t5ins-3113 rifle 5 Official xMpection Form;SubwjIbm Sewage Disposes System-Page 6 or 17 May 03 1510:45p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 160 Vineyard Road Property Address _-_—_— John Jr.&Daniel Flanagan Owner Owner's Name information is required for every Cofuit MA 02635 4-30-15 page. Citylrown State Zip Code Date of Inspecdon D. System Information Description: The system is a 1500 Gal_ Tank D Box and five pipe field_ Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Well Water Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Canons per day(gpd) Basis of design flow (seats/persons/sq.fL, etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: 151ns-3N 3 Title 5 OtfiGal Inspection Form:sub curt"sewage Dispow system•Page 7 or 17 May 03 1510:45p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.&. Daniel Flanagan Owner Owner's Name information is required for every Gotuit MA 02635 4-30-15 page. Cityrown State Zip Code Date of Inspection D- System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA _ Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Titla 5 O iNal Inspection Form:Subsurface Sewage Dis posal sposal System•Page 8 of 17 May 03 1510:46p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.B Daniel Flanagan Owner Owner's Name information is required for every cotuit MA 02635 4-30-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: Tank 1979- Permit#79-6761 D Box and Leaching 1998-Permit #98-630. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑.cast iron 0 40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage,etc.): Pipeing is 4" PVC SCH 40. 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 Dimensions: 1500 Gal. Precast H-10 Sludge depth: t5ins.U13 Title 5 Official Inspection Form,Subsurface Sewage Disposal System•Page 9 of 17 May 03 1510:46p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr_& Daniel Flanagan Owner Owners Name information is required for every Cotuit MA 02635 4-30-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) 29" Distance from top of sludge to bottom of outlet tee or baffle — Scum thickness 8,. Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level.Tank and cover's at 1'below grade. In and outlet tees. No sign of leakage or over loading. 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 15ins•3/1 3 Tide 5 Official In m Fam:Subaaraw Se a spevi wag Disposal Syctem•Page 10 of 17 May 03 1510:46p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.& Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. City/Town State Zip Code Date or Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 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 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 15ins-3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 May 03 1510:47p p.12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.B Daniel Flanagan Owner Owners Name information is Cotuit MA 02635 4-30-15 required for every page. City/?own State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate.on site plan): Depth of liquid level above outlet invert 0 --- 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 30"x3T-16" below grade. Box is clean and solid w/5 line's out. No sign of over loading or solid carry over. 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. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3H3 Title 5 ORidai Ins pedfon Form:Subsurfaw Sewage Disposal System•Page 12 of 17 May 03 1510:47p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.& Daniel Flanagan Owner Owner's Name information is requited for every Cotuit MA 02635 4-30-15 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: i ® leaching Melds number, dimensions: 30'x30' ❑ 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 is a five pipe field 30'x30'.Ck DBox, camera line's out. No sign of over loading or solid carry over. No sign of holding water. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration --�-- -�-� s, 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 [Sins'3M3 TAie 5 official Uapection Form:Subsurface Sewage Disposal System•Page 13 of 17 May 03 1510:47p p.14 Commonwealth of Massachusetts t1 1;vfi� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 160 Vineyard Road Property Address - - — John Jr.&Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. CityrTovm State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l . r 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.): 15ins•3113 Title 5 Oflidel Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 May 03 1510:48p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.& Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately _G I t t5ns•3113 - TNe 5 Official Impecl1w Fa=Subsurface Sem p Disposal System•Page 15 o/17 i May 03 1510:48p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.& Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells tv 10, b Estimated depth to high ground water. 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: 1998 Date ❑ Observed site(abutting propertylobservabon hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: i You must describe how you established the high ground water elevation: T.H. 1998 No G.W.at 1 V+. Bottom of field at 7'-7"above T.H. Depth. i I i i Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5irs 3113 Tine 5 0Mdal Irapec*m Form Subsurface Sewage Disposal System•Pape 16 of 17 i i i May 03 1510:48p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 160 Vineyard Road Property Address John Jr.& Daniel Flanagan Owner Owner's Name information is required for every Cotuit MA 02635 4-30-15 page. CityfTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B,C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate fits I ! l • ll I i j { i j ! I s t51ns•3113 Title 5 Offidal Inspection Form:Subsurface Sewage Dkpasal System•Page 17 of 17 _ !I 0 J rt IME Town of Barnstable Office: 508-862-4644 Fax: 508-790-6304 Regulatory Services Department IF BA Public Health Division Thomas A.McKean,CHO 200 Main Street, Hyannis, MA 02601 Payment Receipt 'Septic Inspection Payment received: $25.00 (Check) on 5/6/2015 Permit number: 10832 'Check number: 32366 Check amount: $50.00 Name on check: Capewide Enterprises, LLC ,Owner: JOHN J JR& DANIEL G TRS FLANAGAN ,Address: 160 VINEYARD ROAD, Cotuit i r , £NVIROT£CII LABORATORIES, INC. .1 A C£RT. NO.:AI HA 063 449 RTZ 130 SANDWICH, NA 02563 506(946-6460) 1 900-339-6460 FAX(509)8918-6446 CLIENT. Steve McElheny LOCATION: 160 Vineyard Rd. ADDRESS: PO Box 1060 Cotuit Ma 02635 Cotuit Ma 02635 COLLECTED BY. D. Peninni SAMPLE DATE: 9-16-98 SAMPLE TIME: 11:00 WATER SAMPLE TYPE: New Well/Repair DATE RECEIVED: 9-16-98 LAB I.D. #: 989407 WELL SPECS.: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 9/16/98 pH pH units 6.5-8.5 4.98 4500 H+ 9/16/98 Conductance umhos/cm 500 132 120.1 9/16/98 Nitrate-N/Nitrite-N mg/L 10.0 1.02 4500-NO3 E 9/16/98 Sodium mg/L 28.0 19.1 200.7. 9/16/98 Iron mg/L 0.3 < 0.02 200.7 9/16/98 Manganese mg/L 0.05 0.533 200.7 9/16/98 C0M1M7ENTS: Low pH indicates high corrosive characteristics. Manganese is not a health hazard, but may cause aesthetic problems. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date f �t >=greater than Ronald.i. S ri TNTC=too numerous to count Laborator irector TOWN OF BARNSTABLE LOCATION 1401hWiYnr42 F2 SEWAGE # 226 VILLAGE'd +a9f — ASSESSOR'S MAP & LOT A/ Ltl'J' INSTALLER'S NAME&PHONE NO. '6/2- B SEPTIC TANK CAPACITY 15,00 LEACHING FACILITY: (type) (size) X j NO.OF BEDROOMS aML-DER OR OWNER V 4*!!, , PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by C � 32 -6,, D7- Wr No.t, Fee1(�� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zippiication for Mi-4po.5al *p5tem Con.5truction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) El Complete System El Individual Components Location Address or Lot No. /� 1//A&-Y)V40 Owner's Name,Address and Tel.No. 5D Assessor's