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HomeMy WebLinkAbout0265 BRIDGE STREET - Health 265 Bridge Street Osterville P A = 093 077 - v ° " e a ° a r l 7 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION RECEIVED MAY 1 9 2004 TOWN OF BARNSTABLE TITLE 5 HEALTH DEPT. OFFICIAL, INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 265 Bridge Street MAP Osterville, MA 02655 Owner's Name: Charles Brewster PARCEL ' Owner's Address: LOB' Date of Inspection: May 8, 2004 Name of Inspector: (Please Print) James M Ford Company Name: James M. Ford Mailing Address: P.O. Box 49 Osterville,MA 02655-0049 Telephone Number: (508) 862-9400 CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fai Inspector's Signature: Date:. May 12, 2004 The system inspector shall subm' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments This report only describes conditions at the time of inspection and under the conditions of use at that P time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 a e 1 P Pg Page 2 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the 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. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2. Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has aseptic 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-eet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2064 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 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. A Page 5 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 Check if the following have been done: You must.indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back u ? — — g P €m g P ✓ _ 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: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)]. S Page 6 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2'years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIALANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gad Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Unavailable Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 6130195-per as built card _ Were sewage odors detected when arriving at the site(yes or no): No 6 • Page 7 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 265 Bridze Street Osterville, AM Owner: Charles Brewster Date of Inspection: May 8, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 2" Material of construction: ✓ concrete metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1500 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any si ns of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): 7 f Page 8 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete metal fiberglass __polyethylene _other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The D-box appeared to be level and was clean. No solids were present. The cover was 6"below grade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 r - • Page 9 of I l OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C .SYSTEM INFORMATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number: ✓ leaching galleries,number: 5 galleys w/3'stone-per as built card leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): The Qalleys had 6"of water on the bottom. The scum line was at the same level. There did not appear to be any si nos of failure. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 • Page 10 of 1 I i OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. I Pro"17 � 6 10 • Page 11 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 265 Bridge Street Osterville, MA Owner: Charles Brewster Date of Inspection: May 8, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 10+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: Topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using a Barnstable topographic map and water contours map, the maps were showing approximately 10'+/- to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE LOCATION a(o:5 80 cC4- SEWAGE # cl V' 3S� I LLAGE. OST/►>>�� ASSESSOR'S MAP & LOT G -7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) J' ) S (size) 3 Sr0/tt NO.OF BEDROOMS 7 BUILDER OR OWNER C; At'L&S aCCVS 1 G1- PERMTTDATE: 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 leachingfacility) --�-- Feet Furnished by :7 1425t ►_i W) - O b b % 39 yr - TOWN OF BARNSTABLE r LOCATION 6S &tdcle A.00� SEWAGE# q,5- 613SA VILLAG D . V I 11,9 J /L. ASSESSOR'S MAP &LOT 77 INSTALLER'S N &PHONE N�6. Q07s e S h ,.