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HomeMy WebLinkAbout0059 BEACH PLUM LANE - Health 59 Beach Plum Lane, Osterville A= 166 - 036 - 002 s 4 F . f /A0 V_ r '06 CIO BORTOLOTTI CONSTRUCTION,.INC. 765 WAKEBY ROAD,MARSTONS MILLS,MA 02648 508-771-9399 508-428-8926 FAX: 508-428-9399 S ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: Date of Inspection: - Inspector's Name: ner's Name and Address: � �— A � CERTIFICATION STATEMENT* I certify that I have personally inspected the sewage disposal system at this address and that the informa- tion reported below is true,accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in the proper function and maintenance of on-site sewage disposalrns. The System: Passes Conditionally Passes Needs Further Ev lion By the Local Aproving Authority Fails Inspector's Signature: The System Inspector shall submit a copy of this inspection report to the Approving authority within thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTIONSUMMARY: A)SYSTEN-PASES: 4-1 1 have not found any information which indicates that the sysien: violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B)SYSTEM CONDITIONALLY PASSES; One or more system components need to be replaced or repaired. The system, upon comple- tion of the replacement or repair, passes inspection. Indicate yes, nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal,cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static:eater level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - I - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or.replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of The Board of Health): . Broken pipe(s).are.replaced, Obstruction-is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ` Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD.OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH,WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)'DETERM INES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility,and the.presence of anunonre nitrogen and nitrate nitrogen is equal to or less than 5 ppm. ._ D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of efluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- f;9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) . Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 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 I of a public well. Any portion of a cesspool or privy is within 50 Feet:of a private,water-supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to he criteria above: The design flow of a system is 10,000 gpd or greater(Large Systern)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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. . The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional olrce of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B C11ECKLIS'T Check if the following have been done: w Pumping information was requested of the owner,occupant, and Board of Health. -None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. `As-built plans have been obtained and examined. Note if they are not available with N/A. ✓The facility or dwelling was inspected for signs of sewage back-up. r/The system does not receive non-sanitary or industrial waste flow. P/The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on site. v'The septic tank manholes were uncovered,opened,and the interior of the septic tank was in- spected for condition of banes or tees, material of construction,dimensions;depth of liquid, depth of sludge,depth of scum. __,4,-�he size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST(continued) t� The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION / FLOW CONDITIONS RFSIDFNTIAT Design Flow: ✓gallons Number of Bedrooms: Number of Current Residents:_ Garbage Grinder:. Laun Connected To System: Seasonal Use: X)d Water Meter Readi gs, if ilable: Last Date of Occupancy: COMMER AI./IND T IAI.:N0 Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: Non-Sanitary