Loading...
HomeMy WebLinkAbout0059 SANTUIT-NEWTOWN ROAD - Health 59 SANTUIT-NEWTOWN A= 031003.003 I No. t j1 (9'0(1s 00-5 Fee ' -I� - 0 BOARD OF HEALTH TOWN OF BARNSTABLE ZippYicatiou -for Yell ugtructiou Permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: hewiLo c4,4 Lo 1 3 k y 3) Locat n-Address Assessors Map and Parcel Lj Owner j Address Installer-Dr+ Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 0 I` PV c- Capacity \O r F M Purpose of Well Agreement: r"Cc`-�k -+�-}�`ci-ct- The undersigned agrees to install the afore described individual well in accordance with the provisions of the Town of Barnstable Board of Health Private Wel4ha- on Regulation-The undersigned further agrees not to place the well in operation until a Certificate o p ' en�isss`ued*by the Board of Health. Signed / 2 . ; r Date, Application Approved By ✓ Dad Application Disapproved for the following reasons: Date Permit Noo 02® "1. d Issued ^T / Date --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Comp' "cc THIS IS TO CERTIFY,that the i ividual well Constructed Altered( ), or Repaired( ) by Instt/aller _ at JA.h 4k I f k1 w t jN/� has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector --------------------- --- No. (_A)O�V C V`r 06 Fee �1 BOARD OF HEALTH TOWN OF BARNSTABLE ZIppYicatiou -for Yell 66n5tructiou Permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: Locat}on-Address Assessors Map and Parcel / J i Y 656L1 'S 5AavTu�I MetA)f Jn 1"iry.24-0n.a Owner / ,q( ( Address l4nyyIn ,Y-N 12e1, Installer-Driller / Address 3/ Type of Building / Dwelling y/ Other-Type of Building No. of Persons Type of Well 011 C_ Capacity li Purpose of Well �u 1�;i , ?V C,, Agreement: 'Cc`-c 1CLC Q(-x1 0-n The undersigned agrees to install the afore described 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 �omplfa}}nce h /bl n issued by the Board of Health. Signed >-l��^ v y Date/ I Application Approved By / 1 l Y`� �,.- P/5 3/S 1 Dat el Application Disapproved for the following reasons: Date Permit Nol ;�,O 1 Do� Issued 73 /7 Date -®-e..--.>000e>see P_P--..-.._ba.00e-+---e-e mo+m..meo..rs-o Qs-esm-•eeoe.'-e-ee-a.e-e-o_e a..-e®eee-4e---oseo-o<e..-oe BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compl".artce THIS IS TO CERTIFY,that the i�n jividual well Constructed Q,,), Altered( ), or Repaired( ) by C�, j Installer i at / 1 Gt h K I /V 1(.0 i y �iV has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. n Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE Vern cou5tructiou permit No. Wc)o "[ —�d 5 Fee 1- 1Zi Permission is hereby granted to � ' � � , .� 1A L2 -Installer to Construct(�, Alter( ), or Repair( an individual well at: t No. �` G'J <�4 ru / &/L lit)ty 60 h rJ , Street as shown on the application for a Well Construction Permit No. Dated y�, Date 7 I/ Approved By ) ivy /,/ �I K� - ---- . 00 A • i I, nl 4 -0 � I/t/K � it I Lo-d y; 10CH­ X�p�S�n P o 0�b b - r . , p ate N ® 50 s f � ��3 Z,`ova - S� � ��•� �,�.. .� ' �� • " �.. /SU ` F'�?��n/T 30 !/ S�1S og 0�0, SET/3A OF M4ss� V\SE • FFs �a SIaNAt- 0/56 ` .8 S '? r.� Vt/ VJ { LEGEND LOT PLAN J EXISTING SPOT ELEVATIO�o CERTIFIED P Ox0 r` . f ' �,.: EXISTING CONTOUR 0 LET 3 -7 - n/. •�, �- rz ; . FINISHED SPOT ELEVATION ''""'`'`� FINISHED CONTOUR 0 ELDRE � -- !a y IN APPROVED BOARD OF HEALTH suo� DATE AGENT SCALE, / �= 40 DATE , 47&.re-V32/E/z �LDREDGE ENGINEERING CO. IN CLIENT I CERTIFY THAT THE PROPOSED EGISTEREDI REGISTERED JOB N0.8Z 0 77 BUILDING SHOWN ON THIS PLAN CIVIL LAND ' CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY• OF BARNSTABLE , MASS. 712• MAIN STREET CH.. BY' ,2 , B ,E . il HYANN I S, MASS. z. 14 h� f gWF'FT OF __ hAT'F RFR- I ANh- SIIRVFYAR Commonwealth of Massachusetts ' REMOVED Executive Office of Environmental Affairs Department of MAR ? 