< SEPTIC TANK CAPACITY I .-- LEACHING FACILITY: (type) l t (size) �- �;NO.Oir BEDROOMS60 r BUILDER OR OWNE�7 Ua,-� , �� tA?S. ®� PERMIT DATE: 3 S COMPLIANCE DATE: Zseparation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by LOT NO. : ADDRESS: OWNERS NAME: r SEWAGE PERMIT NO. : NEW:_REPAIR: DATE ISSUED: IS DATE INSTALLED: `-INSTALLERS NAME: INSTALLATION OF: �SDD, ' X � �Q s WATER TABLE: FINAL INSPECTION BY: DRAWING OF INSTALLATION ON REVERSE SIDE: ( aAll ASSESSORS MAP NO: PARC No. r 'j� E-A0:_�_ Fxs....�. :...... THE COMMONWEALTH OF MASSACHUSET BOAR® OF HEALTH TOWN OF BARNSTABLE Apli iration for Uiirpnitti Work.6 Towitrnrtinn rnraft Application is hereby made for a Permit to Construct (X) or Repair ( ) an Individual Sewage Disposal Syst at: E.....STirr 05l,e-GE Ham. 93.. c� 7'7 .. ------ --- ------------------------------- ------------------------- Location-Address or Lot No. /ei/fdSf6%i .cMrs /ff 17 S l er J�/G �t'J•ICIDK /t��d Installer Address tt UType of Building Size Lot----21_&Od---Sq. feet �. Dwelling—No. of Bedrooms--- .... Expansion Attic $jct Garbage Grinder (A4 a --------------------------------- Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Design Flow........._.S�____ ____________gallons per _-erson per day. Total daily flow.:..` -gallons. Other fixtures ________________ _____ _ _ _ __ k W g - - g. P P P Y•. Y X//U-�--.77 0.-------__. WSeptic Tank—Liquid capacity/5�.galIons Length-_fit__.._... Width----- ------- Diameter._-Y----- De th..J`-__0-- . x Disposal Trench—No_ ____________________ Width......IV.______ Total Length-----�&_..___. Total leaching area..__q� ......sq. ft. Seepage Pit No--------------------- Diameter-----------.-------- Depth below inlet---5,.!0.... Total leaching area..................sq. ft. Z Other Distribution box ( Dosing tank ( j aPercolation Test Results' Performed by----L� -... L�c�v.� ?.__.._...... Date.....:5/31�92._..�...._.. Test Pit No. I____ _Z____minutes per inch Depth of Test Pit-----:1P-------- Depth to ground water-----9.1i......... (S, Test Pit No. 2.....LZ._minutes per inch Depth of Test Pit------ZjlV. _____ Depth to ground water----- ---------------- �:_�_._.____. O - ------- --- ',� -----......................................................... Descriptionof Soil-----------------------------------------------------�-•-•••......---•-----••---------- ..-------- U W UNature of Repairs or Alterations—Answer when applicable............................................................................................... --------------------------------••-----•----•---------------------------•-------_----•-------------------------------------------------------••. --- ---- ............................................. Agreement: The undersigned agrees to install the aforedescribed ' ivi al Sewag ispo 1 System in accordance with the provisions of TITLE 5 of the State Environment ode The and signe urther agr snot pJA the system in operation until a Certificate of Corn a as b i. ued e-b ea l . �".O Signe .... _ ........... ... ....... ............ ......... .. ...._. .. .... .......... ................Dace Application.Approved B - ..... ---------------------------.................. Dare Application Disapproved for the following rearonf: ....... ... .....--------------- --------- .................-------------------------------------------- j ---...........: ............................------ ---.....------------------------------:------------------- --------------. -------- -------------.................... I Permit No. -------'---- ... Issued ..... � . Dace No.... 077 Finc ............ THE COMMONWEALTH OF MASSACHUSETTS a BOARD OF HEALTH i TOWN OF BARNSTABLE } Appliration for DioVinial Works Tonotrnrtion remit Application l s hereby made for a Permit to Construct (x) or Repair ( ) an Individual Sewage Disposal System at: sri�eer v,5TZ-rw1 L-[. 