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HomeMy WebLinkAbout0046 COVENTRY LANE - Health 46 COVENTRY LANE, W. BARNSTABLE A= 110 004.007 9 a j it o o e Q I v No.-------------------- Fee-------=------------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con!5truction3permit Ape is on is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Address /f---- ��'LL' 1_^_ -- ------— -- ----------- Installer — Driller Address ------------------------- Type of Building ��� Dwelling------- -- ---------------------------- Other - Type of Building----------------------- No. of Persons---_-------------------_ aLL Type of Well- ----e. -------------------------------- 1-44 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 Bo of Health. 2 Of bw r� 0-,I— a Signeda[k> - - - --- --- - ----------------------- date Application Approved By - -- --- --- -— — —/- ----- date Appiication Disapproved for he following reasons:--- —-—------------ -------------------------------- ---------------------------------------------------- date r Permit No. -— -2-cob:: Issued - date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f Compliance THIS IS T CE TIFY, �T�haatt the Individual ll Construc�tod ), Altered ( ), or Repaired ( ) b Y- - 1� ✓G_ %2 '1 - - --------------- - - -—- �'��� ` Installer at--------*�-- ---- -- --- '/�-- ---__-1�-�-` ------------------------------------- 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------------------------------------------------------------------------- No.-L/_�-Zoo-,5- 1 q Fee----- - -------- BOARD OF HEALTH TOWN OF BARNSTABLE Application,forVell Co �tructionpermit Apcat�on is hereby made for a permit to Construct ( Alter ( ), or Repair ( )an individual Well at: Location —"Address Assessors Map and Parcel Owner Address --, Gp--------' Lr �" /------------- - -- ----- -r�4 �i/ ° -1 c1 "'> - ------ Installer — Driller Address Type of Building ze.6 Dwelling-----—�---- ------------------------------ Other - Type of Building No. of Persons-------------------------------___________ f oz.,, ELL, Type of Well- -- - G-- - -- - Capacity-------------------- - - - - - ---- `� - �- - 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 Bqxd of Health. Signed -�--------�=�--- -------- ----- -----------0-- ` date Application Approved By— - -- --- ----— -- - �- ©5----- r date 4 Application Disapproved for a following reasons: ----------— -- ------ ---__--_ ---------------------------------------------------------------------------------------------- !1 date Permit No. ----w-Z,D O -' Issued--- --`-' r /-- --5�O d ----- ---------- date -----------------------------------------------------------------------------------------------..— ------ BOARD OF HEALTH TOWN -OF :- BARN-STAB LE Certificate ®f Compliance THIS IS TO CE TIFY, That the Individual Well Constructe I ( ), tered ( - or Repaired ( ) bY- --- r --------------- ._�``- - -------------------------------------------------- Installer 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---------------------------------------------------------------------------- - ----------------------------- I--------------------------------------------------------------��- -�-�_- BOARD OF HEALTH TOWN OF BARNSTABLE 1pell Construct ion permit v�120of- i� No. ---------------- Fee------------- { Permission is he*"reby granted--TD---- ✓ - y4 A/------_______--------_-------- to Construct (I/Alter ( ), or Repair ( ) an Individual Well at: _ p No. - — - ---'.U—�j I\.7rL=�--r.(JJ�I_/- -- - �------�`.---9�'�'�7A�G f ------------------------- street as shown on the application for a Well Construction Permit No.- - - L---- - - -----------------------2��� ��----------------------------------- Date------, 7 - FALT t� -1 N S.�fG'rOP�, DATA S Board of Health f Boyle residence L4L Coventry La. W. Barnastable MA 13'-5" -3'-0" 3'-0"� �Q . 