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0245 LONG POND ROAD - Health
245 LONG POND _ o MARSONS MILLS - -- -- - - - -- A = 613 053 - - - - -- s TOWN OF BARNSTABLE V I:OCA'iION 2 945 Lon, Nrd 9a, SEWAGE # VILLAGE,. tICLIM429 , RMS ASSESSOR'S MAP & LOT 0l3-053 r--ASpe c}e(5 ff EST NAME&PHONE NO. �r is n K.T' I•�ort Sag- 2 ss• 93y3 SEPTIC TANK CAPACITY 00 O LEACHING FACILITY: (type) lira�0/ (size) 10 X -3 c x 2 NO.OF BEDROOMS_ ? _ BUILDER OR O�� . ant- C-av-%Qf0k PDATE: Q 117-12P�S COMP, LIANCE DATE: ' Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility S+ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) S Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility �/ Feet Furnished by I-Z r oa r i 6hALLJ .PIP )JOT To SCALE D �_' Z�'6►� a_i Zo, A-Z 49� �3-2 53�bu A 3 58' o B-3 �2 dD 3n Test kAt Li z' No a Commonwealth of Massachusetts Tine 5 ufficiai Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form inspection results must be subnulted on this form or on the official Title 5 fnsrcdbn Form d" 611512000 Inspectian foram may not be altered to any way. x i A. Cert-ification Important wmm Wmg out I Property Information:forms on the 2,45 Mgrs4nS 140)6 , M9 Z��a computer,use only the tab key Address to man .our ✓0` y cursor-do mot S Qri�, �QiM QIrO'[� use Owmees Name y� key- 2457 ConQ Pon I FC Owner's Addn. Ault s-6n-s MAIS CAYIr wn State Tip Code Date of inspection: r Date 2. Inspector _ �r ialn Name of 1nspecggL Ty-, -14 —s�tt�� 30-7 Company Address F-'a S IV--- O 1�6 y Z City[Town State Zip Code - Telephone Number Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The.inspection was performed based on my 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 Trite 5(310 MR 15.000).The system: Passes Q Conditionally Passes Q Fails ❑ eeds Furlher Evarug by a Local Approving.Authority/Z /200 In s Signature Date �— The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the-appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the saute or different conditions of use. t5insp.doc•11120M Tittle 5 Offtt iai inspection Form:Subsurface Sewage Disposal System Page 1 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) 245 Lon Rd 1'1 1" ;115 Aft - 02 *q 8 City/rown State Tip Code _Ja, (hero f0. 11 2 Zoos owners Name Date of trtsOebUon Inspection Summary:Check A,B,C,D or E I aAvays complete all of Section D A) Sys Passes: 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: ag &"n tS Jr't 1d�4t:f` �tK� �-✓�G rotit ri+a �olace B) System Conditionally Passes:, ❑ One or more system components as described in the"Con • nal Pass"section need to be replaced or repaired.The system,upon completion of th placement 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 wq tain. ❑ The septic tank is metal and over 20 y s old"or the septic tank(whether metal or not)is structuralty unsound,exhibits subs tiat infiltration or exfiittration or tank failure is imminent. System will pass inspection if th xisting tank is replaced with a complying septic tank as approved by the Board of H A metal septic tank pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indt that the tank is less than 20 years old is available. ND Explain: t5insp.doc-1112OD4 Title 5 official Inspection Form:Subsurface Sewage Disposal System- Page 2 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cons.) Property Address Cityrrown State Tip Code Owner's Name Date of inspection . B) system Cond0ionally Passes(coat.): ❑ Observation of sewage backup or break out or high static ter level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settle 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 repl ND Explain: ❑ The system required pumping rrore than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if( th approval of the Board of Health): ❑ broken pipe(s)are laced ❑ obstruction is re ved ND Explain: C)/IheEation is Required by the Board of Health: ❑ . which require further evaluation by the Board of Health in order to determine if failing to protect public health,safety or the environment ill pass unless Board of Health determines in:accordance with 310 CMR that the system is not functioning in.a manner which wilt protect public health, he environment pool 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 V t5insp.doc-1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 3 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Not far Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cant.) Pra1efty add,em City/T(nm State Zip Code Owner's Name Date nspectim C) Further Evaluation is Required by the Board Health(cunt.): 2. System will fait unless the Board of lth(and Public Water Supplier,if any) determines that the system is function g in a manner that protects the public health, safety and environment: ❑ The system has a septic tank nd soil absorption system(SAS)and the SAS is within 100 feet of a surface water s pply or tributary to a surface water supply. ❑ The system has a septic nk and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a ptic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system s a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from rivate water supplyweil**. Method u to determine distance, **This system it the well water analysis,performed at a DEP certified laboratory,for coliform bac t . and volatile organic compounds indicates that the well is free from pollution from that facility d the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,prov ad that no other failure criteria are triggered_A copy of the analysis must be attached to this f 3. ther: t5insp_doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 4 of 16 I Commonwealth of Massachusetts Title 5 Official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form A. Certification (cunt.) ?475 Goha 007 d Rey. Pro r y Address �— kr5"A 626Y city/town State ZipCode - I Q,,.t C a rw o'ua.. 9 f z 2oog� Owners Name Date df lhspec*bn D)System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ L+7 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 u due to an overloaded or clogged SAS or cesspool ❑ E ,Static liquid level in the ddistribution box above outlet invert due to an overloaded or dogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available volume is less than'/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: [] �/ 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 u tributary to a surface water supply. ❑ Eir, Any portion of a cesspool or privy is within.a Zone 1 of a public well. Q 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 DtP 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.] Yes No ❑ The system tail 1 have determined that one or more of the Move failure criteria exist as described in 310 CMR 15.303,thendore the system fails.The System owner should contact the Board of Health to determine what will'be necessary to correct the failure. t5insp.doc•11/2004 Tiie5 Official tnspedion Form:Subsudface Sewage Disposal System Page 5 of 16 Commonwealth of Massachusetts Title 5 Official icial Inspection Form Not for.Voluntary.Assessments Subsurface Sewage Disposal System Form. A. Certification (cont) Property Address citylrown State Tip Code Owner's Name Date of E) Large Systems: To be considered a large tem the.system must serve a facility with a design flow of 10,000 gpd to 13,000 gpd. For large systems,you must indicate either' "or"no"to each of the following.in addition to the questions in Section D- YES NO ❑ ❑ the system itttin 400 feet of a surface drinking water supply 13 ❑ the sys is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the tam is located in a nitrogen sensitive area(Interim Wellhead Protection —IWPA)or a mapped Zone It of a public-water supply well. If you have a "yes°to any question in Section E the system is considered a significant threat, or answered"yes" Section D above the large system has failed.The owner or operator of any large system consid a significant threat under Section E or failed under Section D shall upgrade the system in a ance with 310 CMR 15.304.The system owner should contact the appropriate regional offs of the.Department. 1 t5insp.doc•112004 title 5 Official Inspection'Form:Subsurface Sewage Disposal System' Page 6 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form B. Checklist 245 Lone PDI%d Rd- Ij 79 "*Is Cityrn wn state l Tip Code t)qv%C C&P- ttrotck- �1I2�2oaS' Ownefs Name Date of kispectiah Check if the following have been done-You must indicate"yes"or ono"as to each of the following: YES NO ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ E3 Were any of the system components pumped out in the previous two weeks? 0 Has the system received normal flows in the previous two week period? Q ce/ Have large volumes of water been introduced to the system recently or as part of t�� this inspection? El available as built plans of the system obtained and examined?(If they were not available note as NIA) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? Q 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 ttt�ttt information on the proper maintenance of subsurface sewage disposal systems? The sire and location of the Soil Absorption System(SAS)on the site has been determined based on: [r ❑ 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 11 approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] t5insp.doc•1112004 True 5 Official Inspec:tim Form:Subsurface Sewage Disposal System Page 7 of 16 Commonwealth of!Massachusetts Title 5 Official Inspection Form Not for Volluntary Assessments Subsurface Sewage Disposal System Form C. System Information Psopedy Add Cityfrown / state 911 Zip Code Owners Nary Date of Inspection Residential Flow Conditions: 3Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on.310 CMR 15.203(for example:110 gpd x#of bedrooms): -330 Number of current residents: -- - Does residence have a garbage grinder? ❑ Yes (]moo Is laundry on a separate sewage system?[d yes separate inspection required] ❑ Yes B-*'No Laundry system inspected? 2"fes ❑ No Seasonal use? ❑ Yes ET'-No Water meter readings,if available(last 2 years usage(gpd)): Uyal l W&A%. Sump pump? /Q Yes/E7 No Last date of occ upancy. `�T 7 °s Date Commerciailindustdal Flow Conditions: Type of Establishment Design flow(based on 310 CMR 15.203): Gallons per day tspol Basis of design flow(seats/persons/sgjJL,etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged the Tide 5 system? ❑ Yes ❑ No Water meter readings,' ailable: Last date of o ncyluse: Date Other(d ): t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 16 Commonwealth of Massachusetts Title 5 Official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cons.} 24sg Property Address M aI-s AIoris K,Its MQ, City/Town ++ State Tip Code 91, owners Name Date of General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes El/No If yes,volume pumped:- How was quantity pumped determined? / 4— 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: 12ey�ti-ed Z�/ (NV Box F teac i A411 64141als Were sewage odors detected when arriving at the site? ❑ Yes No t5insp_doc•11/2004 Tflte5 dftiat bispeeGon Form:Subsudiace Sewage Disposal System Page 9 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cone) 245 Gone, IR?&d RA- Psoperty D2L 4A Cityfrown State A 1 J Zip Code `1Gl n wa Q tr o [ t Z't 20 CA— Owner's Name fate of inspection. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑cast iron a100 PVC ❑other(explain): Distance from private water supply well or suction_litre: feet Comments(on condition of joints,venting,evidence of leakage,etc.): Septic Tank(locate on site plan.): Depth below grade: feet Material of construction: concrete ❑metal 0 fiberglass ❑polyethylene ❑other(explain) tf tank is metal,list age years Is age confirmed by a.Certificate of Compliance?