Waste Discharged To The Title V Sys(em: Water Meter Readings, If Available: Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Z�Vol System Pumped as part of inspection: -A.) - >- ped: gallons Reason for pumping: TYPE F SYSTEM: Septic Tank/Distribution Box/Soil Absorption System Single Cesspool Overflow Cesspool Privy Shared System(If yes,attach previous inspection records, if any) Other(explain): AP�TE A�components, �in Called(if known)and source of information: Sewage odors detected when arriving at the site: w -4- SUBSURFACE SEWAGE DISPOSAL-SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (couthwed) SEPTIC TANK: Depth below grade•. / Material of Construction: . --'concrete metal FRP_Other (explain) Ot Dimisions: • Sludge Depth: Scum Thickness: (00 Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to tlet invert structural integrity ev' ence of leakage,etc.) / O v GREASE TRAP . Depth Below Grade: Material of Construction':_concrete' metal FRF Other. (explain) — ,— — Dimensions: Scum Thickness: Distance from top of scum to top of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or.bafles;depth of liquid' level in relation to,outlet invert,structural integrity,evidence of leakage, etc.) TIGHT OR HOLDING TANK: Depth Below Grade: Material of Construction: concrete—metal_FRP_Other(explain) Dimensions: Capacity: gallons Design Plow: gallons/day Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert:_ &VJ Comments: (note if 1 el and distribution is equal,eviden a of solids carp over, evid nce of leak a into or o t of box,etc.) PUMP CHAMBER:-Lid is in working order: Comments: (note condition of pump cliamber,'condition of pumps and appurtenances;etc.) y -5- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM(SAS): ✓ (Locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: Type: ; Leaching pits, number:12?--Leaching chambers, number: Leaching galleries,number: Leaching trenches, number, length: -..',-.Leaching fields, number;dimensions: Overflow cesspool, number: - �'. . Comments: (note condition of soil,'signs of hydraulic failure vel o onding, nditio oZ&2�ation; ' etc,)_.—. dAj CIO // J/ CESSPOOLS: Number and configuration: ' Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) PRIVY Materials of construction: Dimensions:_ Depth of Solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) -6 - SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM. INF011MATION (con(inued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. f 3i3 ' S � 3 06 a7 5 �3 DEPTH TO GROUNDWATER: Depth to groundwater: l y Feet Method of Determination or Approximation: GAG' aJ,/k— /7v'-,J - 7- TOWN OF BARNSTABLE LOCATION S 9 1,AW SEWAGE # 9°--3Ul �� � VILLAGE -�` ASSESSOR'S MAP & LOT�66 "(5:7"'0 INSTALLER'S NAME & PHONE NO. OX�L-,0177 y G SEPTIC TANK CAPACITY LEACHING FACILITY:(type) %— � J (size) Co y NO. OF BEDROOMS (-fRIVAT WELL R PAC WATER UILDE OR OWNERS�Sifl� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No �� ��� I �� -v,�. �,�', l// " ' j r I I No..2l.__.''�t/ 1 �t W �. r:�• li�'ss.efe I 3: THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ,ppliration for Disposal Works C>zonst `union rrrmit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: .. • .ram .. ='_ ._�''��?� t.. ..®.�.... ........................... .C."�/yG�d..§----•--------- �+ Location-Address or Lot No. Ju!5 " Owner Address ---- --•- ... ................ .... Installer Address Type of Building Size Lot...... z,..... Sit - Dwelling—No. of Bedrooms.._......-_.�'...........................Expansion Attic ( ) Garbage Grinder ( ) Pk Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) GW Other fixtures -------------------------------- . w Design Flow..................................9 ...gallons per person per day. Total daily flow__-__`I* ...........................gallons. WSeptic Tank—Liquid capacity/.000..gallons Length._/./ '_ Width.. ' ._.. Diameter...... DepthA=--gl_-.... x Disposal Trench—No..................... Vidth.................... Total Length.................... Total leaching area............