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0009 MATTHEW WAY - Health
9 Matthew Way Marstons Mills A = 065 007 I WNW -tq mt,eww�'y �) ✓ LOCATION � '� SEWAGE PERMIT N.O. VILLAG 065' VZ ,,, c�ru OU 7 INSTA LLER'S NAME A ADDRESS iFcey, OR OWNER /r 4 R V DATE, PERMIT ISSUED DATE COMPLIANCE ISSUED j�/j, - I F 7 C V 2 I 1 { LO CATION /4-o SEW CE PERMIT No. YILLAC I N S T A LE '3 OU7 NAME i ADD 11 RESS e ;0* OW ER DATE' PERMIT ISSUED z Q DATE COMPLIANCE ISSUED , 'v 2 i No. b:� L ���1 Fee .� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION TOWN OF BARNSTABLE, MASSACHUSETTSs application for �i� osal *pstem Construction Permit Application for a Permit to Construct( ) Repair Upgrade( ) don( ) ❑Complete System :;nLual Components Location Address or Lot No. 7 176 'Z/,4y� Qwn r''s aamerAddress a and T�l.No. Assessor's Map/Parcel mjm -no l I ller's Nyne,. ddre and Tel.No., ('08—4120 9' Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 2- v Nature of Repairs or Alterations(Answer when applicable) ` Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar of Health. Signed GP - Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. )-a Date Issued bjj No. Fee THE C ' MMONWEALTH OF MASSACHUSETTS Entered in computer: YLes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppYication for Disposal 6pstem Construction 3permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System 04Individual Components Location Address or Lot No.�' � f"" r �(/ ;iG� ( n Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel l� r / kuL,14 '1-tzi Installer's Name,Address,and Tel.No.fop- `YiU 411S F Designer's Name,Address and Tel.No. .103-ep4l 0-e 9.49 _ _ ��' o Zr Iilk Type of Building:. Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) 9 Other Type of Building t No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow_(min.required) gpd Design flow provided gpd Plan Date 1 Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. , Description of Soil s Nature of Repairs or Alterations(Answer when applicable) Date last inspected: �. Agreement: The undersigned'agrees to ensure the construction and maintenance of the afore described on-site sewage,disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate'of Compliance has been issued by this Board of Health. �. wSigned ,r I Date Application Approved by w a } y - Date VV- V Application Disapproved by Date for the following reasons Permit No. .. d ( — 7 if L Date Issued { ------------------------------------------------------------------------------------------- --------------- ------------------------` THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS //J/ �x �,� S^,�`y!6 Zar-9110 1 i. �WR C� M Certificate of �CompCiante�1-{{{//// •••• THIS IS TO CERTIFY, �that ttthe On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by n t�J/,�//, �^/ at Q d z //d// as been constructed in accordance with the provisions of Title 5 and the6or Disposal System Construction Permit No. n,14 dated Installer e-�.7 �'c�� ,w Designer #bedrooms rx 1.7r Approved design flo , �� /� gpd The issuance of this permit shall not be construed as a guarantee that the system wJll_funct•on as,rdesigne& Date Inspector -------- ----------- -- - - r No. Q� �' �� �r / G �Y�Cf1 //� 4X 1 A,„��� Fee . THE COMM NWEALTH OF MASSACHUSETTS ,J PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS �cw v Bisposar 6pstem (Construction Permit Y Permission is hereby granted to Construct( ) Repair( ); Upgrade( ) Abandon it System located at ' v and as described in the above Application for Disposal System Construction Permit.'The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. .F Provided:Constructio/ri'mus j _..� t r t be completed within three years of the date of this permit. Date J_� J� f. ! ° �. Approved by ! _ , 12 ! No. d-� Fee -7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS I 9pplitation for Disposal Opstem CDYCBtCUttion Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System XIndividual Components Location Address or Lot No. G) MA774 k/ WAY Owner's Name,Address,and Tel.No.I Assessor's Map/Parcel A'rt{1_Crr`1 KV(3i1VS(<( Installer's Name,Address,and Tel.No. �! -�f'Tt- SST 7 Designer �me,Address,and Tel.No. c'AP�cD c "GP tL #45&5 / 153 -) _6t e Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) :r70-5'174-G(_ 0CTT4_ET- _T 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 Certificate of Compliance has been issued by this Board of H h. Signed Date Application Approved by Date 10�. Application Disapproved by Date for the following reasons Permit No. d 1 o S Date Issued r 1 ',"' �s w..i..^ • '.!`.�S - r �..