HomeMy WebLinkAbout0048 BARNHILL ROAD - Health ` 48 BARNHILLA l
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UPC 12034 �6NU. 2.153LUE
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TROY WILLIAMS
SEPTIC INSPECTIONS FF
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Certified by MA Department of Environmental Protection , E; 2400 (508) 385-1300
19 Hummel Drive OF
South Dennis, MA 02660
-- COMMONWEALTH OF MASSSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON MA 02108 (617) 292-6500
TRUDY COXE
Secretary
ARGEO PAUL CELLUCCI DAVID B. STRUHS
Governor Commissioner
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Address: Name of Owner Ed W"i D-11V r1
W. 13 N r h s 4z b I c Address of Owner:- P.o.
Date of Inspection: 0 //9 /0 p
Nana of :(fie Prim) Troy Williams
1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000)
Company Nark: Troy Nfilliams i Insnaction4
Mating Address: 19 Hummel Drive, So. Dennis MA 02880
Telephone Number: (508) 385-1300
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:
Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
_ Fails
ksspectors Signature: Date: q / o U i
The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of
completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner
shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to ttte
system owner and copies sent to the buyer, if applicable,and the approving authority.
NOTES AND COMMENTS
Although system meets the minimum requirements set forth by the Massachusetts Department of
Environmental Protection,certification is not to be construed as a guarantee of future working condition
of system,piping or components. This inspection represents the conditions of the system on the Date of
Inspection noted above.
revised 9/2/98 Pars 1 „rrr
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(contkxied)
Prosy Addrass: 48 Barnhill Road, West Barnstable,MA
Owner: Ed Davin
Date of kupectkm:
September 19, 2000
INSPECTION SUMMARY: Check A, B, C, or D:
A. SYSTEM PASSES: 8
fie/ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure
criteria not evaluated are indicated below.
COMMENTS:
B. SYSTEM CONDITIONALLY PASSES:A114
One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon
completion of the replacement or repair,as approved by the Board of Health, will pass.
Indicate yes, no,or not determined (Y, N, or ND). Describe basis of determination in all instances. If "not determined", explain why not.
The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance(attached)indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or
the septic tank, whether or not metal,is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as
approved by the Board of Health.
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)
or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of
Health).
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass
inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
revised 9/2/98 . Page 2orii
I
SUBSURFACE SEWAGE DISP
OSAL
L SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
48 Barnlull Road, West Barnstable,MA
Property Address: Ed Davin
Owner
Date of Inspection: September 19,2000
C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH. NIA
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 IN ACCORDANCE WFM 310 CMR 15.303(1)(b)THAT THE SYSTEM
IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT TIfE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
Cesspool or privy is within 50 feet of 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 ANY)DETERMINES THAT THE SYSTEM IS
FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT:
The system ties 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 soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a .
priivate water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the
well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less
than 5 ppm. Method used to determine distance (approximation not valid).
3) OTHER
revised 9/2/98 Page 3ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
48 Barnhill Road,West Barnstable,MA
Ed Davin
Property Address: September 19,2000
Owner:
Date of Inspection:
D. SYSTEM FAILS: A1119
You must indicate either "Yes" or "No" to each of the following:
I have determined that one ur more of the following failure conditions exist as described 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.
Yes No
Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool.
Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or
cesspool.
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool.
Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow.
Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).
Number of times pumped
Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any portion of a cesspool or privy is within a Zone 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: N1,9
You must indicate either "Yes" or "No" to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public
health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
the System is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone II of a public
water supply well)
The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional
office of the Department for further information.
revised 9/2/98 Page 4ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
48 Barnhill Road,West Barnstable,MA
Property Address: Ed Davin
Owner:
Date of Inspection: September 19, 2000
Check if the following have been done: You must indicate either "Yes" or "No" as to each of the following:
Yes, No
Pumping information was provided by the owner, occupant,or Board of Health.
V _ None of the system components have been pumped-for-art least two weeks end-the system has been-receiving normal flow
rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
/ inspection.
As built plans have been obtained and examined. Note if they are not available with N/A.
The facility or dwelling was inspected for signs of sewage back-up.
The system does not receive non-sanitary or industrial waste flow.
_ The site was inspected for signs of breakout.
All system components, excluding the Soil Absorption System, have been located on the site.
