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Home My WebLink About0780 WAKEBY ROAD - Health 780 WAKEBY ROAD, MARSTONS MILLS A = 012 003.002 - -- --- - i -1 III r 10 jDepartment of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WEyLyL\\LOCATION Jam% Address / r r f t a �r� . . i� ✓1 Ciiy/Town/'04.�2 G^i^tln ]S 1I'YI r ir}"CY W GS.Quadrangle-Map Grid Locattiio�n :` 1 �, f , Owner' [�f^^fr'a.va( I E VA r1<.X. A 1 Address WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial � Type of Water-bearing Rock Other, Water-bearing Zones 1) From To Method Drilled in C AIQ c� 2) From To Date Drilled ! I 3) From To 4) From To CASING Depth to Bedrock Length ? Diameter Types 1`� �: UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium[ coarse❑ Date measured / / Gravel: fine[] medium❑ coarse❑ GRAVEL PACK WELL Screen: �` / Slot# �y length from �� to t� Yes �. ❑ ,No )� Split Screen (oi 2nd screen) WATER QUALI_T.Y TESTS MADE Slot length from to Chemical ❑ Biological Depth To Bedrock �""' r. `� a PUMP TEST Drawdown feet after pumping days hoat.. GPM. How measured ` Recovery fee after 2"`, hours. 4 w LOG of FORMATIONS COMMENTS: (Onxwe//or water) Materials From4t;. To � � ° 2. DRILLER t m Firm U) �' Address ! (I"1 Y�*.-< f�l ✓a ! i_ ` City n.4 Registration o. 147 a -ez�__ perator s ignature ease print firn y 25M•10.85-807101 ✓r r NO POSTAGE NECESSARY IF MAILED '+ IN THE ' UNITEDSTATES x, BUSINESS REPLY MAIL FIRST CLASS PERMIT NO.37716 BOSTON,MA POSTAGE WILL BE PAID BY ADDRESSEE DEPARTMENT OF ENVIRONMENTAL MANAGEMENT DIVISION of WATER RESOURCES, 4 LEVERETT SALTONSTALL BUILDING, 100 CAMBRIDGE STREET, BOSTON, MASS. 02202 No.-------- ----------- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application JforMelt Con0ruction3permit lication is her9by made for ermit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: /L/ocati n — Address _ Assessors Map and Parcel — —A i- -------------- — -- --- ----------------------- ----- ---------- /� wner Address Installer — Driller Address Type of Building C3 Z�„/Q �� Dwelling----— -- - Other - Type of Building------------------------------- No. of Persons--- -----------------__—____________ Type of Well--� �� ---- Capacity YP � -�- -- - - ---------------------Purpose of of 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 r on Regulation — The undersigned further agrees not to place the well in operation un�ae, ' ate .o has been issued by the Board of Health. Signed - - -- —---- - — — � e!P date Application Approved By--- G ------------ date Application Disapproved for the following reasons: ------------------ ---------- ------------------------------------------------------------------------------ aoo U_ Do , date PermitNo. ---—------ -- --- --—--------------- Issued--------------------------------------------- — ------------- date BOARD OF HEALTH — TOWN OF BARNSTABLE (Certificate Of Compliance � � r THIS IS T �RT h�ttt�FY divid al Well Constructed (�, Altered ( ), or Repaired ( ) bY--------- - --�— -- -L - ------- -- Installer at-------75 v--4---� - -----� — ?_ Ci�------------------------------------------------- -- 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.0 60 --Dated—z'!7_-a- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------— - ----------------------------— — -- Inspector-------------------------------------------------------------------------- - i Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE E� Applicat ion-*r Melt Con0ruct ion Permit Naplication is here•y made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location —`Address Assessors Map and Parcel wner L } Address Installer — Driller Address Type of Building Dwelling ------------ Type Building g--------------------------------- No. of Persons--`'' - ---—-----------Other - 7 e of uildin j Type of Well— ------------------ - Capacity----- --� G �--— Purpose of Well - 7—� ` —r�-- -- ------— i 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 a tion Regulation — The undersigned further agrees not to place the well in operation until-a Cer ' 'cate .of � � has been issued by the Board of Health. Signed -- ---- ----------------------- --__ date Application Approved By —--- -- -- -- ---- -— --- — - - date ,I Application Disapproved for the following reasons:--------------------—----------- -------------------------------------------------- date ; 900 Permit No. ----------- ----- -- -------------- Issued--- -- - - - — — -- date i --------------------------------------------------------------------------------------------------------�i BOARD OF HEALTH j TOWN OF BARNSTABLE i Certificate Of Compliance 1 THIS IS PERT h t the Individ al Well Constructed ( Altered ( ), or Repaired ( ) ---- ---=- � F ---- K/ P Installer— �V — — — --- -- — — ---— —— at- 2 (/-- --- -- , -- - --- ---- ----- --- -- -------- -- --- ---- --------- 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-- -'77 °-- - THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------—--------—-------------------------- — -- Inspector-------------------------------------------------------------------------- ----------------- BOARD OF HEALTH TOWN OF BARNSTABLE Vell Congtruct ion Permit 43 No. —----------—----— / O Fee- Permissionishn eby granted- --------- -------------- to Construct Alter ---------------- --- r Repair ( ) n Individual Well at: No. 