6 1995 Environmental Protection HEALTH Dr:OF EA>,;�� TM William F.Weld Governor Trudy Coxe Secretary,EOEA / David B. Struhs �✓� Commissioner Scn✓ ,,, N C SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A ` CERTIFICATION rifle's C _1 Property Address: 59 tw�tow,� t� Aesron, r` k� j Address of Owner: Date of Inspection: h4mii J.'3i tgSb (If different) Name of Inspector: 1B V-v Ct- a 1� Company Name, Address and Telephone Number: sho%_J%, cow, 8 T��r`a ST, CERTIFICATION STATEMENT' (3 c I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate end 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: Passes _ Conditionally Passes _ Needs Further Eva'.uation By the Local Approving Authority _ Fails Inspector's Signature: // Date: IVI)IaClf a 31 )q Ww4 . ;l Va,C,&/ 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 systen 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: 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. B) SYSTEM CONDITIONALLY PASSES: One or more system components. need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) _ The septic tank is metal, 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. 1 (revised 8/15/95) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 Printed on Recycled Psper IF I ECTI N FORM UBSURFACE SEWAGE DISPOSAL SYSTEM INSP Q PART A CERTIFICATION (continued) l�ewTow.1�- Nll�2sions r1,IL; Property Address: 5"9 �. Owner: �A4 Date of Inspection: tkA'-C ti a 3)Lc�OiL B) SYSTEM CONDITIONALLY PASSES (continued) _ Sewage backup or breakout or high static water level observed in the distribution box is due to broken or°oval of he pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with app Board of Health): 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) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. TH DETERMINES 1) SYSTEM WILL PASS UNLESS BOARD Of HEAL HEALTH AND SAFETY ANDHTHEAT TENE SYSTEM 15 NOT FUNCTIONING IN A MANNER ENVIRONMENT: WHICH WILL PROTECT _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD MANONEREALTH (AND THAT PROTECTBLIC WATER SUPPLIER, IF APPROPRIATE)THE PUBLIC HEALTH AND SAFETY AND THEERMINES THAT THE SYSTEM IS FUNCTIONING IN A ENVIRONMENT: _ 1he system has a septic tanK anti soli absorption system and IS wltnUl 100 feet to a Surface water Supply GI hi"ial"y tv a surface water supply. _ The system ha, a septic tank and soil absorption system and is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: asis Iha ve determined that the system violates one or more of the following failure criteria �eterminne defined l n 310 il^ c wh t wlbe necessary to orrect for this determination is identified below. The Board of Health should be contacted to d the failure. _ 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. Z (revised 8/15/95) ti y ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: Owner: C��r�e� Cro ado y Date of Inspection: DJ SYSTEM FAILS (continued): Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). 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] LARGE SYSTEM FAILS: The following criteria apply to!large systems in addition to the criteria above: The design flow of system is 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: 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 11 of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. • (revised 8/15/95) 3 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: ` 5q uew'lo,,,.. ktol. N1r ,To 1�l ,t�s Owner: Ch(i�`es C^oab� Date of Inspection: Nrc%A as)1c'i.S� Check if the following have been done: Z�Pumping information was requested of the owner, occupant, and Board of Health. 