� ry , :... _. .. "� .yr • �'l}� - ,. • }t` 4n Srt"{'^• - T,..a A /- V s 4 Fee / No. ` THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: y . PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS YeS 9pplitatlon for ;Disposal.6psthn Construction 3permit Application for a Permit to Construct( ) Repair( , Upgrade( ) Abandon( ) ❑Complete System Xlndividual Components Location Address or Lot No. 9 MAT74,6_k 1 WAY Owner's Name,Address,and Tel.No.9 �AT4iL K V 0jNS,t Assessor's Map/Parcel ©[oa60.7 M417HF_W WAIY M Installer's Name,Address and Tel.No. 5a-4 M- VVI 7 Designer's /Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided ' gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) (J—rLET t 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 Certificate of Compliance has been issued by this Board of Heath. Signed ~ Date Application Approved by ��` YL L� Date Application Disapproved by Date for the following reasons Permit No. c a l"7 U Date Issued ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired ) Upgraded( ) Abandoned( )by (2AP c�(�E E1v7Wk 5 at MA-T Ngii;V WX Y has been-constructed in accordance with the provisions of Title 5 and the forDisposal System Construction Permit No. dated Installer ��ty�4C7t�v� G -," -'K_A;J&iGS Designer NJ #bedrooms Approved design flow gpd The issuance of this permi't shall nott be✓co/nstrued as a guarantee that the system will,,function,aa d sued. Date } / Inspector No. e)f' Fee 7 5, THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction i9ermlt k Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at G MA—IT14 tIvAV MAZ5—rWj5 M tLL and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit.. Date Approved by / (/�.t--�/c-- ►`-�� ,. No........................ ��� F�$, v .......... o 001HE COMMONWEALTH OF MASSACHUSETTS VJAI BOARD OF HEALT�/ r4p49)-l. 0F...... .Gl ls'3'1. .. i !!...c Allp iration for 11ispos al Works Tonstrnrtinn Viermit Application is hereby made for a Permit to Construct (A or Repair ( ) an Individual Sewage Disposal S stem at: 4�4R 'n-be a ek� m.C, 0. ....k4...1,741q. ...........I r Lot No. "A Owner A d�re�ss� •-•�--•-----------=---------•-----•- ...�.... P C. .�!. .�.......:... ^........... Installer Address Type of Building Size Lot.............. _.'..Sq. feet U Dwelling—No. of Bedrooms................................ .Expansion Attic 440 Garbage Grinder Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixt res -•------•------•----••••• --------•---• . W Design Flow............. gallons per person day. Total daily flow........... _.. ___...._..._.____._.gallons. WSeptic Tank—Liquid capacity® ®_gallons Length -'.. _____ Width..... __._._._ Diameter________________ llepth__._........... x Disposal Trench—No..................... Width...... Total Length............. ...... Total leaching area....................sq. ft. Seepage Pit No........ ........... Diameter.....26.......... Depti elow inlet...Ez............... Total leaching area ®_�....sq. ft. Z Other Distribution box (�) Dosing gik yy Percolation Test Results Performed by-__. ..a. ........._eL _...l.__. '..¢.................. Date._____..__/Y�z. __ .., 0 ,.a Test Pit No. 1.._.__>�.___minutes per inch Depth of Test Pit____________________ Depth to ground water_____...... .__.. f1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------------•--••-•-•-•---•----.........-----...---•-•--•-----•-------••----••..............---- O Description of Soil................�.� ----- _..._... U ---------- •------------• -. ------------- - - - - - - -- .... - - ...._..- - W UNature of Repairs or Alterations—Answer when applicable................................................................................................ ----------------------••-----••----•-----------------------------..._.......--•---------...........--------------------------......-------------••----------•--• Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has b en issued rd of health. Sig . ... ....... ------••-- 1= = .. ✓ n Date Application Approved By..-'----. mod. --- . .... •-. 1 =t Date Application Disapproved for the following reasons-----------------------•--------•-------------------------------------------------------.._........------...... -•------•-----•-----•---...-•-----•---------•------•-----•------------------------------•---................................-----•---------•-•---•------------------------•-------------------••......... Date PermitNo................................................... ... Issued----.."1.....�-- --...--..................... Date No.......................... F>cls(,�.... .............. a �- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT .10)'7..1.............--..--.OF......�/..1'1�.`-1.!�..�...............................................�` ef Appliration for Disposal. Works Tonstrnr#iun ramit } Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at„ ..�� ./ dr : .� .....__ .....••_.� � S'..ce � l.. .. sA" f � 3�%. . .. .