'w �f ----------------------------------------------------------------------------------- — --------------------- Street 'i as shown on the application for a Well Construction Permit No. --------------------------- - — — - - — —------------- Dated44Board �j ------------------------------------ r ----------- --------------------------of Health DATE— - —-- — ------------------ COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION t V� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 780 Wakeby Road Marston Mills Owner's Name: Craig Lord Owner's Address: Date of Inspection: 9/14/2006 J 57a Name of Inspector: (please print) Patrick T. Sullivan Company Name: Ready Rooter Mailing Address: P.O. Box 311 Sandwich,MA 02563 Telephone Number: (508)888-6055 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 Y sewage disposal systems.I am a DEP P approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The System: _Passes Conditionally Passes Needs Further Evaluation by the Local Authority Fails r Inspector's Signature: Date: :z ` 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 designflow of 10000 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,=ld the approving authority. - i Notes and Comments ,n ,y ****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 same or different conditions of use. Page 2 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditions Pass"section need to be replaced or repaired.The system,upon completion of the replacement or re;ollowing approved by the Board of Health,will pass. Answer yes,no or not determined (Y,N,ND)in the for th statements.If"not determined"please explain. i The septic tank is metal and over 20 years old*or thq:�eptic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or*k failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurilly sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: -' Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: r` The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): f' broken pipe(s)are replaced obstruction is removed ND explain: f l I Page 3 of'I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 C. Further Evaluation is Required by the Board of Health: '/ Conditions exist which require further evaluatiogf6y the Board of Health in order to determine if the system is failing to protect public health,safety or the enviroxfinent. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: i _Cesspool or privy is within 50f,feet of a surface water Cesspool or privy is within SA feet of a bordering vegetated wetland or a salt marsh fie F tf 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in,manner that protects the public health,ptety and environment: r _The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply-or tributary to a surface water supply. r' The system has a septic tank and SAS and the SAS `s within a Zone I of a public water supply. _The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the,SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis;'performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicatesthat 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. r 3. Other: /`, fF f I ff� j 1 6 f Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _ Static liquid level in the distribution box above outlet invert due to and overloaded or clogged SAS or cesspool _ Liquid depth in cesspool is less than 6"below invert or available volume is less than''/z day flow �[ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface / water supply. -L Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] bQQ(Yes/No)The system fails. I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serv..6 a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the,4ollowing: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply i� 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 f If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section Efor failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 Check if the following have:been done. You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks? Has the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) _ Was the facility or dwelling inspected for signs of sewage back up? _ Was