HomeMy WebLinkAbout0060 ANGELA WAY - Health ngela-Way`'
W.�Barnstable2,,...P l
l 6
COMMOIVTIEALTH OF MASSACiUSETTS
E) ECUTIVE OFFICE OF ENVIRONmFNTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
RECEIVED
OCT 2 8 2003
TTTLE,5 TOWN OF BARNSTABLE
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY lswgALTH DEPT.
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
ION
� MAP
Property Address: ��/91y- ` 3
to � �� �� �•: / PARCEL
Owner's Maine:_ ' >' .s- o ' ' �" LOT
Owner's Address:_ .5-/a
Bate of Inspection: leg
Name of Inspector.(please print)L y, 2 e I
Company Name:
Mailing Address- i 0 dv..l �>,<
Telephone Number: 5 0 �:r 3 e'
CEIRT IFICA 10N STATEMENT
I certify that 1 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 U'y
training and experience in the proper function and maintenance of on site sewage.disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CIMR.15.000). The system:
Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
r:
Inspeetoes Signaftm. '`�� bate: / ,2�
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,C-00 `
gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving
authority.
Notes and Comments
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection-does not address hove the system will perform in the.futare under the sauce or different
conditions of use.
r• ,
Page 2 of I I
OFFICL4LL INSPE ON FORM-NOT FOR VOLUNTARY ASSESSMENTS
'SUBSURFACE SEWAGIEDISPOSAL SYMMMWSPEMON FORM
PARTA
It GA'ITION-(wed)
Property Address:_ 1''' �,✓z.- � L''/ {' rr
Owner. J _s
Date of IFtan:-
f
Inspection
Summary:. Check B,C-,D or E/.AI,WAYS complete sdt ofSeeflon flB ,
A. System-Passe$:
live not found any information which des that any of the failure criteria described in3 ill CNM
15.303 or in 310 CNtR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
TD. Sysftm Conditionally Passes:
One-or more system components as-described in-the"Conditional Pass"section need to be replaced or
repaired.The system,upon completion of replacement or repair,as approved by Board of Health,will pass._
Answer yes,no or-not determined{Y�33,ND}in the r for the following statements.If'not determined"please
the septictank.is metal d over 2 rears old*for the septic tank(whether metal nrnot)-is structurally
unsound,exhibits substantial infiltratio ry�ltradm or tauk-fagm is hmnh ent.System will gas&kwer ota i€tae ;-
existingtank is replaced with a m gym g septic tank as approved by She Baud®fHeaith.
A mEtal.septic tank will.pass on it$
it is structurally sound,not leaa and if a Certificate of Compere
indicating that the tank is Iew 20 years-old is available.
ND explain: 1
Observat of.sevvage backup or break�m arlt €static water.level in th gsttilutimJma due to broom or
Obstructed pipe(s)or to'abroken,settled orimeven distt't'bution box System will pass:mspection if(ate
approval of Board of the
broken-g s)are replaced
obstruction.is removed
-distributiou box is lei air.replaced_
ND explain:-
The system required pumpmg m 4 times a year clue to.broken or obstructed pipe(s).The system will
pass inspection if(with.approval of of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
i .
I
Psge 3 of I 1 s
0MCIAI.INSPECTION FOCI NOT FOR voLu TARY ASSESSAMNTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM
PART A
CERTIFICATION(continued),
Property Address: ee✓ ,IV - ;�
Owner:
Date of Inspection:
T
C. Further Evaluation is Required by the Board of.Realth:
Conditions exist which require farther-evaluation by the Board of Health in order to determine if the system
is failing to protect public health,safety or the environment
1. System will pass unless Board of#ealth d irmines-in accordance with 310 CMR153 1)(b)that the
�(
system is not functioning in a ma er wh will protect public health,safety and the environmezat:
_ Cesspool or privy is within 50.'h:Wo/// . 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.Tlealth(and Public'%'Hater Supplier;if any)determines that the
system is functioning in a manner that protects je public health,safety and environment:
_ 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-
The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
_ The system has a septic- and SAS and the SAS is within 50 feet of a private water supply well.
The system has aseptic tank d SAS and the SAS is less than 100 feet but 50 feet or more frond a
private water supply well:'--.Meth used to determine distance
"This system passes if the weI1 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 ether
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 13
fAMCML INSPEAMON FORM—NOT FOR VOLMTARY ASSE,SSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEME4STECTMN FOB
PART A
CERTUT+ CATION(con# _
Property Address.
Owner: eG-
Date of inspection: ,✓�'�X4—',,0�
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No i
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 overloads or
clogged SAS or cesspool
Static liquid level in the distribution box above outlet invert dueto an overloaded or clogged SAS or
-
, .-cesspool
_ � JAquid depth in cesspool is Iess than 6r'below invem or available-volume is less than%day flow
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipes}_Number
of times pumped
'y ,.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 sar&-ce
"Witer supply.
Any portion of a cesspool or privy is within a Zone 1 ofa public well.
y portion of a cesspool or privy is within 50 feet of a private water supply:well.
