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HomeMy WebLinkAbout0717 CEDAR STREET - Health 717 CEDAR STREET West Barnstable A = 109 - 015 - 013 TOWN OF BARNSTABLE LOCATI J N 7 Ire-®'4< SEWAGE#�?3�� Z�� \VILLAG i 8•�,'y�Q g6 . ASSESSOR'S MAP&PARCEL - 0 l —013 INSTALLER'S NAME&PHONE NO,5�&W-l4 %_ p&y SD 8 QZo d f-9S SEPTIC TANK CAPACITY 5e;S7;nq /r3ov LEACHING FACILITY:(type) 7-0 Jey CZ14t*-V*,S (size) ;5`r ' _:_.NO.OF BEDROOMS „c7 OWNER I A q.A- VIZ O(f t P!�0, PERMIT DATE:-717-a f l6 COMPLIANCE DATE: ����y Separation Distance Between the: Maximum Adjusted Groundwater Table to the 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 4-7/7 (edo,r s v,,A AOVA Linc- __j / ® 6D I p 6� f Town of Barnstable P a ate'° Department of Regulatory Services 3 ...NMB,B,: Public Health Division Date Zv qp a� 200 Main Street,Hyannis MA 02601 Mlti L' Date Scheduled 7/aJ �v Tim/0 Fee Pd. � Soil Suitability Assessment for Sewage Disposal Performed By: �' '` ����J Witnessed By: r LOCATIy,/ONN�&GENERAL INFORMATION Location Address q�-�l7 '1 lam .. Owner's Name - / Address Assessor's Map/Parcel:/D / ` Engineer's Name NEW CONSTRUCTION REPAIR 4SC6 Zi Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 1 � II 1 Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ a PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Perc f Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak Rate MmAnch / Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG_ Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other ` Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.° Gravel '30- 1 � BY bT n 411,p - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color .Soil , Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Mao: / Above 500 year flood boundary No es Within 500 year boundary No /Yes- Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pe to l exist in all areas observed throughout the area proposed for the soil absorption system? t Q If not,what is the depth f n Hy occurring ions material? Y Certification F I certify that on (date)I have passed the soil evaluator examination approved by the Department of En ental Pro lion and that the above analysis was performed by me consistent with the training, x pe 'en a described in 310 CMR 15.017. Sign lure Date Q:\SEPTIC\PERCFORM.DOC CO— NO. /j�� �(�PVoTHE COMMONWEALTH OF MASSACHUSETTS FEE BOARD OF HEALTH o' 1�/lNW� OF APPLICATION FOR DISPOS SYSTEM CONSTRUCTIO ERMIT Application for a Permit to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) - ❑Complete System ;��.divd.al Components Own ' Name a arcel# C' Address phonV Installer's ame DesignerWo �Il ©a res /V a aAt;' Z 17 1 v Telephone# Teleph 'e# Type of Building: wkpkk n k\'"[v Lot Size /'� " IC-Sq.feet Dwelling—No.of Bedrooms Garbage Grinder ( ) Other—Type of Building No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. qudd) gpd Calculated design floe gpd Design flow provide fgpd Plan: Date Id Number of sheets �_ Revision Date Title l�Q.� r �a 714�n�' 'l A , Description of Soil(s) b Soil Evaluator Form No. N�ame of Soil Evaluator �+ Date of Evaluatio D SC IPTION OF REPAIRS OR 'LEERRATIIO S CA_ The undersigrl'ed agrees to in I the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and furtQ,agrees not to 1 e the sys ope on until erfificate of Compliance has n issu by the Board of Health. Signed Date Z Inspections FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 ~� //— ..