(attach a copy of certificate) Q Yes 0 No S 6 1 O Dimensions: rt Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness ( it Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? �tp $�fG� ,l?4�Y ?Tl'u� t5insp.doc•1112004 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 10 of 16 Commonwealth of Massachusetts Title 5 Official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. Ntem Information (icons) Prmpetty�dd� C,jay t State h S Zip Code � at�.fZ r�e>r o c� 2- o Owners Name Date of Iftsoiaction Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,eevidence of eakage,etc.): / f - rLId1 l.a, �!/C>'� Al-V 0-G�Ip3�Mq /Vaip4m-1 ttwle Grease Trap(locate on site plan): Depth below grade: feet Material of construction: concrete []metal less Q polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top outlet tee or baffle Distance from bottom of scum bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumpi commendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related o outlet invent evidence of leakage,etc-): /bw Tank(tank must be pumped at time of inspection)(locate on site plan): de: ruction: ❑metal ❑fiberglass ❑polyethylene j]other(explain): t5insp.doc•11/20D4 Title 3 Official inspection Form:Subsurface Sewage Disposal System- Page 11 of 16 Commonwealth of Massachusetts Title 5 Official-Inspection Farm Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cons.) Property Address Mr.(s-#ons l L 1( s ll�a- a2�yg city MM State 4p Code city Ca ,,,�o � !L 2oa5- O mers Nam DaWaftmpection Tight or Holding Tank(cunt.) Dimensions: Capacity: Design Flow: gaff—peCday Alarm present ❑ Yes d No Alarm level: Alarm in working order. ❑ Yes❑ No Date of fast pumping: gate Comments(co n of alarm and float switches,etc.): Distribution Box(if present must he opened)(locate on site plan): Depth of liquid level above outlet invert O 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.): t .Q D NWIK at �(o�.J (ea �r►'Vr a�t Rat Pump Chamber(locate on site plan): Pumps in working order_ "/A- Q Yes ❑ No Alarms in working order: ❑ Yes ❑ No t5insp.doc•1IMN Tate 5 Qf W Impectimt Fmrn:Subsurface Sewage Disposal SystEm * Page 12 of 16 Commonwealth of Massachusetts Title 5 official Inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information (cont) 2 LOKI Pan C/ Pmpetty Addres Iva City'/rown. State Zap Code �s- Owner's Name Date of tnsp"on Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): tj 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 ❑ teaching trenches number,Length: teaching fields number,dimensions: ❑ overflow cesspool number innovative/alternative system f Type/name oftechrtology. Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,eta): 1Jol;wa1 d�t�a+cam. , to� G�ddcc� �l/�sfY f�� W+'Al w.%d Vtkcs �� �vttl¢.R� � �t.t�� Cv� of �(��Vl►c. �i �Vr� t5insp.doc-11MD4 Title 5 Official Inspection'Form;Subsurface Sewage Disposal System- Page 13 of 16 Commonwealth of Massachusetts Title 5 Official inspection Form Not for Voluntary Assessments Subsurface Sewage Disposal System Form C. System Information(cone.) Property Address City fawn State P Code Owners Name Date of Inspection Cesspools(cesspool must be pumped as part of inspection)(locate on plan): Number and configuration Depth—top of liquid to inlet invert Depth of Aids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes 0 No Comments(note condition:of soil,signs of h raulic failure,level of ponding,condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids _ Comments(not cond 'on of soifi,signs of hydraulic failure,level of ponding,condition of vegetation, etc-): t5insp doc•11=04 bile 5 official Inspection Form:Subsurface Sewage Disposal System- Page 14 of 16 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Not.for.Voluntary Assessments Subsurface Sewage Disposal System Form C. System information (coat.) 2-015- Lori`y r%j Kj. Property Address 1 i tit CitylTown State Zip Code Jc� Ca r't.c>ro f� 9/�212o�.s Owner's Name ^Date of Sketch Of Sewage fisposal 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. Y dT To S CALE- ft-t 24'V g-1 ? of VL g- 5340 3�� o 3-3 0 l O 0 ov% EAR Ed }WSE S 3sno}l .3e�d9 � � t5insp.doe•11120134 Title 5 Official lnspeclion Form:Subsurface Sewage Disposal System Page 15 of 16 Commonwealth of Massachusetts - : Title 5 Official Inspection Fern = Not for Voluntary Assessments �Y^ Subsurface Sewage Disposal System Form C. System intoimetion {cant.} Property Address LP Cityrrown State Zip Code Owners Name Date of Inspection Site Exam.- Slope Surface water Check cellar Shallow wells Estimated depth to ground water- Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked,date of design plan reviewed: Date - --- Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Hoard of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must Jdescribe . -how you established the high ground water elevation: ri Sow i - t5insp.doc•11/2004 Title 5 Official Inspection Form_Subsurface Sewage Disposal System- Page 16 of 16 Permit Number: Date: Completed byl 0#2K• istt0l- HIGH GROUND-WATER iEl=Ei COMPUTATION Site Location: 24 L-, And ecl- ' AK44,5 !' ,11; Loflt No. R � " Owner: Address: 2tjs GOT} 48ncl ?• &Rki l"s )Yi/lS Contractor: __T Ae i3o � /� _2�tF/Address- f�� *9o-c 3O7 645,E a?s�+=��t • 02G�2 Notes: STEP 1 Measure depth to water table r j $' rr�e,}� tonearest 1/10 ft. ............................... ................................. Date 1 month/day/year T STEP 2 Using Water-Level Range Zone � and index Well Map locate (1 site and determine: i l Appropriate index well..................................................- . l Water-level range zone .....................................................