_/Any portion ofa 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 colsform bacteria.and volatile or-gamic compounds
indicates that the weRis free from pollution from that facility and the presence.of ammonia
nitrogen and nitrate nitrogen is equal to or less tL-m 5 ppm,provided-that no other f pia
are triggered.A copy of the analysis, be attache to-this-bra j
(Yes/No)The system fails 1-have detennined that one or more of the above fiffimcritcria exist as
described.in 310 CUR 15303,therefore-the-systetn fail",The system owner.should contact the Board of
Health to determine whatwtll be necessary to correct the failure.
E. Large Systems:
To be considered a large system.the system- ast rz$tciltg wMa destaZow of 10,000 gpd to'15,000
gpd.
You mast indicate either"yes"or"no"to eagh of the-following:
(The following criteria app to large systets is addition m the triter above)
yes no
T _ the system is within 400 t of a surface drinking water supply
the system is within,200 feet of a tnburary to a surface_drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IVVPA)or a nupped
Zone R of a public water supply well
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-faded.The.owner or operator.of any large system considered a
significant threat under Section E or failed under Section is shall upgrade the-system in accordance with 310 0A R
15.304.The system owner should contact the appropriate regional office ofthe Department.
f
Page 5 flf 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: r le m . /
Date of Inspection• 3
Check if the following have been done.You must indicate"yes"or"no"as to each of the following:
Y
7�,�Pumping information was provided by the owner,occupant,or Board of Health
— f Were any of the system components pumped out in the previous two weeks
_ as the system received normal flows in the previous two week period?
Have lazge 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 Id/A)
Was the facility or dwelling inspected for signs of sewage back up
,r I
Was the site inspected for signs of break out?
Were all system components,excluding the SAS,located on site?
Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth'of liquid,depth of sludge and depth of scum?
_ Was the facility owner(and occupants if different from owner)provided with 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:
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 CM{R 15.302(3)(b)j
42
:r
Page 6 of 1 I
OFFIC L INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SIBSU"ACE SEWAGE D►ESPO .SYSTEM MPE EON'FORM
PART C
o� SYSTEM P NORMATION
Property Address: /C .l<,
Owner: c .;, �: 1
Bate of Inspection: r /�1
FLOW CONDITIONS
RESIDENTIAL
Number of bedroonms.(design): Number of bedrooms(actual): .
DESIGN flow based on 310.CMR 15203(fear example:110 gpd x-#.of bedrooms):3-3 0
Number-of current residents:
Does--residence have a garbage gender-(yes or
Is laundry-on a separate sewage system(yes:or no): jif yes separate inspection required]
Laundry-system inspected_(yes or no):
Seasonal-use:(yes or-no):/V
Water meter readings,if.avalable{last Z}rears usae.(gpd)
Sump-pump(yes or no):, ,. . .
Last.date-of occupancy:;v y ,r D
-COMMERCIALIINDUSTRIAL
Type of establishment;
Design flow(based on 310 CMR I5.203}: gypd
Basis-of design-flow:(seats#personsl ft,etc.);
Grease trap-present(yes or no):
Industrial waste holding p sent(yes or no):_
Non-sanitary waste dischaDe o -be-Title 5"system(yes or-no):_
Water meter readings,if avilabie,
Last date of occupancytase:
OTHER(describe):
GENER L INFORMATION
Pumping Records
Source of information:
W-as system-pumped-as part of the inspection-(yes or-no):IV
Ifyes,volume pumped:_gallons-How was quantity pampe&determnted?_
Reason for pumping:
TYPE7OFS
_L J-eptic tank,distribution bow soil absorption system-
-Single-cesspool
_ vetflow cesspool
-Privy
Shared-system(yes-or-no)(if yes,atiachpmeviousbspectionrecmxX-if any)
_Innovative/;Alternative-technology:Auadrxcopy off current operation and-maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a-copy-of the-DEP approval
_Other.(describe): .