� , � ' '-Via``�''�-'�'•�,`�j-- �(� ,.��1 I '. No. THE COMMONWEALTH OF MASSACHUSETTS FEE ( y BOARD OF HEALTH APPLICATION FOR DISPOS y `SYSTEM CONSTRUCTIONDELdRMIT Application for a Permit to Construct ( ) Repair ( Upgrade ( ) Abandon ( ) - ❑Complete System ; ndividual Components 7/ Q. Owners Name api arcel# Address Phon �` Installer's ame�� � ^Designer's e'/ x 10 Telephone# Telephone# Type of Building: �J ► t t►Tv:} � t f j �l f '1J t Si e t�'t. . -Sq.feet Dwelling—No.of Bedrooms I ,n ; I l ���Mar'age Grinde� ( ) �J *f Other—Type of Building ►No.of persons Showers ( ), Cafeteria ( ) Other fixtures Design Flow(min. qui d)-W_gpd Calculated design floe gpd Design flow provide I q gpd Plan: Date 1C7 Number of sheets Revision Date Title f�Z nE AAJ n 40:---1 A nOP ;r-/ 14 Description of Soil(s) Lr . .' r- AS Soil Evaluator Form No. Name of Soil E°valuato � �Dateof;kva uatio DESCRIPTION OF REPAIRS OR LTERATIONS �+'�7 G C7 c a -e4c-s w h The undersigned agrees to install.the above described Individual Sewage Disposal System in accordance with the provisiops=of *� TITLE 5 and furth agrees not to I e the sys m-i ope on until ertificate of Compliance has bden issu by the Board of Hem (� Signed Date >� Z b Inspections - _ FORM t - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 _C�►�_J /—______ ____ --- ____ ____--- _ No. �✓P�� HE GOM Or��ALTH OF MASSACHUSETTS�������FEE ��+�r M� BOARD OF HEALTH C TIFICATE OF COMPLIANCE Description of Work: Individual Component(s) ❑Complete System The undersigned hereby certify that the Sewage Disposal System;Constructed( ),Repaired( pgraded( ),Abandoned( ) has been installed in accordance with the provisions of 3 .10 C 15.00 (Title 5) and the approved design plans/as-built plans relating to application No�/t "�'So�- dated -7//D `(o Approved Design Flow 3,30 (gpd) Installer ��, Designer: C1 • V"� ``�� 1 1�.i� Inspector h"j 140 Il\ Date 1 �, �( _ The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. = FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 d ` `� �� COMMONWEALTH F MA AGHUS TTS / v No. O SS E FEE BOARD OF HEALTH DISPOSAL SYSTEM CON�P�Upgrade CTION PERMIT Permission is hereby granted to Construct ( ) Repair ( ( ) Abandon ( ) an individual sewage disposal system at nn as described in the application for Disposal System Construction Permit No. a�G dated J Provided: struct 1 be completed within three years of the date of this per t-A to conditions must be met. Date •, Board of Health FORM 2 - DSCP DEP APPROVED FORM 5/96 FORM 1255 (REV 5/96) H&W HOBBS&WARREN TM PUBLISHERS- BOSTON Town of Barnstable Regulatory Services Richard V.Scali,Interim Director 9� KAM. �0� Public Health Division 039. Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 �n Installer&Designer Certification Form Date: W�� Sewage Permit#ZO/6r Z5Z Assessor's Map\Parcel/ Designer: tij. Installer: Y 4 Address: & :' �ll (1�1G Address: ) '� On 7 2 7 IZ01 b N,011 L COAPA was issued a permif to install a (date) (installer) septic system at 1�� GJ� based on a design drawn by (address) dated (O (designer) _Zlcertify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found'satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in co n�iance with the terms of the approval tters (if applicable) tlf�hqs t nl UAVIU ��r ( staller s Signature) MASON m No:1066 a. . IVI TAIR\ (Designer s Signature) (Affix Desi ;ramp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc Town of Barnstable P# �IRE Department of Regulatory Services .a,,g,,,ST,B,Z: Public Health Division Date .e!19. �e� 200 Main Street,Hyannis MA 02601 FD IMF�' s � Date Scheduled � � `���� Time Fee Soil Suitability �A�ssessment for Sewage Disposal Performed By: 1/` \A`�."'C Lt:;1 ' Witnessed By�' � LOCATION&GENERAL INFORMATION Location Address —7 i"'� /'ti2'f'�.1 0- Owner's Name ({ 1 VrL.lsT'TI/� .7 t Yc� Address Assessor's Map/Parcel: !4)��/a /�� Engineer's Name �l.S71 l y � NEW CONSTRUCTION REPAIR Telephone#6`(J Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other R SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) d ��V *-Z, Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ Time(9"-6") End Pre-soak nit,Rate MinAnch L• ! Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original:Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC Ar DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel © -- /01 If 1 r rtulre- MAID, IZ, DEEP OBSERVATION HOLE LOG Hole# Depda from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) y r Flood Insurance Rate May: Above 500 year flood boundary No /Yes r Within 500 year boundary No �// s -Within 100 year flood boundary No_ Yes_ - Depth of Naturally Occurring Pervious Material Dees at least four feet of naturally occurring pe o terial exist in all areas observed throughout the area proposed for the soil abs rption system? If not,what is the depth illy occurring perjious material? Certification if I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviroental Protection and that the above analysis was perf rme by me consistent with the required training,expert a pe en described in 310 CMR 15.017. Signature Date h (l Q:`SEPTIC)PERCFORM.DOC op �5/00- 8 TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE ASSESSOR'S MAP &LOT _ O INSTALLER'S NAME&PHONE NO. 6(2% Dom) SEPTIC TANK CAPACITY /,-5-05 s r LEACHING FACILITY: (type) Lg.,t c9 (size) NO.OF BEDROOMS BUILDER OR(�VN :�we'Al2w PERMITDATE: !U '2 8 g 7 _COMPLIANCE DATE: f .-►1�j -q A? 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) t Feet Furnished by -" LA w II AsBuilt Page 1 of 1 TOWN OF BARNSTABLE � � . 9 o s o 3 'LOCATION- SEW-AGE A VILLAGE f /A�\j ASSESSOR'S 14AP & LOT INSTALLER'S NAME Q PHONE No. C'�C� Ll/ 26 SEPTIC TANK CAPACITY' LEACHING FACILITY:(r7pe) Q NO. OF BEDROOMS S' PRIYATE WELL OR PUBLIC SVAT19A 7W=. : .. o BUILDER OR OWNER 'DATE PERMIT ISSUED: DATE COUPLU&NCE ISSUED; VARIANCE GRANTED: Yes No J/ r ti Y Q Y �J .. .-� •�'Y. � it 1 Va. + t -h http:/AssgI2/intranet/propdata/prebui It.aspx?mappar=109015013&seq=1 5/23/2016 �/ /\\ TOWN OF BPiR:�TS'TAf3LE l , .� tj Q 3 'LOCATION c-e /9 r S+ SEWAGE ; y; VILLAG /AS&Llf ASSESSOR'S MAP &,LOT INSTALLER'S NAME Q PHONE NO. V �L(2 1 CO �6 N SEPTIC TANK CAPACITY LEACHING FACILITY:(Me) 4)(0 ��'�� (size) NO. OF BEDROOMS 7 PRIVATE WELL OR PUBLIC WATER-, BUILDER OR OWNER N L G U DATE PERMIT ISSUED: DATE COZIPLLA NCE ISSUED: VARIANCE GRANTED: Yes No w N �e 0 v M X �Ic,CC yYh .. ,, Fizz THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH Apliliration for Uhipaaual Works Tomitrnrtiun Vrrtnit Application is hereby made for.a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at L � .