_ The septic tank manholes wits uncovered, opened, and the interior of the septic tank was inspected for condition of baffles
or tees, material of construction, dimensions,depth of liquid, depth of sludge, depth of scum.
The size and location of the Soil Absorption System on the site has been determined based on:
_ Existing information. For example, Plan at B.O.H.
_ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable)
/ 115.302(3)(b))
y - _ The facility owner land occupants,if different from owner) were provided with information on the proper maintanance of
Subsurface Disposal Systems.
revised 9/2/98 Pars g of 11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 48 Barnhill Road,West Barnstable,MA
Owner:
Gate of Ins _ Ed Davinon September 19, 2000
FLOW CONDITIONSRESIDENTIAL:
Design flow: //O g.p.d./bedroom.
Number of bedrooms(design):_ Number of bedrooms(actual):-3
Total DESIGN flow 330
Number of current residents:
Garbage grinder(yes or no): Alo
Laundry(separate system) (yes or no):No; If yes, separate inspection required
Laundry system inspected (yes or no)
Seasonal use(yes or no): Ito
Water meter readings,if available(last two year's usage(gpd): _/�r vo,
Sump Pump(yes or no):_/Q
Last date of occupancy:-O-r-�,/p, �J
COMMERCIALANDUSTRIAL: N/A
Type of establishment:
Design flow: opd ( Based on 15.203)
Basis of design flow
Grease trap present: (yes or no) -
Industrial Waste Holding Tank present:(yes or no)_
Non-sanitary waste discharged to the Title 5 system: (yes or no)_
Water meter readings,if available:
Last date of occupancy:
OTHER:(Describe)
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
/ •' v` M r•-1'4 r• o c r i n U `.� .�l rn J�wc c,w�..e r, .
System pumped as part of inspection: (yes or no)—
If yes, volume pumped: gallons
Reason for pumping:
TYPE OF SYSTEM
y1 Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
Privy
Shared system(yes or no) (if yes, attach previous inspection records,if any)
I/A Technology etc.Attach copy of up to date operation and maintenance contract
Tight Tank Copy of DEP Approval
Other
APPROXIMATE AGE of all components,date installed Of known) and source of information: Or�, k- t�x6 P y
.11�-�'- �^sfiz iI{JI. 8��1 /sy per ws - �uv. !•�'. ��,c�..cJf p� '�' �„r - �f q
Sewage odors detected when arriving at the site:(yes or no) A<o
revised 9/2/98 Page 6oru
i
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(con mmel)
Prop"Address: 48 Barnhill Road, West Barnstable,MA
Owner: Ed Davin
Date of Inspection:
September 19, 2000
BUILDING SEWER:
(Locate on site plan}
Depth below grade:
Material of construction:_cast iron,[40 PVC_other(explain)
Distance from private water supply well or suction line V/A
Diameter y„
Comments:(condition of joints, venting, evidence of leakage,etc.)
-flirt
SEPTIC TANK:_
(locate on site plan)
Depth below grade: V f off l,:11.
Material of construction: /concrete_metal_Fiberglass _Polyethylene_other(explain)
If tank is metal,list age_ ls.age confirmed by Certificate of Compliance_(Yes/No)
Dimensions: S ,k q 'X C /OOU S a It..�
Sludge depth: �
Distance from top of sludge to bottom of outlet tee or baffle:-2"/o"
Scum thickness: 4 I C-yc..,
11,
Distance from top of scum to top of outlet tee or baffle: 0
Distance from bottom of scum to bottom of outlet tee or baffle:
How dimensions were determined: P,.n 6
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.) Pb c- Ttt ,r. /,c.-i a-"v4 ter. .r �� �'a.� o✓1—l.�fi �-o',,. -k
G v J✓ t u G a i c,-rf,
- r .c .k O mo ot✓v�.�; T
I,a 0 ci n. 1 rfn t
GREASE TRAP: N/`
(locate on site plan)
Depth below grade:_
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 outlet tee or baffle:
Date of last pumping:
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.)