the site inspected for signs of break out? _ Were all system components,excluding the SAS,located on site? _ Were the septic .ank 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? -�Z'— Was the facility awner(and occupants if different than owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No _ Existing information.For example,a plan at the Board of Health. _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 78C Wakeby Road Ma-stons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): --'3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): G, Number of current residents: H _ Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): LD Water meter readings,if available(last 2 years usage Sump Pump(yes or no): Last date of occupancy: — COMMERCIALANDUSTRIAL ` Type of establishment: Design flow(based on 310 CNIR 15.203)• gpd Basis of design flow(seats/persons/sq.P.etc.): Grease trap present(yes or no):_ ,�' Industrial waste holding tank prese f(yes or no):_ Non-sanitary waste discharged to Title 5 system(yes or no): Water meter readings,if availab Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: 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: \ -f�'`6P.r 1/, e�Kr:: SEIT C% Were sewage odors detected when arriving at the site(yes or no):N 0 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron_40 PVC other(ex lain): Distance from private water supply well or suction line: I c Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: locate on site plan) Depth below grade: Q'�" Material of construction:—0-concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: 9 Distance from the top of sludge to bottom of outlet tee or baffle: Q i Scum thickness: i c-')" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 6„ How were dimensions determined: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,stYuctural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): c� i-1'C-.Or:�v► .`x91,.SdZS Y1cs1 t'.r.X ^Ttl �A`C' �uti.n.o c �i.w �.l�.oJy�e�.a>c /^/�W,n�.. 1p�.,� •\v�.r �\a�Ci-� • �`.`,jC'..t5 �D.��v.�C �1��,�/-� �vv�i�-..y��. `o � cS� �_��,.�JCir'� GREASE TRAP:_(locate on site plan) Depth belowgrade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlef+tee or baffle: . Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction:_concrete_meta fiberglass_polyethylene_other(explain): Dimensions: Capacity: gallon Design Flow: gall s/day Alarm present(yes or no): Alarm level: Alarm in w king order(yes or no): Date of last pumping: Comments(condition of alarm d float switches,etc.): DISTRIBUTION BOX:—z�—(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: CS, Comments(not if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): _C O v'P..r" :.¢�i'�-��v�' y!i CSC'" S J�A�i�' w� J'"�:i'�,•r"w PUMP CHAMBER: (locate on site plan) , Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,c dition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type =eaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number, length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): (� c, t�..� i c�..t' s�rr <a.�..� ��.o12✓wnn^..��,L_ ---�_:`'ur`�. �r�4 � ter«��' v� �ic`� ,NJ CESSPOOLK. (cesspool must be ped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater aiiflow(yes or no): Comments(note conditi�fi of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): i Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 780 Wakeby Road Marstons Mills Owner: Craig Lord Date of Inspection: 9/14/2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building. ? l S6'T� • I z� O Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 780 Wakeby Road Marston Mills Owner: Craig Lord Date of Inspection: 9/14/2006 SITE E IAM Slope Surface water / Check cellar✓ Shallow wells Estimated depth to ground water LLj_feet Please indicate(check)all methods used to determine the high ground water elevation: i Obtained from system designplans on record—If checked date of design plan reviewed:P 1�P 6 6 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with the local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _Accessed USGS datGbase-explain:_v- , v r 5, 5,�v `�.r.r•d 3G,r v�.r.Go vim.,, You must describe how you established the high ground water elevation: 1,�C' c..i r`c��t�_.., 'C]�` ocC('�r�.J-' a�'�-ram�,k-ti.i(.� '!y��C1 �`� �l.�.� •� ( y��(c��l"P 1F� C'/JCd 17.A S f C3 J �V• �A j� Z "F s wA 5 or 'i e Sy� < l lI Y �qls C GQ (ke / -k Ve f- F�_ "I��S i k5u YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30:00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1st FL., 367 Main Street, Hyannis, MA 02601 (Town Hall). DATE: _0-5- �� Fill in please: 1 APPLICANT'S YOUR NAME: � La z BUSINESS YOUR HQME ADDRES ,e 77S=7g a p V S 1�+�5 T L S [� ;,. z.....k .. TELEPHONE # Home Telephone Number: 508--9-71-1-3,5-3 NAME OF NEW BUSINESS 0. t'.o tSir1 TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES ......NO -� #cave you been gnren appro t from the bui ding div�s�on? YES NO gpDRE'SS OF 13USINI�SS .! . 