Apprax' . to ag�,e of all components,date installed(if known)and-source-of_information:
. � / ,
r
17
Were sewage_odors-detected when-arriving at-the site(yes or no): 6/
Page 7 of I I
OMB INSP.EC#' ON FORM—NOT FOR:VOLUNTARY ASSESSMENTS,
SIBSiLWACE SEWAGE DISPOSAL-SYSTEM.INSPEI."MN FORM
PART C
SYSTEMI/INFORMATION(cor6md)
Property dress:-�<d
Date Gf Ins_pertion:-- / y✓ (J
BUILDING SEWER(locate on site plan)
Depth below grade:az
Materials of construction: cast iron,- 40 PVC other(eVlab):
Distance from private water supply well or suction line: / S d,
Comments(on condition of joints,venting,evidence of leakage,etc.).-
SEPTIC TANM_(locate on.site plan)
Depth below grade:
Material of construction: concrete_metal`fiberglass,__,polyethylene
other(e)Tlain)
li=1k is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of
certificate)
Dimensions- /0,.s x
SiudLe depth-__a '
Distance from top of sludge to_botto of outlet-tee-or_ha#Ile:. �e,,,3
Scm thickness: 3` ,
Distance f=tOp of scum to top-oftuilettee-oI-baffle: r f
Distance fiom bottom of scum to bottom of outlet fee oI baffle: T1 � J
How we;e dimensions determined /►z�.��=�-,�,.s r �
Commentslon pmg enftu ins,mkt andv6 --tee orbaMecmi idor:, l ty,�i ze::Is
as related to outlet invert,evidence oflealage,etc.):
CREASE Tom':- (Iocate on site plan)
Death below grade:� co
Material of construction: metal:_._fiberglass_polyethylene other
Duaensions:
Scum-thiclmess:
Distance from top Of s to`top of outlet tee or-baffle:
Distance-from bottom of s." to bottom of outlet tee or-baffle:
Date-of g;,
Cammert#s(on p nnping recommendations,inlet and outlet tee or baffle condition.-structural integrity liiquid le=.eIs
as related-to outlet invert,-evidence- rf-leahge,etc.):
P ;e8ofll "
frN �
LUWARY
SMl ,
p C_
PF'4Dp � $'€S$; �C r ��/yi' O (�iYIYl3t d) ... _.... '
Owner:
D8tL'of a „ ,.. �ram✓� � _ ...-
— (taux must bepmmped at time of.
Depth below grade: on site plea;
MIaof coII
Cage-
Design.Flogs: ons.. .
r�
level:
c-tlf (3�es cn nod:
fl PMIa.
Li1eIl� -of atmm:and float S*itches,
IT
ITIOgt be �,�i�r�
41 ,WaDepth gA al a f?3t3}
Of liquid lev$J-aboveComm -eegavert
ents1note-if_box-is-level
j �dj�—
kage into o..out of-box iosi to.o 23'a ce flf-sOii C
fJ b •�t .): / Jyr,atye�risc -of
CEX. '
pocate site Plan 1.
I;tIMPS in-WOr)CMl flrd
�S o$ 0 :
! IarIDs iII Svor�fl
Cf)i`illIIej3#t � bE��Il3I�d3f 5 a�- ...-. ......_.._
{n L'D
smg �ttt
. Page 9 Of l l
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSAM INSPECTION FORM
PART C
�' SYSTEM INFORMATION(continued)
Property.Address:, 6 6 ' ' A
Owner: 7c A.";:-
Date of Inspection:-.t'0 z z_A
SOIL ABSORPTION SYSTEM(SAS): =:: (locate on site planrezcavation not required)
If SAS not located explain why:
Type
,leaching pits,number._
=leaching chambers,number: ..
leaching-galleries,number-
leaching trenches,number,length
-
leaching fields,number;dimensions:
overnow-cesspool,number:
innovative/alterative-system Type/name of technology:
Comments(note condition of soil;signs-of hydraulicfailure,level of ponding,damp soil,condition of vegetation,
etc.):
CESSPOOLS: (cesspool must be pumped as part of inspectionXIocate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:_
Depth of scum la er:
Dimensions of c pool:
Materials of c on:
Indication of groundWaAr inflow(yes or no):
Comments(note condition of soil,signs ofhydraulic failure,level of ponding,condition of vegetation,etc:):
PRIVY: (locate on site plan).
Materials of construction-
Dimensions:
Depth.of solids: --
Comments(note conditi of soil,signs of hydraulic-failure,level of ponding,condition of vegetation,etc.):
• J
Pnve 10 of Ll
'OF F'I INSPtMON,FORM=NOT�Olk OLUNTARY ASSESSAMgW
SUAS L'E SEWAGE DISP4ISAI.SX SPECTIO j FORM L
PART E
SYS'i'E EWORMATION{cpntin aed}
Property Address ,
Owner: c
Date of Inspeefim: .i. o
SKETCH OF SEWAGE DISPOSAL SYSTEM' r"
Provide a sketch of the sewage disposal system-includingties to arleasttwo-permanent reference Iandmarks or.
benchmarks.Locate alrwells within'100 feet Locate where public watersupply enters the-building.
}
i
P 31
_ s
10,
;r
k F
i
O
'+ ENVIROTECH LABORATORIES, INC.
IMA CERT. NO.:M-MA 063 �,,,e ( 30
449 RTE. 130
SANDWICH, MA 02563 D v
79 508 (668-6460) 1-600-339-6460 1
FAX (506)SW6446
CLIENT: Jeff Jones _ a.l LOCATION: 54 Angela Way
ADDRESS: PO Box 705 Barnstable, MA 02630
Barnstable, MA 02630
COLLECTED BY: D. Pennini/DA Scannell SAMPLE DATE: 3-10-98
SAMPLE TIME: 3:OOPM
WATER SAMPLE TYPE: New Well DATE RECEIVED:3-10-98
LAB I.D.9: 983171
t ,
WELL SPECS.: 73'
a
RESULTS OF ANALYSIS: `
Parameters Units Recommended Results Method Date Analyzed
Limits
Coliform bacteria /100ml 0 0 9222 B 3/10/98
pH pH units 6.5-8.5 6.16 4500 H+ 3/10/98
Conductance umhos/cm 500 162 120.1 3/10/98
Nitrate-N/Nitrite-N mg/L 10.0 0.86 4500-NO3 E 3/10/98
Sodium mg/L 28.0 11.4 200.7 3/10/98
Iron mg/L 0.3 0.50 200.7 3/10/98
Manganese mg/L 0.05 0.002 200.7 3/10/98
Volatile Organics See attached.
