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HomeMy WebLinkAbout0140 CEDAR STREET - Health 140 CEDAR STREET AJWEST BARNSTABLE 131- 331 I TOWN OF BARNSTABLE LOCATION /mod G90,4e 07pgFc'T SEWAGE # VILLAGE__ Gy. l$ ASSESSOR'S MAP & LOT /3/.d Z/ INSTALLER'S NAME & PHONE NO.45'0A�P-e-WV7 eaAMP7 SEPTIC TANK CAPACITY z� LEACHING FACILITY:(type) �Z' j (size) NO. OF BEDROOMS IVAT WELL PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED:- DATE COMPLIANCE ISSUED: ~"'/ VARIANCE GRANTED: Yes N� 1 r r `�° Id ` ►�, air � O � No. Fee-----__ BOARD OF HEALTH BARNSTABLE ApplicationArlVell Con0tructionpermit Application is hereby made for a permit to Construct Alter or Repair ( )an individual Well at: t-Czqq_' _fir Location Address Assessors Map and Parcel 7( __5 !Ok&iner Address ')Cerf Installer — Driller Address Type of Building Dwelling Other - Type of Building No. of Persons-------------- Type of Well 94r—IL"2f 1 47 Capacity-------- Purpose of Well---- -�_(a 6(-e Agreement: The undersigned agrees to install the aforidescribed 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 Compliance has been issued by the Board of Health. /ate Application Approved date Application Disapproved for the following reasons: lak date Permit No. Issued date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate (Of COMPhance THIS IS TO CERTIFY, That the Individual ell onstructed Altered or Repaired C ---- by - -- ✓ Installer at /Vc) has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE Inspector j i No. '�'= _--Qj �P Fee---------1--� -- BOARD OF HEALTH TOWN OF BARNSTABLE Application Ar Well Congtruction.Permit Application is hereby, made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: ---��f�----�'�•{-i4R. S� dt1�Sim ----___—_ --_-- -- Location— Address Assessors Map and Parcel — d ner Address Installer Driller ly . Address Type of Building Dwelling _—- - --------------------------- Other - Type of Building No. of Persons------------------------------ Type of Well 1524;11"-6f — Capacity--------------------- --- i 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 Compliance has been issued by the Board of Health. Oa te Application Approved By i PP date Application Disapproved for the following reasons: l date Permit No. `4 O �' -- Issued--- - -! ----- -- date - ,.s f i BOARD OF HEALTH TOWN OF BARNSTABLE If C ertif irate Of Compliance THIS IS TO CERTIFY, That the Individual1W ell Constructed ( ), Altered ( ), or Repairedby— ( ) _ Installer at has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -----------------Dated----------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL I; SYSTEM WILL FUNCTION SATISFACTORY. DATE—------- ---- - --- Inspector------ - - --—------ BOARD OF HEALTH i TOWN OF BARNSTABLE Well Congtruct ion Permit No. Fee— 4 Permission is hereby grantedto Construct ( , Alter ( ), or Repair (� an Individual We at: f No. — — — Street i as shown on the application for a Well Construction Permit f r a't -- -7-__ i a Board of Health DATES a i CLUB WED ♦� THE ANTIDOTE FOR CIVILIZATION li 2^ 2' WINDOW SCHEDULE II a I yoBe © II SYM. MANUFACTURER'S UNIT ROUGH OPENING REMARKS A ANDERSEN M452 2'-6 1/8'x 5-5 1/4 I i 2B6 8 ANDERSEN TW24310 2'-6 1/8'x 4'-1 1/4' II O v II I C ANDERSEN TW2442 2'-6 1/8'x 4-5 1/4' I i BATH B 3, 6B8 FI LOCATEFLUE O it D ANDERSEN(51245 4'-Vx4'-5 3/8' TEMPERED GLASS I I B L 01 TO Mm SPECS E ANDERSEN 0145 2'-4 7/8'x4'-5 3/8' TEMPERED GLASS II LINcc a II F ANDERSEN C235 V-O 1/Yx3'-5 3/8' I nI LIN xa' vN L? I I ANDERSEN RV 4446 44 1/2'x43 1/Y SKYLT I I BATH 2568 I , N ANDERSEN 2817 2'-8 5/8'xi-7 1/4- UM WM WINDUN I I I i In - . NOTES. I II 2BBa 2BBa _. I. SEE ELEVATIONS FOR GRILLE PATTERNS. I I 2. INTERIOR GRILLES TO IBE VINYL SNAP IN. I I B I O 0 8 50Ba O S B ____ __ ____ ._ I II II oI BEDROOM II II II II Ll c II II 2' ' II I II © © © 97 - - -------------------- --- - - ----' -------- L————————————— ————.