{ STEP 3 Using monthly report"Current Water Resources Conditi on s" demar aine current de thtom $ {)� 23•? � water level for index well........................... # enonihiyear f STEP 4 Using Table of Water-level Adjustments , for index well (S T EP 2A), current depth ( , II { to water level for index well (STEP 3), I t and water-level zone (STEP 2B) determine water-level adlustment .......................................................................................... l `' i STEP a Estimate depth to high%vater j c by subtracting the water- level adiustrr:ent (STEP 4) from measured depth to uvater level4t SILC {STEP i) -----------------------------------------------..............-.............................................. � Figure 11-Reproducible computation foal. 15 United States Geological Survey Observation Fells As a service to Cape officials, engineers and other interested parties,the Cape Cod Commission publishes monthly groundwater data gathered by its Water Resources Office. The water level measurements shown below are taken monthly from United States Geological Survey(USGS) observation wells and compiled during the last week of each month. They are published as soon as possible thereafter. Listed below are nine out of the 61 wells measured across Cape Cod by the Commission's Water Resources Office. These nine are employed as index wells to be used with Technical Bulletin 92-001 to predict high groundwater levels. For your convenience,we've also provided links to USGS national and state data. See the a_=:, J k€inn, in the table and the footnotes below. To see what's happening in real time at a separate well in Brewster,visit the USES site: ._ 00,i I A- For further information about any of the data or links on thus page, please contact 'I c' :' trE, nie 1` Ei{ at the Commission offices (508-362-3828). August 2005 Departure from Low* Higher LowsAverage" a t e „ €r ;:.`�..; Location Veil No. Water RecordRecordJlL Overage m :Levels _ - Monthly Overall vi ,Tle -lei. , awhas_; Barnstable A 23.7 20.5 26.6 0.3 0.0 4?_ s 6-7,0 i . _ Barnstable 'A 7 23.0 20.5 2$.6 1.5 1.5 4111540701 Brewster BA �J 21 8.7 6.9 13.6 1.3 1.5 - : 4 Chatham CGW 138 ?3.0 20.9 26.6 1.0 0,9 � s;_ =00,1 i0, 1 f Mashpee MA NT 29 8.41 5.6 JE:10.0j 0.4 IF1.0 SD'41� Sandwich 46.7 45.8 48.3 0.7 0.6 4'A-118' ; Sandwich. SDVd 49.6 45.8 SS.I 0.4 0.6 ': (Tn�ro TSW 89 1?0 iQ_3 13.0 0.3 0.0 �V llfleet 17 10? 7.3 12.3 0.4 0.3 L i ?S_Sy7lY+iti 411 Measurements are in feet below land surface. http://wwA,,,.capecodcommission.org/wells.httn 9/17/2005 f . CERTIFICATE OF ANALYSIS Page: 1 9s, ��%' Barnstable County Health Laboratory ...rRCtNSt,i -' Report Dated: 8/152005 Report Prepared For: Order No.: G0532468 Brian Tilton The Building Inspector Inc. 265 Candlewood Drive Eastham, MA 02642 Laboratory ID#: 0532468-01 Description: Water-Drinking Water i i Sample#: 32468 Sampling Location 245 Long.Pond Rd.Marstons Mills,MA. Collected: 8/11/10.03_ I Collected by: B.Tilton Received: 8/11/2005 i ;Routine +Ammonia i ITEM RESULT UNITS RL MCL Method# Analyst Tested Note LAB: IC Lab Ammonia BRL mg/L 0.10 EPA 350.3 LAP 8/112005 i i LAB: Inorganics I Nitrate as Nitrogen 8.8 mg/L 0.10 10 EPA 300.0 LAP 8/112005 LAB: Metals Copper BRL mg/L 0.10 1.3 SM 3111B LAP 8/12/2005 Iron BRL mg/L 0.10 0.3 SM 3111B LAP 8/122005 Sodium 14 mgfL 1.0 20 SM 3111B LAP 8/122005 i LAB: Microbiology Total Coliform Absent P/A 0 0 309 AF 8/112005 i LAB: Physical Chemistry Conductance 180 umohs/cm 1.0 EPA 120.1 DCB 8/11/2005 I I pH 6,0 pH-units 0 EPA 150.1 DCB 8/112005 i EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Noe LAB: GCIMS 1,1,1,2-Tetrachloroethane BRL ugfL 0.5 EPA 524.2 yn 8/11/2005 1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 yn 8/112005 1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2. yn 8/112005 1,14-Trichloroethane BRL ugfL 0.5 5.0 EPA 524.2 yn 8/112005 i 1,1-Dtchloroethane BRI, ug/L 0.5 EPA 524.2 yn 8/112005 i 1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 yn 8/11/2005 I RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 tV M' Page: 2 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 8/15/2005 Report Prepared For: Brian Tilton Order No.: G0532468 The Building Inspector Inc. 265 Candlewood Drive Eastham, MA 02642 j 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 i i 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 yn 8/11/2005 1,2,4-Trimethylbenzene BRL ug/L 0s EPA 524.2 yn 8/11/2005 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 5241 yn 8/11/2005 1,2-Dibromoethane.(EDB) BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 f 1,2-Dichlorobenzene BRL ugtL 0.5 600 EPA 524.2 yn 8/11/2005 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 5241 yn 8/11/2005 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,4-Dichlorobenzene BRL ug/L OS 5.0 EPA 524.2 yn 8/11/2005 I2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 t 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 I Benzene BRL ug/L 0•5 5.0 EPA 524.2 yn 8/11/2005 Bromobenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 ` Bromochloromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 i i Bromodichloromethane BRL ug/L 0.5 EPA 524.2 yn 8h 1/2005 Bromoform BRL uglL 0.5 EPA 524.2 yn 8/11/2005 Bromomethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 f Chlorobenzene BRL ug/L os 100 EPA 524.2 yn 8/11/2005 Chloroethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 . 