Map/ParcelZvv In er's N Address,and Tel.No. Designer's Name,Address and Tel.No. /�� s /,>2 Wgilt)57- /% Type of Building: Dwelling No.of Bedrooms— Lot Siz�sq. ft. Garbage Grinder(140) Other Type of Building.44 a'' �f� No.of Persons Showers(_5T Cafeteria(AAf) Other Fixtures Design Flow gallons per day. Calculated daily flow /1 y gallons. Plan Date Number of sheets / Revision Date Title Size of Septic Tank /.SD Type of S.A.S. 3e) •359 / S AI Description of Soil /1hL7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been i sued y th' Board of Hea, h. Signed l - ate � Application Approved b Date Application Disapproved for the following reasons a Permit No. Date Issued Fee y ' THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ ` Yes PUBLIC HEALTH DIVISION 'TOWN OF BARNSTABLES MASSACHUSETTS 01pplication for Miqual *potent Construction Permit Application for a Permit to Construct( Repair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components Location Address or Lot No. Uj/ yQ C Uj Owner's Name,Address and Tel.No. Assessor's Map/Parcel �31��'el C� � - , Ins r';GC Address,and�e�No. Nr/�,, xlt Designer's iVame�Addres�d Tel.No. L ��1- 05 �/02 /14alle)SY• ,e9 /.al G Type,�of.Building: Dwelling No.of Bedrooms _ Lot Size.3-�000- sq. ft. Garbage Grinder(No) Other Type of Building a-lo No..of Persons Showers Cafeteria(At) Other Fixtures Design Flow Ca 'gallons per day. Calculated daily-flow //y gallons. Y Plan Date �� 9� Number of sheets Revision Date Title f" Size of Septic Tank �_5�0'� Type of S.A.S. 3d X W /ST L/_V/_:S v Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the constructs n and maintenance of the afore described on-site sewage disposal system r in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- -cate of Compliance has been ' sued y thialBoard of Hea r.. Signed Application Approved byDate-S ---� --9 Application Disapproved for the following reasons Pe Date Issued --.— —._-----_---.—._--_—.---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal*stem Construcj!( )Repaired( )Upgraded( ) Abandoned( )by ;n > at i!�� Wee 41L1110` '�/a 7" has been constructed accordampe with the prov' ions of Title and the for Disposal System Construction Permit No. �t�''f� dated Installer Designer The issuance of this �t si n e construed as a guarantee that the s will funct' Date � U�-' / Inspectd / ��asesjrgne, -� t No. /!J C'�- Fee / THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS lwigosai 6 stem Construction Permit Permission is hereby granted to Construct( Repair )Upgrade( )Abandon( ) System located at ��O "1�5c%+� ._. �� " and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local p Tvisions or special conditions. Provided:Construction must be completed,within three years of the date of the e it. Date: — Z S"'.lam Approved by TOWN OF BARNSTABLE LOCJNknoN )6o l/1`y=42+-B U. SEWAGE # YR 6130 - VILLAGE ('d'f till- 2[° ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 0�-�LJJ� SEPTIC TANK CAPACITY 1 Zd b LEACHING FACILrrY:,(type) Pi-dd. (size) 361' X �a NO.OF-BEDROOMS BMRDER OR OWNER A�' y N PERMTTDATE: ?f 9 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility r Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility)}`F " Feet Edge of Wetland and Leaching Facility(If any wetlands exist k within 300 feet of leaching facility) "' Feet Furnished by sit - 2G' } vilu L.O-C-A T' 10N : ,� SEWAGE PERMIT NO. VLILAGE f IN_STkLLER'S NAME ADDRESS t01 Df,R OR WNER DATE. PERMIT ISSUED i�fe� Sy D-ATE COMPL.IAN°CE ISSUED tFly / �1 r't No....-• Fn$.............:............... THE COMMONWEALTH OF MASSACHUSETTS BOARD HE L -qLs�AECT TO BARN STABLE _.......OF........ ... :.. .. . ----- ;� ! A c9ralISSION! 1 ;j Appliraatiou for DhiposFal Works Tonstrnrtiun ramit Application is hereby made fo a Permit to Construct ( ) or Re air ) a ,I ual -ewage Disposal System at: (�' � r .... .. Y a .�"� .....d4v..,............. .......