——————————— ——_—1 —— II II it II I — II II II II II II ------------- - I 131 ®31 SECOND 00R PLAN6CALE,I/4'-I'-0' k r} D 1/Y LG BTL ABWEra LC. - • O __ ___________________ ,� o 2• 21 0's sod, I _ _ 1 FROM :6 '1 ENTRY 1 STUDY O 1 A I I LIVING ROOM L--J qu. �-——-� - 6A3 /P I w/RA s NEAR I TERRACE } L_—J M ! COVERED PORCH 01 EXIDN O UP i - 1 2668 9068 • _ n 1_ • O 1 � ANDERSEN ANDERSEN DINING ' TJ Gbo,, �p'k' '_ KITGEIEN t 2n i I I I I OX3 � I I I I 2 L J L---J L ` 1 M. BATH 2668 ' T 6FR DR. w LC. ' n e 9 E�26 D i , L WIN M. BEDROOM CAV cw. CCC 777 2668 1 — 1 ———————— ® ZB6B O C I = B LAUNDRY CLOSET 2668POWDER ENTRY B�9 2868 ° • t_ 266 © ® BO ©X4 ----------------------------------------- L GO 1 • ` v OFFICE ' Oe` DN 1_ • 1_ 1_ 6. V EX1571NG/ RENOVATED 1_ n FIRST FLOOR PLAN SCALEIVa°-I'-O° Commonwealth of Mossochusetts Executive Office of Environmental Affairs CEIV�Q Department of MAR 2 5 1997 Environmental Protection T W!7F WIIIian1 F.Weld Q HEALTH 0 Go`wna T A►peo Paul Celluccl , U.Goamor he 4 r 8U1B9URFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM �ea / PART A ERTIFICATION Property Address: I t{ C Gh A V 3 Dab of Inspection: .3/1019 Address of Ownerstt--vv E Name of inspector. v; �-� (It different) Company Name,Address and Telephone Number.•� CERTIFICATION STATEMENT A✓1S1 �� � JAA. S_104�? 76 `t- 0;X_3 S I certifyw that I have personally inspected the se •3 3 age poeal 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 Fail / Inspectoes signature: C I a --_=.- Date: The System Inspector shall submit a copy of this inspection report to the Approving Au((((thonty within thirty (30) days of completing inspection. If the system is a shared system or has a design flow of 10,000 r or p this to the appropriate regional office of the Department of Environmental Protection. , the inspector and the system owner shall submit the The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving authority. INSPECTION SUMMARY: Check A, B. C,or D: A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in Any failure criteria not evaluated are indicated below. 310 CMR 15.303. B) SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired The system, upon completion of the replacement or repair, inspection. passes Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all The septic tank is metal, cracked, structurally y ms If"not determined", explain why not) urally unsound, shows substantial infiltration or ezfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a ponforming septic tank as approved by the Board of Health. (revised 11/03/95) 1 One Wlntsr Street IS Boston, Massachusetts 02108 s FAX(617)$56.1049 s Telephone (617)292•5b00 w ��Pnnted on Recycled Paper r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A /� S CERTIFICATION (oontinued) Property Address: �I Q c-cACL�."( �1T. Owner. cS�e.V i-- �M r•Q J Date of Inspection: 3/1 O/iCj , Bl SYSTEM CONDITIONALLY PASSES (continued) Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipets, or due to a broken, settled or uneven distribution box. The system will pea$ inspection if(with approval of the Board of Health): broken pipe($)are replaced obstruction is removed distribution box is levelled or replaced — The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C) FURTHER EVALUATION 1S REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to rotect the public health, safety and the environment. p 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM 1S NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRITE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH A AND SAFETY AND THE ENVIRONMENT _, The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. — The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and is leas than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicate$that the well is bee from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm 3) OTHER (revised 11/03/95) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A �, ( t CERTIFICATION (continued) Property Address: ��0 Lie c40.V Owner. Date of inspection: 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 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 in below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply _. Any portion of a cesspool or privy is within a Zone I of a public well. ._ Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis If the well has been analyzed to be acceptable. attach copy of well water analysis for coldorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: 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( 3 health and safety and the environment because one or more of the following conditions and the system is a significant threat to public 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 6.00. Please consult the local regional office of the Department for further information. (revised 11/03/95) 3 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Addreswc 14 Q C�GctiA.