1 Chloroform 0.66 ug/L 0.5 EPA 524.2 yn 8/11/2005 i Chloromethane BRL ug/L 0.5 EPA 524.2 yn 8n1n005 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 yn 8/1112005 RL = Reporting Limit t.9CL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph:508-375-6605 :t`°F NaA�s'L Page: 3 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 8/15/2005 Report Prepared For: Order No.: G0532468 Brian Tilton The Building Inspector Inc. 265 Candlewood Drive Eastham, MA 02642 jcis- L 1,3-Dichloropropene BR ug/L, 0.5 EPA 524.2 yn 8/11/2005 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 yn_ 8/11/2005 Dibromomethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 I Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 i Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 yn 8/11/2005 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 i Methylene chloride BRL ug/L 0.5 5_0 EPA 5242 yn 8/11/2005 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 n-Propylbenzene BRL ug/1 os EPA 524.2 yn 8/11/2005 Naphthalene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 i p-Isopropyltoluene BRL ug/L. 0.5 EPA 524.2 yn 8/11/2005 sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Styrene BRL ug/L 0.5 100 EPA 524.2 yn 8/11/2005 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 5242 yn 8/11/2005 j Toluene BRL ug/L 0.5 1000 EPA 524.2 yn 8/11/2005 Total xylenes BRL ug/L 0.5 10000 EPA 524.2 yn 8/11/2005 l trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 5242 yn 8/11/2005 t trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 5242 yn 8/11/2005 i Tr1eh10TOethene BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 Trichlorofluoromethane BRL ughL 0.5 EPA 524.2 yn 8/11/2005 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 yn 8/11/2005 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By. (L irector) 6 �� 31- = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Cox!mil NAL v CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Report Dated: 8/15/2005 Report Prepared For: Brian Tilton Order No.: G0532468 The Building Inspector Inc. 265 Candlewood Drive Eastham, MA 02642 Laboratory ID#: 0532468-01 Description: Water-Drinking Water I Sample#: 32468 Sampling Location 245 Long Pond Rd.Marstons Mills,MA Collected: 8/11/2005 Collected by: B.Tilton Received: 8/11/2005 i Routine +Anzntonia ITEM RESULT UNITS RL MCL Method# Analyst Tested Note LAB: IC Lab Ammonia BRL mg/L 0.10 EPA 350.3 LAP 8/11/2005 LAB: Inorganics Nitrate as Nitrogen 8.8 mg/L 0.10 10 EPA 300.0 LAP 8/11/2005 LAB .,.Metals C 0PPer a :- x :, ;; BRL mg/L 0.10 1.3 SM 3111 B LAP 8/12/2005 Iron 4 l n ,,, ;:; BRL mg/L 0.10 0.3 SM 31_I 1 B LAP 8/12/2005 Sodium.- . :, ,k. ,i,:; r:. }; 14- mg/L 1.0 20 SM 311IB LAP 8/12/2005 LAB: Microbiology. Total Coliform Absent P/A 0 0 309 AF 8/11/2005 LAB: Physical Chemistry Conductance 180 umohs/cm 1.0 EPA 120.1 DCB 8/11/2005 PH 6.0 pH-units 0 EPA 150.1 DCB 8/11/2005 I EPA 524.2 - Volatile Organics by GCMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note LAB: GUMS 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 4.j,1-T_richloroethane BRL ug/L 0.5 200 EPA 524.2 yn 8/11/2005 I IJ,1?,,2jetrachloroethane BRL ug/L, 0.5 EPA 524.2 yn 8/11/2005 I. 1,1,2-Trichloroethane BRL ug/L 0.5E 5.0 EPA 524.2 yq4 8/11/2005 I 1;:1=Dichloroethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1.1,1-D.ichloroethene BRL ug/L 0.5 7.0 EPA 524.2 yn 8/11/2005 s RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 t� fJ pF IiA�S. o$ Page. z CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 8/15/2005 Report Prepared For: Brian Tilton Order No.: G0532468 The Building Inspector Inc. 265 Candlewood Drive Eastham, MA 02642 1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 yn 8/11/2005 1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2-Dibromo-3-chloropropa BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2-Dibromoethane (EDB) BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 yn 8/11/2005 1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Benzene BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 Bromobenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Bromochloromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Bromodichloromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Bromoform BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Bromomethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 Chlorobenzene BRL ug/L 0.5 100 EPA 524.2 yn 8/11/2005 Chloroethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Chloroform 0.66 ug/L 0.5 EPA 524.2 yn 8/11/2005 Chloromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 1 cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 yn 8/11/2005 RL = Reporting Limit MCC.=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page: 3 CERTIFICATE OF ANALYSIS Barnstable County Health Laboratory Report Dated: 8/15/2005 Report Prepared For: Brian Tilton Order No.: G0532468 The Building g Inspector Inc. P 265 Candlewood Drive Eastham, MA 02642 cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Dibromochloromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Dibromomethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 yn 8/11/2005 Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Isopropylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 n-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 n-Propylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Naphthalene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 ,sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 'Styrene BRL ug/L 0.5 100 EPA 524.2 yn 8/11/2005 tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 Toluene BRL ug/L 0.5 1000 EPA 524.2 yn 8/11/2005 i Total xylenes BRL ug/L 0.5 10000 EPA 524.2 yn 8/11/2005 trans4,2-Dichloroethene BRL ug/L 0.5 too EPA 524.2 yn 8/11/2005 .rans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 yn 8/11/2005 Trichlorofluoromethane BRL ug/L 0.5 EPA 524.2 yn 8/11/2005 Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 yn 8/11/2005 Water sample meets the recommended limits for drinking water of all the above tested parameters. Approved By:� � (L hector) RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court Mouse, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 TOWN OF BARNSTABLE LOCATION ��� w�,� � ��` ' SEWAGE # VILLAGE �ll'1����r✓ ���/� ASSESSOR'S MAP & LOT QZ, - Z� INSTALLER'S NAME&PHONE NO. &17:� o4>6W5,2` 77/ ��99 SEPTIC TANK CAPACITY /000 e4 LEACHING FACILITY: (type),jr!!426wh's l �_ (size) io X 30'xp' NO.OF BEDROOMS BUII.DER 0 OWNER.1(: �cr ,PERMITDATE: COMPLIANCE DATE: s D Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility rf Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) �p Feet 1 Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by id etL <?UjGj ao k ry , TOWN OF BARNSTABLE LOCATION w� �� SEWAGE # h a — VILLAGE �t�rr��' S �I�/� ASSESSOR'S MAP & LOTS f3�J� N r 1 �B . .INSTALLERS.NAME&.PHONE O. i�C� fly � i`15/` 77 :eF99 j SEPTIC TANK CAPACITY /000 e-4 . i LEACHING FACILITY: (type).;'�/ :^��i•s All) (size) io'X 30,x,' NO.OF BEDROOMS II..li BUDER OR(OWNER Lra.w.