---•.-•--- . ... ... --•= ........... ..... ... Owner Ad re•s••-- a 61. ....................... ...._....___.__....._`..........._.............._.._........ ...... .............._ ....f1p.n.......................... Installer� Address �• Type of Building Size Lot��` � .-"".-Sq. feet Dwelling-'No. of Bedrooms....... ..................................... Attic ,( gip Garbage Grinder (A/a a'4 Other—Type of Building No. of persons............................ Showers YP g -•.......................... -------.P ( )� Cafeteria ( ) dOther fixWr�•------•..................•••-••-••.•--• -•-.-�••--•--------------•------;.._...............A Design Flow_._.--__.__.4/.................. .........gallons per person per day. Total daily flow........... u�___.........--....._gallons. WSeptic Tank—Liquid capacity----.--.•-•.gallons Length-••. ` ... Width....6._..__.. Diameter................ Depth.... x Disposal Trench—No. .................... Width-...y............. Total Length............#...... Total leaching area....................sq. ft. Seepage Pit No......... Diameter_____ _________ Dep 1 elow inlet...6............. Total leaching area.aa./_....sq. ft. Z Other Distribution box (�) Dosing tank v ,p Percolation Test Result ___ Performed by..._l�__.�._ __.! '!. '.� .l..../-.- ..�................... Date..........��/`/�_�_. .: �F..l , Test Pit No. i................minutes per inch Depth of Test it........ ....._... Depth to ground water...._.............._•__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.-----_................. a ........... •. . Descriptionof Soil.................•_...... ----�•-------•--•----•-•---•---•--••------------------------.-----------•-•-•----------••----------------------------------- W UNature of Repairs or Alterations X Answer when applicable............................................................................................... ,r v ....................................................................................................................................................................................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TTT`' p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has,be-n issue-the• d of health. ig .� `1 Date Application Approved By—.-., � • ••-•••-•••••-------------= ..--•--- . _ _ / �_ Application Disapproved for the following reasons:'-....°'-::`... ..................................................................... ........................................................ •--•-------------------••--------------......----------•----:.--------------•---------•---•---••----------••-••••--•......---••••-•••..._...._ r Date P = -. , , S•.:. �.," Issued........................................................ Permit No......••--••••••-- , y . Date t THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH O F... rz�ifir a n rr rlt�anre T IS IS :0 CERTIFY, That the Individual Sewage Disposal System constructed 4.-t or Repaired ( ) -------------•----------.-;---------•----•-•----•-- _: .............:........_. by �... ........ j ) ��' lj� f Installer 0 _ � ;- has been cost 1 in arl. i; ccordance with t11e p ovisions of j of The Sta >fiitar`y Cade gs�deScfib� in the application for Disposal Works Construction Permit t �_ __.y-tE --_-_•--•.--.__--•••• dated___ ._____�_ _N .J_--_--•-•-____---- THE ISSUANCE OF THIS CERTIFICATE SH NOT CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................•-••-•-----.....-•-•----.............••-•........-----•--------• inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS _ ~ BOARD OF HEALTH FE ��- Disposal Works Tons#r ion rrmit Permission is hereby granted....... .••. -•-••.... . --..._•..... ...... -••••-•-••••••-••-•••...........:...•••••-••-----•-......••----........................-- to Cons��( ) or pair ( ) a ivi S , a e _ 6sal System atNo w �. .................... � y O'[��� Street as shown on tVappKcation for Disposal Works Construction Per it No.,................... Dated. ,2,A._;�,1.-,J-.....--.... DATE- _-•-•-- FORM 1255 HOBBS & WARREN, INC., PUBLISHERS r— 0 N �c/ZOGa �� 0 Fee-----yS_CTa' BOARD OF HEALTH V TOWN OF BARNSTABLE Application,forWell (Constructionpermit Application is hereby made for a permit to Cons ruct ( ), Alter ( ), or Repair (tX n individual Well at: `t 6 7 Address f� r Assessors Map and Parcel Owner ddress ---------------- ----------------------------------— — — ----— — Installer — Driller ,Address Type of Building Dwelling------------------------------------------------------- Other - Type of Building------------------------- No. of s Type of Well Capacity---- - - ------- -—— Purpose of Well Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate .of ompliance has been issued by the Board of Health. Signed�- ------- -- _ S ��oo---- date Application Approved By 2,4� i✓( �� date Application Disapproved for the following reasons: ----------- --- --------------------- --------------------------------- date Permit No. S_3 O -z-or/D - -- Issued------------------------------------- ------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired (-I by---- -/) A /-- -------------------------------------- � Installer. at—t '_ �4 /.