-•••••.....r............ 1............. ..... ? .A%//- , - ----------- Location-Address, or Lot No. Owner Address a ................... ............................... Installer Address U Type of Building Size Lot- `f J Sq. feet Dwelling—No. of Bedrooms.._...! ----•--•-----------------•Expansion Attic ( ) Garbage Grinder ( ) Other—Type T e of Building No. of persons............................ Showers W YP g --------------------•------• P ( ) — Cafeteria ( ) Q, Other fiNtures ••--••......-•--••......----•--• - W Design Flow......... '...................gallons per person r day. Total daily flow......... WSeptic Tank—Liquid'capacitvOgc.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..._...�,� C ._._._._..._ . ..____. Date. .......!_.__..__.__.. Test Pit No. 1___....Z-_-_minutes per inch Depth of Test Pi _...._ ..C.__ Depth to ground water ___ _ __ f=, Test Pit No. 2..4`___-._minutes per inch Depth of Test Pi .._../Depth to ground water_-_._-.. __i a ••--•••....-••••--------•--••---•--•••--.... ................. Description of Soil.•................... _-- •-•._-•_..._- x .................................................... ..... :-- �:-�,� ........ - - --------------- W UNature of Repairs or terations—Answer,whe5-app Licable-----_---------------- Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L I T LE 5 of the State Sanitary Cod —The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee i', ue 'the bb�_cd of It Signed •... -- ......... --..---- ate Application Approved BY E ... lv. -- - --- .............. Application Disapproved for the following reasons:....................................... ...............................................---•••-•-••••••••-••-•-••----•-•••••-•...--•---t e.............. L� f .. ....••---•.••••...............•-•--....••-••••-•-•••-•-••••-••••----•-••------•-------••••--•••------•.•.......- ••---••-•----- Dau Permit No._L `�' .. �................ Issued..... �" �� --------•--•----•-- ----•---- Date ----•--•--�---••-------. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH --------------.OF............ ...& L cj -/� Appliratiun for Disposal Works Tonutrurtiun Wrinit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..... .�--e;.'0.. :.��..----.. r .....xzt.....�� .1" G�� _m--................... .• -----Zocauon-Address or Lot No. ----------..,,�,4 G �--., . ---••.•.... „.............`........ ...••-• --/..'...- C✓ •--'-l-- wner fy —�Ad s .. W=......... O s +Vf_Z - - ..................................... Gt�rs Installer Address d Type of Building a � Size Lot?_ /__��._Sq. feet Dwelling—No. of Bedrooms----- _____________•-_-•--__•--_Expansion Attic ( ) Garbage Grinder ( ) '4 Other—Type T e of Building _...___.... No. of persons............................ Showers W YP g ----------------- P ( ) — Cafeteria ( ) Q' Other fixtures ----•............•-•---•-•-••......•--- . d W Design Flow........I.I�............ ......gallons per person r day. Total daily flow_._.......P..�___.......... nse/ WSeptic Tank—Liquid capacity 60A..gallons Length_ --__-•-•- Width. h._...-- Diameter................ Dept __._........._.. 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 b / G / Y-------- - �-2......-•--------�`-�------------- Date ---�.f'�l___.------- ----- a ....minutes per inch Depth of Test Pi Depth to ground "water.___. ,.� Test Pit No. 1_�.�_ P P ---,- �----- P � --- s- - p Gi, Test Pit No. 2--,f�••minutes per inch Depth of Test Pi ...--.... Depth to ground water............. 1 p4 ..........