5 .0 cch MAP/PARCEL NUMBER "7�- When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFF This individual nen infor a of any permit requirements that pertain to this type of business. A orized Signat COMMENTS: 2. BOARD OF HEALTH This individual infor d of the per it reuirements that pertain to this type of business. 8 ' uthorized Signature" COMMENTS: 4,j, Co `` GL ; o&L '' w e r c,c # 7 7,2 7. 1 3. CONSUMER AFFAIRS (LICENSING AUTHORI This individual h en inf rmed of P lic sin requirements that pertain to this type of business. MpAaA4 44AA--R— Autl�rized Signature** `�' ,,' ` L COMMENTS: S V.Qi1�( Z� - -( / Commonwealth of Massachusetts .Jolm Grad Executive Office of Environmental Affairs D.E.P.Title V Septic Inspector 2119 Department of P.O. Box Tealicicet,MAA 02 02536 Environmental Protection (508) 564-6813 01 �3 o SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM P �b PART A CERTIFICATION ✓ RfCf� Ce 780 Wakeb v Rd. Marstons Mills, Ma. Address of Owner: —t N 1 Property Address: (If different) 99J !' Date of Inspection:1113197 G.E.Capitol Name of Inspector:John Graci �^,. �l •;' Company Name,Address and Telephone Number: /aw 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: X P8SS8S This inspection is based on criteria defined in Title V code 310 CMR 15.303.My findings are of how the system is _ Conditionally Pass performing at the time of the Inspection.MY Inspection does _ Needs Furl er Ev I ation By the Local Approving Authority not imply any warranty or guarantee of the langevnv of the Fails septic system and any of its components useful life. Inspector's Signature: Ix, Date: 1122197 The System Inspector shall sub it a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A,B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. 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.) s _ 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. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 r i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 790 Wakeby Rd.Marstons Mills,Ma. Owner: G.E.Capnol Date of Inspection:1113197 _ Sewage backup or breakout or high static water level observed in the distribution box is due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public 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 volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D] SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. _ Backup of sewage in 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 cesspool. SAS is in hydraulic failure. (revised 11115195) 2 i� SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 780 Wakeby Rd.Marstons MIAs,Ma. Owner: G.E.Capitol Date of Inspection:1113197 D] 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). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and Ism. Please consult the local regional office of the Department for further information. (revised 11115195) 3 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CH ECLIST Property Address: 789 Wakeby Rd.Marstons MIIis,Ma Owner: G.E.Capitol Date of Inspection:1113197 Check if the following have been done: x Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. NaAs built plans have been obtained and examined. Note if they are not available with NIA. X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout. X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened, and the interior of the septic tank was Inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge, depth of scum. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised 11115195) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 780 Wakeby Rd.Marstons IMlms,Ma. Owner: G.E.Capitol Date of Inspection:1113197 FLOW CONDITIONS RESIDENTIAL: Design flow: 440 gallons Number of bedrooms: 4 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): No Water meter readings,if available: nla Last date of occupancy: spring COMMERCIAL/INDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings,if available: n1a Last date of occupancy: n1a OTHER:(Describe) nla Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: n1a TYPE OF SYSTEM X Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 1988 Sewage odors detected when arriving at the site:(yes or no) No (revised 11115195) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 780 Wakeby Rd.Marstons MOIs,Ma. Owner: G.E.Capftol Date of Inspection:1113197 SEPTIC TANK: X (locate on site plan) _Depth below grade: 2' Material of construction:X concreate_metal_FRP_other(explain) Dimensions: L 8'0'H 5'7"W 4'10- Sludge depth:4' Distance from top of sludge to bottom