��- ..... ....... .. . ..... . on-Address or No. _ .:... —M-C ----------•------------ ------ . :. �... Own Address W ----------------------------- --------•-•----•---..-__.----------.--------------.------.----------------------.-----------..---- ,� �1.. Installer Address .Type of Bu in Size Lot............................Sq. feet aDwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) p4 Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures r WDesign Flow...........................................gallons per person per day. Total fda ly 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......................................... aTest Pit No. 1...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4 Test Pit No. 2.................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 --•.......................................................................................................................................................... 0 Description of Soil................................................................................----------------------------------•-•-•----•-----••------......_...._.._-------------- M U ..........................................----------------.._......._........-----•------------------•--•-----•--••----------•--•--•••---•----------•------•--•--•----------------•-•---•--------•------ ...............I............................. ...................................---•••.......-...... ----- ---- -...........-- --------- U Nature of Repair r A'iterations—Answer w a licab -- ---- -------------- ...-- � ... -------------------------------------- Agreem ent: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITU 5 of thesState 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..... ------. D.................. 1Dat Application Approved Dy-••-- _ ._ . . .-.-� = .../V f-�� Date Application Disapproved for the following reasons----------------------------•---•-----------------------------•------------------------------------•------------- -----•--•-•••----•-----------------------------------•---•-•••------------•---•.._..........-----•-••-•- ... ---------•---•---•........... 1 Date PermitNo........_............................................... Issued---. ................................................. Date No. (y' THE COMMONWEALTH OF MASSACHUSETTS ..;- BOARD O !-I E L . .-. . ........... ..... ... ........................ Applutttion for llhiposal Vorkfi Tontitrnrtiun thrmit Application.is hereby made fo, a Permit to Construct ( ) or Repair ) I i '' ua�l' 'ewage Disposal System at• �. "T'��4-4,1 , oc on-Address or No. CA Owner Address w ! ------------- ......-......----•-------- Installer Address Type of Bu in Size Lot............................Sq. feet U Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other. Type of Building ............... No. of ersons.._..................._.__.. Showers P.1 YP g --------•---= P ( ) — Cafeteria ( ) QI Other fixtures -----------------------------•- . Design Flow......................I......................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........................ Lz, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ R�+ ----------------------------------------------- •........... -.-.--------------------------------- ---------- ----------- •------- ------- -...................... 4 0 Description of Soil........................................................................................................................................................................ x x •••-- -- --• ----- ------------- U Nature of Re )airs r Alterations-Answer/wn licab - ----- - -- ---- --------------------- --------------------- ...... ✓ �� '------ ' � -----. �-------------------------------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITIE 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. Signe ?9-;62 - ------ r1 Da Application Approved B Date Application Disapproved for the following reasons:........................................................