�/�•c. PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility �f Feet x Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200._feet of leaching facility) Sp �" Feet Edge of Wetland and Leaching FactLty(If any,wetlands exist l-= wittun'3fX)feet of leactung`facility)` Feet j Furnished by. /�Cr I . ,efve i i O 45 I 1 0/3 —,!95-3 No. In-6 I 0 Z Fee 5 V —/ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprtcatfon for Migpooar *pztem Construction Permit Application for a Permit to Construct( )Repair( y)Upgrade( )Abandon( ) ❑Complete System 'U Individual Components Location Address or Lot No. y/r Owner's Name,Address and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(W® Other Type of Building e e-ee; No. of Persons Showers( ) Cafeteria( ) Other Fixtures DesignFlow q �� gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Z4?00941 4! 1 Type of S.A.S. Description of Soil A© Nature of Repairs or Alterations(Answer when applicable) //e ��i� �� Date last inspected: .Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued b his Bo d of eal ` Signed Date Application Approved by Qa G�-2�-^�.-e Date Application Disapproved for the following reasons Permit No. 2 001 r O Z 3, Date Issued 3 0 alp --as-� �0 No. ZW I O Z 3 Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Zippfication for Mizpool bp!6tem Congtruction Permit Application for a Permit to Construct( )Repair( ')Upgrade( )Abandon( ) 0 Complete System 'CJ Individual Components Location Address or Lot No. Z q$`6,aa ��,j p Owner's Name,Address and Tel.No. Assessor's Map/Parcel /S,�DhJ� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 7 7/ Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(/ / Other Type of Building / e✓/ No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow l/e;�p gallons per day. Calculated daily flow �34 gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank hnDD'9ll;pll Type of S.A.S. _/Y/� Description of Soil l Nature of Repairs or Alterations(Answer when applicable) l 7/e `�r Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issue`dbyb AthisBooa�rd of He h. ` / Signed _/ �� �/ Date z/ � Application Approved by � ��+�� CA-� Date t p 2 5 Application Disapproved for the following reasons Permit No. 2 GAO E ' O 2 Date Issued O ----------- — THE COMMONWEALTH OF MASSACHUSETTS 0/,3—o S-3 BARNSTABLE MASSACHUSETTS Certificate of Compliance THIS IS '0 CER , that thg On-site Se age Disposal System Constructed( )Repaired(�Upgraded( ) Abandoned( �)b OrJ`®GGt � d�!S at Z f DG/9 �� r Ql5)`Oi7a^ a een constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.--2 W 1"O 7 � dated J J-`-AU Installer I Designer :A The issuance of s t� 1 n b construed as a guarantee that the s ti-,1,1 function as,�esigned" Date Lam✓ 114 Inspector i� �� r , v V No.aC�U� UZ� -----------=---------Q/�..3�J ✓Fee SUS--- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS lwi#pooal *potem Conotruction Permit Permission is hereby granted to-Construct( )Rep r( )Upgrad ( )Abandon( ) System located at Zh ��y and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must becompleted within three years of the date of this permit. Date: +�_Zrz t l 2 y Approved by • w�77 NOTICE: This Form Is To Betsed For the Repair Of wiled Se -tic Systems.Only. _ ------------ "RIMCATION OF SKETCH AND APPLICATION FOR A DI,SPOSAI, WORKS CONSTRUMON PERMIT OUT DESIGNED PLANS hereby certify that the application for disposal l works construction permit sinned by me dated / A o concerning the property located.at Z� %• eets all of the following criteria:. Tile:ailed system is conne cted to a'residential dwelling oniv. There are no commercial or business /uses associated with the dwelling. ae soil s cassined as CLASS I and the^A-- • P _.._ocanan at-is less than or�quai :o 5 minutes per inc.L net a are ao wetlands within 100 eet of me proposed septic system /7 Here are no private w t -e--s within. .ee,of:he he proposed sc-p ti c sys-L__:sere is no inc--,se in flow and/or.cha nge to use proposed. /7,1ere are no varances.reou:strd or need /The bottom of the proposed leaching: '.agility will not be locate less han Eve feet above the ma.Yimum adjusted groundwater table elc o.,,ration. [Adjust ..a•ust[ ) the groundwater.aol,,ustnQ the: Method when hmptor if applicable], lf:the S.A.S. will be located with 250 feet of any vegetated wetlands. the bottom of the proposed leaching facility will not be Iocated less than fourteen(14)feet above the tna:amum adjusted groundwater table elevation, Ple2e complete the following A) Top of Ground Surma EIevation(using GIS information) B) G.W.Elcvadon J 2's+th,__MAX High G.W.A justmcnt. 7 DUT Rr'TICE BEMWEET1 A and B / SIGNED DATE: [Sketch proposed pLan:of system on back], ¢heft toidc.mt 16X 30 P t.eNG� I✓ o twig v 13 r ul � 0-C A T 1 TU SEWAGE P IT NO. ,VI•LLAGE INSTA LLER'S NAME i ADDRESS J. CRAIG MEDEiROS rac ng aZ,ang �b JA9 Q" Skeet OR OWNER Hyannis, Mass. 775.0828 DATE PERMIY ISSUED a DATE COMPLIANCE ISSUED 1J/ F �s COQ �t . 60 ✓Cn- 7 e Cr i No.. 7' fo ..........................._. F�$ THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH 'rQ ................OF............0.k..12-�.