of outlet tee or baffle: 23" Scum thickness:1- Distance from top of scum to top of outlet tee or baffle:2' Distance form bottom of scum to bottom of outlet tee or baffle:n1a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) Septic tank and all components are structurally sound.Recommend pumping system every two years for maintenance. GRE ASE TRAP: (locate on site plan) Depth below grade: n►a Material of construction: _concrete_metal_FRP_other(explain) Dimensions: ►da Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:n►a Distance from bottom of scum to bottom of outlet tee or baffle:nla 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.) nla (revised 11/15195) Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: T80 Wakeby Rd.Marstons M01s,Ma. Owner: G.E.Capitol Date of Inspection:1113197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: nla Material of con structi ow—cone rete_metal_FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: nla gallons/day Alarm level: n1a Comments: (condition of inlet tee,condition of alarm and float switches, etc.) nla DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: Na Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) n1a 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.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 78o Wakeby Rd.Marstons MMs,Ma. Owner: G.E.Capitol Date of Inspection:1113197 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: nla Type: leaching pits,number: 1,000 gallon leach ph leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length: n1a leaching fields,number,dimensions:nla overflow cesspool,number:n1a Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) The leach pit was empty at the Ume of the Inspection It is structurally sound. CESSPOOLS: (locate on site plan) Number and configuration: n1a Depth-top of liquid to inlet invert: n1a Depth of solids layer: nfa Depth of scum layer: n1a Dimensions of cesspool: n1a Materials of construction: n1a Indication of groundwater: nfa inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) n1a PRIVY: (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) n1a (revised 11115105) 8 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 79O Wakeby Rd.Marstons Mills,Ma. Owner: G.E.Capitol Date of Inspection:1113197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' &m e RcC I A �g �q AC 6 31 DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: USGS Maps and Charts (revised 1 V15195) 9 '- Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT WE L LO ATI N Address City/Town G.S.Quadrangle Map Grid Location Owner Address WELL USE CONSOLIDATED WELL Domestic Public ❑ Industrial ❑ - Type of Water-bearing Rock Other Water-bearing Zones 1) From To Method Drilled 21 From To Date Drilled 3) From To 4) From To CASING l/ Depth to Bedrock Length` Diameter__ Type , J. UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium CK coarse'❑ Date measured Gravel: fine❑ medium❑ coarse❑ Screen: / / GRAVEL PACK WELL c Slot#length from to Yes ❑ No Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slog length from to Chemical ❑ Biological Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To Ot o �Y1• `C° S u DRILLER h Firm i 1 012; 9 n ° a Address Pic, \ City1A7 Reg i qion 90. 119/ 91"erator's Signature- ease print irm y CUSTOMER COPY 25M-10.85.807101 T} �.-- Department of Environmental Management/Division of Water Resources i WATER WELL COMPLETION REPORT 1 -WE LL LOCATION Address / .+ ! 4 ),1 k r- Ir City/Town i-jA e!10 c >n lC, G.S.Quadrangle Map Grid Location• +� Owner Address WELL USE CONSOLIDATED WELL Domestic❑i' Public ❑ .Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled tl From To ° 2) From To Date Drilled �/ 6P g .3) From To 4) From To CASING y // Depth to Bedrock Length 7.) Diameter Type Y C UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface -�iyy s�' / Sand: fige❑ medium®' coarse❑ Date measured /1 l (J`7 Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: / _ Slot# l� length 41 from to ` Yes Q No 01 Split Screen 02nd screen! WATER QUALITY TESTS MADE Slot# length from to Chemical ❑ Biological 12`1\ Depth To Bed ock PUMP-TEST 1 '+ � " Drawdown feet after pumping days hours at� G'PM. +� 1 W w How measured "' , R:epovery feet after r~ hours. LOG of FORMATIONS .COMMENTS: (On well or water), Materials From-, Tolb DRILLER h p '" f m Firm 0/o tit )el I 00. I ! e U { o C� r) a Address #+f'��-�--��' (�/ ✓'t � \ City ' egistratio N. 7 operator s ignature Please pant Trm y BOARD OF HEALTH COPY--' 25M-10-95•807101 �t _ mtmmrtmmimtmini "!MTMMMMMRMMM= mMTM!,, s i ENVIROTECH LABORATORIES 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 Frank DiMassini Lot #1 Wakeby Rd _ CLIENT: LOCATION: — ADDRESS: Marstons Mills,MA COLLECTED BY: Ray Leary SAMPLE DATE: 6/30/89 TIME: 8:00 AM _ DATE RECEIVED: 6 30 89 SAMPLE ID: #2 JOB #: New Well WELL DEPTH: RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 F pH pH units 6.0-8.5 6.19 _ Conductance umhos/cm 500 55 Sodium mg/L 20.0 5.8 - ; Nitrate-N mg/L 10.0 .08 _i Iron mg/L 0.3 ,05 Manganese mg/L 0.05 Hardness mg/L as CaCO 500 EF: 3 Sulfate mg/L 250 Potassium mg/L 20.0 c Alkalinity mg/L 200EE _ Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 ci Background bacteria _ COMMENT: E YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TE ED. DATE �........