-............................................. -......................................................................................... O Description of Soil..................... U ..... - -••-------------------------------•----•---•........-••-•----------•---•------••---••-•-•---------•---.--••--••-•-•-••--••---........................----•-••------------••-••--•----............... 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 1 T t 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 tVboardheal A lication A roved B � ?-?` 5- ..... . ---- /------- at Application Disapproved for the following reasons:........................................ --•------------------•---•--••-----•--------•------------......---------------------•-------•--------•----•••-•-••-••-••••----•••••---••-•••-•-••••---•-------••••••---•-•----•-•----•-••-•-••--•-.•---- ` Date �" r a. Permit No. ...A:7" _. _10K.................. Issued.....................I...................------------. ilste THE COMMONWEALTH OF MASSACHUSETTS l � BOARD OF HEALTH ?....................0 F...100 - .. ... ol;.... '1��.............................. (Inrtif iraft, of Turitpli ttv b .............................. THIS IS TO CERTYY, That the,.Individual Sewage Disposal System constructed f' ) or Repaired ( ) .................. fj `. p . ------Y ? � � • �A `� -- nsta - . at �, ------- - - has been installed in accordance with the provisions of TITLE 5 of The, State SanitaryCo as tbed}� the application for Disposal Works Construction Permit �'o.._ �-r_� ._... dated-. —'__..�_. f°._�.... THE ISSUANCE OF THIS CERTIFICATE SHALT. NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.......... ........ ....".....4-?-Y............................... Inspector::..._:.. /7. :.....:..........._... .-•-••--- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ....OF:.......,F% .lL ..._+a. No... �/ _ FEE........................ Permission is hereby granted............. ..................................••---...................------ to Construct ( ) r Repair ( ) an Individual Sewage�iDi'sposal em atNo.----- �•-----..... ....... .r..--•--. ; as shown on the application for Disposal Works Construction Permit No.. .....—IE�Oated.._._..._........._......l........ ----------------------•---------••---•-------•-•--Ioard of Health DATE...............�._r.J.�. = t� -------------------------------------- FORM 1255 HOBBS & WARREN. INC., PUBLISHERS �ttttittlt"tttt!tTMJJ(t!trt►rtttttJlJlJlt!IJJJJJJJJJJJJJJJJrtr�JnfJtfJJnfestt,rtttrt,++Jrrt►rrrJnt!Tt,J,tJtitt�trtr+r,!?sr,tt+t!+►ttttsm,tsrt,r++t+,tnttett rtterT►tttstsf ty ns►trs ssrssftt sett tt ssfs er srnmsm .. ........ . :.... .. ....t ....,i. .,.:L.tt..t.•:•::aR:,:::::•t:.,,t:J,,:,ltttt„R't: ::,f ENVIROTECH LABORATORIES Mass. Cert.#:MA063 �= 449 Route 130 Sandwich,MA 02563 (508) 888-6460 CLIENT: Larry Nickulas _ LOCATION: ._ Lot 6 Cedar Street _ _ ADDRESS: zz W. BarnstabYe MA _ e _4 COLLECTED BY: L. Wile SAMPLE DAT 5 11 _9Y TIME: AM DATE RECEIV _ .1 W91 SAMPLE ID: Z 262 e ra JOB : New Well _ WELL DEPTH: _112/160 ft z. RESULTS OF ANALYSIS: M e_ Parameter Units Recommended limit Result z.41 Colitorm bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.96 Conductance umhos%cm 500 85 ;rz -- 3 Sodium mg/L 20.0 6.4 Nitrate-N mg/L 10.0 0.11 eRE Iron mg/L 0.3 <0.05 Manganese mg/L 0.05 0.03 ;r ra: Hardness mg/L as CaCO 3 500 22.0 E Sulfate mg/L 250 11.9 _ z.. Potassium mg/L 20.0 = 0.7 c Alkalinity mg/L 200 10.4 c :_ Chloride mg/L 250 14.3 .3 