------------------------•---------------- ::. -----------•-•--------- ------ Date PermitNo......................... :" ...................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD O . HEALTH fit .......OF....... .. .. ......................................... _ f�r�ifirtt#p �rf f�nrm��ittnrr '� THIS 0 CERT , That the InddMdual Sewage Disposal System constructed ( ) or Repaired byf 't' r! ............. =---------------------------- ----- ...... Instal r 7 --•- ----------- -- Y.IX Th tate Sanitary Code as described in the has een installed in accordance with 1e provisions of T T da.ted.._ ''application for Disposal Works Construction Permit No. 7 .. .......... /�_____/:d__-..-.•-.� -,_---•••. THE ISSUANCE OF.THIS "CERTIFICATE SHALL NOT BE CONSTRUED A A GUARANTEE THAT THE SYSTEM-WILL FUNCTION SATISFACTORY. DATE.--... U lf-•.. 7 .......... Inspector__.. .... e ft THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH / .,.OF........ � ...'" No..........�q)I ........... FEE. .................... �i��rgstt ' �� tr�tuan�„ rrutit Per' ission 's ereb granted_ ... ...... to Cons uctt}, o epair ri In livid Sewage Disposal .stem ¢�� Y " Street as shown on the application for Disposal Works Construction_ Per ed.. ��__ .....� ....... oar of ealth DATE. FORM 1255-.HOBBS-& WARREN, INC.. PUBLISHERS No.�-1 -=- BOARD OF HEALTH Fee---7 TOWN OF BARNSTABLE Apptication_*rlVett Congtructionj3ermit Application is hereby mad for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address — Assessors Map and Parcel Owner Address -------- =4--_SLi- --- -------------------------------------- ----------------'�D•..9�0�^---- ___/ �^_--�_!�'� --- Installer — Driller Address Type of Building Dwelling------C s c�_`r cc- ---------------------------- Other - Type of Building---------------------------- No. of Persons-------------- ----__—_____-______ Type of Well---------- - ------- Capacity---- - - --—---- - --— Purpose of Well------ `� --- `�?- -------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The ` Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to + place the well in operation until a Certificate .o Compliance has been issued by the Board of Health. Signed !,7� g � � --- date Application Approved By —-------—— date Application Disapproved for the following reasons:------------------------------------------_---__--_ ------------ ----------------------- �r date z Permit No. \A 5e -=4-�--- — Issued---— -- - --- ---— ----------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered (_ ),.or Repaired ( )_ �� Installer — —�—�" / has been installed in accord ce with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. "- - ---Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------- —- -- Inspector-- --- -- ----- —- --- No.w_-1n- II Fee---1 --- --- BOARD OF HEALTH TOWN OF BARNSTABLE 01pplication-*rVelf Conoructionpermit Application is hereby mad for a permit to Construct ( ), Alter ( ), or Repair;:.( )an individualMell at: 0 L V. g '�. Locanon Address Tr y i - Assess Map'and Parcel Owner Address S14,, — — ----— —— - — --------- Installer — Driller Address Type of Building rr Dwelling c c_ Other - Type of Building --- No. 'of Persons--- _---�-Q^-R � ----r---- - Ca acitY-- - --- --- — _TypeGof.,Well Purpose of Well -- ---='� g A reement: -Tli7 undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .o ompliance"has been issued by the Board"of Health. Signed �G ' - Li c a 1' JO - date'. -- Application Approved By Lam" --- date. r Application Disapproved for the following reasons: �^ ---------- ----- ------ ---- — date. Permit No - =- --�` — 'Issued-- - - - #— ---:- - --- date" u!b4i?i!i!.iwyilw9ilsli•?i9i9i Y01!!dM8Tc9i�o'!i•!iti!!Glo,H15±i±i�94'RXOi969e9dlil3!l1tl984ti96•Ii4iW 9iT:'1R690%'M9,A901b WFMG7!i46MQi!VT9'!i'Sa9i�9613s9iA0!X489ii9X9ls!dV ffi4b!iTi43T69iE: BOARD OF HEALTH TOWN OF BARNSTABLE ertif irate ®f �Comriarice - THIS IS'TO CERTIFY, That the Individual Well Constructed ( '); Altered'(," ); of-Repaired Installer at- -J — _ - --- - --------------—-- --- ------ has been installed in accord Ace 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.Vj?f_* ___Dated-=_--- ___-____ THE ISSUANCE OF THIS.CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. N DATE------- -- Inspector-- ----- - ----- 9i9iTsElL9i�Je!i?L'TiYYT48T9f�4lAaTa#i�iiB9'ilS�®'93:so - _ '�+ M'4e1!Yi4.9aSiVitiM[2i*62S16^i!OrMMi'9�#iBSSi'9i9®6G9ri.Y45AY.69�SlYiReIYFEvNiii-4i''Sb!LffS-ct6r4ii4Y+'lP'�itSYtG!