_.._...._... _. .. :: :..: : ... .:.::::...... .. . ... _ , .ffifill1111tlUilU!!!UllUtlit;liUitt;€iiillflll all4UUiittililUiiWUUU!litlUl!!lU!ltUIUUWIIIItIllitllllt r'i TOWN OF BARNSTABLE I.`O!:ATION SEWAGE # I � � VILLAGE ASSESSOR'S MAP & LOT0/-�� INSTALLER'S NAME & PHONE NO.,ez 4r,6—Zoe n&XS7-- SEPTIC TANK CAPACITY LEACHING FACILITY:(type). (size) Z'NO. OF BEDROOMS R WELLIYATE R PUBLIC WATER BUILDER OR OWNER le;a .C.}/ DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No -�..�, \1� �� I ��G I I ail 4'e I' TOWN OF BARNSTABLE SEWAGE# -3,k (`nAr ASSESSOR'S MAP&PARCEL (5la— 0g)3 —ciz--Q -LERS NAME&PHONE NO. .Lr'TIC TANK CAPACITY LEACHING FACILITY:(type) (size) ro'x G `K �D NO.OF BEDROOMS OWNER PERMIT DATE:7J COMPLIANCE DATE: ci Separation Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility 8 Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) t Sb Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ';,> � ,,� � fl n.��uaN d N � � � a� i j 4 ��r _ �� 3 � _ 3 .� � � .� _ �� O, a t3� = �{ 6' ,,., .. .. _. � � �� _ s.� ��! O ~ L q • � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OQG .® !v.................OF... ..................... Applutt#ion for Disposal Works Tonstrndion 11trnti# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal S stem at, -0 '?0 ......�'`,�..............•-• .......------•-•-•---p------.....-----.....---•------................•-•.................------.. Location-Address or Lot No. !............/ll � ............................ .............• -- ;.._. ........ ...- �` '� ......................................._----- Owner �/ \ Address :......... ......... . ..................................... ...._. .,.. Installer Address � UType of Building 22 ize Lot. Se,,.. ......._Sq. feet ,.., Dwelling—No. of Bedrooms ..._._ .1___________________________Expansion Attic ( Garbage Grinder � Other—Type of Building Z4Z................ No. of persons............................ Showers ( ) — Cafeteria ( ) PaW Other res .................•--•-••••--..................._...._•-.---•-•-- . ------------------------0............ Design Flow..... gallons per person er ay. Total ily flow... .!....................... ons. Liquid*ca acit ._ allons L Width..K,'- -..... Diameter................ De th.. .......... WSeptic Tank x Disposal Trench—No..... Width.................... Total Length_______ _......._.. Total leaching area..........._.�.` sq. ft. Seepage Pit No...�1 iameter../1iQ----------- Depth below inlet_._............ Total leaching area...-1`...sq. ft. z Other Distribution box ( Dosing tank, ( ) llitf. Percolation Test Result erformed by.-&/ 'e ��9!d .. G..................... Date _.� ... .... .............. ,aa Test Pit No. 1................minutes per inch Depth of Test Pit...l0.......... Depth to ground water..440._........._. Test Pit No. 2................minutes per inch Depth of Test Pit..._................ Depth to ground water-_____----_...__...._... 0� ........ .........................................••---..................•--•-.. ........................................................ --------------- ODescription of Soil....................................................................................-............................................----------------------................. x V ......_......••-•-....--••••-••--•..................•----••---•....-----••--•....-•••••----••••-•-••--••••..........•-••••--.............••-•..................•--•----...•---•--•-----•-••-•------••••-- W ..-•...................................................................................... ? n. 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 TITLE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been ' s d by e rd f ealth. Signed._. ...-- ......•........... .......................... ..�,�/ Date Application Approved By--.........- -.. �1.e ',-.............•-•---................. -------•-' D �'.... te Application Disapproved for the following reasons-.................................................-..............................................0............... ---•.......•-------••••........-•---•••-•••--•••-•-•.............•........•---••--••---••-•-----•-••-•--.--•----•----•......-----•--•--•-•..........