c Turbidity NTU 5.0 6.5 . Color APC units 15.0 <1.0 :z Background bacteria COMMENT: Volatile organic compounds UG/L see attached None detected (EPA Method 601/602) YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. M ❑ x dl DATE /IiUllUtiUUtllilUlitiUlliitlUiililtUii!!Utlt!!!!lUlt!lllttli11111iilitlltilitiiiitilitttitiill�lbiili;iii�+tliiliiiitiiiu+tiiil;ilEl;iliiiiuiiii` i'lUliliihlliiililliiillUlititiiilllilljiliilltiliiliiillliiiliiilltiliil�`` GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: Z-262 Lab ID: 1320-01 Project: Nickulas/Lot 6 QC Batch: VGA-771 Client: Envirotech Sampled: 05-13-91 Cont/Prsv: 40ml VOA Vial/Cool Received: 05-13-91 Matrix: Aqueous Analyzed: 05-15-91 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL I m+p-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 32 107 % 83 - 117 % Fluorobenzene 30 30 100 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). l i ' s No. 6- Fee— �— _ BOARD OF HEALTH TOWN OF BARNSTABLE 0ppiication-*rVeii Cootructiouperutit Application 's hereby made f a permit to Con truct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and PTrcel Owner Address Installer — Driller _ — Address — — Type of Building r' Dwelling ------- Other - T e'of Building ----------- No. of Persons-__-______-_____________________—____ Type of We11--—— -- — --__-__ Capacity-------- — —-__—— — — Purpose of Well �� �--`�"�' 1 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 Cert' ' Ae of Co3NJLnce has been issued by the Board of Health. Signed date Application Approved By— date Application Disapproved for the following reasons:---- ----- --- - -- ------------------------------ j date Permit No. Issued----- ------ date BOARD OF HEALTH / TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) - -----------------------------------------=------------- -------------------------------------- ----- �staller L N— -02 ---� has been install 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. g PP --W-_L_-�--Dated— THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE____—-------— -- --- ---- - -- Inspector-------------------------------- No. Fee--_�--_-�--_-=� BOARD OF HEALTH TOWN OF BARNSTABLE 2pplitat ion Ar Vell Con5tructioupermit Application is hereby made for,a permit to Co .truct ( ), Alter ( ), or Repair ( )an individual Well at: Location --Address Assessors Map and PC(el Owner ---------------------------------Address------------------------------ �!� �^rc-' "`7 -'--"� 4 -------------------- --------------------------------------- ---------------------------------- Installer — Driller Address Type of Building Dwelling--------- /s �iwt�► - Other - Type of Building-------------------------------------- No. of Persons----------------------------------------------------- Type of Well-------- -- --------- -- ------------------------------ YP ___ ---------------------------------- apacity-------------------------------- Purpose of Well 004c/ 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 Certi#i re of Comp-i ce has been issued by the Board of Health. dne Si --------------- =�---` --—�� g �� 4� date r. Application Approved By------------ �^~� - "� ---- ---= -- - 1 date Application Disapproved for the following reasons:------------------------------------------------- ------- -- --- ----- - -- - -- date Permit No.