revised 9/2/98 page 7of11
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(cormnued)
Property Address: 48 Barnhill Road, West Barnstable,MA
Owner: Ed Davin
Data of Inspection:
September 19, 2000
TIGHT OR HOLDING TANK:-,j//!7 (Tank must be pumped prior to, or at time of, inspection)
(locate on site plan)
Depth below grade:_
Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain)
Dimensions:
Capacity:_gallons
Design flow: gallons/day
Alarm present
Alarm level: Alarm in working order:Yes_ No
Date of previous pumping:
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
DISTRIBUTION BOX:�/
(locate on site plan)
Depth of liquid level above outlet invert: lc—o< I
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box, tc.) d— �-
J V !^ t J /�
�r
PUMP CHAMBER: N
(locate on site plan)
Pumps in working order:(Yes or No)
Alarms in working order(Yes or No)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances,etc.)
revised 9/2/98 Page 8ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 48 Barnhill Road,West Barnstable,MA
Owner:
Date of Inspection: Ed Davin
September 19,2000
SOIL ABSORPTION SYSTEM(SAS): /
(locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods)
If not located, explain:
Type: 7/XC ' �.,.c p, f w: /t, �Is �ti� (Dl�lc✓
leaching pits, number: a P/-� wi 11. 3
leaching chambers,number:_
leaching galleries,number:_
leaching trenches,number, length:
leaching fields, number, dimensions:
overflow cesspool,number:_
Alternative system:
Name of Technology:
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)
G 'k L_.� �. PI W cj. < -s s' .� w -!'�. / ./."t- w + .a i -t
r7
r. a Lf CA. I /
CESSPOOLS--AL119
(locate on site plan)
Number and configuration:
Depth-top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater:
inflow (cesspool must be pumped as part of inspection)
Comments:
(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
PRIVY: N14
(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.)
revised 9/2/98 Page 9of II
I
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 48 Barnhill Road,West Barnstable,MA
Owner:
Date of Inspection: Ed Davits
September 19, 2000
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent reference landmarks or benchmarks
locate all wells within 100' (Locate where public water supply comes into house)
D�r
7(> sy" s°
- n .t3ox
/ovuywl�"^
�hw
prey".h�,t 4'X6 ' 1c46GP�� �gr
revised 9/2/98 Page 10ofII
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(corrfirxed)
Property Address: 48 Barnhill Road,West Barnstable,MA
Owner' Ed Davin
Date of Inspection: September 19, 2000
NRCS Report name IV
Soil Type_
Typical depth to groundwater
USGS Date website visited
Observation Wells checked
Groundwater depth: Shallow Moderate Deep ✓
SITE EXAM Slope
Surface water
Check Cellar
Shallow wells ✓
Estimated Depth to Groundwater 50'Feet
Please indicate all the methods used to determine High Groundwater Elevation:
Obtained from Design Plans on record
Observed Site iAbutting property, observation hole, basement sump etc.)
✓ Determined from local conditions
Checked with local Board of health
Checked FEMA Maps
Checked pumping records
Checked local excavators,installers
Used USGS Data
Describe how you established the High Groundwater Elevation. (Must be completed)
11 /Q C
1k' 14, O/� �J.�jam.. �c``-k., v �.,..�t 1 onp�h /U ,
�uv+c✓ nv �f1r- y yvo/+�✓( �Jc f</ c��— c.��o.ulc :S9 n Sc� c Imo. , y�
Nj-S y. G G r.fib KJu S v)J �-
/ Jt c•,C//
revised 9/2/98 Page 11 of 11
TOWN OF BARNSTABLE
LOCATION � �`4 v �� ��A SEWAGE #qG ^ Q
VILLAGEU ASSESSOR'S MAP & LOT/91 Q -
INSTALLER'S NAME&PHONE NO L2.4 X—
SEPTIC TANK CAPACITY (00 0 fir_
LEACHING FACILITY: (type) g` Po (size) k'00t) Se—
NO.OF BEDROOMS
BUILDER O WNER �OLk— aI�
PERMITDATE: t0®01 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
'L
Furnished by
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ASSSESSORSMAPNo-:.��`
No. 6-,— PARCEL No: - O g• Fee _ i
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
Application for Zitpozal *pztem Conztruction 30ermit
Application is hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. 7 Owner's Name,Address and Tel.No.
rN
c Ae,ai MA.