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. NI As'built plans have been obtained and examined. Note if they are not available with N/A. Z/The facility or dwelling was inspected for signs of sewage back-up. ✓The system does not receive non-sanitary or industrial waste flow the site was inspected for signs of breakout. All system components, ex4wd4ag the Soil Absorption System, have been located on the site. Z�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. Z—The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. Zhe facility uv.ui: iand occupants, if different from owner) were provided with information on the proper maintenance of Sub- Surface Disposal System. • 4 (revised 8/15/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: S9 kl'A Owner: GnR(Aej CrM4� Date of Inspection: knI�r~ a3,���6 FLOW CONDITIONS RESIDENTIAL: Design flow: 330 Rallons Number of bedrooms: 3 r Number of current residents:J Garbage grinder(yes or no): /✓0 Laundry connected to system (yes or no): Seasonal use (yes or no): NO Water meter readings, if available: IVC-1/ Last date of occupancy: On 6v 5 COMMERCIAUINDUSTRIAL: ` Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: Last date of occupancy: OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped 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 mow" Shared system (yes or no) (if yes, attach previous inspection records, if any) Other(explain) APPROXIMATE AGE of all components, date installed (if known) and source of information: I C/��/ /F2 /Ge% 4eC01?0s htiecH-Iig6 Sewage odors detected when arriving at the site: (yes or no) do (revised 8/15/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: C V\Ae) Cr s. Date of Inspection: SEPTIC TANK:_ (locate on site plan) Depth below grade: 8 Material of construction: concrete _metal _FRP =other(exp'lain) Dimensions: C 6" X, g1 /o" x S 27" Sludge depth: O Distance from top of sludge to bottom of outlet tee or baffle: ✓y//I Scum thickness: Distance from top of scum to top of outlet tee or baffle: iv dd Distance from bottom of scum to bottom of outlet tee or ber affl Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP:_ (locate on site plan) Depth below grade: Material of construction: concrete _metal _FRP —other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of cram te, bottom of outlet tee or baffle Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) W (revised 8/15/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: E9 Owner: C.�\q'Aej Date of Inspection: �1grc.i�t a 3t��.S6 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: Material of construction: _concrete _metal _FRP —other(explain) Dimensions: Capacity: Rallons Design flow: gallons/day Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ (locate on site plan) Depth of liquid level above outlet invert: ':aT4 Comments: - II (note if level and distribution is equa!, evidence of solids carryover, evidence of leakage into or out of box, etc.) DijJ. L x i codo'Sh/3PC PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 8/15/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 5 N e"'�`"„'('�p� t A. Owner: C\r\RAe> cm,1 Date of Inspection: r\Areh &Ij\c:�17 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: ptn� rt�orv` �:�t•� To (�.\�S t`��� S&C)'�e yC leaching pits, number:' _ - _ \ leaching chambers, number:_ t.v\ e-` thew l �n t, Rl�e t�• leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) 0 t 't ' S — V �`v 2 e �c 1, `O P. ` w, 41 CESSPOOLS: — (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: (locate on site plan) Dimensions: Materials of construction: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 8/15/95) 8 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: C�tar\ea cmob,y Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' N2w\ow \C cF)3 t.