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HomeMy WebLinkAbout0130 FLINT STREET - Health 130 FLINT STREET, MARSTONS MILLS _ A= 123 004- ©0 Z No..W-------------- Fee 4- ---------- BOARD OF HEALTH TOWN OF BARNSTABLE App[icat ion ArVer[ Con0tructioni3ermit Application is hereby made for a permit to Construct (-I','-Alter ( ), or Repair ( )an individual Well at: ------ ------------- Location — Address Assessors Map and Parcel caner Address ---- ----------- ----- Installer — Driller Address Ud 57 Type of Building Dwelling Other - Type of Building------------------------------ No. of Persons------------------------------------____-- Type of Well '��SGh Y�'w� apacitJE ---------------- ----- ------------------- ----------------- 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 ertificat . f mpliance has been issued by the Board of Health. Signed - — — — - J ')O•D/ -- date Zv Application Approved By — -! --—— 3 ��_-- date Application Disapproved for the following reasons: -------------------_______—__________—__—__—_--_ --- --------------------------- — date Permit No. — — Issued-------------------------_--_-- ___-- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS4§ TO CERTIFY, That the In vidual Well onstructed ( ), ered ( ), or Repaired ( ) by --- -- _- - — --------- --- �Inst�aller ,�Q has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------__________Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE---- Inspector--------------__-_- — —_ II No ----- ------------ Fee- ---------- BOARD OF HEALTH TOWN OF BARNSTABLE Replicat,onjhrW ell c�ori�truttion ermit Application is hereby made for a permit to Construct (✓Alter'( ), or Repair.( ` )an individual Well at: ' 3— Location, SAddress. s��s Map and Parcel------- � 1 Qwner Address Installer - Driller Address Ua C 1 Type of,Building Dwelling----— ` --------------------------- • r. Other - Type of Building --- --- - _ No. of Persons-___---------- ------ l Tye of Well.-- 7 — YP -- - Capacity;— - - -- Purpose.of Well o T _ _� 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 '>ertifiTZ' t f Cmpliance has been issued by the Board of Health. Signed ' - -- . � � „' date -- Application Approved By, "- -- — - — —— —3j�G �(-- -- date Application Disapproved for.the following reasons: ------=-------------- _-_____—__—_ �_ --_--.date —"--- Permit No; ---_ Issued----- - - ----- ---- — - date _ituaeR�9alititr7li�li¢.y4i��fe!FwY4illidilWrilt.�yiwtl4ATT.w4uYwlaSii7itCSi1rlirwl::!14liti Nile�Fililti�niNRiWiRr'fi!h�liWil:itifl3liwfilSliQiilililiW.i4a�R4l i9i/ialiti Ili4ililila/W GIs lwWslPlv'}� BOARD OF'HEALTH'.' R TOWN OF BARNSTABLE 'Certificate Of Compliance THIS I 'TO CERTIFY That the Individual Well,Constructed ( ) Altered ( ) or Repaired ( ) by --------- `=�_= -- - -- - -- - — - -- ---- - .. Installer has been installed in accordance with the provisions of the Town of Barnstable Board of Health.Private Well Protection 1 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-_ iris — - — - - --_--- .. ; tor. . - --- ----- 4iRi?!iti7irliti!i!iti4i!s+!�ai4i!�i9,Pi,i4ii11fi!'.4i4�i1i'�w'!i4i!#tititi'iilitf!!lAtitMiliTiZil89Nliml�F!IMlrNTf4lilir(AiliM fillrGgi�Y'�i±iYiSNYIiNliTi934r��itT_eF'i�liriri0i++i�.V�r^_A� BOARD OF HEALTH TOWN OF. BARNSTABLE Melt Conotruct ion Permit No. r, � Fee-------------- � Permission is reb ranted to Construct ( Alt r ( ),-.or Repair ( ) an Individual Well at:. G' Street as shown on the application for a Well Construction Permit end IZIOW /_.;p �7 D 2.G pf No.-- ---- — ---- —_— ated -- — —- > -- -------- --- a --- (''' -- -- DATE Board of ealth j 1 Commonwealth of Massachusetts Executive Office of Enviromiental Affairs Dept. of Environmental Protection One winter Street'Boston,Ma. 02108 John Grad D.E.P. 'Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508)564-6813 Governor ARGEO PAUL CELLUCCI 9 Lt.Governor -- _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A (� CERTIFICATION Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR 004 LOT 002Address of Owner: y Date of Inspection: 9/29/98 (If different) Nov 3 1998 Name of Inspector: JOHN GRACI CASSIDY I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) HEALO jH E :Company Name, Address and Telephone Number: CERTIFICATION STATEMENTm,��""�� 