Chloroform ug/L 100 0.7 EPA 524.2 3/12/98
Toluene ug/L 1,000 1.0 EPA 524.2 3/12/98
m+p-Xylene ug/L 10,000 0.8 EPA 524.2 3/12/98
M'M
COMMENTS: pH is below recommended limit and may have corrosive characteristics.
Iron level is not a health hazard, but may cause taste and staining problems.
I
I
YES WATER IS SUITABLE FOR DRINKIN6 PURPOSES FOR P1E8"ETfsRS TKSTED.
{ Date 3 �
Ron Id J.Saari "
Laboratory Dir ctor
<=less than
>=greater than
TNTC=too numerous to count
• e I v
GROUNDWATER
ANALYTICAL
EPA METHOD 524.2
Volatile Organics (GC/MS)
I
Field ID: Jeff Jones 983171 Lab ID: 20169-01
Project: Well Batch ID: VM2-1792-N
Client: Envirotech Sampled: 03-10-98
Cont/Prsv: 40mL VOA Vial/HCl Cool Received: 03-11-98
Matrix: Aqueous Analyzed: 03-12-98
PARAMETER CONCENTRATION REPORTING LIMIT
(ug/L) (ug/L)
BRL 0.5
Dichlorodifluoromethane BRL 0.5
Chloromethane BRL 0.5
Vinyl Chloride BRL 0.5
Bromomethane BRL 0.5
Chloroethane BRL 0.5
Trichlorofluoromethane
1,1-Dichloroethene BRL 0.5
Methylene Chloride BRL 0.5
BRL 0.5
trans-1,2-Dichloroethene
BRL 0.5
1,1-Dichloroethane
BRL 0.5
2,2-Dichloropropane
cis-1,2-Dichloroethene BRL 0.5
Bromochloromethane BRL 0.5
Chloroform 0.7 0.5
1,1,1-Trichloroethane BRL 0.5
Carbon Tetrachloride BRL 0.5
1,1-Dichloropropene BRL 0.5
Benzene BRL 0.5
1,2-Dichloroethane BRL 0.5
Trichloroethene BRL 0.5
1,2-Dichloropropane BRL 0.5
Dibromomethane BRL 0.5
Bromodichloromethane. BRL 0.5
cis-1,3-Dichloropropene BRL 0.5
Toluene 1 0.5
trans-1 ,3-Dichloropropene BRL 0.5
1,1,2-Trichloroethane BRL 0.5
1,2-Dibromoethane (EDB) BRL 0.5
Tetrachloroethene BRL 0.5
1,3-Dichloropropane BRL 0.5
Dibromochloromethane BRL 0.5
Chlorobenzene BRL 0.5
1,1 ,1,2-Tetrachloroethane BRL 0.5
Ethylbenzene BRL 0.5
m+p-Xylene 0.8 0.5
o-Xylene BRL 0.5
Styrene BRL 0.5
Isopropylbenzene BRL 0.5
Bromobenzene BRL 0.5
Bromoform BRL 0.5
1,1,2,2-Tetrachloroethane BRL 0.5
1,2,3-Trichloropropane BRL 0.5
n-Propylbenzene BRL 0.5
(Continued) Page 1 of 2
3-18-148 8: 23 AM :GR.OUNDWATFP AMAT V�T -n rr+•••o .Tr.� r --
a -
GROUNDWATER
ANALYTICAL
EPA METHOD 524.2
Volatile Organics (GC/MS)
Field ID: Jeff Jones 983171 Lab ID: 20169-01
Project: Well Batch ID: VM2-1792-W
Client: Envirotech Analyzed: 03-I2-98
PARAMETER CONCENTRATION REPORTING LIMIT
(u9/L) (u9/L)
2-Chlorotoluene BRL 0.5
1,3,5-Trimethyl,benzene BRL 0.5
4-Chlorotoluene BRL 0.5
tent-Butylbenzene BRL 0.5
1,2,4-Trimethyl,benzene . BRL 0.5
sec-Butyylbenzen:e BRL 0.5
1,3-Dichlorobenzene BRL 0.5
4-Isopro%ltoluene BRL 0.5
1,4-Dichlorobenzene BRL 0.5
1,2-Dichlorobenzene BRL 0.5
n-Butylbenzene BRL 0.5
1,2-Dibromo-3-chloropropane (DBCP) BRL 0.5
1 ,2,4-Trichlorobenzene BRL 0.5
Hexachlorobutadiene " BRL 0.5
Naphthalene BRL 0.5
1,2,3-Trichlorobenzene BRL 0.5
QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS
Dibromofluoromethane 10 9 89 % 86 - 118 %
Toluene-d8 10 10 101 % 88 - 110 %
4-Bromofluorobenzene 10 9 87 % 86 - 115 %
BRL Below Reporting Limit. Method Reference: Method 111.1 - Measurement of Purgeable Organic compounds
in Water by Capillary Column Gas Chromatography/Mass Spectrometry, Methods for the Determination of
Organic Compounds in Drinking Water, US EPA EPA/600/4-88/039 (1988).