� e�` d.z e-OSe o* Rot% i Ts, o r,"'Vritri � 3 Lt3' ewe: 1 , ti8 New ��1 6� DEPTH TO GROUNDWATER , Depth to groundwater: b0"r feet method of determination or approximation:h •S G•S ' (revised 8/15/95) 9 • N �� 'tip ��• �� v �"1' f5 ` 6601Dj'-)-70WN OF BARNSTABLE LOCATION w SEWAGE # ®9� VILLAGE,A)WArldnJ J)i f ASSESSOR'S MAP &LOT 6 3 r INSTALLER'S NAME&PHONE NO.V 02.®0+1 Q wtA VJ q a 8-,T6 L/O SEPTIC TANK CAPACITY 400 O G/a'� j LEACHING FACILrrY: (type) �l�r/dJ ��/I (size) UZ�" y l //1 v, c3,1S%alt. NO,OF BEDROOMS '3 I BUILDER OR OWNER e rx &J Croab o / PERMIT DATE: h A�er tF at`g'b COMPLIANCE DATE:J J Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by G 3q 43 JJ�w`t �► Cx�o1 Cw.J�'1 ►�L- 56 �'x;1 j�.� S� , IV" x W. AS�S/E��S/S1ORS MAP N0.,0�I PARCEL �V �� 3. ® Fee THE COMMONWEALTH OF MASSACHUSETT PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSAC USETTS ZippYtcation for Mtgpo.5a1,*patent Con!5tructton Vermtt Application is hereby made for a Permit to Construct( )or Repair(V 1 an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. Chr�2�Y, crujt- Installer's Name,Address,and Tel.No. [� Designer's Name,Address and Tel.No. c co �7/cal /SIR iJ/1 SJ 9 ,1✓t//1J Type of Building: Dwelling No.of Bedrooms Garbage Grinder(A10) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil Nature of Repairs or Alterations(Answer when applicable) Q-, 4`?;► t ,"A 3'Akld.t STv ►e 17 r 1 t sl61 —ASiD 'C' 1A A1101,.;1n oo °o e1 SiQ 1 AADPPT­ 14 r\ 2eCu21 a .eb'- E1 e. C CPri, Co. 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 issu by this Po of He It Signed Date O / c0 Application Approved by Application Disapproved for the following reasons Permit No. % L5 ` l Date Issued �. ———————————-—-——————— ———————————————— /USETTS e �• THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLEs MASSAC 2pplication for Miopozal *p$tem Cons&uction Permit Application is hereby made for Permit to Construct( )or Repair(P<an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. v 1 N@w-T—olv.n'QOINa - Nna-SToni Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. G020or��L u�P�s 9,\8- s6yo L' %oiz,oy C'nJ%nrerL,,j co, Type of Building:-- Dwelling Dwelling No.of Bedrooms - Garbage Grinder(No) Other Type of Building No. of Persons Showers( ) Cafeteria( " Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil - i it Nature of Repairs or Alterations(Answer when applicable) Q�p 4/1 T(-,_A 3 -�\��� Sion - AS per 13IAg 0010 C-J0An sioh, 11�Al9AT�- 9/61/8y —� 'R- al 2eco2.o -bony y Elcsaiole E-,(\ fro. Date last inspected: Agreement: The undersigned agrees to ensure the construction anO 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 issu#by this P Z of He 1 / Signed Date O D Application Approved by � Application Disapproved for the following reasons r Permit No. 9LA' . � - Date Issued --- -.--�-��� v ---.------.'.--.--.- ------------c------- -- +— r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or repaired/replaced by 95 A for as has been constrtts ted in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. r dated_1!2F,"V;70 3 Use of this system is conditioned on compliance with the provisions set forth below: 11 c,7f14 f� No. Fee I r THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS I=ig;po!6a[ *p5tem Construction Permit Permission is hereby granted to U0 kZ 0",- j M U S Ili to construct( )repair(j/fan On-site Sewage Syste located at /S/PwToc.,n - J' lTdn1 /t?i/ 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. All construction must.be completed within two years of the date below. 