93 e_evT -7-7 .................. .............. ..... . -------------------------------••..........•. Location-Address _ or Lot No. C... ...✓.ZIZ06 ....1./Ii tg_!w ---/•GSige45 /T,•) _ T J(/C W r- V S l 9w�er �4� /dC/G, O•%7�7A� 7 lj.�P S G/Y ��yr . a ••••...-... ............. --•-• Installer Address CQ < Type of Building Size Lot-_.C-/ 0---Sq. feet �-, Dwelling—No. of Bedrooms._...._.'l _______________.__-_.__._--.Expansion Attic Pcj) Garbage Grinder (/ a`4 Other—Type of Building .__. No. of YP g ----.....--•------------ Persons------------------------_.. Showers ( ) — Cafeteria ( ) dOther fixtures - ------ --------------------------------------------- ------------------------------- W Dest n Flow............ gallons per person per day. Total daily flow._._` X//U= �5%D g g P P P y y gallons. WSeptic Tank—Liquid capacity/J�_b._U._-gallons Length----C1........ Width_...G_-_____ Diameter..._'S''.__.-. De th.-5-�G x Disposal Trench—No- ----___-_••_••____-_ Width......�V_.-.... Total Length-----Z.&....... Total leaching area....�9G....sq. ft. Seepage Pit No............ --------- Diameter.....::..,--------- Depth below inlet-_- Total leaching area..................sq. ft. -,� Z Other Distribution box ( ) Dosing tank ( ) 'a Percolation Test Results Performed b Pam- cZL_� /�' � / /� Z , ZY----.--- - - ,----� -- - ------------�-------------------- Date-----�---3-•----�-------•------- Test Pit No. L...............mmutes per inch Depth of Test Pit..----._-........ Depth to ground water-.--- ........... (x, Test Pit No. 2.....�Z..minutes per inch Depth of Test Pit-------lv..._... Depth to ground water..... P+ ' ......................................................... Description of Soil........................................... e-� . V Nature of Repairs or Alterations—Answer when applicable....__............................................•...--_....._......-...__-._-__..._..._..._.. ,Agreement: The undersigned agrees to install the aforedescribed '1'd v 1 Sewage ispo 1 System in accordance with the provisions of TITLE 5 of the State Environmenta,Code The and signe urther agr s-not p e the system in operation until a Certificate of Complia'i as b i ued e bo o heap Ltom Signe .......... -- _oDace Application.Approved B ........... ...... ..._.._.....-... .....-...... <... .. -........_....... .....-..._...-`.------------------------ Dace Application Disapproved for the following reasons: -------------- -----------------------------------------------------------_...._..-------------_---------------------------------- Permit No. _..:./--:. `'--- -- --- Issued ----- _`-�_- --��----.ter.....:- Dare THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE g�Sftcatr of r�TIImpItttdce THIS IS TO CERTIFY;That the Individual Sewage Dis7osal System constructed ( x ) or Repaired ( ) by , 5 -r ------------------------------- Ins�aller at . �LtP._..��1 /_n.l' ------�g-T.---- t- ----------_----------- has been installed in accordance with the provisions of TITLEd of The State Environmental Code as described in the application for Disposal Works Construction Permit THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNC ION SATISFACTORY. r Inspector --------- - DATE--------------- �. -a. �� ----------------------- ----------- -------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE _..-- No. ... �!� �-✓ FEEZO D-•-�••--- DioVoottl Workv Tonotnut' n f rrntit Permission is hereby granted._�_� .1'. :R-.- a __ ( to Construct (X) or Repair ( ) an Individual Sewage DIsIlbsal System at No.. .... Zh /s.?, �,! -...5 e�' !� _ 2'. i%= b�.J as shown on the application for Disposal Works Construction Permit`V;� `Y _>_J.._ Dated_ -�"� •`..�'• . •-"-------•-•-•--•--•---•"----------""----------"-------""---------"------...