Igst�ll el e 's Name,Address,and .No. 36 Z 2 Designer's Name,Address and Tel.No. -Z G 2 q 2
"(,>Q,� �o� ��nS�cL.C. `o'er 7e-�e< Mo�..l•�ovr
115 /CC>MLjtL% tD< csct lget t5 Cro^wetI QK rrviaAAA NZg
Type of Building:
Dwelling No.of Bedrooms 3 Garbage Grinder( µ)
Other Type of Building No. of Persons Showers(Z,) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title �-
Description of Soil
I
Nature of Repairs or Alterations(Answer when applicable) cC hov4' t.� `�q��Q �b -�o fNseJJ c-
Ac 0.r� ���5 6 J wa�44n an
li _if.7
IV
rate 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 provisio le 5 of the Environme tal Code and not to place the system in operation until a Certifi-
cate of Compliance has been i su this/hoard of eal mot,
Signed v"� Date °' t
Application Approved b
Application Disapproved for the following reasons
Permit No. �r" L, >� Date Issued '���
——————————————————————————————————————THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CEFTIFY,that the Opp-site Sewage Dispo al System installggd(V)orp repaired/replaced( )on
`I by 7 �C V_)0% r\ 60 �C%&ti,Q�for C LJa(*
as l h «. has be constru�d i�cc��with the provisions of Title 5 and the for Disposal System Construction Permit No� ated
Use of this system.is o itione o compliance with the provisions se)Jorth below:
R•
No. / Kr � S./ Fee i -76
THE.COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
[pplicatfon for Migpo.5al *p5tem Construction permit
Application is,hereby made for a Permit to Construct( )or Repair( )an On-site Sewage Disposal System at:
Location Address or Lot No. Owner's Name,Address and Tel.No.
y8 13crlflh�
In aalle 's Name,Address,and el.No. 3'6 Z t L Z. Designer's Name,Address and Tel.No.
.�L Z Z Z
(�2 -�c ("10L..1ot1 �o�nS'CC1�L O'er �2-�C! C`rloc..��-ov�
l rj �c�tY►lJct� �7t 6c -� Poet 15 CtdMc,jell ('3< lw,o,,,4,CA }'
Type of Building:
Dwelling. No.of Bedrooms 3 Garbage Grinder( )
i Other Type of Building No.of Persons Showers(2_) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date Number of sheets Revision Date
Title
Description of Soil
Nature of Repairs or Alterations(Answer whe;;n applicable) Ce Move. (ArN4iA c,6(e Sty• � -�Q re estur—
Qv
ac ,d ',n t 4 A w.41, 1 c n
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 provisio le 5 of theaz
Code and not to place the system in operation until a Certifi-
cate of Compliance has been t sue y this oard /
Signed �J� Date(" b
Application Approved b
Application,Disapproved for the following reasons
Permit No. CJ � Date Issued
� THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE. MASSACHUSETTS
r Certificate of (Compliance
S IS TO CE TIFY,that the O -site Sewage Dispo al System installed(�or repaired/replaced( )on
� by k Mo�1 n Co I►c,�c-�o�for Ec�'t,��cc� �- �a
as .+n \ C has bee constructed in accorda e
with the provisions of Title 5 and the for Disposal System Construction Permit No. ated �--/G--- �
Use of this stem is Co ditione o compliance with the provisions se rth below:
owe
�, �;
i
r d i
VV
No. 9,�,��i4 �.% Fee y(�
THE COMMONWEALTH OF MASSACHUSETTS'
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Xis pogar *p.5tem Construction Permit
Permission is hereby granted �
o e_ MO L„I
to construct( )repair( k4 an On-site Sewage System located at 24 R4c nr), k\ �Z
L.J , r3GcnS�a �1e_ Mom.
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
All constructio
,�njnust be completed within two ears of the date below.
Date: Approved
J
8
60
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TOWN OF BARNSTABLE'•' .
LOCATII+1 R SEWAGE 7
VILLA Q1 aG.� ASSESSOR'S.MAP 6i LOT 1 t
/r' t'T �km�R �'yE��A�a�-sa;�.�1 L i Y � R�•
• ii ,
INSTAL AR'S NAME 6 PHONE NO.
SEPTIC.'BANK CAPACITY_
LEACHACILITY:(type) �. �,` ' (site) r �,
+G'F } i
:i��::•. G rr": �It�*f..x s tit>~'t` � �k�E..3; a•r` L
NO. OF:AgbkOOMS PRIVATE WELL Old PUBLIC
BUILDE{y:OR OWNER
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE•GRANTED: Yes No
• �� � � ��i+SF* J` piA r; +�t ; fie, 4
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-
' ASSESSORS MAP
- - ---- NO
PARCEL NO:
-----------
No
. ---- ee
BOARD OF HEALTH _"`--`:"
TOWN OF BARNSTABLE
z.ppiitation r It C n5trnrtion ernat
Application is/h�ereb a/de forr7rmit
/to Construct' Alter ( ), or Repair (lkn individual Well at:
--- ------------------—--------P-----------------------------------------------
Location — Address Assessors Ma and Parcel
S -
----- ---- -----------
Owner Address - /
-------------- ----------_-7 C� -- �— _ --�rSG `_--�- �
Installer — Driller— AddreV
Type of Building
Dwelling.....