-------•---•----•••-•-•---•-•--•-----•--•-•--•-•-••- Date PermitNo..._.��-M...e�.1 1-----------------_.._ Issued.....................................................-- Date s y No...Sc.�. »3 l y Fps '"'^--- 9v . .......... THE COMMONWEALTH OF MASSACHUSETTS ./ BOARD OF HEALTH AV oration for Bilipnstti Works Tonstrur#inn Fermi# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at .»_.._» ........... 9"�:l. '.r ...hg.:_ .......3. ..»........... ......................».................... ....-•-.•--.............................. Location-Address or Lot No. ............... ..fit_..�:4.zL...... ................ ...0---- .. `1........ .R........................................_..... Owner_ Address ..................................... 22. zZ2n_'411.......7............f............ ............... Installer . Address UType of Building ize Lot.a F� '"' ........Sq- feet Dwelling—No. of Bedrooms . ............................Expansion Attic ( Garbage Grinder (X46 Other—Type of Building e =-_.._... p ( ) ( )___.... No, of ersons____________________________ Showers — Cafeteria G, Other fi2pres . d .................... Design Flow.:-...15 ___•-•----------- ---------gallons per person per day. Total dail flOW....�t -�: W �g Ions. WSeptic Tank—Liquid ca.pacitya -.gallons, Length. .,,-..... Width..-e-----... Diameter________________ Depth-. •----------- x Disposal Trench—No.................... Width.................... Total Length......,........... Total leaching area---- _. .::sq. ft: Seepage Pit No._;� �....... iameter../10-------.--- Depth below inlet................ Total leaching area.._�K ..sq. ft. z Other Distribution box ( + Dosing tank ( ) ` '-' Percolation Test Result _,--Performed by..e.• '' _"�... ...e ..................... Date: f"`.r...... ........._.. aTest Pit No. I................minutes per'inch Depth of Test Pit.../a.__....... Depth to ground water..! ............. ri, Test Pit No. 2................minutes per inch Depth of Test Pit.....................Depth to ground water........................ 04 ..........................-•--••----•----•••....---•.............••--------•--.....-••••-••--•••--•-•-•-•----••----•----•.....•--•••--••••-•---•......---••- ODescription of Soil.......................................................................................................................................................................... ----....-•-------------------•--------------- ......-..............-------- :.:. .... W 4 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 TITIL4 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been •ss ed by t e rd f ealth. Signed. ..�. ............ !d*,;, ..� Eli— _..._ Application Approved By-•-------- ...... -z- : ...... .--•..............................._ -------- Date Application Disapproved for the following reasons:............................................ ............................••------•............---•--.........-••-•-•-----------..........---------•--•..--•-•---------...---•-••..._........---••----------------------------..... ••----......_ Date Permit No.....V.. . .................».... Issued.....-----------•-- ................................................. Date ._... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH r` ..r . ...................O F., x.s . "' ,�"t " . .... .... . ............................................... Trrti$irtttr of Toutpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( °or Repairedby ( ) ...........••-••-......•••. --.....• ... .... , Installer has been-installed in accordance with the provisions of TIT F 5 of.The State Sanitary Code as described in the application for Disposal Works Construction Permit No. dated 9.- _ .. d TISCETICT SHALL-NOT BE ISSUA " E STRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD Q'9 . OF HEALT OF............. ...... ... ......... o.•. ......... / .......... . . ........................••....... N ` ,L : FEE,.. 5 .:..:. Disposal World Tuunstrnr#ion autit Permission is hereby granted........................................... .. ,....» to Construct ( or Repair ( ) n Individual eA,age Disposal System --•••- Street . as shown on the application for Disposal Works Construction Permit No. . ated.......................................... ................................. ........................................................... ; / Board of Health DATE. /./ .O.-.....��1.................................. �. FORM 1255 A. M. SULKIN,INC., BO$TON, - Fee----7---j____- BOARD OF HEALTH TOWN OF BARNSTABLE - ��fication,�or�erf �on�truction�ermit pplication is hereby made fora ermit to Construct ( ), Alter ( ), or Repair ( ,an individua Well �t: —Yt�— ——--- - , --------------------- - p------ - _ .