97 Date: s7 Approved b<_4&!k4Z 1 3 ti (� U -_ l J (J� �- Vjff A--'T Al n� IOC X - pox 0� �1b W /5 U f" � n/Tip. 3 �►` o o SET/3Ac k - � w tN OF MAS i o abRSE v . � �NGip i 1 O • Ul FFSSIONA\-�a s LEGEND . oa'" .,. F ! EXISTING SPOT ELEVATIO� Ox0 CERTIFIED PLOT PLAN Y EXISTING CONTOUR -- 0 -- - `�; : ; �� T 3 . f��i� n/' �r�,',:....� n' FINISHED SPOT ELEVATION `'` ``''� �' FINISHED CONTOUR 0 BRUC[ � �f� %� 4% � ?�%''_ Al'/ ' � s' JI�R N ELURE 1 a IN APPROVED , BOARD . OF HEALTH /sT� Off` ��l di�`��•��:J��,�� /�1��� :. DATE AGENT SCALE= / �40 DATE', 9�.z0 "?<7 LDREDGE ENGINEERING CO. !N �32 - CLIENT I CERTIFY THAT THE PROPOSED EGISTERE REGISTERED " ' JOB N0.810 77 BUILDING SHOWN ON .THI'S PLAN ' CIVIL LAND ' CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY �'' OF 'BARNSTABLE , MASS. 712- MAIN STREET CH. BY: ELL s, H YA N N I S, MASS. �; z &AE-��f - ' .-� - SHEET— OF _. . REG. LANDy,SURVEYOR No........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H LTH 1 .d4...................OF_�&—�o o6l-(----------------------------------- Appliration for Utgpaoal Workii Towitrurtion ramit `0 Application is hereby made for a Permit to Construct ( 4"or Repair an Individual Sewage Disposal System at #... ... ......... ........ ... . ............ - ------------------------------------------------------ .,ati.n s or lo./ ........ .......7? ..Cl ... .................................. . .. .............. owner Address f4 .................................. ....... ------- -----b-M.. ...................................................................... Installer Address Type of Building Size Lot..40).-705.....Sq. feet Dwelling—No. of Bedrooms.... Expansion Attic Garbage Grinder (njD ----------------------------- (r%o Other—Type of Building ............................ No. of persons............................ Showers Cafeteria 04 04 Other f=Uw-es ................................................................................................. low...........6..s Design F ....................gallons per person per day. Total daily flow___.... ...........gallons. 1:4 Septic Tank—Liquid capacitylpPo.gallons Length................ Width....._.._._..... Diameter___..........._. Depth.....__......... Disposal Trench—No. .................... Width.........._..__._... Total Length....._.............. Total leaching area....................sq. f t. Seepage Pit No..................... Diameter......_..__._....... Depth below inlet.._................. Total leaching area..................sq. f t. Z Other Distribution box ( ) Dosing t ( ), Percolation Test Results Performed by .... �40n_C.<Cb!5 Date....._.(. . ------ Test Pit No. nutes per inch Depth of Yest Pit.- .... Depth- ground waten. /7 ..............mutes utes per inch Depth of Test Pit_................. Depth to ground f34 Test Pit N, water......__............_............... ..........Z........ ;4.oj....... * --------------------------------------------------------------------------------- 0 Description of Soil.... =..q............... . ..................................................... It lk ............................... .... U ........... ..................................................... ......................................................................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable.............................................................................................. .......................................................I................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL I`IU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by Aboard of heal i ned. ... ... .. ....... IYI............................ -Ax//,J10; D ApplicationApproved By........... ................... .......................... re at ----------- Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Ljo Date Permit No........ ...... ..492.9=�- 103-----A ........................ . q Issued ... .............. ............. Date --------------------------------------------------------------- -------------------------------------------------- --------- Nod .--' ( F>l THE COMMONWEALTH OF MASSACHUSETTS BOARD OF H ALTH '/ _ ,.� Appliration for Dispniittl Works Tonstrur#ion ramit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at � -.• -- �- .. ..17 _.�. ........ -• • . .. Location dress sue' or t No. P .......... .� ' - r'.r -- !✓b..... i� 3........... •. _..���....... nil.�'" 1.. .... -......•• Owner Address a .: .. . _C .10 ------ ...--------------------------------------------------------------------- Installer Address U Type of Building "� Size LotQ ____..Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic tNQ Garbage Grinder (6)& `4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other es ......................................•-- .......................................................... ------------•--------------------- ------- .... W Design Flow.......... . -.............................gallons per person per day. Total daily flow.._... . ..........................gallons. WSeptic Tank—Liquid capacity! W0._gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing,,ta'0 Percolation Test Results Performed by._.....J. __ P"J _... __.$� �"! Date____ _��'�.._. _____.. 0-4 1.4 Test Pit No. I. .. ....._ 'nutes per inch Depth of est Pit_.__ _. I...__ Depth ground water_.._ . � , - GzI Test Pit No. ................n nutes per inch Depth.of Test Pit__�__..........._.. Depth to ground water........................ p4oc Descri Description of Soil .. 4 ...._s _ &3! �.. � gj --------------------------x �. W V 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 TITa 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued byA board of hea h. ned- ............................... 1, l_. .`�._..... Application Approved B a.....' at:_ p i2uK ^_______________ ( __ Date Application Disapproved for the following reasons---------------------------------•---------------------------------------------------------------••------•....-- ................................•••••---•......_.....•-.................................................. Date Permit No... _` .............. - Issued..................•--------•-......._.... ------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH j ,�" 140 ....................OF....(1A. n 15...4.61-e............................. Turrtifiratp of Tomplittnre S IS TO RTIFY That the Individual Sewage Disposal System constructed or Repaired ( ) ------------ ' Installer has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No....._- ..` ._�W ted_._.._._.__.................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL PJINCTION SATISFACTORY. DATE.......... ........................................... Inspector ....... E THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. OF... ....................................... Oly 0. ` N ................ FEE:_5.0 .. .. �i���a� nrk� lan��r trait .rrnt # �1 P Permission is ereby granted........ ........ • ------------••----•-•-------••......••----•-••......---••-•--•••••••. to Const ct or Repair ( ) i ndivi rgall Se gage Dis�psal ystem atNo.. ........................................ PP P... i iF it Street <WC4 as shown on the application for Disposal Works Construct: -e o"._ ;9_� D c.&!KC-;.. ............:__:.---:.