✓- Owner. '54-e,v t, Date of Inspection: I© /Cl `J Check if the following have been done: Pumping information was requested of the owner, occupant, and Board of Health. None of the System components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. l�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 were uncovered, opened, and the interior of the septic tank was inspected for condition of baMes or tow, 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 or approximated by non intrusive methods. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of Sub. Surface Disposal System. (revised 11/03/95) 4 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (( ( SYSTEM INFORMATION Property Address: 1 l� c 2c "'- Owner. SCvf. ��✓+dqq Date of Inspection; 3/`©/el, U RESIDENTIAL- FLOW CONDITIONS Design flow: ? ors Number of bedrooms: Number of current residents: 164 Garbage grinder(yes or no):,dW Laundry connected to system (yae or no l: Y(.�S � T Seasonal use(yes or ao): Water meter readings, if available: Last date of occupancy: o d L"5"+- COMMERC[AL/1 NDUSTRiAL- Type of establishment: Design Dow:_ gallonvday 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: ALA L System pumped as part of inspection: (yea or no( If yes, volume pumped gallons Reason for pumping: TYPE OF SYSTEM Septic tank/distribution box/soil absorption system Single cesspool Ovwrflow cesspool Privy Shared system(yes or no) if yea, attach pre 0�ors mmpect n records, if any) Other(ezplain) aft~ b l� y l`� ✓Q.�U �'"�IJX APPROXIMATE AGE of all components, date installed (if known)and source of information: _�7 Vl K-Ld ..� Sewage odors detected when arriving at the site: (yes or no)AJO (revised 11/03/95) 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 140 cel x_- v4 Owner. '�S'Ir C V L, Date of Inspection: '3/1 0 /61 —1 SEPTIC TANK:X (locate on site plan) Depth below grade:,, Material of construction: Xooncrete_metal_FRP_othene:plain) Dimensions:A. Ai't;X x�; xR I�Oo Cruet Sludge depth: y Distance from top of sludge to bottom of outlet tee or baffle: �� Scum thickness: .5 Distance from top of scum to top of outlet tee or baffle:_�� _ Distance from bottom of scum to bottom of outlet tee or baffie: 14 Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) GREASE TRAP-._ TRAP._ (locate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(esplain) 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: 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 i (revised 11/03/95) 6 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: NO C���^(S cc Date of Inspection:v� �UL ��c�✓;d`�1�.•3 TIGHT OR HOLDING TANK:_ (Ideate on site plan) Depth below grade: Material of construction: _concrete_metal_FRP_other(e:plain) Dimensions: Capacity: eallons Design flow: gallonsiday Alarm level: Comments: (condition of inlet tee, condition of alarm and float switches. etc.) DISTRIBUTION BOX_ (locate on site plan) Depth of liquid level above outlet invert: Comments: (crate if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) PUMP CHAMBER_ (locate on site plan) Pumps in working order:(yes or no) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (revised 11/03/95) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: v C Q '4'- Owner. SS�tJI. Date of Ins i— peotion: 3/I O/9 SOIL ABSORPTION SYSTEM.(SAS):.x (locate on site plan, if possible. szcavation not required, but may be approximated by non intrusive methods) If not determined to be present, esplain: Type: leaching pits, number. leaching chambers, number:_ leaching galleries, number: leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Comments: (r}ote condition f so • signr of by ulic f urea evel of ponding, condition of vegetatiometc.) �C o ✓ v 1c yr CESSPOOLS:_ (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of acum layer: Dimensions of cesspool: Materials of construction. Indication of groundwater: inflow(cesspool must be pumped as part of inspection) Comments: mote condition of aoil, 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.) (revised 11/03/95) S SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (oontinued) Property Addrear. , () C(A'�4 Owner. Date or Inspection: �'��' ✓ Q 3[10f-i -� SJWMH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmariLs locate all wells within 100, xP cl �0:J 5 O (1 $O To DEPTH TO GROUNDWATER D*Pa to patndwater. /0 feet �p `, p I method of determination or approximation: y 1� (revised 11/03/95) 9 - _ 9904Gi Gate 03/29/96 !3o C ie Number .