�:K'?3V.�4iT7�i'!'i3ii:e�« BOARD OF HEALTH TOWN -OF BARNSTARLE. Well Con5trutt ion Permit 9 Fee: Permission is hereby granted -4 4 ___--_— to Construct(,>,), Alter ( ), or Repair ( ) an Individual Well at: No. —-16 — --� ,_t—.------=---- --- _—�--- ---- --- - - St e as shown on the application for a Well Construction Permit No.- —� Dated 7-- =- ------------------- ---- — ---- --------------- --------- Board of Health DATE — __ 0 #10/15 '� � �( oko No ei TP A�p '0O Z 0 N E Vow 1 1 EL 14) S ^p s¢ TR E E S ZONE V1 7 T F p• ��- ''' CONCRETE HEADWALL T R E E S , � O O• lcV / - \v/ Z O N E � � COAST ell 150,100. / EXISTING WELL SITE iA / T. R E E S PK SET EL 1248 Z 0 N E C iO�. /, ` ,: i Bor OM OF c,p O N —r— COASTAL B Wt �Py CONCRETE T UCTURE oo OVER -ENVIROTECH LABORATORIES, INC. HA CERT. NO.:MMA 063 449 RTE. 130 Q SANDWICH, MA 02563 ®S e $04(999-6460) 1-900-339-6460 FAX(509)888-6446 SEP 21. 1 CLIENT: teve=McElheny LOCATION: 160 Vineyard Rd. ADDRESS P Box 1060 Cotuit Ma 02635 F` Cotuit Ma 02635 COLLECTED BY: D. Peninni SAMPLE DATE: 9-16-98 SAMPLE TIME: 11:00 WATER SAMPLE TYPE: New Well/Repair DATE RECEIVED: 9-16-98 LAB I.D. #: 989407 WELL SPECS.: N/A RESULTS OFANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 9/16/98 pH pH units 6.5-8.5 4.98 4500 H+ 9/16/98 Conductance umhos/cm 500 132 120.1 9/16/98 Nitrate-N1Nitrite-N mg/L 10.0 1.02 4500-NO3 E 9/16/98 Sodium mg/L 28.0 19.1 200.7 9/16/98 Iron mg/L 0.3 < 0.02 200.7 9/16/98 Manganese mg/L 0.05 0.533 200.7 9/16/98 COMMENTS: Low pH indicates high corrosive characteristics. Manganese is not a health hazard, but may cause aesthetic problems. WATER MEETS EPA 'STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. <=less than Date Nm >=greater than Ronald J. S ri TNTC=too numerous to count Laborator irector A •Y No.—�-Y' ---�y y Fee---- -'---- BOARD OF HEALTH TOWN OF BARNSTABLE Application-for Vell Con9tructionpermit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (/)an individual Well at: ----/1° c�t N c� R�1 �'�u, Location — Address Assessors Map and Parcel c1'a e F/o�, 4 r\, 3 ,Oo-Q&S e?� ,Qo�r 6 /ee v� - - - - - ---- _-_- - - ` 3 nc j Owner Address ----------------------— — �1_.__t_�c�'_W SlD/= �_- ------- Installer /V14 G��J — Driller Address T Type of Building Dwelling ---------------------------------------------------- Other - Type of Building------------------------------------ No. of Persons---------------------------— --- Type of Well— '�`—'- --- - ---- ---- Capacity -----------— --— — Purpose of Well-AOA.dS1`%--------------------------— - —- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Co liance has been issued by the Board of Health. Signed - - ------ — - -=S /G�f J-------g date Application Approved By-- -- _ _ K-_� — ------ -- date Application Disapproved for the following reasons:-------------------------------------_____________—__—_—______—_ ------------------------------------------------ ------------------------------------------------------------- ------------------ date GO Permit No. -- - - ---- -L/------------------ Issued----- -` it--— ----- __ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIF�pY1, That the Individual Well Constructed ( ), Altered ( ), or Repaired (� bY-----------—---------0_L'---J UNNC`�— ----------------------------—---------------------------------—--- ——— — ——— Installer at-----------1 -- "-'—y ' /s =----LOLt — —--—------------------------------------ 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)(3--?,7=—V4----Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------— - — -- — - -- ------ Inspector--------------------------------------------------------- No. Fee-*----� BOARD. OF HEALTH TOWN OFF BARNSTABLE ApplicationiforlVell ConorurfionA9ffmit Application is hereby'made for a permit to Construct ( ), Alter.