Page 2of2
(00 TOWN OF BARNSTABLE
LOCATION AR'f AV - p td A N SEWAGE# 9 2- d of
VILLAGE I). RA210,5+4 ig ASSESSOR'S MAP & LOT /.33 - ?
INSTALLER'S NAME&PHONE NO. JD 14AI 44I40 qa R-9S9 5
OEPTIC TANK CAPACITY /'SQO 6-i9'
1J LEACHING FACILITY: (type) G-10t 1 C 0AW be, (size) Q.9 X 33 , S
"4O.OF BEDROOMS
kBUILDER OR OWNER J Fr odes
0 PERMPTDATE: COMPLIANCE DATE: !�-
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
� sa as
3 V9
p 0 '
' TOWN OF BARNSTABLE
LOCATION S`1 ► YQ,dA Id Iq j SEWAGE # 98- 1?d
VILLAGE a19;Ztj5+il g ASSESSOR'S MAP'8c LOT /33 ' 7/
INSTALLER'S NAME&PHONE NO. CIO 14d AAI% 4/a R-9s9 5
SEPTIC TANK CAPACITY /SC00 &n
LEACHING FACILITY: (type) 3 - 5cb G-n C OAm be (size) Q,9 X 33 . S
NO.OF BEDROOMS 3
,.
BUILDER OR OWNER J FF oA/E S
PERMITDATE: _COMPLIANCE DATE:
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
..:.o. 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 by19--- �'
L19 P.
Id 3 S6'
i
j
0
No. � +:� Fee
lam,
f4 COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
ZippYtcatton for Xkgaaf *potem Comaructton Vermtt
Application for a Permit to Construct( ,4kepair( )Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No W4 d1 ( Owner's Name,Address and Tel.No. 'R Q.60 A 7 p,C
'
Assessor's Map/Parcel W 64—S�N t
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
TwW A6LG- �Udnt�n
Type of Building:
oy
Dwelling No.of Bedrooms Lot Size 1�4 sq. ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 440 gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank IS"b� �l�l• Type of S.A.S. 0-0
Description of Soil t-_T rj L .Tt M t-0 • '$Alt".0
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of thq Environmental Code an not to place the system in operation until a Certifi-
cate of Compliance has been issued by is o of He
Signed Date lJ`9 8
Application Approved by Date -7-Application Disapproved for the following reasons
Permit No. Date Issued 3_ ?-S
—.�
No. Fee /V!
T E COMMONWEALTH OF MASSACHUSETTS l./lk-tered in computer: Yes
PUBLIC HEALTH DIVISION --Tt)WN OF BARNSTABLE., MASSACHUSETTS
application for Misspogaf *pgtelu "Co tructton Vermit'
Application for a Permit to Construct(Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No. P fl.g0 j( 7 OS
5� �` N e �, W�l aa j, u,�
Assessor'sMap/Pazcel W , �4��J'1�WlP JIZ� TaHrs VA.W.1 " II►(4•
soy' ?1�2- f 3oz oZe3D
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. r
Tww QLTo &1 SuWur) `_ti 1�?
813E
Type of Building:
' Dwelling No.of Bedrooms Lot Size l sq.ft. Garbage Grinder( )
Other Type of Building No. of Persons Showers( ) Cafeteria( )
Other Fixtures `' `, l t
\ I S sign Flow 1 gallons per day. Calculated daily flow ? gallons.
P am�ate Number of sheets Revision Date
Title
Size of Septic Tank 1Sbo -Type- of S.A.S. 501D G& ,
Description of Soil 4�r ri T In M-0 • S f�j 0
1
Nature of Repairs or.Alti rations(Answer when applicable) t
i
i
Date last inspected: / \
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of th Environmental Code an not to place the system in operation until a Certifi-
cate of Compliance has been issued by is o of Hea .
Signed Date FJ
Application Approved by - Date
Application Disapproved for the following reasons
Permit No. /4P Z Date Issued 3
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of (Compliance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( Repaired( ) Upgraded( )
Abandoned( )by
at S has been constructed in accorda ce
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated 3
Installer
Designer
The issuance of this permit shall not be conslue�d as a guarantee that the system will function as designed.
Date "!� Inspector
---———————
So. 9,r—,1XZ_. Fee AV,_
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
Migpoga[ tywm Congtruction permit
Permission is hereby granted to Construc Lj Repair( )U gr de( )Abandon( )
System located �(�/•
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this permit.