---. Board of Health DATE �� z FORM 1255 A. M. SULKIN, INC., BOSTON 3 l 4 0 7- 3 v� G V^ � Z-o R� S10 x.. I /v� p0z L y3 yy J�q - f s v fa canVTB� 30���'s/�S I � 1Y �J QQ I Ajj t �, v 1 1lVI6RSE o, ,p No.10�i51 011 0 '3 JJ � v LEGEND oa'" EXISTING SPOT ELEVATIO Ox0 CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 -- - L 3 FINISHED SPOT ELEVATION �(� 1" OT 7:_! --n/:.. rr.. .,•�. �z,� FINISHED CONTOUR 0 oHucc / !.�► k.� 1 J/�'J= ->/4 _-- ELDR v IN APPROVED s BOARD OF HEALTH ,sTe� DATE AGENT SCALE, / " 40 DATE S g DREDGE ENGINEERING CO. ING� `/32�E� CLIENT i CERTIFY ' THAT THE PROPOSED EGISTERE REGISTERED JOB NO.8g o 7 7 BUILDING SHOWN ON THIS PLAN CIVIL LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR OR.BY= OF BARNSTABLE, MASS. 712- MAIN STREET CH- BY HYANN I S, MASS. Z s` SHEET� OF _.:.. . A E REG. LAND SURVEYOR Number: 4168 Bottle # RR 24 Date: 1.0/1.1/84 04 BA s� BARNSTABLE COUNTY HEALTH DEPARTMENT SUPERIOR COURT HOUSE BARNSTABLE, MASSACHUSETTS 02630 o • Asa DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2311 EXT. 331 Client: ; Greenbriar Development Collector: Fred Clifford.'. Mailing- Address: = Box .510 Affiliation: well driller tr Centerville, MA 02632 Time & Date of Collection: r 10/9/84, 3:00 P.M. Telephone: Type of Supply: . ,--well water - Sample Location: Lot 3, Newtown Rd. , Well Depth: 73 ft. Marstons Mills, MA Date of Analysis: 10/10/84 PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 ml O 0 H Conductivity (micromhos/cm) 500.0 Iron m) 0.3 Nitrate-Nitrogen ( m) 10.0 Sodium ( m) a 20.0 I'. X Water sample meets the recommended limits for drinking of all' above tested parameters. II . Based only on results of the parameters tested for this sample, the water is .suitable for drinking but may present the problems checked below: ' A. Water 'sample has higher than average Tevels of Nitrate. Future monitoring is recommended (2-3 times per' year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water may present aesthetic problems (taste:, odor, staining) due to D. Water' sample has h-igh levels of sodium: Persons on -low sodium diets should consult' their doctor. - Due to one or more of the reasons checked below, this water sample is unfit for human consumption: A. High Bacteria B. High Nitrates REMARKS: J ' CC: Barnstable Board of Health / p CC: Clifford Well Drilling (J� laboratffry Director 7/17/84 Explanation of Test,Results' „ Total Coliform Bacteria " t Coliform bacteria are an indicator of the sanitary quality of a water supply', Water supplies may become, contaminated:from'malfunctioning septic systems,cesspools and surface runoff. A total coliform.count of zero.' indicates that your water supply is safe and approved for human consumption. A total coliform'count of greater than zero is most often the_ result of accidental contamination of the sample bottle through_improper sampling methods.-For this reason, it ,would be advisable to retest any well.water that is not approved: _ J. pH is the measure of acidity or alkalinity of the water. On the pH scale,the number 7 is neutral, less than 7 is acidic and more than 7 is alkaline. The pH of water on Cape Cod tends to.be acidic in,the range of.5:0 to 6.3 Conductivity Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos'cm are generally considered unacceptable and may have a laxative effect upon users. . iron The presence of iron in water in concentration of .3 ppm or.greater may: give the water a bittersweet astringent taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain. The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may cause the-problems listed above, it is not considered deleterious to health.. Iron may be removed by use of an iron removal system. Nitrate-nitrogen • s, The Massachusetts Drinking Water:Regulations have set a maximum.contaminant level for nitrates it.10 ppm. Excessive concentrations may cause methemoglobinemia (an infant disea'se)`and have been,suggested'to. form,potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial . wastes. Copper v Due•to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not present a health hazard; however, concentrations in,excess of 1.