_.......sq. ft. Seepage Pit No------------:9;!!o_.. Diameter....... ,......... Depth below inlet....._4�--._.._._. Total leaching area...4. .4r...sq. ft. Z Other Distribution box (V� Dosing top ( _ Percolation Test Results Performed by_____ _ ___ ................. Date...5_'. iv.....f.4........... Test Pit No. 14&t__7?vm.minutes per inch Depth of Test Pit....A5.......... Depth to ground water........ '1_.._-_-. 44 Test Pit No. 2-------"......minutes per inch Depth of Test Pit...!_,$_:.! __.. Depth to ground water..__._.�...._... R+' ---------------------------------------•----------------------.....----------------•-......•......•......................................................... O Description of Soil.......:77*... ._.A-4::k.....C6,Pi! .5. _. �esf??-.: !��. _... ��--------------------------------------- x U ---------------------------------------•-------------------------------------------------•----------.....-----------------------••------•---------------....------------........--•---------......------ w UNature of Repairs or Alterations—Answer when applicable............................................................................................... ----------------------------•---------------------------------------------......--------...-•.......----•-------------------------------------------------------------------------------............---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned. further agrees not to place the system in operation until a Certificate of Compliance s b en iss d b ' he board of health.. Signed --- - ............. -- --- ------ .................................................... V A lication A roved B 14P ............._Date........ Application Disapproved for the following reasons• ------------------------------------------------------------------------------------------........................................... ----------------------------------�.......- .................................................................................................................................................................. Dale....... ........................................ Permit No. I�..-�. �. ........... ........ Issued ..........1....� '� � ........ THE COMMONWEALTH OF MASSACHUSETTS 01 BOARD OF HEALTH �� o sd• °°a TOWN OF BARNSTABLE •f r Appliratiun for Disposal Works Tonstrnrtiun jhrmit Application is hereby,made or a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: f 1� 'Location-AIdd+rress 'Av,A�r oorr Lot No. / l .a:l�+✓�e'�•'v /G l�/-�_w !s,3.'•• ,/r' 1�r/:/. ✓%l'�F Sir Y._. �iA .P...'f. ,� 7 J ...........-:... ........... .•---........_.•• ............_...__.._........... ..... ...... _-•-_... ' Owner —� Address / e ........ r Installer Address A _Type of Building Size Lot-----:_.•�t4 Dwelling—No. of Bedrooms______________ ________________________4xpansion Attic ( ) Garbage Grinder ( ) p-, Other—Type of Building ____________________________ No, of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures ----------=.................................................................................................................:.__... ......... W Design Flow..... _____________�'�►`_gallons per person per day. Total daily flow_._.__'` p___________. .....gallons. WSeptic Tank—Liquid capacity_/.CR 2.gallons Length___/ _G_. Width__.><_$___ Diameter_.__---_-... Depth...N:- _.. f/x Disposal Trench—No._.__..'_f......... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage"Pit. No._._______!Zn`ADiameter.___.__. Depth below inlet.......'4r.._..... Total leaching area___4-4-1_ _sq. ft. Z Other Distr Bution box ( V) Dosing tank n Test Results. Test Performed by _4 ._____sl.-L_._ •4%� ._ -=��1'��i _______________ Date____` s_ f -_:� ________--. ,aa Pit No:, 1u tf._ rr(inutes per inch Depth of Test Pit.....!' _'.__.___ Depth to.ground water_. ____._-. Percolation fs, ,Test Pit No:��2_ _____. .....n ute per inch Depth of Test Pit-::'!. .