Date: — �i�7 Approved by
, t
S
/J 7 rNo. - u-----�/-
`' ---'--------------
BOARD OF HEALTH Fee--
TOWN OF BARNSTABLE
Rpp ication_*rVell Congtructionpermit
Application is hereby made for a permit to Construct (VI, Alter ( ), or Repair ( )an individual Well at:
4iz� � -6/.a�e�� - tom• of�v n�►�, P 13 3 Al
Location — Address Assessors Map and Parcel
if-6a_P�,.eS 7! e,- for /& c..�u tr__ _
— -� --- ------------ -—— - - - - --- - - —
dd C� (Owner Address /
--------- e
Installer — Driller Address
Type of Building
Dwellingl�oy S Q
Other - Type of Building ------------- No. of Persons--------------------------------------------------
Type of Well—k/ ----,------------- ----- Capacity ----------------— —— —
Purpose of Well---P""ez 1.c ------ - - - —
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate .of C Jmpliance has been issued by the Board of Health.
Signed
- ----------------------------------------
---------------------------
- date
Application Approved By
- ----------------=------- - --
date
Application Disapproved for the following reasons:--------------------------------------------------------------------------------------
- — -- —__--------------— — - --- — --- —-------------
--------------------------------------------------
date
Permiteo -_-
`" — ---- ---------------- Issued —_- - —-----------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif irate ®f Compliance
THIS IS TO CRE�TIFY, That the Individual Well Constructed (01 Altered ( ), or Repaired ( )
/�_ C N
----------------------------------------------------------------------------
Installer
- -------------------------------
at----71- Q -� e� vt/ec V ---------------------------------------------------------------------------------------------
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. 4��W:4--Dated =-
I
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------=- - ----- -- - - ------ Inspector--------------------------------------------—-----------------------------
�!�--.,w� r ,•. r �. �, � t.' t, 'T" � ='a'►i'ht�'c r v^.,13,...a' �.w• , w*T., , ,. .. ..i-" „` -, .. .-r
NoFee--- ------------._...__ �.
BOARD OF HEALTH
TOWN OF BARNSTABLE
Applicat ion Ar Vell ConQructionprrmit
Application is hereby made for a permit to Construct (VI, Alter ( ), or Repair ( )an individual Well at:
N /'AfA � �33 _ A , -- -
Location - Address Assessors Map and Parcel
O r-..q S l — ----------------------------------
--� --c'^ --c�u
Owner Address /
rl -SCG -
Installer - Driller Address
Type of Building I,
Dwelling /Yuv S e--------------------------------------------------
Other - Type of Building ---------- No. of Persons----------------------------------------------____
Type of Well—y—- - - - -- - ----- - - Capacity-— - - - - — - -----
Purpose of Well-post c s Tic -----------------------------
Agreement:
i
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificat .of C mpliance has been issued by the Board of Health.
J /
Signed - M
- -- -- y ------ —
^. ;t date g -
Application Approved By date
'�'� ~I
II
u Application Disapproved for the following reasons:-------------------------------------------------=----------______________________
-------------------------__----_--_
date
Permit o. -- _ - --- --------------- Issued ---- tr =-> �------ --------------------
date
ore eair�raetss_wm�r . MAN =90-ruslalom
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate-.04 Compliance
THIS IS.TO E�TIFY, That the Individual Well Constructed (✓f Altered ( ), or Repaired ( )
nx
Installer r..
-`
at 71 _ ^_(o e ( cJvu
-- — —---r - ------ ------- ----------------------------------------------- ---
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. l��-�`' ^-1 Dated-�----"''�'1�-'-��
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
Ivell Con5truction3permit
nn n Fee-- ---- -- -
U J �c�.t�.�,e
Permission is hereby granted--+------- --- �-------------------------------------------------------------------
to Construct (""', Alte ( ), or Repair ( ) an Individual Well at:
N
No. -71 f- `'t— -- Qq--w`-k r-
- ---------------s-----treet---------------------------------------------------
as shown on the-Application for a Well Construction Permit
No. - '�— - -—------------------------ Dated---- _/ ` -- -
Board of Health
DATE--�/—_`__ _--------------
i
v
r -
,
f
p
:
V
:
y
\� GREATMARSHES P
aCOVERS ,ACCESS CDV ERS MUST BE 9 WITH!N
9• !N M 1MU M
V V 0 II
INVERT T T s R ELE A 1 N DES C
P
OF FINISH GRADE
E I GN Rl TER IA :
P
., N A E
U COVER
3 MAX M O ER
e
4v ! M
• 38 8
V BUILDING:
INVERT /LOIN
O OW.
4T. DESIGN FL
OW:
H
qy
_F RST 2 T4
• : 8 a 3 5 0
V 'B D 06S 0 r INVERT IN SEPTIC TANK 4 E R ! AT I l O.P.D. PER PT .
. BE LEVEL -
E
M! OF PEAS TONE ,
N 2 PEA T NE ,.
• 38.25 BEDROOM EQUALS 440 G.P.D.
'INVERT OUT SEPTIC TANK. _
� D lAM Pl
E P
-- -= PDX: '37.67
INVERT DiS
P
_ N T. . . I
3 D
/4 / l/2 /A.