�Lf.. j_. W&\/ M M -------------------------------------- — has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well r�o�tection Regulation as described in the application for Well Construction Permit No!!Z—?�2! Dated�{'z THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--_ _ —_ Inspector-----------_______— —_—_—___ No.-------------------- w -- Fee----- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVer[ Conotruct ion Permit Application is hereby made for Fit to Construct ( ), Alter ( ), or Repair (44n individual Well at: ocation Ad ress Assessors Map;and Parcel M ' C 4 ! (G {n —/ /lit G _�'—J—IJ_ /M1.l • /+4 . G Owner ddress _ Installer — D'ler Address �r [greem, ent: of Buildin�DwelliTng ?—----------- -------------------------------Other -type of Buildin -------------------------- No. of Persons-----------------------ofWell 4/ t4`' c-- -- - --- - Capacity-----------------se of Well- Q U"—c r f- c-- e undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of P ompliance has been issyd by the Board of Health. � Signed�- ---------------- � �---- J -�---------- I date Application Approved By -- date Application Disapproved for the following reasons:----------------- --- ---- � W date Z 5�_ Permit No. — -- Issued---` --3 --�� ---- ------------ date 'r'!:T:+:•iv��•.Ta!-eae:@aTi•:Tscs•r+:l:l:+�silisil:sre:lalrtireilrwrciTiairrerlrersititra�:sslrlali+sl:lsna::l:si+alil:s::rxilreiwliw@:w:.li@:liTin.aerlx�s:er.Ti�ava�u� BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate (Of (Compliance THIS IS TO CERTIFY', That the Individual Well Constructed ( ), Altered ( ), or Repaired (•') b --- Q� cc�.,..�. f Installer at --mac. c< .�— w rm�� — M 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�J— DatedS THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------- - -- Inspector--------- ---- —------ T:S:p S:dal:li9rRili@iB.itiRfiRilrT.FQi4li�i/iSiTiiiilr•HlitiT i?r9rTi•rlb4iliTila9rTiiSilLliKliRYli............... BOARD OF HEALTH TOWN OF BARNSTABLE Vell Contruct ion Permit No. --- --- Fee -- Permission is hereby granted /0•A LIZ to Construct ( ), Alter ( ); or Repair ( 4-f"an Individual Well at: No. — 9 Street as shown on the application for a Well Construction Permit d No.-- (� ?ifl't/7J - 2 ____—_—_- Dated----5 '—- � ---- --------------------- DATE Board of Health � � 4 G i i 10 ck i i { i f a 1 5 i } ' 1 i r i. ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 449 Rte.130 Sandwrcb, MA 02963 908(888-6460) 1-800 339-6460 FAX(508)888-6446 CLIENT. Mr. Callahan LOCATION: 9.Mathews Way ADDRESS: 9 Mathews Way' Marstons Mills, MA 02648 Marstons Mills, MA 02648 COLLECTED BY. DA Scannell SAMPLE DATE. 2/25/2000 SAMPLE TIME. 2:OOPM WATER SAMPLE TYPE: New Well DATE RECEIVED: 2/25/2000 LAB I.D. #: 0002268 WELL SPECS.: 75` RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 2/25/2000 pH pH units 6.5-8.5 5.73 4500 H+ 2/25/2000 Conductance umhos/cm 500 55 120.1 2/25/2000 Nitrate-N mg/L 10.0 0.055 300.0 2/25/2000 Sodium mg/L 28.0 6.2 200.7 2/28/2000 Iron mg/L 6.3 < 0.005 200.7 2/28/2000 Manganese mg/L 0.05 < 0.001 200.7 2/28/2000 COMMENTS: Low pH indicates high corrosive characteristics. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date VRaid J. Sa " Laboratory it ctor <=less than >=greater than TNTC=too numerous to count dd Mq y-0 Department of Environmental Management/Division of Water Resources #WELL COMPLETION REPORT �'v p 0 WELL LOCATION GEOGRAPHIC DESCRIPTION Address C c• 80 L w o N S of � q• /l>t u MI,-�� (feet) (circle City/Town /�V's S M,(/S ` tM C.{r A c..v s �� Well owner M Co //,/ (road) Address 5 �" f~ `1 C•v r^'"� N S E W of (mi.in tenths) (circle) Board of Health permit obtained: yes ❑ no ❑ intersect. w/ �cw/rH n� (toed) WELL USE WELL DATA Domestic E�Public❑ Industrial ❑ Total well depth 7S ft. Monitoring❑ Other Depth to bedrock ft. Water-bearing rock/unconsolidated material: Method drilled (.tu Ge� �( coo ,/�S /o� Description /1^ c Date drilled f ( Water-bearing zones: CASING 1) From To Type SG `<� ✓)�G 2) From To Length ft. Dia(I.D.) 4 in. 3) From To Length into bedrock ft. Gravel pack well: dia. Protective well seal: dia. Screen: Grout ❑ Other Slot#�_length 3 ' from Z to 7 5S STATIC WATER LEVEL (all wells) Static water level below land surface 60 ft. Date— WELL TEST(production wells) ) Drawdown ft. after pumping 3 hr. min. at gpm How measured r-O Recovery <IG'ft after_ hr.