�4E A � .; BARNSTABLE COUNTY HEALTH AND�EN usRONMENTAL DEPARTMENT SUPERIOR COU r BARNSTABLE, MASSACHUS�TTS 02630 U �b: h P"ONE:962.25tt t�. A!A S` �O11�S►GGr: ALSCk MC GARTHY r, .ient.: MCQre0THY362 IC Affiliation: OTHER Mailing Address : CUMMAQ0Z'5 MA 02637 TVPP of Supply: W a�959a Well Depth: 55 FT Telephone: 36 Date of Collection: 03/26/96 Sacnple LOCation: 1.42 CEDAR ST Date of AnalySi.s : 03/26/96 Town: WEST BARDSTABLE MATS RECOMMENDED LI . -- - sAMPt�r•, RESULT PARAMETER - � 0 Total Colitorm Bacteria/1�1C mL ?. 5 nH tao 500 Conductivity lmicromho�lc:m) ` 0 0 . 3 iron (ppm) 1010 ^�] trat�;-;vlt1: (1 1 luprti} �, '� 20 . 0 cditarn (pp;n) 0 1 .3 �;uDPe I' (piim) BASED ON THE-ANAL'1SES PERFORMED, THS FOLLOWING Af V1GORIE'S ARE GIVEN: x. Water Sample i1as higher than average levels of nitrates. Future monitcri� i.s rccomrnended (2-3 ti[n2a pPr Year) to establish any upward -trends. W Iter sample meets the rec:orpmencled limits for drinking water cf a.l above tested parameters . Thomas F. Rour.ne, LaboriltOr"' Dir'eCtor i �Gf�Ory'rICWAL 17ER EPA MET14005 601 and 602 volatile Organics (GC/pxD/ELCD) Lab ID, . psis ioi5dw Field 1D: Vicki 7 a 140 Cedar $t. W- Barnst. gampl�ed 02_26-97 Project: Vicki Eldredg I Received; 0,_26-97 Clietlt: �I1ViEOteE�! Analyzed; 02-27-97 Cont/Prsv: 40mL VOA Vial/Hcl cool Matrix; Aqueous CONCENTRATION REPORTING LIMIT PARAMETER (u91L) BRL 5 Dichlorodifluoramethane BRL chlorometnane BRL 5 Vinyl Chloride gRl Bromomethane BRL 5 Chloroethane BRL I Trichlorofluoromethane BRL 1 1,l-Dichloroethehe BRL 1 Methyl erle Chloride BRL 1 trans-1,2-Dichlor0ethene BRL 1 1,1-Dichloroethane BRL 1 G11-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1 1 14richloroethane BRL 1 carbon Tetrachloride BRL 1 Banzene BRL 1 1,2-Dichloroethane BRL 1 Trlchloroothene ORC 1 1,2-pi chl oroprapane BRL 1 BromodichloromQ have E,RL 5 2-Chloroethyyl Uinyl Ether BRL 1 cis-1,3-Dichlor WPOne BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL I 1,1,2-Trichloroethane BRL 1 Tetrachl oroethene BRL 1 Dibromochlaromethane BRL 1 Chlorobenzene BRL 1 Ethyl benzene 1 meta-and pars-W ene * BRL 1 ortho-Wene * BRL 1 Bramoform gR` 1 1,1,2,2-Tetrachloroethane B 1 1,3-D i chl mbwene BRL 1 I,4-Dichlorobenzen2 BRL 1 1,2-Dichlorobenzene SPIKED >NEASURED RECOVERS QC LIMITS QC SURROGATE COMPO4lNb � � a,a,a�-Tri rl uorotol uenP 30 39 �? � 1i3 1 9197 83 - 11'1 1 ,2-Dichloroethane-44 ' CLIENT: YiGKi LlAr 09v W.Barnstable MA 02668 ADDRESS: 140 Cedar Street W. Earnslable 1IAA 09000 COLLECTED BY: GG6nt SAMPLE DATE: 2-26-97 SAMPLE TIME: NiA WATER SAMPLE TYPE: Existing Well DATE RECEIVED: 2-26-97 LAB I.D.#: 97-2307 WELL SPECS.; NIA RESULTS OF ANALYSIS: Parameters Units Recommended Rewift Method LtiiMft Coliform bacteria /100ml 0 b 9222 8 Nitrate-N/Nitrite-N mg/L 10.0 0.07 45b6-Id03 Ammonia-N mg/L 1.0 <o.t 350.2 Volatile organics* ug/L None Detected 6011602 COMMENTS: "See attached YES WATER IS SVITADLE.FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date Ro Id J.S I Laboratory ctor <-1ess than ?-0reater than TNTC=too numerous to count )� �JC, tS Zt ii-�U-�e6I. No...... rll .s�.�� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE AVVliratiun for Bispoii al Workii Tunitrur#iun Prrutit Application is hereby made for a Permit to Construct ( ) or Repair (0<) an Individual Sewage Disposal System at: •• •• - ..................................... ...................................... Location-Address or Lot No. • .......l F-vl_! ._.......1� i�..-------- . 1�Q C' ... -- :.. -------_4&m.. . - Owner Address r ��OGO 7 ICl/ ? 76.E ----------- -------- ... �a Installer Address Type of Building Size Lot. ...._._. ..Sq. feet Dwelling—No. of Bedrooms............... ..........................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons________________-_-__-____ Showers — Cafeteria a Other fixtures ------------------------------•. . ------------------------------ --------------------- W Design Flow................... ----------------gallons per person per day. Total daily flow__._............._......._....gallons. WSeptic Tank—Liquid capacity............gallons Length---------_---- Width................ Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----------_-------- Diameter.................... Depth below inlet__...............•. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ �+ -------------------------------------------------------------------------------•••••............--••......................................................... O Description of Soil------------. _4 ' ------. -_¢° ...5.56&----5. 14 =�` x W ----------------------------------------------------- -•---...