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Title V COndl 10 Ily Passes code310 CMR 16.303.My findings are of how the system is performing at the time of the Inspection.My inspection does — Need F rther Evaluation By the Local Approving Authority not Imply any warranryor guarantee of the longevity ofthe Falls septic system and any of Its components useful life. Inspector's Signature: Date: 1018198 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: _One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no, 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, unless the owner or operator has provided the system inspector with a copy of a Certificate of CoMpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not rnetal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04n7197) One Winter Street is Boston,Massachusetts 02108 • FAX(617)556-1049 a Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR 004 LOT 002 Owner: CASSIDY Date of Inspection:9129J99 _ SewaQe backup or,breakout or high.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled 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. i) 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) DETERMINES THAT THE SYSTEM IS FUNCTIONING 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 of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply 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 the SAS 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 that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: 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. Yes No _ — Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the 5urfeoe of the ground or Surface waters duo,to an ove.rloede-d or clogge.d cesspool. SAS is in hydraulic failure. (revised 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR OD4 LOT 002 Owner: CASSIDY Date of Inspection:9129199 D]SYSTEM FAILS(continued) Yes No 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 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped 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 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. 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: You must indicate either"Yes"or"No".as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) 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 office of the Department for further information. (revlsed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR 004 LOT 002 Owner: CASSIDY Date of Inspection:9129f98 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: _c_ — Pumping information was requested of the owner, occupant, and Board of Health. x None of the system components have been pumped for at least two weeks and the 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. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. —x— — The site was inspected for signs of breakout. x All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is — — unacceptable)[15.302(3)(b)] (revised 04127197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR004 LOT 002 Owner: CASSIDY Date of Inspection:9129199 FLOW CONDITIONS RESIDENTIAL: Design flow: 3W g.p•d./bedroom for S.A.S. Number of bedrooms: 3 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Ye: Seasonal use(yes or no): No Water meter readings, if available:(last two(2)year usage(gpd): n!a Sump Pump(yes or no): No Last date of occupancy: nla COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow.0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra Last date of occupancy: nra OTHER: (Describe) nfa Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: HICKEY CESSPOOLS PUMPED SYSTEM LAST APPIL System pumped as part of inspection: (yes or no)No If yes,volume pumped:8 gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc. Copy of up to date contract? Other: APPROXIMATE AGE of all components, date Installed(if known)and source Information: 1987 Sewage odors detected when arriving at the site: (yes or no) No (revised MP97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR OD4 LOT 002 Owner: CASSIDY Date of Inspection:9129198 SEPTIC TANK: x (locate on site plan) Depth below grade: V Material of construction:x concreate metal FRP Polyethylene_other(explain) If tank is metal, list age n1a . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Lee"H5'7•w4.10" Sludge depth:"' Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness:0 Distance from top of scum to top of outlet tee or baffle:S" Distance form bottom of scum to bottom of outlet tee or baffle:0 How dimensions were determined: MEASURED Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: concrete metal FRP Polyethylene_other(explain) Dimensions: rva Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:nta Distance from bottom of scum to bottom of outlet tee or baffle: r0a Date of last pumping;la Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on srte plan) Depth below grade: 1-6-- Materialof construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction lineTOWN Diameter: n1a Qmments: (conditions of joints,venting,evidence of leakage, etc.) (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR 004 LOT 002 Owner: CASSIDY Date of Inspection:9l29f98 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: nfa Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Capacity: rda gallons Design flow: rya gallons/day Alarm IeveC_nIa Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) Poa DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: LIQUID LEVEL WITH BOTTOMOFPIPE Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND. PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_Ye: Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revlaed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 130 FLINT ST.MARSTONS MILLS MAP 123 PAR 004 LOT 002 Owner: CASSIDY Date of Inspection:9129199 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required, but may be approximated by non-intrusive methods) If not determined to be present,explain: rda Type: leaching pits, number: 1000 GALLON LEACH PIT leaching chambers, number:rya leaching galleries,number: rda leaching trenches,number,length: nfa leaching fields, number, dimensions:nla overflow cesspool, number:nla Alternate system: rda Name of Technology._rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY,THE PIT HAD 2'OF WATER IN rr,AND HAS NOT BEEN MORE THAN 3'FULL. CESSPOOLS: (locate on site plan) Number and configuration: rda Depth-top of liquid to inlet invert: We Depth of solids layer: rya Depth of scum layer: We Dimensions of cesspool: rda Materials of construction: rda Indication of groundwater: Na inflow(cesspool must be pumped as part of inspection) Ma Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rda PRIVY:_ (locate on site plan) Materials of construction: rva Dimensions: rda Depth of solids: rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) rVa (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 130 FLINT ST.MARSTONS MILLS MAP 123 PAR 004 LOT 002 CASSIDY 9129198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) PeA OQ (reviced 04127197) Page 9 of 10 ~ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 130 FLINT ST.MARSTONS MILLS MAP 123 PAR OD4 LOT 002 CASSIDY 9129198 Depth of groundwater 12. Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local ccnditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS MAPS AND CHARTS (revlsedOWTST) page 10 of 10 _-9WN OCF BARNSTABLE LOCATION 3 v +1 r - J SEWAGE # VILLAGE ASSESSOR'S MAP & LO -CcN� LC(Z INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY ffx)() LEACHING FACILITY: (type) 1���C�t S �� (size) l jj U O NO.OF BEDROOMS BUILDER OR OWNER PERM TDATE: —COMYLIANCE DATE: d 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' J l�( j f n AA TF C LL TOWN OF B.ARNSTABLE LOCATION)r/N y / ate-- SEWAGE #_ � VILLAGE.42AD � �ASSESSOR'S MAP & LOT / Z q-2 INSTALLER'S NAME & PHONE NO. ,6 D SEPTIC TANK CAPACITY fJ e)o / LEACHING FACILITY:(type) re Ct95 (size) 4090 NO. OF BEDROOMS 2- PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERRA �/ DATE PERMIT ISSUED: DATE .COLIPLIANCE ISSUED: Z "- VARIANCE GRANTED: Yes No L t ,-�1� X"�✓ I V� C�� a/ /'�� � 1 � � � ! � ���� � � .—.. '�ie 3 �I .,�. 15 �"�� � ►MPrl? i23 No....�.�JQ- --- 4.2 THE COMMONWEALTH OF MASSACHUSETTS _ BOAR® OF HEALTH ......... FP to � ... ApplirFatinn for 14,6voii al Works Tonstrnrtion rrntit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: f�T..l.:.I�+h¢�S ,s �T 2 f'13 a _ _ _ _...... ---•-••--..... ------------- ------•--------•---------- Loc ion-Address or Lot No. • �•••�- -��--• - ......................u -ry A 4 A_sI��`�......... -.. � `.J;u rL�L J r vt�-�2 mo�ur-N Po R.i` .......