-_ :=- Depth to ground water............ "::.....- . 0 Description of/Soil_ _I ' '* ::.CQ!,-,4.-A'K�..... ------ UNature of, Repairs or Alterations Answer when applicable_______________________________________________________________________________i________________ } --------------•..... - `ti Agreement: /The undersigned agrees toi isfall the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the\State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificat&,of Compliance h/as been iss/u�d�by/s�.he board of health. Signed ............�....- -- ---.......4 .- --� .�............. Application Approved BY ---7....0..... =- ..... --­­ ------- - --------- - - ------------------------ -------------------- ...�'`'p� Date Application Disapproved for the following rea'ins.-I..... -----........................-......-------------------- -------------------------------------------------------------- - .................................. .........-.-i......-1 `-..y..............-..-...............................-.---. -----------......ate----............ Permit No. ... Date v ' THE CO.MMONWE�ALTHl F MAjSS!A&, -ETTS BOAR I OF HEALTH TAN. BARNSITA • el-er#i#1�Utr of Can lign L� THISIS TO CERTI� ,Y,?.T,,h the Individual Sewage Disposal System constructed ( /) or Repaired (bY......................................................... ..... ................... tJe,�(..� a .................................................................` ..--.................. ...-.. at ........ �° --......�� .. has been installed in accordance with the provisions of TITLE 5�of The State Environmental Code as described in the application for Disposal Works Construction Permit No. .ram .` n...;,�0/...... dated THE ISSUANCE OF THIS.CERTIFICATE SHALL NOT BE CONSTRUED; S A GUARANTEE THAT7HE SYSTEM WILL FUNCTION SATISFACTORY. DATE..-.f-.- ��--" a„� p �.......Ins ector .............. THE COMMONWEALTH OF MASSACHUSETTS 0,3 6 - oa BOARD OF HEALTH TOWN OF BARNSTABLE No....:..e(.�..... ...� �, {+ Disposal arks Tuns#rnr#iun .erntit' 7 Permisslon is hereby g ranted.._. � ......... .................................... to Construe or �eepair,(�\, a dividual Se r�ajge D' sal ystem l,'a O+!�;_.... 5.2!���1 ....��...�f�✓.�'�/�1. vff-� ��.F!�..................................................... Street -has shown on the-application for Disposal Works Construction Permit Np�__�_.�'�,�� Dated..Ztf!�Z�.' •---------- ' r '� -------------------- - --- ---------- Board of Health DATE '" � '�--------••-----•-•-------------------- ` FORM 36508 HOBBS&WARREN,INC..PUBLISHERS /teach Ptu* .bane a0 wide. �z I _ss•� s.( ' i ; 300.73 Iz4.z� 5� ) Cam+ \ 1 4L9Qd- ++ 1 0 r' f 20 O Al �o � 1 II \ k ` 1-� ` ` Aue. -i' .�,\ ____Y__-�*-s�y •.� �.j 'zO - � I �t�,�1, ' ,.. 11 � rJ a No,te': 33 �ha ed area Ge' gittecI' w-i d� E 5 A . �.� �.: �"oo.�to � •``1/_ . 1 ; , ,. i .. � I (.f a P. 49 ' •3 Ll 3wspo4at no cdtiAc 8d poll) L4L0 1 a tea Cap � .. - gg:J: �,d 1 % c�.ty ;J a-60 Pa,�bo t noted + : 1 ...CLEA.iv 1500 2 � `` t• .. I Iti Nil, 4�,.0 ,� „ 0, �.Q%1 'P� to .�'.cu�ul iA 04�tetGu�(ili z, r3aitnAtabte, C{� Pqan 1,�e2nct t.25 aa, dio w►a on { Ctwar Pui ate on an aj, anted datrun. f 1 . ,_ ' : yl '� 1p OFlryA ' I 9+, W Made 5-26-94 + No: wd t" enadunte ed 4 p° J ., fJ P j 2 , t I q NA IF, a` 4�9 476 r ' {{ f J J ' , I , come come ! � �a-�;'', Aran '_,,�z, �� -�•t ` IL -1:r 4 : -t I � {— ; r I i I I t-� {—� I r��� ;'. �. `� -� �_•� —.�— I 4 r �.< l3ecuh PtU/IC Pane LIO i w•idP — �f.1'. —Pot 25 300.73 IZ4.z� 55.1 'cAi .; A/ Y0ij —\ 0 i 20r\ _ � 't .. 1i . . \b j p .26 30 ICOT o� etb Note: Shaded a tea be;J.itted w astound �0 YL .a1 ahouin, ioo`J• J% 1'=1ddo 4: ' Sep ./� j ESP 44.3 i, '., off1 ,4 No. bed�toonv� L! 4i.f ted w 440 qp d Xe wji nq ateh :466 l�ele�uve " 466 Capacity j 881 gpd l►►-60 � i 4U Cape +..i.. '�9 /da tbo-t 1?d. : .. .i_ . 45• a�`. i.. a� noted o � hi` ,_ ,-13 rn o 2-1000 p dton" Sketch P.Can o Xapid .in Odtee4Vi le, 13a�rnAtab&., M4 9o2 ohn nyan , .:... .}_�..:... l.