`5 - 42JT7 -
Other,- Type of Building --- - - --- No. of Persons--------------------------------------------------
--------- Ca acit ------------------------------
Type of Well---� - -- ----- - --- P y-------- 1 ---
Purpose of Well- � lr_ - —----------------
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 u a Certificat f rice has been issued by the Board of Health.
Signed A � -� -- ----
date
Application Approved By ----- -- - - -- -- - ___
I Vv /
Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------------------
--------------------- ------------ - --------------------------------------- -------- ----------------------
date
Permit No. - r - - - Issued-- - --- d6te ---------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifitate ®f Comprianlre
THIS IS C'ER IrFY, Tin t the Indi��o))'dd��1T al Well Constructed ( ), Altered ( ), or Repaired ( )
by---! �LL_n -
1
at-------- -- 1 ` 1_ - (L1 C1}-------------------- ----
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. ------------------Dated THE ISSUANCE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE - -- - ----------- -—_=___ — Inspector-- ---- __—__--- ---- - - -
ti
No.---------- - - Fee--- ---------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application for Perr Conotruttion ermit
Application is hereby mft!orAritto Coonstruct ( ) Alter ( ), or Repair (�an individual Well at:
��/�. _ -{z 'P'�� ,�fl�✓--------------------- =--- ----------------------------------------------------
Location — Address Assessors Map and Parcel
f Owner Address
-----------
Installer-Driller Address/
Type of Building
Dwelling___. ------------------------
Other - Type of Building-------------------------------------- No. of Persons----------------------------------------------------------
Type of Well ------------------------------------------ Capacity 4L- — -
Purpose of Well----
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate of Com,lfance has been issued by the Board of Health.
Signed
Q date
Application Approved By - - --------.. - --------- —--17- r-r-
daT(e
Application Disapproved for the following reasons:-------------------------------------------------------------------------------------------------------------
/ s
-------------------------------------------------------------------------------------------------------------------------- -----------------------------
date
Permit No. Issued - -.—------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifirate ®f (compliance
THIS IS TgOI CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
bY- - __1~--i- �15_I��_------U: � �/e -
at- -- _ __ -�n- a ')71� (, lV �/�tall� eta= - -
-----------------------
has been installedin accordance with the provisions of the Town of Barnstab`a 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------------------------------------------------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Yell Construction Permit
No. -- /- ------ d Fee---�-----------
Permission is hereby granted-----( _ t/_ J
to Construuct, ( ), Alter ( ), or Re air ) an Individual Well at: /)
No. - -- 1 ----- C ----- '' n / — n-._tN ® ��!
t w . rJ Street
as shown on rthe application. or a Well Construction Permit / � ,� ,
No.-_"/{ % � - - -- - - --------- Date , �`' r�f-` L ;-"` = - - -- - - =-o
}! qq -- Board of Health
DATE------------:ice:;'�y--�----y- -�----�-------
' TOWN OF BARNSTABLE
' LOC:ATION, ` S c-S ss ;;k SEWAGE #
VILI AGE001° i
ASSESSOR'S MAP & LOT 02,T
INSTALLER'S NAME 6i PHONE NO.Ve_A-fX' jy%N. Ap,:-N
p
SEPTIC TANK CAPACITY °
j LEACHING FACILITY:(type) (size) ® �,
NO. OF BEDROOMS LPRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER .
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
9 -
VARIANCE GRANTED: Yes No
o- _,
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` � � � .. ��
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15.....
THE COMMONWEALTH O M#CHUSETTS' '
BOARD OF HEALTH
'.r✓ ....................0F./&,,eo/ ......................................
Appliration for Disposal Works Tonstrurtiun ramit
Application is hereby made for a Permit to Construct ( —1-41or Repair ( ) an Individual Sewage Disposal
System at: �
#eA# .2%
Location-Address •.-•••'•.••-------•---••••-------•----•.--or Lot No.