-----•--- .....--•- ... -•-- ---• •--- .................... Owner Address . ate A-iu ry Installer Address Type of Building Size Lot..43�?0.......Sq. feet Dwelling—No. of Bedrooms........ ................................Expansion Attic (Y� Garbage Grinder (rl Other—Type T e of Building p� yp g ..........................:. No. of persons............................ Showers ( ) — Cafeteria Otherfixtures ----------------------- • ------..-----------------------•------------------------.--. - :.... W Design Flow...........$$'IV.......................gallons per person per day. Total daily flow........2Z.0.......... ............gallons. WSeptic Tank—Liquid capacity.IOW..gallons Length%. '... Width._A':!.kQ"�.. Diameter.... -........ Depth:5.1— . x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.......I--- ........ Diameter......1Z........ Depth below inlet...S.t.S....... Total leaching area.240.1.....sq. ft. Z Other Distribution box (Y Dosing tank U6 Percolation Test Results Performed b . . ve�.rr►.�tA.►�i►... 11 Y �`��..1N�.Date..lz-.l.l_'.8.4�.............. Test Pit No. 1__,�l........minutes per inch Depth of Test Pit-__.1D.......... Depth to ground water_.1Ql,. iitn�u�g�6� f34 Test Pit No. 2...4.?r......minutes per inch Depth of Test Pit....)Q.......... Depth to ground water....."............... P4 ----------------------•--------------------------•---------...------......------........-•--••....--•................................. Description of Soil....... '. --4AdKL�... .�B.gQl.4--. .- Q-- = 5 r V $eMa Y.E,t.. ----------------------•------------------...----------•------•------•-•---------... •-•--•-•...........................•---.........---••--•-•------=--....---•----•---..................n=_i�^ t�Rl F.�,1/�!. �JL(� ��!. �_Ca. off.e!Ie _. _.. ... r.Vt.•rf. i�@'R-'GSfi -6U5'edS—d..yam r— -------------- U Nature of Repairs or Alterations—Answer when applicable?:ETA!LATaON--AndD-CEctTIF-v--1l i--IktRj:rinlr---------------- ----------------•--•-•--•-------•--...----•--•-------•-------•------..........................T!lh..1RYACbT�l�ll.. d -.IN ST ..Ih�.. R4�T... Agreement: r"'0RDANCE TO PLAN. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed. --- ----••---------------•-----•-- Application Approved BYC=__Z.... . ............-............ ................................ --- _akf3 .S� 0.------ Date Application Disapproved for the following reasons-------------•---------...._...------------------•---•-------------------------....-----•--...-----..........•--- -•------•-•------......----------------------------------------••--------- ------------------------ Date Permit No........... l Issued. -----------••--•........• Date BAXTER & NYE, INC. Registered Land Surveyors and Civil Engineers 7 Parker Road/Osterville,Massachusetts 02655/Tel. (617)428-9131 WILLIAM C.NYE,R.L.S.-President RICHARD A.BAXTER,R.L.S.-Vice President PETER SULLIVAN,P.E.-Vice President Engineering April 29 , 1987 Town of Barnstable Board of Health P .O. Box 534 Hyannis , MA 02601 RE : Lot 2 - Flint ST Friel Family Realty Trust Dear Board: Per your request for the above referenced project, I have inspected the system as installed. The system is as per the approved plan dated, December 29 , 1986 . Very truly yours , Peter Sullivan, P . E. Baxter & Nye, Inc . PS/fmj T OF P,_TER SULLIVAN No. 29733 A�0�- Q/STEP�O ONA t MEMBERS OF CAPE COD SOCIETY OF PROFESSIONAL ENGINEERS AND LAND SURVEYORS/AMERICAN CONGRESS ON SURVEYING AND MAPPING MASSACHUSETPS ASSOCIATION OF LAND SURVEYORS AND CIVIL ENGINEERS uutp,7 t23 No... :::.. ........`.: _< <:✓ �c� q-? Fizz.............................. THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH �u..............OF ! 1.5.. Appliratiun for Disposal 10orkii Tonutrnrtion rrmit Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at -�L.LS `•-'(-�T Location-Address or Lot No. ...----•-----••-------............................••------•---•------..............._............ •----•-----•••-••-•--•--•..._...--•--...........-•-----•-----•---•----............................ Owner Address a < ` _,k.... � _...`Z -----------•----...-•.....................................................•-----•....... - - .