—min.- LOG of FORMATIONS COMMENTS 0 Materials From To l` / N c a Driller A Sk4 rv� /� ;_ n Goa--e © Go Firm /Q14 9c, r d Address /Oo 6.,. L& c /,C' City/Town o a G Y LU n, SJ Supervising Driller Reg.# Signature of supervising registered well driller Please print firmly BOARD OF HEALTH COPY A ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AF , 12 DEPARTMENT OF ENVIRONMENTAL P CTION 1 ONE WINTER STREET, BOSTON. MA 02108 617-2 _Q®00 VO rp < W WILLIAM F.WELD �"O,r �9 . UDY CORE Governor al�jy Secretary ARGEO PAUL CELLUCCI ID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR7N Commissioner PART A CERTIFICATION Property Address: 9 Matthew Way, Marstons MillMdress of Owner: Richard Lindau Date of Inspection: /®—/d_(1 7 (If different) Name of Inspector: Wm E Robinson Sr I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Service Mailing.Address: PO Box 1089 , Cent-ervi 11 ar MA 02632 Telephone Number- 5 0 8 Y 7 7 c,_R 7 7 6 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 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: 1/ Passes _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails n Inspector's Signature: ` Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] YSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indica a 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 j 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 metal, 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 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep e'j Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 9 Mathew Way, .Marstons Mills Owner: Lindau Date of Inspection: 10 -0&f- 1 B] SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C] FORT R EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Co ditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the pub is health, safety and the environment. 1) SYS EM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WH CH 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) SY TEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT T E SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE NVIRONMENT: The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system.has a septic tank and soil absorption system and the SAS 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 presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) THEIR (revised 04/25/97) Page 2 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: g Mathew Way, Marstons Mills Owner: i ndau Date of Inspection: L D] SYSTEM FAILS: You t indicate ei;,,er "Yes" or "No" as to each of the following: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis f this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct th failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 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 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 I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,"volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LA GE SYSTEM FAILS: You ust indurate either "Yes" or "No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: 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: j 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 re uirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 9 Mathew Way, Marstons Mills Owner: Li ndau Date of Inspection: ,a Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following: Yes No e/ _ Pumping information was provided by the owner, occupant, or Board of Health. 't✓ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. V _ The site was inspected for signs of breakout. ✓ _ All system components, excluding the Soil Absorption System, have been located on the site. 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. The size and location of,°he Soil Absorption System on the site has been determined based on: _ The facility ownerltand occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. _ Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM t PART C SYSTEM INFORMATION Property Address: 9 Mathew Way, Marstons Mills Owner: Lindau Date of Inspection: FLOW CONDITIONS RESIDENTIAL: Design flow:3?D g.p.d./bedroom for S.A.S. Number of bedrooms:_ Number of current residents:A� . Garbage grinder (yes Laundry connected to system (yes or no): n-d Seasonal use (yes or no):_ Water meter readings, if available (last two (2) year usage (gpd): N/A well water Sump Pump (yes or no):14-6 Last date of occupancy: CO MERCIAUINDUSTRIAL: Type establishment: Design f w: gallons/day Grease tr present: (yes or no)_ Industrial aste Holding Tank present: (yes or no)_ Non-sanita waste discharged to the Title 5 system: (yes or no)_ Water me r readings, if available: Last dat of occupancy: OTHER (Describe) Last d occupancy: GENERAL INFORMATION PUMPING RECORDS an source of information: System puWped as part of inspection: (yes or no)_ If yes, volume pumped: gallons 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) I/A Technology etc. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: 6 47R S Sewage odors detected when arriving at the site: (yes or no)�i v (revised 04/25197) Page 5 0f 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Mathew Way, Marstons Mills Owner: Lindau Date of Inspection: �b��^Q•� BU WING SEWER: (Loca on site plan) Depth low grade: Material f construction: _cast iron _40 PVC _other (explain) Distant from private water supply well or suction line , Diame r Com ts: (condition of joints, venting, evidence of leakage, etc.) SEPTIC TANK: (locate on Cite plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age _ Is age confirmed by Certificate of Compliance _(Yes/No) c � t Dimensions: 16 Sludge depth: '`/'=a' Distance from top of sludge to bottom of outlet tee or bafflel�l Scum thickness: V—G , t Distance from top of scum to top of outlet tee or baffle:_ , J Distance from bottom of scum to bottom of outlet tee or baffle: /b How dimensions were determined: �— Comments: (recommendation for pumping, condition o inlet and outlet tees or baffles, d th of liquidlevel in relation to outlet invert, structural integrity, evidence of leakage, etc..). D �$ t/'�t� 7 w ec a. GREAS TRAP: (locate o site plan) Depth low grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene -other(explain) Dimensio s: Scum chic ess: Distance fr m top of scum to top of outlet tee or baffle: Distance fr m bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comment . (recomm dation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural Y integrity, vidence of leakage, etc.) (revised 04/25/97) Page 6 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) -Property Address: 9 Mathew Way, Marstons Mills Owner: Lindau Date of Inspection: .16_16 TI TOR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate n site plan) Depth low grade: Material f construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimen5 ns: Capaci gallons Design low: gallons/day Alarm le el: Alarm in working order_Yes; _ No Date of pr vious pumping: Comments (condition f inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and,distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) r PUMP CH MBER:_ (locate on site plan) Pumps ' working order: (Yes or No) Alarms ' working order (Yes or No) Commen (note con it of pump chamber, condition of pumps and appurtenances, etc.) (revised 04/25/97) Page 7 of 10 " v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Mathew WaY, Marstons Mills Owner: Lindau Date of Inspection: 66 r6 d^ 4 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation not required, .but may be approximated by non-intrusive methods) If not determined to be present, explain: Type. PIe ev leaching pits, number: 4 leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, vel of ondigg, conditi of vegetation, etc.) �d d! / d� �/�.�ul� �/.� .d�sZ i►-s' J� CESSPOOLS: (loca on site plan) Number nd configuration: Depth-to of liquid to inlet invert: Depth of olids layer: Depth of s um layer: Dimension of cesspool: Materials construction: Indication f groundwater: i flow (cesspool must be pumped as part of inspection) Comme ts: (note ndition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on s to plan) Materials o construction: Dimensions: Depth of s lids Comment : (note co ition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc. (reviaad 04/25/97) Page a of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: g Mathew Way, Marstons Mills Owner: Lindau Date of Inspection: —)6 S ,J 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) �1 W): 0', � 3 v (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 9 Mathew Way, Marstons Mills Owner: Lindau Date of Inspection: /0-/6--9 '7 Jd Depth to Groundwater M-� Feet 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 conditions/ Check with local Board of health L/Check FEMA Maps Check pumping records Check local excavators, installers ✓ Use USGS Data Describe in yo r own words how you established the Hi h Groundwater Elevation. (Must be completed) 136 , )L5 / /,� /y3 j (revised 04/25/97) Page 10 of 10 Cates T,e uG r/o^1 t J _ w /O '( jq ,V- i /,p A,� 1 0 . Ziog i ,. .,gam y - a !y.,. 4 {, f h / .,a f'o n c°' L.o• a • y ►� 9 / o y �j�, ;" 4 ►� of O-Tr ScVetoof fir:op - }i 1 t I' M .r' Y ZN OFM4 `K Of A#'44 1. VA FRANK o FRANK rn J.•. 1 . o CONERY - A. CONERY 6 No s�3 0 G No. 6232 ST - - -- - t r vso A,JA 7- r�r w- .4 y-� o .. PA N of LAIN ,5, �,,� 4 eV -ST"A AJ.Z MASS. ow'NED BY FRANK CONERY 5 T•RENTON ST - NIS. MASS. 02601 • . Rf.ojssVRea ENGINEER a LAND SUAVEYtAt } SCALE s IN -j4F'r• /q $ 4 - a