�e ivrd tot 2 S aa, ahow►, on .�'.C.#/9680 £teva.�lA19/1. ate on an arLJumed datum. date----A-erct--rsa7t►ii#,aze �wca o �decr,7.tj- 1`j OF feat pit #P- !70: Made 5-26-94 i j � .Wit. £d 13a ... y, No wa t e t encd un termed 4 �� /�eJtc. Cep 2 nun: :pet p ! 4a 9 .9 n:2 ♦i e �. i !V lOL 1. to to 4and T o.--- --- --------q Fee-- ---------------- BOARD OF HEALTH TOWN OF BARNSTABL. E 2pplication Ar Vell Con5tructionpermit Application is hereby made for a permit to Construct (i-1, Alter ( ), or Repair ( )an individual Well at: Location — Address ` Assessors Map/and Parcel ` -------------------- —— LCJ �S• �f'G C h i'!ua�+(J G iu / Owner Address (l r(J�r /fy ___ �l owc�_R� �a l���G /4ftS� oeO - --�- - - �= ' -- - ------- Installer — Driller } Address Type of Building NO(A S e Dwelling - -- ------------------------------------------ Other - Type of Building ----------- No. of Persons---------------------------------------------- Type of Well_ �i ��c - - - 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 .of Compliance has been issued by the Board of Health. - - 'c`, ^ - Signed - - ---------------------- o --�-Z����------- -- date Application Approved By- - ' - - date Application Disapproved for the following rea ----------------------------------- -------------------------- --------------------------- ---------------- ------------------ - - -- ---— - --- - - - ------ -- ------ date Permit No. -- -z-- date -- - - — --- - — e BOARD OF HEALTH "TOWN OF BARNSTABL. E Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual WIe11 jConstructed (�), Altered ( ), or Repaired ( ) by-----------—`� ti � (^z� -�- �' &I------ ----------------------------------- -- Installer C n.— N has been installed in accordance with the provisions of the Town of Barnstable Boar of eat ivate 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--------------------------------------------- ------------ - BOARD OF HEALTH TOWN OF� BARNSTABL. E . y (certificate Of Compliance THIS IS TO CERTIFY That the Individual Well Constructed (b-), Altered (--), or Repaired- ( ) -- ---^- Installers r 8 t O ( ."-V J --- 't�b(L —L—!la,✓413 -- ---------'-- ------ -----'------_——---—--------—'----------"------ s f , has been installed in accordance with the provisions of the Town of Barnstable Bo r of eat ivate Well Protection . Q j 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 a i SYSTEM WILL FUNCTION SATISFACTORY. t DATE- ------- - - - - - - - - - Inspector- - ------- ---------------------- ----- BOARD OF HEALTH '4 TOWN OF ' BARNSTABL E Well Con5truct ion Permit No. W- - ---- Fee-- - - r, Permission is hereby granted — - ----------�-- --- to Construct`�), Alter ( ), or'Repair ( ) an Individual Well at: _ - -- 4 C I- P/�� No. --- � - -- — - - --------------------- -------- - _ _ Street q as shown op te pplicati or a Well Construction Permit s No. - - - - - -- Dated - C� -- -- -Y-L ---- ---- f ------ ---- w --- - -------- ---- -/ ._.._ . � Board of Hearth 4 DATE- -- .---------- - � r •r..f'�f ..q.z ,.y 't ^ r,ylr..�'ar'-f,'�s't-r"�+i'�L't,-rlN',�'�°r-r,� y.�i(``'`�"'`••"7-+..rwr-rrn;t�'ti'*C�.�.�a.ex-.i•�,,• •,. u !, }" Fee- ------ --- k O.--- --- ------- �- g . .a BOARD OF HEALTH ----- r. TOWN OF BARNSTABL E Appticat ion ArVett 'ConwtruttionPermit ,. { Application is hereby,/made for gpermit to Construct (!✓r, Alter ( ), or Repair ( )an individual Well at: .w Location - Address Assessors Map and Parcel / N - �/Q- Owner ----- - ------— , - - -L r `�f �J_PG C,�i_Add�reec t na `-n -- �, 1 . , : ss S ccc, eve (1_ rif e /-1 j✓_/ �� l ,�o r_-.-_?rJ � fJoX l6a I'1-d G - - - Installer - Driller ea.v +" Address f Type of Building. Dwelling /o Es S �° . Other - Type of Building -- ---------------------- No. of Persons --- - -- — - - t Type of Well_Y w 7-- -- 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 ,of Compliance has been issued by the Board of Health. 