0 GARBAGEG D
4
0
- V
37.5
N GRINDER
a INVERT .OUT DI ST BOX. -
WASHED STONE .
8 � T o T E
0 38.8 3 .25 37 5
P 'I
GAS
•
0
i a 3 5
,v
3 .
V
,35 5
r r C C ,
38 5 37.67 35 5
!N ERT /N LEA H HAMBER
1 BAFFLE
_SEPTIC TANK REQUIRED.
- OF
33 5
BOTTOM ECHCAM
LOCUS 3 OUTLET
3 50O`GAL LEACHING CHAMBERS
LEACH CHAMBER:TLET 444 G.P.D. X 200x 880 GAL :
, W 0 0 ADJUSTED GROUND.W ER.
N/A
D BOX /4 STONE AROUND. 12.8 X 33.5 X 2AT ,
1500 GAL
- SEPTIC TANK PROVIDED. I500 GAL. MIN.
OBSERVED GROUND WA
N/A
.� G N TER -
q
SEPTIC TAN
� K 6 CRUSHED STONE AS
o HE T E BASE i
* • 23./
o BOTTOM'OF..TEST HOLE 2. SOIL ABSORPTION SYSTEM REQUIRED. . .
DESIGN C PER RATE C 5 MIN/INCH
SOIL TEXTURAL CLASS ,.. .
0 0
T T L LA l
PROFILE : N T r SCALE
9 EFFLUENT LOADING RATE 0.74 GPD/SF
s
u 440 GPD / 0.74 GPO/ F = 595 S F REQUIRED
S R R
z
o r ,
o F• _ a
PROVIDED. 3 500 GAL LEACHING CHAMBERS
W/4 STONE AROUND. A-614,S.F.
LOCUS MAP
z
:
GENERAL LNOTES :R
C
I. THIS PLAN, IS FOR THE DESIGN AND CONSTRUCTION EXISTING LEACH P/Ts
SOIL TEST PIT DA TA
OF THE SEWAGE DISPOSAL SYSTEM ONLY.
INDICATES V INDICATES
0 D PERC LATI N _ , .OBSERVED
S - GROUNDWATER
TE T _ ;
2. VERTICAL DATUM-I S ASSUMED. FOR BENCH MARKS
SET. SEE SITE PLAN.
i
TP ,�/ TP #2
. J. 0 ALL CONSTRUCTION METHODS AND MATERIALS AND
_ HORIZON TEXTURE. COLOR HOR 1 ZON TEXTURE COLOR
MAINTENANCE OF THE SEPTIC SYSTEM SHALL 0 40.0 0 34.`!
LOAM
CONFORM TO MASS. D.E.P. TITLE S AND LOCAL
Y IOYR
0 A
SAND
BOARD 4/3
A F HEALTH REGULATIONS.
t I
FINE
4. ALL SEPTIC.SYSTEM COMPONENTS .LOCATED UNDER
LOAMY IOYR IOYR
AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER
SAND 5/8 SAND 7/I
d 7. 14 32.9
THAN 3 - /N DEPTH SHALL °BE CAPABLE OF WITH- .. _
COMPACT 0 C
STANDING' - 0 W O <
PA T IOYR COMPACT IOYR
H 2 HEEL LADS. , C
B
LOAMY O s
... L A Y ` 6/6 LOAMY AND" 6/8
0
SAND AND
5. ALL SEWER PIPE SHALL :BE SCHEDULE 40 OR
STONES COMPACT IOYR
APPROVED EQUAL. r
LOAMY SAND 7/8
AND STONES
I
CATCH BASIN
6 S A D,SEPTIC TANK D BOX.SHALt BE REINFORCED
\
1
PRECAST CONCRETE AND WATERTIGHT.
f \
t
{
` 1 84 ••• 27. 1
-
H T \
7, BEFORE CONSTRUCTION CAL D G SAFE \L ! { FINE.SAND '2.SY
•'\ ,,fir
I ' C2
1
1 888 D!G 5AFE AND THE LOCAL `WA � � AND 0 - 6 3
TER DEPT. 1 o I STONE /
:
1 -
l2O 3 0 0. !32
FOR LOCATION OF UNDERGROUND UTILITIES. I 23. !
CATCH BAs I
1
NO WATER NO WATER
I I
{
{ I 8
1 1
ALL UNSUITABLE MA TERlAG lA 4 B HORIZONS. COMPACT
I I
C LAYER) ENCOUNTERED 1
1
A ER I EN 0 NTERED BELOW THE INVERT OF H ! TP 3 �THE h TP 4 :
o l
1
I
1
LEACHING FACILITY TO BE REMOVED FOR A DISTANCEi 1
1
1 1
U COD HORIZON U COLOR HORIZON TEXT RE COLOR H R N TEXTURE C L R
f 1 { 1
lZ TE R
OF 5' AROUND AND REPLACED WITH SAND IN 'ACCORDANCE t. ) p
\ m 1
{ r 33.8 0 4O,0
W !