48:1" 3'-11" 5'-8" IV 3'40"- '1 ,¢*� 11-5" 10'-4" 24'-4" iiiiiiiiiiiiiiiiiii 9'-0"x 4'-0' 3-0"x 4'-0" 4'-0"x 3'-0' 3'-0"x 9'-0" ski a b N i �4 112 bath °D kitchen ro family '-0•xe• N A e P 5 6 5-0"x B'-8'SD garage = § 8'-3"-- r 8'-4" � 1"000L x El ---------------CO ------- 14'-0" 5o xe a"co 1- _ " 2-7' i T-2" w _ . . °p CO ----------- r-----------� 4 Mr) living w ; ;g dining I I I f _ I I I I I I I I w I I I I �o I I I I I `I � it �OWOHD � ; ; 5'-8" 7-10" 7'40" 5'-8" ,I�— 34,0" - - 4�+ i Boyle 2nd floor 34'--3" 3'--0" 6'-4" 6'-3" 4'-4" W-5" A 4'41" 24'-0" X T x 4'-0' 3'-0°x 4'-0' 3'-0"x 4'-0' 2'0'x 2'-0" 2'T x 2'-0' y M y M CZ o ao � o0 00 CD bath co -1 1 1 bedroom 1 i� �•$•• o bath '1 R x r N oY0 -4 o'xq CD o r �116 -4'-1" b 14'-6" $ x k 4 3-61I_ -T-611 -3,61I ti o 2'---- 6'-6�.. future master suite N <"> 5'-0°X 6'-6'SD 5'-0'x 6'-8•SD IV 1�- D! ^ 10-All 1` Y 14'-6" 1 N 5'-O'x 6 8'SD 4' 1 II _414" y 1` T II to bedroom 2 00 � bedroom 3 0 C`') H R o R 5'-6" 3'-10" 23'--10" .......-. 3'-0'x 4=0' 3'-0'x 4'-T - 3'-0'x 4'A' 3'-0'x 4'-0' t� 007 COMMONWEALTH OF MASSACHUSETTS 9 F EXECUTIVE OFFICE OF ENVIRONMENTAL IRS �® 3 DEPARTMENT OF ENVIRONMENTAL P ECT ONE WINTER STREET, BOSTON, MA 02108 617-292 T 10 � Al p V 2 5 1998 a WILLIAM F.VELDZ4D DY COaE Govemor A Secretary ARG_O PAUL CELLUCCI ti VID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A CERTIFICATION Address of Owner: Property Address: 46 Coventr Ln W Barnstable Sam Abbott Date of Inspection: l6—/,C— � (If different) 29 Carlson Ln Name of Inspector: Wm E `Robinson Sr . Filmouth MA 02542 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000) Company Name: Wm E Robinson Septic Serv; _A Mailing Address: PO Box 1089 , C nt-Prvi 1 1 ey MA 02632 Telephone Numbers,, 5 0 8 ` 77 c,_R 7 7 b 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 se a disposal systems. The system: asses _ Conditionally Passes Needs Further Evaluation By the Local Approving Authority Fails Inspector's Signature: Y Date: The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (30) days of completing this inspecion. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and ccpies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check`�)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 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 6] SYS CONDITIONALLY PASSES: One r more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon comp I tion 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 conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Wide Web: http:/twww.magnet.state.ma.us/dep �'j Printed on Recycled Paper 9 '. .Y SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) � t Property,-Address: 46 Coventry Ln, W Barnstable #Owner: Abbott Date of Inspection: )17 �B] SYSTEM:CONDITIONALLY/PASSES (continued) Sewage'backup or breakout or high.static water level observed in the distribution box is due to broken or obstructed Ripe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced Th system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass ins ction if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C) FURTHER EVALUATIO IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist w ich require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safe and the environment. 1) SYSTEM WILL PA S UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PR TECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspoo or privy is within 50 feet of a surface water Cesspo or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM ILL AIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYST S FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONM NT: The stem has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet to a surface water supply or tribut ry to a surface water supply. The s tern has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The sy tem has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. _ The sys em has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private ater 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 Ile- (revised 04/25/97) Page 2 of 10 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) 46 Coventry Ln, W Barnstable Property Address: Abbott Owner: Date of Inspection: 16—16 _ 5 D] S TEM FAILS: You mu indicate ei;?:er "Yes" or "No" as to each of the following: have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis fo this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct th 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 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 coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYST FAILS: You must indicat either "Yes" or "No" as to each of the following: The Poll wing criteria apply to large systems in addition to the criteria above: The syste serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to public he th and safety and the environment because one or more of the following conditions exist: Yes No t e system is within 400 feet of a surface drinking water supply e 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 ublic water supply well) The owner or operat r of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 MR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revised 04/25/97) Page 3 of 10 r f,. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 46 Coventry Ln WBarnstable Owner: Abbott Date of Inspection: 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. 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. 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 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: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. 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) [15.302(3)(b)] (revised 04/25/97) Page 4 of 10 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 46 Coventry Ln, W Barnstable Owner: Abbott Date of Inspection: 9, FLOW CONDITIONS RESIDENTIAL: Design fIow:, >;.p.d./bedroom for S.A.S. Number of bedrooms: rl Number of current residents: O 'f Garbage grinder (yes or no):...Ae0A Laundry connected to system (yes or noV4e�'s Seasonal use (yes or no):lf Water meter readings, if available (last two (2) year usage (gpd): Sump Pump (yes or no):­j!L40 Last date of occupancy: 6d COMMERCIAUINDUS RIAL: Ty of establishment: Desi n flow:_gallons/day Gres trap present: (yes or no)_ Indust:ial Waste Holding Tank present:'(yes or no)_ Non-s itary waste discharged to the Title 5 system: (yes or no)_ Water Teter eter readings, if available: Last da a of occupancy: OTHE . scribe) Last Last date of occupancy: GENERAL INFORMATION ,Ig PUMPING RECORDS and ource of information: System pu ped as part of inspection: (yes or no)&,e If yes, volume pumped: gallons Reason for pumping: TYPE_OF STEM 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. Copy of up to date contract? Other APPROXIMATE AGE of all components, date installed (if known) and source of information: Sewage odors detected when arriving at the site: (yes or no) (revised 04/25/97) Page 5 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C "SYSTEM-INFORMATION (continued) Property Address: 46 Coventry Lin, W Barnstable Owner: Abbott Date of Inspection: .�� ' 9 B LDING SEWER: (Lo to on site plan) Dept below grade: Maten I of construction: cast iron =40 PVC —other (explain) Dist ce from private water supply well or suction line Di eter C ments: (condition of joints, venting, evidence of leakage,.etc.) SEPTIC TANK: (locate on site plan) ) Depth below grader Material of construction: _concrete —metal _Fiberglass —Polyethylene —other(explain) If tank is metal, list age _ Is age confirmed,by, ertificate of Compliance _(Yes/No) e., Dimensions: Sludge depth: 'Z d� L � Distance from top of sludge to bottom of outlet tee or baffle. f Scum thickness: d' Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom ofouutlet.e�o�b�Ike How dimensions were determined: L ' Comments: (recommendation for pumping, condition of inlet and outlet ties or baffl� depth of liquid level in relation to outlet invert, structural 9 integri evidence f leakage, etc.) I'Ico o G' 0 A r�Y GREAS TRAP: llocate o site plan) Depth bel w grade: Material o construction: —concrete —metal —Fiberglass —Polyethylene —other(explain) Dimensio s: Scum thi ness: Distance from top of scum to top of outlet tee or baffle: Distanc om bottom of scum to bottom of,outlet tee or baffle: Date of as pumping: Comments: (recommen ation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, a ,idence of leakage, etc.) (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Coventry Ln, W Barnstable - . : Abbott Owner: Date of Inspection: TI HT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (lo a on site plan) Depth below grade: Materi I of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensi ns Capacity gallons Design ow: gallons/day Alarm I vel: Alarm in working order_ Yes; _ No Date o previous pumping: Cc nts: (cond' ion of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_V (locate on site plan) '\ Depth of liquid level above outlet invert: CJ Commens: (note if level and distribution is equal, evidence