4 Signed --- -- - - - ------- — -- 1 . - --- date 3 Application Approved By — date - Application Disapproved for the following rea s:-------------=------------------------- ------------- --— - a., .,"date r Permit No. —--- Issued ----- - — — -- - �t --- date � '; i3each ,/2.�u x� .(ane a0 ' w 5S 9�F - _ __` - .. Pot 26 ............ __...--- � __.crs r__.. •_� _ c�'i3hN1. Note: ? ,Shaded a2ea to be i-it Ced - / ��tt� \ 1-looOa OLL G/fAtiYla �oUU2da ttOn ad anOwn, \ i 1 00 !, \�i .' \ PiTb W T,'�iToa16•Tv...;,. No. .bedhomi �l , Di4po� no •43., t Cd,tupated itow 4,10 gpd o� .C'each� a tea 466 a 44 r iced e/u�e " 1466 Capacity 881 gppd ScaLe 1 "-60 Date S-?I 2ev -3-9t s;ems- A•!,C C e. � Ll9 /datbo t Jed e 14yan4i4-, M 02601 ---- ad noted ` .00tl 21 C LG A kj r-I cL _ 6 I S00 ) _ j Sketch Ptan o�. a i,n yul . od t e tpi tf e, 6a, ))&, M9 902 hn P\yan ;)ems -Cot 25 as shown on , .(",C.i I WO G '� ttw Can4, ane on an add wxed datu,n, Jate - Agent P�a��;itc�Ze .�oc✓uZ o� l�eaZtli S�edAt pit #P-8170 l~'la.de p-26-9u Enrz. N, Wit. Ed 13" No wa•tet e.c=untehed J?eice. Leda. 2 ll.�.n. p2e/c n YJ l �� � /J co a t,ie co a4ld.e to medium ntieduun Land i I !LU.YL(.L i Al ryt'ori i3each r Cunc4 .bane u0 wade ;az i � sty._j 300.73 Pot 2 SI- IS Ac. t' 0 to r 20FT � 9 0 ! I Note: 33 \' 49�i _- Shaded ahe,o. to be' f�i,�Ud wade i 02ound id n.a,, ahown. too-!0i _! , �aiTb STou Sep .ic 'Cle No. bedfiAo L .. V _ 4 »i> ..l...k •}3.a� �-' __I bidpo4at { I £a.ti.muted g.Cow 4,10 0pd e�eJwe x 1466 i- C 88 l. -60 t_ late'5-31-9Ll ; . RU-Cape _. ! 4 j :9 Ryan�, lin ,0260�1 GiJ t20eC( i �O lZ�j. i CLEAU r If- . • � r 2-1000 Pitd14 e} � !atone Ir ; Sketch PthA o Xdnd in Oa test itte, J3aa,a.�.tab Ce l�9 1 o t y� hnh l3eot;2S a4 down on l'.C '#1gb0 I ` } ��etlQ.�.ti0n4'ate. on 'an aa.�,u ld 4tuan `.._ �c-te: Abet:, avt7.ta�Ze' aZ o� IVA OfIN, ! feat pit #P-8170 ZDWA y Made 5-26-94 n Wit. Ed i3cJcy �.._. s 6 No water encountetezt 610 ! ?^e,m. Ceaa 2 Hurt. p er. is I f �FS �`.4 Co colt . co a&.e s !. , -� f toto sfedtturt H2PCl�tllllf. �� '1 ' ' ! `r'" dand 44i'1 d ^ w t t ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 CLIENT: John A. Ryan LOCATION: Lot 25 ADDRESS: 727 Main St. 59 Beach Plum°Rd. - Osterville, MA 02655 Osterville, MA SAMPLE DATE: 8-9-94 COLLECTED BY: D.A. Scannell DATE RECEIVED:` 8-9-94 TIME: 10:.30AM e- SAMPLE..:I.D. : JR-1• w- ,_ JOB TYPE: New Well WELL DEPTH: N/A RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml ` (MF Method) 0 0 pH pH units 6.6 8.5 5.62 Conductance umhos/cm 500 v 480 Sodium mg/L 28.0 _ 98.5 Nitrate-N mg/L 10.0 0.56 Iron. mg/L '0.3 0.06 ". Volatile Organics a EPA 601/602 * ug/L , Chloroform COMMENTS: Low pH indicates high corrosive characteristics. , Sodium level indicates possible salt water intrusion. If on a low sodium diet, consult a physician before drinking. * See report attached. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES FO PARAMETERS TESTED. Date 4_ Monad J. Sa i Laboratory D rector. IT = Less Than 8—ig-9= i_: , i•'1 _UP•irixdArEP. ANALYTICAL 5!? 7=9 4475; 9 _. } I GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: JR-1 Lab ID: 8416-01 Project: John Ryan/59 Beach Plum Batch ID: VG2-0434-W Client: Envirotechh Sampled: 08-09-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Received: 08-09-94 Matrix: Aqueous Analyzed: 08-10-94 PARAMETER CONCENTRATION REPORTING LIMIT (u9/L) (u9/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL I 1,1-Dichloroethene .BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane 1 BRL cis-1,2-Dichloroethene * BRL 1 Chloroform 2 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL I Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL Bromodichloromethane BRL I 2-Chloroethyyl Vinyl Ether BRL 1 cis-1,3-Dichloropropene BRL Toluene BRL 1 trans-1 ,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL I Ethylbenzene BRL 1 meta-and pare-Xylene I ortho-Xylene * BRL 1 Bromoform BRL 1,1,2,2-Tetrachloroethane BRL I 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 27 90 % B7 - 113 % 1,2-Dichloroethane-d4 30 32 106 % 83 - 117 % BRL - Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1966).