••-•-•••---•---•--••--•---- ............................................. Board of Health FORM 36soa HOBBS 6 WARREN,INC..PUBLISHERS ASSESSORS MAP KN` � :0 No. - -- -" PARCEL NO: - _ -7Z BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con0ruct ion Permit Application is hereby made for a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at: --,---------5� o$7`rru:- �C� -------------------------------------- --------------------------------------------------------------------------------- Location — Address . Assessors Map and Parcel Gu c f< r c w S rel----- ------------------------------------ - -----4✓'Jj--- s - - -�--�- l/0 -- /� (1 / Owner /� /l p Address 1_ JCCtivy., -G�---->��t__-d1.1 0-11-��- - t -'—C'->`----- .r 2 Installer — Driller Address Type of Building Dwelling------------------------------------------------------------------ Other - Type of Building ----------- No. of Persons--------------------------------------------_-------_-- Typeof Well ------------------------------------------ Capacity--------------------------- --- --------------------------------------- Purpose of Well - „Zy------------------------ 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. Signed-� G��4✓� V10 s date Application Approved By --- -- --------- --y - l-- date Application Disapproved for the following reasons:-------------------------------------------------------------------------------—----- --------------------------------------------------------------- - -- - - -------------------------- date Permit No.--1 !`__ ------- --------------- Issued __-- �~� � - � -- —--------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFFY, That t e Individual Well Constructed ( -), Altered ( ), or Repaired ( ) ASCCi c• = A' / ---------------------------------------------------------------------------------------------------------------- // Installer at- J C_S_:—`�—�—` `1 c SIT. ©8�`e/ L� -- "'-� ---------------------------------------------- ------------ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection .�r Regulation as described in the application for Well Construction Permit No!!<��4--A6� ated- n THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------—----—--------------- -- Inspector--------------------------------------------------------------------------- 09 t, 7 Fee-- No ---'�- -- ' _ BOARD OF HEALTH TOWN OF BARNSTABLE Appticat ion,forVeil Cotl5truct ion 3pernrit. i Appplircatioln^T is hereby made for a permit to Construct (✓), Alter ( ), or Repair ( )an individual Well at: _�fr�+__' /✓ f� -1------/—,-- ©Jt [l U 1 l e ` ----------------------- --�--------- --- Location - Address r Assessors Map and Parcel c / S_T P Owner-- --'- ----------------------- s Address �J_TC (L_�'' — - oaGy+j D 1 Installer — Driller } Address Type of Building ~mil Dwelling------------- - -------------------------- i Other - Type of Building-------------------------------- No. of Persons---------------------------------------------------- Type of Well -----J --------------------------------------------- Capacity-1- Purpose of Well-�_t�_14c_%o�______� ----_.___-_ - s V x � Agreement: The,Zundersigned 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 1 place the well in operation until a Certificate of Com liance has been issued by the Board of Health. ' Signed -� -------------------------------------------------- (/A S/f6 date Application Approved By- --- - '— — — — '--b _ E date i Application Disapproved for the following reasons-.------- -------------------------------------------------------------------------------------------------- date i r Permit No. ----�'-� � ------------- Issued---------- °'--------=a r `-------- --------------- BOARD OF HEALTH TOWN OF BARNSTABLE�,y Certificate Of Compliance THIS IS TO C ERTIFY, That t e Individual W/ell Constructed (�), Altered ( ), or Repaired ( ) b —e- ---------- --- ----------------------------------------------------------------------------- - —- Installer at u. - 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 NoA___ r' ated--� ' THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL `f SYSTEM WILL FUNCTION SATISFACTORY. DATE—---- -------- - - -- — — -- Inspector--------------------------------------------------------------------------- i.:st +�o�o-�v ve�ms�c��ssraeas e�av� �t a�n, r amn mac+mc�a�.,r�r�ecssa.ara�aAeea os�a��e�ax •ca� �. BOARD OF HEALTH TOWN OF BARNSTA:BLE Wert Congtruction J)ernit t No. - ---- --- IT Fee r - j Permission is hereby granted � �Q N� wt-�r--- �l r`� --------- - -- - to Construct (vL Alter ( ), or Repair ( ) an Individual Well at:No. S7 •_ 6 S ------------------------------------------------------------------------------------------------------------ Street as shown on the application for a Well Construction Permit INo. -------- � "_'�—�°-- --- -----—--------------- Dated- — AFK?