( ), or Repair (t/)an individual Well at: 1�Ur -- --- ----------------- ---- Location Address Assessors Map and Parcel 3 . �oX��' /ee,.�v��c�e Owner Address Dd_CGiJ.�P// ---- Installer — Driller Address Type of Building Dwelling_11-ou-�-!�------------------------------------------------- Other - Type of Building - ------ No. of Persons-------------------------------- Type ----_________ of Well— n`��--- - .,. --- --------------- ------------------- Capacity----------------------- Purpose of Well-- 0A1L—y try.- - - - - -------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate f Compliance has been issued by the Board of Health. Signed D�� -------------- - date Application Approved By-- - -- ------------- — z--j =T__ ---- 1—. -- data Application Disapproved for the following reasons:--------------------------------------------------------------------_------------____-- -----------— -- ---- —-------- — ------ date Permit No. -- 7 -- Issued--- -=- —-------------------- . —_� date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate 01 Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( 1-T D, J Gu NNC ----------------------- Installer at-----------A - - -- •. 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. r-y-- - HIV-----Dated'- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE ---------- ---— -- —-- ----- Inspector----------------------------------------—- ------------ BOARD OF HEALTH TOWN OF BARNSTABLE Yell ConstructionVermit NoV--- Fee. �-- Permission is`hereby granted-to Construct( ), Alter ( ), or Re air (.4) an Individual Well at �. No. v --— - -------------- ----------------------------------- Street as shown on the application for a Well Construction Permit No. - - - - --_ ---_-� -------- - . Dated--- �� 1 — --------------------------------- �___-_-_---_--___-_-_- �---------------- ------------------. ._.... i Board of Health DATE---- —=-+ --- - -- '�' ��.,,__� {;`!!.: �( \ x 1 s- ( •Wy �l 1. o3s..�� • - , AGGREGATE DEPTH (BELOW THE 11'"rRT OF THE DISTRIBUTION 1 Q + .. 1 _ oM , :.. UN ES) — SIX INCHES MINIMUM, '12 INCHES MAXIMUM 4'F `� . Rushy o 1lfarah- FINISH GRADE _ r et d v 2 PEASTONE 4 PERF PVC . r " COVER VARIES: oseberry 1 -� N s 0+ SCH 40 PVC (TYP) 9" MIN TO 36" MAX nd f o o , j IF ENCOUNTERED REMOVE UNSUITABLE MATERIAL TO INSURE THE REMOVE UNSUITABLE SIDEWAU_ AREA OF SYSTEM IS IN 3 4" TO 1 1 0 2" MATERIAL FOR 5—FEET r " WASH ST PVE rA� ' " % 0 t CLEAN MEDIUM SAND OR FILL PER IF ENCOUNTERED LOCUS 310 CMR 15.201 — 15.293 3' 6' 6' 6 Mals nd 30, \r ; Mead- 40' LEACH FIELD cw%ss SECTION hatch ;• ' island NOT TO SCALE LOCATION MAP COTUIT QUADRANGLE SCALE: 1:25,000 ASSESSORS MAP 15 PARCEL 3 ZONES: USE (1) x 30' LEACHING FIELD AQUIFER PROTECTION OVERLAY DISTRICT (5) 4" !):AMEIER DISTRIBUTION LINES REMOVE UNSUITABLE MATERIAL FROM BENEATH SYSTEM IF ENCOUNTERED DATE: JULY 22. 1998 ZONING DISTRICT: RF OVERDIG 1' INTO MEDIUM SAND LAYER ENGINEER: BAXTER do NYE, INC. MINIMUMS AREA 43.560 S. F. BACKFILL WITH CLEAN MEDIUM SAND PER 310 CMR 15.002 HAND AUGERED TEST HOLES FRONTAGE = 150' FOUNDATION EL = 19.0' TEST HOLE 1 do 2 SAME PROFILE WIDTH = N/A FRONT SETBACK = 30' SET COVERS TO WITHIN SIDE SETBACK = 15' FG 18.5' 6" OF FINISH GRADE FG = 18' DEPTH ELEVATION REAR SETBACK = 15' 0' 16'3'OO ORGANIC FIRST TWO 0.2' 16.1' FEET LEVEL E COARSE SAND 5Y 5 1 FLOOD ZONES: C, V11 do V17 17.0' — - —_ 0.3' 16.0'O COARSE SAND 10YR 5/6 FIRM COMMUNITY PANEL 16.3' 1500—GAL - No. 250001 0022 0 SEPTIC TANK ry5 5, 15.0' 16.0 1.2' 15.1' O REVISED: JULY 2, 1992 ' '` BOTTOM EL = 14.0' SEE NOTE RE LOCA110N/ORIENTATION BEDDING 15 