-- /- - —------------------------ Issued------------------------- --- - -------- --- — date BOARD OF HEALTH TOWN OF BARNSTABLE __. . \0 Certificate (of Compliance � > IV THIS IS TO CERTIFY, That the Individual Well Constructed ( ),_Altered ( , -), or-Repaired- by �} ----------------------------------- installer a—, �� -------- —-— has been installedin 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. ELi-/ -----J-LDated--------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEI'CHAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------------------------- Inspector------------------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE Iftl Con5tructionpermit No. ---��-- /-----2 S Fee--- ee --------- Permission is hereby ranted - ���� -- ��----- to Construct), Alter ( ), or Repair ( ) an Individual Well at: No. --------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- - Street as shown on the application for a Well Construction Permit No.-------------------------- ---- -----------------— Dated------------------------------------------ ------------ ------------------------ 9 v Board of Health DATE ----: �—� ;� ----------------- - -- t - - ��UrliP11.. ...1... .tinitlltiniiinintrr11int1nnrttttmnxm xtrxm tntnnntttnlnnr+tnnnrttxr+++tltrtttrrtxr+trr+trtttrrtn+trtrtrttttr+txttrtt nmmn ntr mnn nnrt+tn m xmn n trr not ........1.........1........:::.... ...... _.. ............ .......... . .. ii 1. 1 it ttttnrt, ENVIROTECH LABORATORIES _- Mass. Cert. #:MA063 449 Route 130 Sandwich,MA 02563 (508) 888-6460 _ CLIENT: _Ltarj7 Nickulas LOCATION: Lot 6 Cedar Street _ _= - - ADDRESS: _ W. Barnstable,MA COLLECTED BY: T, Wile e SAMPLE DATE: 5 11 91 TIME: AM = DATE RECEIVED: 5 11 91 SAMPLE ID: Z 262 '�iJg x: New Well _ 112/160 ft LVELL DEPTH: €t - _= • RESULTS OF ANALYSIS: Parameter Units Recommended limit Result — Coliform bacteria;"100 ml IMF Method) 0 0 PH pH units --- 6.0 S 5 6.96 Conductance umhos./cm 500 85 _ Sodium mg!L 20.0 =_ 6.4 Nitrate-N mg i L 10.0 =- 0.11 Iron mg/L — 0 3 <0.05 Manganese mg%L 0.05 0.03 -- Hardness mg/L as CaCO S00 22.0 - 3 - Sulfate mg/L 250 11.9 Potassium mg/L 20.0 - 0.7 Alkalinity mg,�L -- 200 -- -- 10.4 _ Chloride mg;L -- 250 14.3 _ Turbidity NTU 5.0 6.5 _ Color '-- APC units 15.0 <1.0 =" :3 Background bacteria 3 fE COMMENT: Volatile organic compounds UG/L see attached None detected (EPA Method 601/602) _ i= YES NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. ,= xn 1 - �L DATE Z l '1 liiilliliiillllilIilllllllilllillllllititliiiliiillilliilliililiiililiiililililiiiiii" �<�` z wank 3c� t S ���✓-� vC �� -7-7 4 / Lou V/1 i 1ZZ C[M10 74KE1J F¢OM- -- =d�iG�.• ��.t. yC E MU�IGIGAt_(�1a'iEf� -�- A►�/tLi�oLx�� V4 3, p pr, Frre-4.2 t Jr} f t'u►,1L� a?uEL�is� �•It�?CV. 4 mStC,t� La&ritJL At-L PF'-Ec_A ? 5, MOE JOIuzs G4ALL E,E MAM kt.4?�QTIf T. i v l � p,. � � 1 �� .�'� ,)•, -�s . G G a i.l�?'�c�1"i ctJ- �'t'�.t�...5 'f'o t?� t�.l a.c.c c4't';n!�lt� 1�11"t't4 TOlS-FL-&td Fcc �PcsEi7 WoeV- of jL--( pr iu L 7 11 ! \ °' � .S � `% r '�' � `�; � S�C� IJ�F( �--� I�lUt" � t�+✓b >~pt TYU N� '�ul..tC.t►.lG+. + , �1Clrl a!/ -✓' ( `. :3 `� ��"��O SG.G.,...E... � 7 � ,,Ly•-t-=-y "{yart�^. u.►7ct: �bafcs '�-} 1•-ieca.'c"�= Jolt, 'c. .-,,rr�r 1� r•J�7 r or ✓tot rr.►:iF--- ii �0 ± f 144 ZC ± ( ei t?Z , D Jll !+ -.._ :_ 3f 4 -I I� W ASN Ev 5t�►��-- L. - J �.4�1� - . � \ ` t� =O/ �eor-oo►� Q 1�p�(�rz, = 3 �.� Gpb \ 140, USE 2-2 Get_t.a4 -T-4kl� ire 4c or. on Ort, 1 -- ::'^, ? ol• �.�O� �'.. � Jam` h _- - ✓..,E S"`- `'L.,��i JTr,.