{� Location dress Assessors Map and Parcel caner A dress Installer — Driller Address Type of Building Dwelling ------ Other -- Type of Building ----------- No. of Persons------------V------------------------------- Type of Well— -- _ J1 ---— - - Capacity------12 = -- - - '- -- Purpose of Well�-i--'`i= 1 ----- -l� r`' i Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Healt Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a ertificate Corn nce has been issued by the Board of Health. p �L�Sign - - ---- �---------— -- p—�- date Application Approved By_------------------ ------- --- - -- dace - Application Disapproved for the following reasons:-------------------------------- ------------------------------=----- -------------------------------------------------------------- date Permit No.- �� ------------- - - Issued—---------—----------------------- ---- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered (,\), or Repaired - --------------------------- --------------------------------- - -------------- Installer at -- ------------------------ ---- - ----- - - - has been installed in accordan with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. - -----Dated-- ��--- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------—_—__—--------___-- - Inspector-- ---- - --------------------------------------- No.--A2 9=----- - Fee------------------- BOARD OF HEALTH v TOWN OF BARNSTABLE Zppritation-ftlVell Cootructionpermit 1Application is hereby made for arpermit to Construct ( ), Alter ( ), or Repair (*,Ian individual Well at: Tj / Location —(Address AssessorssMap and Parcel - �fZ tail- — _ ASS 1_��l__— --- _ 'Aait,2h� .Owner Address --- Installer — Driller �� a� Address —— }Type of Building , Dwelling Other - Type of Building----------------------------- No. of Persons----------- , ------___—___ ---- ----- Capacity -__��_______ _Ee , n) Type of Well— - �kJ_ ------- - - ---� - Purpose of Well—��`1-``�=- - (,I��Y►��S'�i V Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of"The Town of Barnstable Board of HealtWPrivate Well Protection Regulation — The undersigned further agrees not to place the well in operation until akertificate of Com Dance has been issued by the Board of Health. g T — date Application Approved By----- ------------_—_—_ ____ _________—_ date N.• Application Disapproved for the following reasons:----,----------------------------________________--_ ---------------------------------------------_____—________—_—___— ------- date ---- Permit No._ ——-—------ Issued--- - —----- - - ---- --— -- -A__ date BOARD OF HEALTH TOWN 'OF BARNSTABLE _ Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered (\), or Repaired 01 Installer at---�� -- - //kfrr!� � -- - - -—-- ---—---- - - - 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. -f��—�---�----Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE.THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE— --- —---—— —--—— - - Inspector------------------------------------------------ -- -— BOARD OF'HEALTH tv TOWN OF BARNSTABLE Well Con5truction3permit No. -- 1 /------- Fee--- m Permission is is hereby granted----------------------------------------------------------------—- -- _ —- -— ----- —— -- to Construct ( ), Alter ( ), or Repair (Kran Individual Well at: --------------------------------- --------------------------- Street as shown on the application for a Well Construction Permit / No.—= y'~'3--—- ----- ----- -- Dated— !/ ' — - -- - — — --— - y DATE---2�/�!�'9----------------------------- Board of Health-- I 7yc) &"�j a a. 5_ rOP ar FVt#A4 nrw COACREM CO VIM COACAS r CaOHor EL . � PM--imm Par -- P170N w Pm,FT '!i .ti! 3/I"h w L ^• I� sTLyYE , ONV�7PT N r NVERT tf PW 'AST T 3 LT.. bamw P# ... WASMW EL /53 - Q.. `5 .; srcwK 10 20 ° a EL �""_1 10 --1 4 150.00 P p p E�. 3s o FIL E F f R AV pWU W WA TER TA" 43 SEPTIC SYSTEM 45 SOIL LOG 47 DA rE S��te� ,K,mq 7278 GENERAL NO TES wrAv" / 2 ALL PIPE 4 P.V.C. SCH:40 AL SO.O y 11Fr1d dF /.t/SO/TfI6LF r7ATFPiAL �n t° /lJ �i L07 49 , �. A �.� /�EcTio J,5 ,v �'a(rPC,f+✓cE i.✓/7& 3/Q�/T � O 7- 7) LOT 2 CRAW-L SAW-• DESIGN DA TA Mc V? OF SM900A6 3 � 45 TEST � TOTAL FLOW -�� BOTr M LEA AREA Sit fT. PlT 5� d S�QE' LEAAF,/WfJ AREA SO o s MED SAND CIMMGE DISPO L sox ha•.aer• TOTAL LEA CHM AREA ' 2GG sal PERCUAWant SPA1F Pi COL aLA 17i0M27 M - .- �� os o RQ� . 5 P�� H ' •00. PROPOS HOUSE s PLAN OF LAND LOCA TEO- IN 1 SITE 53 MA RS TONS MIL L S BARNSrABLE 10 REPA RED FOR 52 PROPOSEa FRANK DeMASSINI ' , E LL 50.05 PPA P� x . 150.00' 51 +_ 1 f�AV �a t „A„ASSUMED . � . .r ELEV.50.00 _-.- - - E.T.W. .. b SURD WAKEBY (PUBLIC-40 WIDE) 0 r YANKEE SURVEY CONSUL TANTS 143 ROU TE 149 (P.a BOX 265) 0 30 60 90 MA RS TONS MIL L S# MA. 02648 s ;, 89 6/7/89 • RS PLAN ZONE: RF FLOOD ZONE. C SCALE. I = 30 DATE. 5/3/ , PLAN REFERENCES.37518A 8 SUBDIVISION' PETITION RES. t w l