�� ._(:.A�..Pd...-�.►-....... _-.._._.. Appliraiiun for Uiipu, al Workii Tomiunriiun Vamit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: ` ....�� T__!'� N G► PoN v }zD:.....M A fLS-ry A.t S M I I,LSt.... .RN `?'F .Ps L:r�, A4A. Location•Address or Lot No. M c+-i A��-.. .aG W... ............37 ./u.o�I uM .... , ,A,.L. ..tA ddress r:.- �.. ... ------------------------------•---------.----------.--.----�----•--- Installer Address Type of Building Size Lot..___.7f_17.46?-----Sq. feet Dwelling—No. of Bedrooms............................................................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons-----------------_.......... Showers — Cafeteria Q' Other fixtures .................................. -----------------------• ------ W Design Flow....................1V_.r1...___......_...._gallons per person per day. Total daily flow-___-._....��_"Nt:;. •.............._gallons. WSeptic Tank—Liquid capacity- PO4Pgallons Length._��IP Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.......... Total leaching area....................sq. ft. � Diameter-___-.Q I.__...._ Depth below inlet__Seepage Pit No.•.______(._._ r � p _.5r............ Total leaching arez..2.."..:.'O...sq. tt. Z Other Distribution box (✓ } Dosing tank ( ) Percolation Test Results Performed by..___w ..........................................� . ... Date....._..�.��._��0.4--•--_. a ,� Test Pit No. 1__-_LZ..minutes per inch Depth of Test Pit_____`!;._.____._ Depth to ground water.N b.�4.e___. I= Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •••••••--•••••-••...................................•--•• •-••-•-•-••----•-•---------...-----------------•------••-•-•---•-•-•----......-•-.._..-----...... ' . s 5u O Description of Soil 3 T .I'--..r------------•113-..S..o.. 1...-%-•--�� f M b��1M 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 Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bees d y the board of h. d. Date Application Approved Be��gni .......................•-•••••-••••••---------•........................-•-- ---------------------------------------- Date Application Disapproveding reasons: ------•----•••-••••----••-•---•---------•--•---•-•---------------------------------•---•--•.._..........•----- ------•----•-•••••••--•......---•----•---••-•---••-------------•••---•---...----••••-•--....-••-•--•----.-•-•••-------•-•••-•-----•---••••-••---•--•----••---------•----------------••-....••------..... Date PermitNo--------------------------------------------------------- Issued....................................................... Date NO._ •••- ...s...... Fss.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ... a Appliratinn for M-4potial 19orkri Ton5t•rnrtinn Vamit Application is hereby made for a Permit to Construct (✓�) or Repair ( ) an Individual Sewage Disposal System at:. t. t .+� L—r, r`-1 £r .. r r• 1 `3 tti' t t. t i 1 L - ----------------_. ._ - ..........---....._..---•-•------.............................. .......................................... ............................................... Location-Address or Lot No. s' �`.........�—r--........................................................ ............•_ �L i.�::_t`=`:__t_._...._? .:..:._.t... __+ ."............? � `..�.:A..... OH,nc: `. ---------Address a -------------------------------c:"...._._...-, - .....�-�-. Installer Address VType of Building Size Lot._'_'.......................Sq. feet Dwelling—No. of Bedrooms......... .................................Expansion Attic ( ) Garbage Grinder ( ) aOther-Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a d Other fixtures Rom.. W Design Flow___________________.._..................gallons per person per day. Total daily flow______.___________._=:___._________________gallons. 1:4 Septic Tank—Liquid capacity.......-)-gallons Length__----'_`__.. Width________________ Diameter................ Depth................ Disposal Trench—No_ ____________________ Width_.______._._..____._ Total Length.._______y_______._ Total leaching area....................sq. ft. Seepage Pit No--------- -.__-___-___ Diameter.____.'_ ____________ Depth below inlet.................... Total leaching area_.................sq. ft. Z Other Distribution box (1/ ) Dosing tank ( ) Percolation Test Results Performed by_____ti AN ty �A-j s e �� � = � ....... Date------------- f 14 _._... a ___ �_____________________________________ r.a Test Pit No. I____. ._:"_-_minutes per inch Depth of Test Pit____ _ ___________ Depth to ground water_!{__!':_`.<__. fs, Test Pit No. 2.........._.....minutes per inch Depth of Test Pit.................... Depth to ground water........................ ------------- ---------------------••-----•----•-------- -----....---------•--•-------•--••--------........................................................ 0 Description of Soil............. '___ t s t , . I I,y ; ' \ ,-I t- x = V -----•--------•-------------------------------------------•--------•--------------•-------------•-•-----•------•-•---------•---------•••------- 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 TTT E r- of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bees d ,th�board ofth. tgned---------------•---................... Date ApplicationApproved B� /r-.--•-------•-•----•----............................................................ ------•-------•-------•--••-•----•------ Date Application Disapproved or��he following reasons:.............................................................................................................. -------------•------•----••--•---•-••----•----------•------•-------•------•--•----•-------------------•------------•--••-------------•.