�t � rt�EPAEEo rot �I {4�?�tt aK (zE1:EtJc_E — E�t,_�t? i.. CJnct�r, C6F- CR<J/�Je�r'//-kl � /r1G � A, i''��Q Iy J � �(s V►l Jo � Q A� f IttLet-16,t,!U,i S .f ' noAet7or- 4eALT4 M ►- 127Ec:,°` YAeot�Tu ►-14, AC rJ c . Q1 ALA , �-L .c' , 1 P E, pe E �,rrealep DATE AssEssoRs TEST HOLE LOGS PARCEL : I 1) The installation shall cornply with Title V any) Town o**—board of FLOOD ZONE: I^.� SOIL EVA UATORa 1 lealth Regulations. (, �`-01 I�,�� --- -- - -- WITNESS : 1 1� 2) The installer shall verify the location of utilities, sewer inverts and septic REFERENCE: l DATE: Z5 0 components rior to installation and settingbase elevations. L (l , � ` " PERCOLATION RATE- < 2. Vl/i1 l 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first - _.___ � _ -1 � ,� `� l ITS I 1Y. lift �6 ' 1Zq two feet out of the d-box to the ic�,ching shall be level. 4) This plan is not to be utilized for property line determination nor any other / TH- 1 TH-2 purpose other than the proposed system installation. "MI A, / 5) All septic components must meet Title V specifications. � 6) Parking shall not be constricted over 1110 septic components.---- - — ►� l o S 7) The property is bounded by property corners and property lines. 3Z ' 10 to to 8) The property owner shall review design considerations to approve of total LOCATION MAP C t /Jll l LID" C OUT `O '""I design flow and number of bedrooms to be considered For design. Receipt I dQ of payment for the plan and installation based on the plan shall be deemed CEDAR STREET a `�'�,�� `�rV, approval of the design flow by the owner. + � 9) The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall `�� r - \ ✓ 150.00' -,mot_ 2 1p n l� -��� be removed along with contaminated soil and replaced with clean sand per �� Title V specs. �b rr.. 10)System components to be 10 feet from water line. Sewer !ines crossing the - - 4t `i water line shall be sleeved with 4 inch SC1140 PVC with ends grouted if applicable. The proposed SAS is being installed below he pp p p g t water service line. The line is to be sleeved as aforementioned and maintained in place. 2 l l SEPTIC. SYSTEM DESIGN 11) If a garbage grinder exists it is to be removed and is the responsibility of the \ CONC. owner to ensure such. (FOUND. FLOW E5T I MATE 12)The installer is to take caution in excavation around the gas line if such exists. � BEDROOMS AT//0 GAL/DAY/BEDROOM -3 GAL/DAY 13)Tne installer shall verify the location, quantity and elevation of the sewer lines exitinn the dwelling"rior to the installation. 14 This plan is representative only that a system can fit on a property meeting SEPTIC TANK ) p P Y Y P P Y 6 1 ` Title V requirements. �- G&/DAY x 2 DAYS - ULJ GAL I /3D USE ICCOGALLON SEPTIC TANK EX16Rh,JCr \`�u�.o`, �� SOIL AEISORPT I ON-SYSTEM - 11b �1-dF.J�� wy, 1rJp VkIP�v1(Iln( _ L 229 �, ,� /� :.�. ^^ wail-�✓—� ' — I --- l z 1\� _ - _ � cs �..-'• Fir.....+ �r�Y�'`'t`t i.il/,i�s,\S SIDE AREA: Z Z5 -t IZJ83r XZ� ,7 l�(,q ia� DAVID B. c �= t: BOTTOM AREA: /Z� Qr s Zyf�'�`� MASON \ I I p No.1066 0 -i Fa� EP ---- SEPTIC SYSTEM SECT I ON i 41 ` Iln� 10 \'U�75 �� ®✓ �FFI, Lit `y O { �7bb 1 ' �_ GAL .17 O 1;2�i�8 !k - v ( � )� ` Z �},I SEPTIP TANK Z QA opt SITE AND SEWAGE PLAN off.--- I-TP ___, - PREPARED FOR : C 2>,4 A U SCALE: v DAV I D B . MASON RS DATE: (� 10lal t� I DBC ENVIRONMENTAL DESIGNS G` EAST SANDWICH . MA DATE HEALTH AGENT ( 508 ) 833- 2 177