.. ,11..._... 1._Y. ........................................................_... ........................•...........................
Owner Address
W l�e. 4<<... � .3�5!.\ Qom..............................
- -•- .........................................�c c�rn!�® �.�vC .....A�
,_a •-- .. .i ••••-
$4 Installer Ad ess
UType of Building Size Lot-_.V0� �-.........Sq. feet
�., Dwelling—No. of Bedrooms........ ...............................Expansion Attic ("_� Garbage Grinder
'4 Other—Type T e of Building •S
p,, yp g ..._�.. .............. No. of persons............................ Showers ( ) — Cafeteria ( )
04 Other fix ures --•--•-------------------•---.......------------...........--•------------••-•--------------------•-....•-•••••...--••••......---•----••••......••----
W Design Flow......... ..............................gallons per person per day. Total dai�lY flow....... .........................gallons.
WSeptic Tank—Liquid capacity/&4.,PM.gallons Length._glik..... Width.y..b-..... Diameter................ Depth...,'--_-----.
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No.OAE....... Diameter.../.P........... Depth below inlet-tl*- ..... Total leaching area..&_7.....sq. ft.
Z Other Distribution box Dosing tank ( ) / /'
~' Percolation Test Results Performed by...�_.. r—pa............................................. Date..!1�1.. ,..
._.
a ?/ y Z
Test Pit No. 1................minutes per inch Depth of Test Pit._Z.." Depth to ground water_._.,,_..................
fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
....................••--•-•----------...............-------------•-•-----------••-•---------••...............................................................
ODescription of Soil........................................................................................................................................................................
x
V ...............••••----....--------•--•----•-•-••••••---•-••---•••••-••.._...-•--•--•••-----•-•-------•.........•----------•------------•--••......------------•------------------•--•--••-•----......._
W
-------------------------------------------------------•-••--------......................-•--------•----•---------------•---------...--------------•-•-----------------•----------------......---•••..--
U Nature of Repairs or Alterations—Answer when applicable...............................................................................................
-------------------------------••--••--------------•-----------------------•--------•---------......---------...---•-----•------...-----------------........------..........---------•--••--•---••......
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIILE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b e sued y the board ealth.
ty
Signed-• = or //
Application Approved By....- - --- ---•- - -••-- - - - -•----------------•-
7. e
ate
Application Disapproved for the following reasons:----•----------------------------•------------------------......---------------........---•••............•••--
...................................... ............................................_....._...........---------•--------------..- _•. -----.........._
Permit No.. . .......!..!( ................_.._ Issued.....4
-�•�--• - --•- ---•------Date............. -
utaay. -. -W_—___--- ------------------------
YN .i•�*
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
....._.....OF. ✓lr ( /?!L.-r.........................................
Appliration for 14sponttl Works Minntrurtion thrnti#
Application is hereby made for a Permit to Construct ( ✓ or Repair ( ) an Individual Sewage Disposal
System at: -� N.I.I�.C7:1 / •�'�? L •..'--•---•---.... .......-•................................
.. ...._.. a y� �.....
Loeation-Address-- ---- or Lot No.
.......................................................... .....---..-_............................... .............................................
Owner Address
W
Installer Address
UType of Building 3 Size Lot. _p'. =...---.--..Sq. feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( Garbage Grinder k1b)
A4 Other—T e of Building ............ No. of persons............................ Showers — Cafeteria
0.1 Other fixtures -------••--••-••••......•••••• .. ... ......._
Design Flow......... ..................:......gallons per person per day. Total dail flow.....:330.__.._._.._...............gallons.
W ', �'
WSeptic Tank—Liquid capac>tyO���.gallons Length_.�.:.�...... Width..:.:........... Diameter................ Depth....`._.........
x Disposal Trench—No..................... Width.................... Total Length.......__.�..... Total leaching area....................sq. ft.
3 Seepage Pit No.� ._-_____-- Diameter...l.�........... Depth below inlet�...�_......... Total leaching area_.?K7......sq. ft.
Z Other Distribution box ( � Dosing tank ( )
Percolation Test Results Performed by.............................................................................. .............................................. Date.-"./3/
Test Pit No. 1.... .._._minutes per inch Depth of Test Pit../__v......._._ Depth to ground water..'''v...............