1 / S
TH TITLE S. \ I LOAMY IOYR LOAMY IOYR
r l ♦t
/ !
A A
I
r
, l s
SAND 3 - SAND
/ l' 1 sr 4/ 9/3
! /
8 f
9. - NO :DETERMINATION HAS BEEN MADE AS TO RPOSED
! 3 ,
�b SELL / i F
/ W
I / EiL ,
! LOAM 0 LOAMY ,IOY
COMPLIANCE
i Y IOYR > L Y R _
L E WITH DEED RESTRICTIONS OR ZONING � 1 / __..
! {'
i
B ,
i
1 � B -
S :
REGULATIONS. S w
AND 7/l SAND '7/!
IT HALL;R MAIN THE CLIENTS
T 1 f / 1 � CB/DH FND
IY�LL �� '/ 1
/
-f- i
) l i / •J4 0� 24 3l.8 24
RESPONSIBILITY 0 0 \ o o�>R ! i ♦ EL
T OBTAIN ALL PERMITS, `SPECIAL I i ,.
1 1 7 ♦ __ �
\ / � 4
! r
I I F 5 5
♦
!NE MED 2. Y Ff NE MED 2. Y
PERMITS. VA C , .l R lAN ES ETC. 'F S 'PROJECT. /OR 'THIS PR ELT. ,. i �_ '
�o i ! C I C
i I
/ SAND AND 6/3 SAND AND 6/3
1 ♦ i . a4�
-'
STONE,
/ r
/ STONE
T.SHALL REMAIN THE CL%ENT_S RESPONSIBILITY / / � . a _ '
/LIT i ,� ,
0 V
. /
7 HAV
E THE PROPOSED BUILDING O FOUNDATION
T I ON
/ / l
/ r
7
DESIGNED 0 ACCOUNT I
T A UNT FOR THE EXISTING GRADE
AND SOIL COND l T ONS TLOCATION \ ► ! 1 \l A THE `OF THE
Y
PROPOSED BUILDING.
! - !
l
Tvi
l LOT 30
n, \
t
l / ! 46.008 S.F.
� �.
TP sJ NO WATER _ NO WATER ,
I20 23.8 126 29:5
� 3F \
*2
TCN N ,
/ 1 I l
1 EL 6
DATE. OCTOBER 2. 1997
! ! ! 1 _ \
_ \ S B ST PH HAAS
l ! t \
! / 1� WITNESSED BY GERRY DUNNING
CB/DH FND i 1 I 1 \ \
l l 15 G ., �. \ 1
( o
I PERC RATE. l 4 MIN/INCH
CB/DH FND _ l l I SEPTIb.TANK
� ! l I
EL•62 GJ ! 1 l
/ / I +o \ I
I 1 ( \ !
/ 1 I
1 c � �P I
1 / i I
l' I
1 _ /
a t t
r 1 0 _
1 ! ! aR po /
Op \ .G._
r \ /< ! r
Apt
i 1 I i I 1 F4
- o \ / r
BIDH FND
/ \ \ $r ♦ \/
a -
O. / CL !FT DIA ROCK0 1 �•+ 6 F':;' ',.
!
CATCH BASIN
G L O T 0 0 A /V GE-L A WTI Y: MA P / .3 0 P,A R CE`L 7 /
EXISTING LEACH PITS
f 4�e.r S 1 A R f V mow/ l /I°'°'7, & L. E • 1 0�/ /� •
, •`.� PRE-RARE-O FOR .
„WELL
41
S MIA 024500
>, F' . O . BOX �05 . B.4R/V TABLE . .
I
V
S C.4 L E . / 3' O /1i'!A R CH
/
WELL `}
31 I � � ��
EAG E SURVEY I NO I NC
923 Route 6A
Yarmouthport , MA . 02675
µ .� 508 362 8132
T� 508 432-5333
s
-0 15 30 60
DB NO _97-30 FIELD: TAW/CF4J ].CALC: SAH/CFW CHECK: CFW DRN• SAH
I
•-......R,s.._.w.v_. __. _. _ 3 E _.,.!""`' .saw,>w�.�._,a _' 7 � i '.
EXISrINa LEACH plr$
TCH WIN
44 TCH $fk
fj
R
+IrELL
-4
WELL
+
—44
ct
TP 38
#2 -34
I TCH BASIN
C91VH,FND 491-DIA FA(D 36
$EPTIC
>
M14
V/
>
44--————
-yo
/DH FND
-7
��+Avfty 6 ROCK
-*CE Jr FT DfA ROCK
TE' 0 F L A IV ZD
CATCH WIN
WA' Y . ' MAP 0,3 . 71
-L A-
A IVG�E PA R E
Ts
LEACH PI
SA RIVS - TA & L. E� "A
P R E-1:'A R 2FO F-OR
L,�?L ff
001><1 1710.5 ' 'BA R"S 7 .4
0 29'jTR 7 .
0(0� 7
S
�q -7
0 45' 57
.4 S2�
-A
f-t-w
'60
6AHICFW PRN: SAlY
4L
7,