-----lv--- o�----?--".< ---------------------- ----------- ----1�'r- --74- Board of Health DATE-- '� ENVIROTECH LABORATORIES, IN MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Chuck Brewster LOCATION: a65 Bridge St. ADDRESS: Osterville, MA SAMPLE DATE: 4-29-96 COLLECTED BY: DA Scannell DATE RECEIVED: 4-29-96 TIME: 11:00AM LAB I.D. #: E4-382 JOB TYPE: New Well . SAMPLE I.D. #: E4-382 Irrigation WELL SPECS. : 4" well 23' RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 4.90 Conductance umhos/cm 500 106 Sodium mg/L 28.0 16.0 Nitrate-N/Nitrite-N mg/L 10.0 0.19 Iron mg/L 0.3 0.67 Manganese mg/L 0.05 0.347 COMMENTS: Low pH indicates high corrosive characteristics. Iron and Manganese are not a health hazard, but can cause taste, staining, and odor problems. Yes WATER IS SUITABLE FOR DRINKIN URPOSE FOR PARAMETERS TES XXX l�.Qti... - / �� Date Ronald J. aari Laboratory Director LT Less Than 7 1� r ACCESS COVERS MUST RE WITHIN GENERAL NOTES : 13.50 12' OF FINISH GRADE INVERT EL E VA T I ONS : DESIGN CRITERIA : FIRST 2- TO r. THIS PLAN IS FOR THE DESIGN AND BE LEVEL INVERT AT BUILDING: 11 . 25 - DESIGN FLOW: CONSTRUCTION OF I THE SEWAGE DISPOSAL INVERT IN SEPTIC TANK: 10. 75 4-BEDROOMS AT 110G. P. D. PER SYSTEM ONLY. 4* PVC MIN. 2* OF SCHEDULE 40 INVERT OUT SEPTIC TANK: 10. 50 BEDROOM EQUALS LA_4QG. P. 1). PEA STONE TONE 2. ALL CONSTRUCTION METHODS AND MATERIALS 0 0 /0 0 3.29 INVERT IN DIST. BOX: 10, 20 AND MAINTENANCE OF THE SEPTIC SYSTEM 1 75 1 112' DIA. NO GARBAGE GRINDER INVERT OUT DIST. BOX: 10. 00 SHA L L CONFORM. TO MA SS.. D.E.P. TI TL E 5 5 OUTLET 6.55 WASHED STONE AND LOCAL BOARD. OF HEALTH REGULATIONS. /0' MIN. 1500 GAL i3d INVERT IN LEACH GALLEY: 9. 84 D-BOX 5- i i i SEPTIC TANK 4'X 4 BOTTOM OF LEACH GALLEY: 6. 55 SEPTIC TANK REQUIRED: i. ALL SEPTIC SYSTEM COMPONENTS LOCATED LEACHING GALLEYS 440 G. P. D. X 150Y. 660__GAL . ADJUSTED GROUND WA TER: 2. 55 UNDER AREAS SUBJECT TO VEHICULAR TRAFFIC SEPTIC TANK PROVIDED: 1500 PROFILE : NOT TO SCALE -GAL . OR GREATER THAN J* IN DEPTH SHALL RE OBSERVED GROUND WA TER: / . 30 CAPABLE OF WITHSTANDING H-20 WHEEL L6ADS. -0. 20 2.94 SIZE OF LEACHING FACILITY REQUIRED: .4. ALL SEWER PIPE SHALL BE SCHEDULE 40 HIGH GROUNDWATER ELEVATION FROM 440 G. P. D. BOTTOM OF TEST HOLE: OR APPROVED EOUAL. OBSERVATION WELL ON LOT 9. P-7848 DES GN PER C RATE _( 2 MIN/INCH S. BEFORE CONSTRUCTION CALL 12.94 PROVIDED:-5-4 'X 8 * GALLEYS W13 ' S TONE 1-800-322-4844 AND THE LOCAL WATER DEPT. ,:�P 24 FOR LOCATION OF UNDERGROUND UTILITIES, SIDEWALL : 236 S. F. X 2. 5 - 590 GPD 6. VERTICAL DATUM IS: NGVD BOTTOM: 260 S. F.X / . 0 ._260 GPD 5-4*X GAL Y$ TOTAL 496 S. F. 850 GPD 7. FOR RENCH MARKS SET. SEE SITE PLAN. WITH J" ST .4 CATCH BASIN 8. NO DETERMINATION HAS BEEN MADE AS TO cx COMPLIANCE WITH DEED RESTRICTIONS OR LCRID 12.79 50 1 L TEST P I T DATA & , ZONING REGULATIONS. IT SHALL REMAIN 2.94 THE CLIENTS RESPONSIBILITY TO OBTAIN s INDICATES INDICATES /500 GAL PERCOLATION OBSERVED 12.9 ALL PERMITS. SPECIAL PERMITS. VARIANCES I TEST GROUNDWATER SEPTIC TANK ETC. FOR THIS PROJECT. P-7876 12 4 TP* 1 2 GRND EL. 9-8 GRND EL. 9.8 9. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY TO HAVE THE PROPOSED BUILDING FOUNDATION G. W.EL. I. G. W.EL. 1.3 Tp #I 7 DESIGNED TO ACCOUNT FOR THE EXISTING GRADE ao- *OA 0* 0 ' AND SOIL CONDITIONS AT THE LOCATION OF THE t 9.7 lle�_6 WOODL OAM WOODLOAM PROPOSED BUILDING. 0* 8.8 8.8 �p 4A- 14,0 Al MEDIUM MED I UM 10.4+ wp\02 SAND SAND 9.9 C6 6.5- 8.5- 10 /0' -0.2 -0.2 91.7+ 4jO.7 DA TE: MA R CH 31 . 1992 TEST By PETER SULLIVAN WITNESSED BY: JERRY DUNNING PERC RATE: 2 MIN/INCH LOT 8 _ P T C 4i o.4 5 zS 5 \X' S T E +p.4 -------------z BENCH MW COR 091DH 10.76 7 SA R /V5 TA S L. E" 0 S TER V L LE- PREPARED FOR ------------ C:� S CA L E- : 00 " MAR .20 _<p-5 0 0. er Ar..E7_,P7,R -or Ar(9 jr Arc�, If C.5 E7.1Vc +IW2 .4 gs> cz .6 cz ez n k-_ Af cz ol�> 60 1 0 cz "VAL 0 a 0 a-,) 432 -- 5333 0 15 30 60 6---------- L 0 H CK CFW JOB NO: 95-227 r F CA L C_ : SAI DRN: 'SAH