�� .. -.._.... Installer Address q d Type of Building Size Lot.. ?3: V._.._._S . feet Dwelling—No. of Bedrooms........ ......................_..........Expansion Attic (Y S Garbage Grinder Other—T e of Building No. of persons............................ Showers a YP g -------------•-•--•--------- P .(...>--- Cafeteria ( ) dOther fixtures ------------•-- ••-•••--••••......--•••---- --....-••••--•----•••-••-••----••-----•------•----•-••••-•_.. .. ...... WDesign Flow.............. ,`?..................•......gallons per person per day. Total daily flow........ < .........................gallons. I:4 Septic Tank—Liquid capacity. ?gallons Length J� �t.'.. Width_.'.- Diameter---_....... Depth. _=g. W Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area.................... ft. Seepage.Pit No#,,.____�--._.-____-- Diameter......1.4......... Depth below inlet....:.?....•... Total leaching area..2 .....sq. ft. Z Other Distribution box (yr�5 Doss=i tank (K c� Percolation Test Results Performed by_ �uz.��.vC ���.. ! "c .. �ir !v�.Date..�?.' �_` .............. Test Pit No. I..L'_-_-____minutes per inch Depth of Test Pit-----1.0.......... Depth to ground water..lQ0-!.. ue0.v� ;14 Test Pit No. 2---�. ......minutes per inch Depth of Test Pit----A�......._. Depth to ground water...___.'................. I W ._...__f.............................................................................................................................. O Description of Soil Q---�------.��aw`.. 1..�•u@3SC.� ......`......•Q._,M•- �:-,-U- oav'. ..`' ?. !! - - V ......................�.......C_'L�hw�!; -�................................................................................................................................................ W ....................•................................................................................................................................................................................... U Nature 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 TITI..E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed.............:. .-OD.0 .................................. -__ _r� Date�w Application Approved By , =w ............... -=�� ....... Date Application Disapproved for the following reasons________________________________•___.------__-----------•----------------------•--••--•-. .................... .................•-•---••----••••----••••••--••-••-•---•••-•-.....••-••••--•--•--••-------••••-•-•-•••••---•-•----••••••••••••••-•-•----•••---•-•-•••--••-••••-•••--•--••----•••-•-•---•-•••••...------ Date Permit No...... ...............'= '=3 Issued .. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH T a .. u � .......................................... ...: ^+,!y�.^..!: ..................... (9rrtifiratr of ToutpliFanrr THIS IS TO CERTIFY hat he Individual-Sewage isposal System constructed ( ) or Repaired ( ) by := 1 . =�e ��f A- ............................ •....--......• ------......-•---------•----.........---------•-------•--...------......_..--------•-•------••. 4 Installer at..................................................... �Y✓... C has been installed in accordance with the provisions of TLTLE,, 5 of The State Sanitary Code described in the application for Disposal Works Construction Permit No...... ..cam..._._.ate' ._... dated................----.---f........................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION ^^SATISFACTORY. . DATE............... .....Lt.. ---I•-,<.................................. Inspector.... �- `t-w----......•....................... THE COMMONWEALTH OF MASSACHUSETTS ��---- BOARD OF HEALTH -: - ...... /.lW...........OF.................... ........ .... . .. ......................................... No c'.................... FEE........................ Disposal Workii 031nstrnrtion Vanfit Permission is hereby granted. ----- .�.....---=�-::w:� .r............................. to Construct �) of Repair ( ) an Individual Sewa e Disposal System Street as shown on the application for Disposal Works Construction Permit No..-O'.!._3� Dated........ ............... ••-- ..................................................... V"" Board of Health DATE........ �.:. ••--•- - 9 •-1 ................................ FORM 1255 HOBBS & WARREN. INC:'•PUBLISHERS ri Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION AddressLoT l. A F>',tiT sr. City/Town Mr,/57cr S M e IIS M 4 G.S.Quadrangle Map S Grid Location Owner eol' % vc' Cc.S S .l V Address (�8 el,-J ST• .w��srn,.S r f�, ca�G WELL USE CONSOLIDATED WELL Domestic® Public ❑ Industrial ❑ ' Type of Water-bearing Rock Other Water-bearing Zones Method Drilled G U Cie/ t) From To / 2) From To Date Drilled /o /91 , 6 3) From' Tc 4) From To CASING , Depth to Bedrock Length_ /�1b Diameter c� Type Y u C UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium❑, coarse 0' Date measured lJ�9 t Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot#/U length, from' to y3 Yes [] No ❑ Split Screen (or 2nd screen) WATER QUALITY TESTS MADE - Slot# length from to Chemical ❑ Biological ❑V Depth To Bedrock PUMP TEST r/ Drawdown feet after pumping days /Z hours at /S GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From :To 0 eA SO m M t n ^ DRILLERcb Firm /QA. DRILLER ° Gnu�Se ° SCr.,c! r]r3 y,3� Address City IL114.1, ,4 1,140 rJ 06 51,9 Registration No. Operator's Signature Please pant irm y BOARD OF HEALTH COPY 25M.10-85.807101 Log' Number: ` ! Bottle # E711 Date: December 11, 1986 8^Q�s BARNSTABLE. COUNTY.,HEALTH.AND ENVIRONMENTAL DEPARTMEN r D SUPERIOR COURTHOUSE" O BARNSTABLE,.MASSACHUSETTS 02630 V. AS DRINKING WATER LABORATORY .ANALYSIS ' PHONE: 362_2311 X. T;,' ° Ir fl' Ext. 337 Client: -I;. Corl1inet Cassidy;. ,.,. Collector, ! , p , L.-;Kelleher:,. Mailing Address: .68! Flint ,-Street r ."Affi.1.iation ,, .F: ;;,psi driller" r` ' t,•Marstons Mi 11 s. MA 02648` Time. &;Date of :Coyle :t)�«f w•:.. ction: 2 / 6 +1:0 : .k `��1� /9 8 0 p.m. Telephone: 477-2811 Type of Supply* well _ Sample Location: Lot 130 Flint Street Wel Depth: . 43' Marstons Mills. MA Date.of.Anal`ysis U10/86 11:10 am. '` ,. PARAMETER , ;' SAMPLE. RESULT RECOMMENDED, LIMITS:. Total Coliform Bacteria/100 ml 0 0 H 5.3 . Conductivit (micromhos/cm 106.0,.; 500.0 Iron ( m) ' " ' : ,i•,' ,,, .,,; '; C.1 0.3 Nitrate-Nitro en ( m) 0.2 10.0 Sodium+} m ' 8.0":, Iflt*.I'i•"i .• „[r tri •,+ • •a rri'i:20 0••#':Fi .y,i . +1' 1'1:}'<If, {)il!. '+ i, i • tt ;,,1; ,� ;!� r ., 'J i _ ,i 'f'i . •:..! jfl; ,3 '.). ++�f) .�I�I�i ) 4ftf;i:I. �✓{ri:, (rp 3,•,ic,, }1r,.i !, :?':f7{3fr'C'J:+ '(iii,,I )f 1.l Ol'Y, drF !'lil`,7:rf ,i I .tl�� Jl+f,• I . X Water sample meets' the. recommended limits for.drinking of all above tested parameters . II . . Based-..only on results of. the parameters tested for this sample, the water-'is a�su table ;fort,drinking,,.but:,maysprfesent�•.the�pro,bl,ems:,:;checked,,below,:�,,t,1,,,i , .,. ,r I;,i Cf3'liii A: „6Ja.ter sampile;:has;;h:i.gherrthan; ave,rage:,levels ,.o.,f,,,N ;iirate.r ,,Future ,;mon1j,tor,jng;;i,s, ,, ,,, recommended (2-3 ,ti'mes per year) to establish any upward trends.. B. The low 'pH of the water may shorten the. useful .life of the house's `plumb i"h . .yq. j f C. -jor" Wafteri,niatyi,presentieaesthe,t o probl,emsf,(t,aste-, ,.odor,, stai,ni.ng:.), d4e.,to .,,i•,,. =,,jf rf •r{5�,4)fffi . {'f' ) �!iif'1itY t •}t J +'furl t+)t'f i'.i T(i I, .:"Itdii D. Water sample has high levels of sodium. Persons on low sodium diets should . .consult their doctor. III Due to one or more of the reasons checked below, .this water sample is unfit for- �,ar,:•lhuman. consumption.:; f: +A. ',' High Bactertia,, •,B.; i' Hi,gh,,Nttrates .r,Wrr,,: ,-vofw. ,k r ;(lr,. , 'fl+1f1 I}�. F[ iA1 1" i .`1! r •: '. f�l (f, t)'. ",{ :. Sr t:: I ,!r t if , ,. ,.I! t, •t ( .;, ,i i„( r•7„i.,_ ,.,i+: i4 ';''i„ , REMARKS: ,• a erns a e oun•y ,Mealth nv�ronmen:a Department shall not endorse any .statements, interpretatio s or conclusions: made by anyone else concern g these-resulf without written consent. CC: Barnstable Board. of Health CC: " Scannell Well Drilling 1I7/85 L . 0rato y Di rector. NIPJG ENGINEER MUST SUPERVISE :_... �. I. pD 'NSTALLATION AND CERTIFY IN WRITING.' 3 THE SYSTEM WAS INSTALLED IN STRICT i;••GRCANCE TO PLAN. 2 650 �o a � 714- 1 0 Lam / s- VACt Zia � .CcZT� F`(..Tt-EAT.�E�F��_�� Stldw�.. I � l �r :•8 � , wt�t: ; ' }% i ` l 14�14LW- — /2iSE2 S TDell -57 Last q''(� ' AO arc, 56. �o s �5/_ 3 r ' c 3 -ate, 3 P..TAR h 1'1t';d.�rtJ >> y SJ'LiV'm 29733 . ="�•�,rµ'�� �iS,� a t'c�j `C[I' J-E LXP,�►.IS�Ot .Q mot. ,,;• �)^ i 7fiZDA-/ !��Ccv L477/6,,�/ . 2,:1-77, G