G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 -•••-•-----•-----------------••••-•-••••....••-------------••-............._............••--......-•.........................................................
0 Description of Soil........................................................................................................................................................................
.....................
W
UNature of Repairs or Alterations—Answer when applicable...............................................................................................
...-----•-----•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TIT LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed_.:... ...-•---- v--- --------------------
7 ,j�.� la
Application Approved By.•_. _Cl��:..��tl. �� Cf ------ - --7e
Application Disapproved for the following reasons:...........................................................-•----------...------------•-••••-•--............-
...................................... ....._........-•••--------•......-••-----------...'•••----•••---•-•-----•••----•••......--•.._•• •.••-• .......................................
9
Permit No.. ........ .. ..J..--------------._...._ Issued_---
-u.....
ate
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
...........!!i ...................... .li-L---4 ...........................
(Intif ira ,af font t�innrr
THI�IS C RTI Y, Th the bdivi al Sewage Disposal System constructed (--)"or Repaired ( )
•-'•.. .................................
n alley ///�1� �, �I
at----- �a ..........�3..........- _Fr/. /iE ........... -------ll-t�-°.{(�% ! .5..?.. --•------•....-•--
has been installed in accordance with the provisions of TI 5 of,�ih tate Sanitary Code as described in the
application for Disposal Works Construction Permit No..... ..........�(_�___. . ._.. dated................................................
THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CON TRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.........................fJ.."..�.,.....ia............................ Inspector------.............•---•-.. .............................................
THE COMMONWEALTH OF MASSACHUSETTS
.. ....44..BO7 F LT t77
o .14
.....W
...... .. ...n
_..
No... ... .... FEE.. . ...
�an��r�tr#Uan anti#
Permission hereby granted �.r .... („1 LrQ . ...................•••--•-•••-•........................-•-•----.-•-•-
to Construct or Repai ( a I dividual S wa a Disposal-,Sys V
at No.L.� ��� a-� !NQ
---------------------
Street
as shown on the application for Disposal Works Construction Permit N Dated..._... _:j...................
-------------------------------------------------
--------
....................
Board of Health
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
t "" Department of Environmental Management/Division'of Water Resources'-` fi
WATI�i WELL COMPLETION REPORT
• r
WELL LOCATION
Address 467— !ate Atlxwm.-;,e 2CQ
City/Town V e—C% ��a/2h/ST�IG'Jt.,rf /11r0.
G.S.Quadrangle Map
Grid Location
Owner 0&Z64 i2» 1Jl�IJt t-..
Address
WELL USE CONSOLIDATED WELL
Domestic] Public ❑ Industrial❑
Type of Water-bearing Rock
�S Other Water-bearing Zones .
); 1) From
Method Drilled pGTv_#?"4, 21 From To
j Date Drilled F To
9 From To
CASING Depth to Bedrock
Length Diameter
. Type UNCONSOLIDATED WELL
Water-bearin Materials I
STATIC WATER LEVEL g
% Feet below land surface �9 Sand: floe medium coarse❑ i
`. Gravel: fine medium coarse
�o. rDateeasured ❑ ❑
Screen:GRAVEL PACK WELL
Slot#.20 length/Ifromf, 2LtoZ&es ❑ NoSplit Screen(or 2nd screen)
TER QUALITY TESTS MAD Slot# length from to
Chemical Cl Biological Depth To Bedrock
;.,s:•<;n PUMP TEST i
Drawdown _feet after pumpingLjj�—_days_tfS,_hours at GPM.
y� How measured Recover4od_feet after. 2 hours.
3` LOG of FORMATIONS COMMENTS: (On well or water)
Materials From To
7-0P r ;
DRILLER rcb
t -
//vt F.irrrv(�'1f�G �iG� �l3CCL QIZIcci.� �° �
- t — - ---- :.ddress. "16W J7_A?
t City
Registration No. �yo
. erator s S.gnature
ease print rrm y CUSTOMER COPY zstl to as 8onot
t J
�ti1��,[n,r,,.;;,._,. „,n ,,,{Jnm..n.n...,n..,..,,mm�llqit������1111)Il�liiiii��tltlllllltlmt���lirltiitiilitil IttllllltflttlllltfiittttitTiiltiiittit t►t t t .iiili�a
' �;.' .ram ..... •'4� , -i"� - - -..