2 ��'• PEf' TITLE 5 I 30' TOWN WATER IS N�JT - AVAILABLE AT THIS SITE. 15' 20' 2.5' 11' (typical) ^ OC COARSE SAND 1OYR 6/6 NOTES: DEVELOPED PROFILE OF PROMM SEPTIC SYSTEM 10.0' 6.3' NO WATER WATER SUPPLY FOR THIS LOT IS PRIVATE WELL NOT TO SCALE LOCATION OF UTILITIES SHOWN ON THIS PLAN ARE APPROXIMATE. AT LEAST 72 HOURS PRIOR TO ANY EXCAVATION FOR THIS PROJECT THE CONTRACTOR SHALL MAKE THE REQUIRED NOTIFICATION TO DIG SAFE (1-800-322-4844) AND O APPROPRIATE WATER DISTRICT FOR LOCATION DATA. 4116 THE CONTRACTOR IS REQUIRED TO SECURE APPROPRIATE PERMITS FROM TOWN AGENCIES FOR CONSTRUCTION DEFINED BY THIS PLAN. INSTALL RISERS AS REQUIRED TO WITHIN 12" OF FINISH GRADE. N ALL STRUCTURES BURIED FOUR FEET OR MORE OR SUBJECT TO VEHICULAR TRAFFIC TO BE H-20 LOADING FOR ALL ASPECTS OF THE SEPTIC SYSTEM THE CONTRACTOR SHALL COMPLY WITH ALL GOVERNING CODES AND REGULATIONS; IN PARTICULAR 310 CMR 15.000 THE STATE ENVIRONMENTAL CODE TITLE 5, TOWN OF BARNSTABLE BOARD OF HEALTH REGULATIONS PART VIII: ON—SITE SEWAGE DISPOSAL REGULATIONS AND THE G BOARD OF HEALTH RECOMMENDATIONS FOR ACCEPTED PRACTICE. REMOVE UNSUITABLE SOILS BENEATH PROPOSED SYSTEM IF REQUIRED. NOTE BACKFILL WITH CLEAN GRANULAR MATERIAL FILL TO BE GRADED AS FOLLOWS: NOT MORE THAN 15% RETAINED ON No. 4 SIEVE, NOT MORE FLOOD LINES DIGITIZED FROM TOWN OF BARNSTABLE I THAN 90% RETAINED ON No. 50 SIEVE, OF FRACTION PASSING No. 4, GIS SHEET #15 — SURVEY LOCATION OF EXISTING 10% OR LESS TO PASS No. 100 SIEVE AND 5% OR LESS TO PASS No. ' SINGLE FAMILY STRUCTURE ON LOCUS ALIJGNED WITH 200 SIEVE, SOIL TO BE APPROVED BY ENGINEER FOR COMPLIANCE LOCATION OF STRUCTURE ON CIS SHEET AS BASE FOR ORIENTATION. PRIOR TO PLACING ON SITE. C h o� DESIGN DATA: PROPOSED 6—BEDROOM SINGLE FAMILY DWELLING 374• / NO GARBAGE GRINDER EXISnN DESIGN FLOW: 6 x 110 GPD = 660 GPD G �ACy PIT HOC SEPTIC TANK: 660 GPD x 200% = 1320 GPD CA TO PROPOS / USE 1500—GALLON SEPTIC TANK fD WZC Sly / PER TOWN OF BARNSTABLE BOARD OF HEALTH ON—SITE SEWAGE DISPOSAL CONSTRUCTION GENERAL REQUIREMENT 1.14: BOTTOM AREA / REQUIRED: 660 GPD/0.74 G/SF/D = 892 SF APPLICATION AREA USE A 30' x 30' LEACH FIELD WITH FIVE 4" DISTRIBUTION LINESn / ZONE B' ALL PIPE TO LEACH FIELD TO BE SCHEDULE 40 PVC SOILD NIF RIC`iARQ W. Ll,QYO, .dR, . 14 ALL PIPE IN LEACH FIELD TO BE SCHEDULE 40 PVC PERFORATED r �w • LOT VACANT / / C�iQ , ENDS TO BE CAPPED ' � NO ALLOWANCE FOR SIDEWALL AREA / 14//15 ;�16 4 0 1 >y TOTAL DESIGN: 900 SF / .tea/ I ` �Q� N � - REQUIRED: 892 SF ALL COMPONENTS TO BE H-20 14 q N r 0 / PERCOLATION RATE: LESS THAN 2 MINUTES PER INCH /"TP 2\ S91 ID �^ / o N/P MARGARET H. LLOYD, ET ALS TR + LOT OCCUPIED — HOUSE #185 �9�0 Z 0 N E V 1 1 WELL IN BUILDING CELLAR / O / / qcF S A�00 (EL 14) LEACH PIT APPROXIMATELY AS SHOWN PER OCCUPANTS — 7-22-1998 @ S S� hh�0 o �0• ��j� T R E E S C8 DH #1 /16 9' E` P,, 14 / �'�, q � CONCRETE HEADWALL Z 0 N E V 1 7 EL = 19.01, \ � �� 0 4 � �� ,��• ti� (EL 16) / T R E E S ZONE C TOP OF S 2 6 4 Q / COASTAL 10 / .�O BAW 00 OPP \ 1 / /EXISTING PROPOSED FI r' J 5� T, i WELL SITE WELL SITE fl,`I llb- / jo be removed • � /\�. TREES ZONE C / �Os� fJ I PK SET S . EL = 12.48' BOTM OF x° COASTAL 41 o°• / BAW LOT 8 L. C. Plan 11542 E / , �/ P�� CONCRETEOVER STRUCTURE �1 STORAGE UNDER LOT 9 N L. C. Plan 11542 G 0 11S1 __ /_ - _ _ __- _ T____ `� _ -_ / S E A C H / AREA TO TOP OF COASTAL BANK: �So 45,436 Square Feet ,p TO- ` 1.04 Acres 700. � NY . do- 0 PROPOSED PLOT PLAN 18 ' 4 E' / BEACH O L 11�0 j f12/ / / P� �e C> AT 9 9 y � � / #160 VINEYARD ROAD 'I�LOF4,,j 11 ►+'�N of �r�s P S TOP OF +'w yG� �� SN sy COASTAL O COTUIT, MASS. o A tS cr v r30216 �y ul 8 / G a. r�874 FOR 6 G STER� 0017 M OF �N r JOHN J. FLANAGAN, JR. BONA L 8' COAWAL 4 s 2. P SCALE: 1" 30' AUGUST 26, 1998 Z O N E V 1 7 �0+ BAXTER & NYE, INC. (EL 16) 812 MAIN STREET / OSTERVILLE, MASS., 02655 (508)-428-9131 /Z O N E V 1 1 / (EL 14) GRAPHIC SCALE 30 p 15 30 60. 120 ( IN FEET ) 1. inch = 30 fL 97098 (SITE05.DWG)