-0 ppm.may,cause A metallic taste and/or a - bluish green.stain,on porcelain fixtures. Sodium . A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the , water supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm indicate that there may be ocean water or road salt runoff water vetting into the well; Massachusetts Water Resources Commission/Division of Water Resource`s WATER WELL COMPLETION REPORT l WELL LOCATION Address Of 1 LJ 2 CA- City/Town MA-fZ S Voan S Mil S G.S.Quadrangle Map - Grid Location Address�QX .S 1-0 C 9-i1 tad+ 1 e ©IM 3 WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From To Rotary(type) AQ -r Cable ❑ 2) From To Other 3) From To 4) From To CASING Depth to Bedrock Length 7© Diameter a Type r UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium❑ coarseK Date measured Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: Slot* 1� length 3 from�to73 Yes El No rRr Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours it GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To A. M /,SA.d I 3 DRILLER Firm CLIFFORD WELL DRILLING Address 65 Blue Rock Rnntq p City Registration No. 02 f perator s ignature Please print firmly 10M-W81.184843 /Y07E /F• E/7w—a 7Ne SEPT/C TANK OR ` 20 FT. M/N. GEi4C/tvG P/T ARE MORE 7"NAJV '/2"BELOW SNALL B.F BROU6NT TO 61�A DE.�AN ,F�1"Ti�A 4"PVC P/PE GONCR�FTE JyEAVy CA ST/RON CO{�ER Si/.4LL L3.E USED- M/N. P/TCN /F/N DR/VEyt/A Y EL, I b it' C04ER5 'PER FT. ' _ 2�r M/N. Co/VCRE"7'F A i o /_ G/�i4pE CO✓ER CLEAN SANG BAC.JCF/L.L Mile ew JAW. hCG P/PF / . o /N.P/TEN% QO D GAL D/ST. • • • . • beef e •,• ryASHEO S7nNE PER f'7: . SFPT/C TANK • • s . • • • • • •e . p set :..:_ • too DEPTl+/ • • • • • • . WASHED STGA(E • -_ _ � o • • . • • �•• 1 Aso • j // 3 x ! p /!3 i a.. • • • • • • • • p ••o PRECAST sAsw 'Jaz . s o • • • • • • • • s o P/70R EQl!/V 1AWR97 EL EVAT/ONS PiT c_A P A c� T y ¢9 D GA L�ph / ► I lNYERT AT Ot//LD/N6 9 8.0 FT. j < 3. 6-•T- A/AM. /NLET SEPT/C Ti4NK 97.0 FT, /z FT. O/i4i�9. C(SEA TAOI/L.4T/O/V, OUTLET SEPTIC TANK 9 G AFT /Nd.�7•D/STR/BIITJON SOX 95-•7 FT. GROUND xVATER TABLE i SEC7"/0/1 0F' OdTGETDJSTJ�/Bt/T/ONBOsX 9S.S.4W7 s o SEWAGE O1SP1 A L SYSTEM T NI I�/T T.LEA /NLE c Nt �_.f � 7' LATIDN L ZACH!/VG PIT . /ice i Je�LE /l~ o� OJMEM.F/ON A a �, f / D/r9LFJVS/ N �. I, D�FS/6/Y CRI TER A NllM6�ER D/�BEOROOJyS 3 - D/MENS/ON C_�._FT. � GARBAG.eD/SPOSAL 4VV/T NowE SOIL LOG TOTAL EST/M�rEO oj-o*/ 3 3 4SAL.1,DAv . DSO/L TEST .*/ SO/L T1cSTs*2 NU/NBER QF L,EAcmmr- a/T,S / Irl'LEY. 9 9 A54A OATS OF SO/L TEST 9 //`/�' S/DE LEACHJNG PL°R;P/T /-s/ SCE PT. r JgESIJLTS iVJTNESSED dY T a L 06FFo R r� BOTTOMLSACN/)/G.PERP/T -//3 $0. RT. PERCOAAT/OW MATEj*l MIAVINCH ' TOTAL LCACN/NG AREA - S FT. e' L n T 'T z4�¢ Q sv3 /L. PERGOLA /ON#VA7E 1�2 MJN1INCN 'REswmv,F LEACNI N6 AREA SQ. /=T. z o �� `�• S o r 7'0s T l' a aria 'a'as° OF n/C—+-✓-rOWAI .r<C> (H MSS M otu M � 7 3 T- 7U Cj q 1z S� c/ ROSERT �- o A / .4 Tz 5-To //S >, c BRUCE ELDRE u O MORSE H " A ,�mc 0. �o i�.DR ® �J�M 11l RdfI s !/IfC. r 9 FGrsTE WO MAIN NYANA//33,,MA fi Q4 O r. T prTE �D sum N. fi: /�ra. /�puntt � e /cou/�rre�A: �c- va,e� 9 AWFro } _4s7, - ' e �� ,. , :,.: <. t-r ..1,�.: .:,.. ,; -• '�,'' •G A''�is.,u..•r ,.. - ,.• } t.: xs.�` tea, _ r4 °-s;,s x , x > c '`-„.. '+�- ,..:+:t.' .}-.., -a...-..✓." td,..'... lea;:.. ,r,:_,.i, *i.1.. 3.,cr.•t 1 �^rtr,»Y . a v,,; wf - w"i ,".a c +.+Y,• q. ....x... t._q�.'