ENVIROTECH LABORATORIES
449 Route 130 Sandwich, MA 0256.3 • (508) 888-6460
.. CLIENT: Edward Oavin LOCATION: Lot 63 Barnhill Rd
ADDRESS: W. Barnstable,MA
= COLLECTED BY: N. Kapolis SAMPLE DATE: 3/31/89 TiME:
DATE RECEIVED. 89 SAMPLE ID: ET 243
JOB #: New .Well WELL DEPTH:
c '
RESULTS OF ANALYSIS:
Ei
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0 0
EE
pH pH units_ .6.0-8.5 6.18
;^ Conductance umhos/cm 500 107
ff Sodium mg/L 20.0
EE 12.7
;r
Nitrate-N mg/L 10.0 .98
Iron mg/L 0.3 .30
Manganese mg/L. 0.05
Hardness mg/L as CaCO 3 500
i= Sulfate mg/L 250
= Potassium mg/L 20.0
Alkalinity mg/L 200
Chloride mg/L 250 —_
Turbidity NTU 5.0
Color APC units 15.0
c
t^ Background bacteria -
;
COMMENT:
Ea
YES NO WATER 1S SUITABLE FOR DRINKING PURPOSES FOR PA METER /�ESTED.
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1ST FLOOR FRAMING PLAN (16" ❑/C J❑IST SPACING)
ATERIALS LIST+ Design not checked by FASTPIan 5.0.0.4D (Synchronization Enabled)
ark City Length Product Ser/Gr Width Depth Total Length Add. Info
13 28' GPI 65 2 1/2' 11 7/8' = 364'
5 24' GPI 65 2 1/2' 11 7/8' 120'
3 21' GPI 65 2 1/2' 11 7/8' 63'
1 11' GPI 65 2 1/2' 11 7/8' 11'
2 17' GPLAM 2.0 1 3/4' 11 7/8'• 34' 2 @ 1 Plies
1 8' GPLAM 2.0 1 3/4' 11 7/8' 8' 1 @ 1 Plies
1 4' GPLAM 2.0 1 3/4' 11 7/8' 4' 1 @ 1 Plies
1 28' STEEL 28'
1 48' FIBERSTRONG 1 1/8' 11 7/8' 48' RIM 1 @ 1 Plies Rim
1 28' GPI 65 2 1/2' 11 7/8' 28' Blocking 1 @ 1 Plies
angers (Not verified by FASTPIan)
ark Qty Man. Model Nails Add, Info
1 Simpson HUS1,81/10 Faces 30 x l0dj Members 10 x 10d
7 Simpson ITT311.88 Facet 2 x 10d x 1.51 Top flange+ 4 x 10d_ x 1,5j Members 2 x 10d x 15
1 Simpson Optimal
1 Simpson IUT9 Faces 8 x 10d x 1,5j Member, 2 x 10d x 15
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MATERIALS LISTi Design not checked by FASTPIan 5 0 0 4D (Synchronization Enabled) ---
Mark Qty Length Product Ser/Gr Width Depth Total Length Add, Info
1 13 20' GPI 65 2 1/2' 11 7/8' 260'
2 5 17' GPI 65 2 1/2' 11 7/8' 85'
3 3 15' GPI 65 2 1/2' 11 7/8' 45'
4 2 20' GPLAM 2.0 1 3/4' 11 7/8' 40' 1 @ 2 Plies
5 2 17' GPLAM 2.0 1 3/4' 11 7/8' 34' 1 @ 2 Plies
6 1 8' GPLAM 2.0 1 3/4' 11 7/8' 8' 1 @ 1 Plies
7 1 4' GPLAM 2.0 1 3/4' 11 7/8' 4' 1 @ 1 Plies
8 1 28' STEEL 28'
9 1 48' FIBERSTRONG 1 1/8' 11 7/8' 48' RIM 1 @ 1 Plies
Hangers (Not verified by FASTPIan)
Mark Qty Man. Model Nails Add. Info
A 7 Simpson ITT311.88 Faces 2 x 10d x 1.51 Top flanges 4 x 10d x 1.5j Member, 2 x 10d x 1.5
B 3 Simpson HUS1.81/10 Faces 30 x 10dj Member, 10 x 10d
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RES.ZONE:RF FLOOD* ZONE: C .PLAN REFER rNCE:279/65 Y . kJ Q�ALE: 1 30 REVISED: //25/89, 214189