-------------------------------------------------------•-•------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ................... .:....................OF......................................I.......................................... `? �rrtifiratr of ToutpliFatta THI -'& T CER T the ndividual Sewage Disposal System constructed ( or Repaired ( ) by WInstaller has been installed in accordance with the provisions of TI'r-'~ j of e State Sanitary Code as described in the application for Disposal Works Construction Permit No---- ............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFAC O �. / DATE .. �._ ..... Inspector.........._(�----------------•----------......------••---............._.. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH s.l '.Z ��2_. ......................................OF........................................ .-._.._.-....__......--....... No.Z.............. �✓.� S _ PEE........................ hspaod Workii Taanitrndinn rrnti# Permission is re by granted_ - ...................--•----•-------•---•----• .. to Construct (/ or $epair ) an -Ziv• ual Sewage Disposal System atNole-4 _------..................---•----f=J--•- ---- ........__-•-•-- Street as shown on the applicat• r Disposal 'Works Constructions Peerr i .__................ Dated.......................................... ........... ___ ___...................._...................................................... ).SATE. �1�+� Board of Health FORM 1255 HOBBS & WARREN, INC., PUBLISHERS = Massachusetts Water Resources Commission/Division of Water Resources WATER WELL C6MPLETION REPORT WELL LOCATION wilt- 3a�J Address f.� ��l�/y J /�G�s9/1J �? O City/Town /?7�3'�!C0�3 �✓� 2 t a G.S.Quadrangle Map t ..„,._.... Grid Location ' Owner Izia 4C lie Address ,OO Ig,:.x 0 r7'% 1®/�I�JJ9aPc C ELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) Cable ❑ 2) From To Other 3) From To 4) From To CASING Depth to Bedrock i ,Length .7 Diameter .�� Type Pe L UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface �� �s, Sand: fine medium coarse Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot#/0_length�from to Yes El No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# lenqth from to Chemical ❑ Biological ❑ DEe�pth To Bedrock Dr down i!` feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) 'Materials From To 0 f M A H DRILLER r.. Firm 'l AG,Cf1 Address A61 A—R" Registration No. AV � Operators b gnu ease print firmly 1OM-8181.164843 SITE PLAN SHEET I of 2 SCALE: I tL ho ' } nC 0 ll� v � ' tL � 0 � s d fi 0 � Q u CL ._ s All r• Z !off A4- c S5T C7. P�1�E G A s�r c-p r..1 L. r •� ----..__..._.. r o a�yrR�r� Aft 79K5( /— 51 12EGAs-r 4 . TA Z V.f3°ec 7 Le 1 `>7 7 VA.C A�1 T 1 I- T . 1-L 4!°� 41' _ n 14°D ti I.eAGi-( 13,ngitil (2v? L f7 �LI M. /WARWICK con No. 19771 e a ./STEg� / �a � REGISTERED LAND SURVEYOR FOR �, M I G 1-� �`�, E L f 2 A C- . LoT ?,.I Cot (VoND 9OAC) ZONE hTo1.1 -to MIt_L 'a AAA- PLAN REF. 37�} o� 3 SL, Z DATE 3 `t- BENCH MARK DATUM �s5un'Aaa; o WM. M. WARWICK 8 ASSOC., INC. DOMESTIC WATER SOURCE P R I v A` u1 80X 801 - NOR TH FA L MOUTH FLOOD ZONE. N °E ' N z A. rc o Gp MASS. 02556 (6/7) 563 -26 3B 1 a pppp� i L EAGH/NG 3A JOIN SECTION NOT TO SCALE 24 C.1.MH COVER ti �• _FART/l\f'/LL BRICK AND MORT4R COURSES AS-REO'D TO BRING 4" COVER TO GRADE q 8"FLOW L INC \ I INLET.' L_ _ ._ __ __ ,_ 2 A"TO%" WASHED PEASTONE FREE OF IRONS, FINES AND OUST IN PLACE OPENING WITH 4%8" y �X4 ' To /%2'•WASHED CRUSHED ,STONE FREE OF OUTER D/AMETER IRONS, FINES. AND DUST IN PLACE ANO I3/q"INSIDE DIAMETER :{ 1. CONCRETE TO BE 4000 PSI 28 DAYS .r- 2. REINFORCED WITH 6"x ro" NO. 6 GA. W.W.M. 3. 2'AND 4' SECTIONS ARE AVAILABLE FOR r` GREATER DEPTH REQUIREMENTS 4`0.. z' — 4. NUMBER OF PITS REQUIRED 1 MIN' r_-- to NOTE: EXCAVATE TO ELEVATION 6,7'�, OR / (NOT TO EXCEEDEFFECT/V£3 T/MEsD EFFECr/AMETERVE DEPTH) LOWER AS REQUIRED TO REMOVE ALL TABLE - LOAM AND CLAY BENEATH PIT. REPLACE (NDN E AT r-L• (o0,o) EXCAVATED MATERIAL WITH CLEAN TYPICAL PROF'T LE GRAVEL TO DESIGNED GRADE. /8"STD LT. WGT. C.I.MH COVER �o.5 •., bo,v �o,o 4'C I.PIPE 4"B/T.FIBER PIPE OUTLET LEVEL DWELLING FLOW_LINE TIGHT JOINT 0 oo TO FIRST JOINT 77.74 14 77,yl 110 00e1 C.I. TEE +-" ��'�5 I1 000100 1 1 1 I T 77,-q 'STD. PRECAST CONC. : 7 7,12 \D/ST BOX TO BE 7,1;j•O ' '1 0 0 0 00 1 1 1°°oGAL.SEPTIC TANK I I 1 000 0 0 0 1 I 1 �'• — .STABLE BASE INSTALLED ON LEVEL, I i 1 000 00 0 1 I i sEPT/C TANK jTo BE I '1 000 00 1 1 I INSTALLED ON LEVEL I if 100 I O 0 1 1 ' ' STABLE BASE. I I I 0 0 0 0 0 0 1 11000IG 0 11 „ LEACHING BASIN , 11100 00 0 1 , BASE TO BE L EVEL 1 1 1 0 0 O 0 1 1 , SOIL AND PERC. DATA PERC. RATE �Z MIN. /IN. 0„ TEST PIT NO. P 7 TEST PIT NO. 2 Tin/<�U P✓h AIL TEST BY : t✓RL)&c--- OSLP --- - WITNESSED BY: J,9'AtJ Jti.GvrDl 03,e,+}) lvMFD• 5dtii TEST PIT GR. EL. 'a' .� DATE: Z ' l 64 �l o rz ram,o w,a-r e.lz DESIGN DATA GENERAL NOTES BEDROOMS NO HEAVY EQUIPMENT TO RUN OVER SYSTEM. DISPOSAL N ° t-' E SEPTIC TANK, DIST. BOX AN LEACHING BASINS TO BE STANDARD EST. TOTAL-DAILY EFFL.332GPD. PRECAST REINFORCED CONCRETE UNITS. SEPTIC .TANK Ivvv GAL. ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN ACCORDANCE SIDEWALL AREA L SGAL./SQ•FT. TO REVISED TITLE 5 OF THE STATE ENVIRONMENTAL CODE, MINIMUM REQUIREMENTS FOR THE SUBSURFACE DISPOSAL OF BOTTOM AREA 1 GAL/AQ.FT. SANITARY SEWAGE EFFECTIVE ON JULY. I , 1977. LEACHING REQUIRED 179' I SQ.FT. : ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD ACTUAL LEACHING AREA OF HEALTH. �3—y--SQ.FT. AT COMPLETION OF CONSTRUCTION, PRIOR TO BACKFILLING, THE BOARD OF.HEALTH SHALL BE NOTIFIED FOR INSPECTION. PITCH ALL SEWER LINES 1/4, / FT. UNLESS INDICATED OTHERWISE. SEWAGE D/SPOSA L SYS TEM MARTIN �1 E. FOR- 1�• NA 1 c N A I- L_ 12 A, ,p f 223 1N Q sn L o 1 I L O A p I\.n A R h T v hl '7 ►vA t L L 5 13 A Fz r`t 'p T P-5 LL e M p, SCALE AS INDICATED DATE 311- 04 WM, M. WARWICK 8 ASSOC., INC. i 8OX 801 - NORTH FAL MOUTH ` ;� : MASS. 02556 - (617) 563 -2638 PROFESSIONAL ENGINEER "