-•----••-•-•-•--•-•--•--------•--•---------•----. .................................................... Nature of Repairs Alterations—Answer whe ap licable.._IGTL: QDI� C - �' ............ I----- . i7'..1 ` c Seel1 .................................................... Agreement:. The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance s been issue by the board of health. Signed ....... -- . -- . --------- --- -- gl ApplicationApproved By ----------------------)._� .............................................................-- -------------ate-- ---------- Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------- ------------------------- - ------------------------------------ ........................................ Da. Permit No. ----- 9 f - �'��--- -- --------------- Issued ................................................................... i Dace yo' p 4, Fss..�_.�.�.2..� a. THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Ui"osal Works Tnnstrnriinn Vanat { Application is hereby made for a Permit to Construct ( ) or Repair an Individual Sewage Disposal System at: .... ... Location or Lot No.-Address Owner Address ----••........ .•...............•••••-••••••---•••-•-••........••••-••.• .. Installer Address Type of Building Size Lot. A:Qe_--._Sq. feet aDwelling—No. of Bedrooms----:.......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ---------------------------------------------------------------------------------------- ---------•-----------------------------•-•----.-------------- W Design Flow................. . _________..gallons per person per day. Total daily flow............... G................ WSeptic Tank—Liquid capacity.............gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area....-----------...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date......... .............................. aTest Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fi Test Pit No. 2................minutes per,inch Depth of Test Pit.................... Depth to ground water........................ ----------------------------------••----••------•--------------.............._......._............••......................................................... O Description of Soil............. ....... ...... ..... x UNature of Repairs 9.7 Alterations—Answer when applicable__ ......,....�.o ___ra% ._ �slrll_� sv.r c� 1 cs ------ADD -•z::;,........................... ---------------------------------------------------- i Agreement:,A The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental 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 ------�----^1!� ...J -- .... -5- Date Application Approved BY ,�+-•.w+� . ..��.�.<_: , .... te------------------- Application Disapproved for the following reasons- --------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- //- Date Permit No. ------- .�f. C f � -.. ----------------------------- Issued Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE tuPltifirate of Q1IImytiance THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by........................................................................ . --.... p ------...........--...-------------------------------------------...--------------- Installer T PA at ..................-------- .............................. --------------------------- � ............... ?..;._-------------- has been installed in accordance with the provisions of�TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ......,j��-..... .4....//.............. dated ................................................ THE ISSUANCE OF THIS CERTIFICATE;SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY DATE.......... ..�......Yr .�........1. ......................... Inspector. � .... - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No......y.�.n. FEE.S2;i............ Disposal Works Tlanstrnr#iman Prrmit Permission is hereby granted...................... ....... ................................................... to Construct ( ) or Repair (�< an Individual Sewage Disposal System atNo.......................... .........4__7 ........1..4 rf ........... -� :__. �i. %s`� ..................... street as shown on the application for Disposal Works Construction Permit No..qr L.2/�1... Dated.......................................... ...........................: ...6-ih ............................................................ �]DATE................................................................................ V Board of Health FORM 36508 HOBBS&WARREN.INC..PUBLISHERS `