of soli carryover, evidence of leakage into or out of box, etc.) 0 IQ6 9- PUMP AMBER:_ (locate o site plan) Pumps in working order: (Yes or No) Alarms in working order (Yes or No) Commen s: (note co ition of pump chamber, condition of pumps and appurtenances, etc.) (zevieed 04/25/97) Page 7 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C -SYSTEM INFORMATION (continued) Property Address: 4.6 Coventry Ln, W Barnstable : Owner: Abbott Date of Inspection: 16'-16-�P� SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible;_excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number: 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, condition f vegetation, c.) CESSP OLS: _ (locate o site plan) Number an configuration: Depth-top o liquid to inlet invert: Depth of soli s layer: Depth of scu layer. Dimensions o cesspool: Materials of c nstruction: Indication of g oundwater: inflo (cesspool must be pumped as part of inspection) Comments: (note conditioi f soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY:_ (locate on site plan) Materials of constru ion: Dimensions: Depth of solids-- Comments: (note condition s il, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) (revised 04/25/97) Page B of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 'SYSTEM INFORMATION.(continued) Property Address: 46 Coventry Ln, W Barnstable Owner: Abbott Date of Inspection: SKETCI OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) Go �Z (revised 04/25/97) Page 9 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 46 Coventry Ln, W Barnstable Owner: Abbott Date of Inspection: Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record V/Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) radlq (revised 04/25/91) Page 20 of 10 _ V / f TOWN OF BARNSTABLE � 1. Ln LOi;ATION L a �.c yeQ-i-QY_b�ytic. SEWAGE # ,VILLAGE ASSESSOR'S MAP & LOT 11 ' ti INSTALLER'S NAME & PHONE NO.,---)- /Et� 3z>914 "�,Oq0 T-I� 4 SEPTIC TANK CAPACITY ;,].."LEACHING FACILITYAtype) Lzr) (size) NO. OF BEDROOMS4PRIVATE WELL OR PUBLIC WATER AC-L,-- BUILDER OR OWNER jr�12C-P::- DATE PERMIT ISSUED: - —> g� DATE COMPLIANCE ISSUED:` ' VARIANCE.GRANTEDi.Yes No A 1 t -� -s i i r No.- y-:� 749 Fas......Ida......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH W/ 9 -- / TOWN OF BARNSTABLE Applirativit for Di!ipim Yl Murky Tomitrurtion rautit Applicatign is hereby made for a Permit to (.-oast*uct ( ) or Repair ( ) an Individual Sewage Disposal System at: ..l.o-f C�[F �!v1.._Ukve.....Ui_ gA"_5T4q.LE �_5_-� SSd�I.S--M-jP 110 P4Egg_ y--Z ---- -----------•--• • ---..._........_... ------------.........-----------------•-•-- ..._....... Location-Addre's or4.ot No. ................. ... D 1 t �►J 1 �S}........................l4 owner dress w ..............--�J rN..... _z�-------_-_-----_--------- Q..:.`�.��?c _1 t,CO ► ►J 1� -. Ltstaller T I........... Address �. Type of Building Size Lot.....36 600___._....Sq. feet Dwelling—No. of Bedrooms--------------------------------------- ----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons.-_--------..--__-----.-._ Showers ( ) - Cafeteria ( ) dOther fixtures --------------------------------------_---------.---------------------------- -_- --------.------------------------------.-----------------•--- W Design Flow..............5.5.......................gallons per person per day. Total daily flow............`NP.....................gallons. R: Septic Tank—Liquid ca acity.).�60__ allons Len th-- y`t..---_ Width---I Diameter................. De th... _-- gFF Disposal Trench--No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----&t M----- Diameter...... ----_-- Depth below inlet.....4t......... Total leaching areas 1..69�5.stp-ft Z Other Distribution box ( ) Dosing tank ( ) q Percolation Test Resul s Performed by._7P0t4A5._RCAZ—(_`1... P�:............... Date-__.�"��.".1.3.................. Test Pit No. I.1 _!'Z..minutes per inch Depth of Test Pit--- q......_ Depth to ground water..:NMI$....... LZ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a' .......-•--------- • ......................................................... 0 Description of Soil_._0.-.3�i`l..�QP. 0 4b `� ll`� 5� x ------=-----36- 5l l.Y• --- i"' U .....-----•---------------------------------------•------------------------------.....-------------••-•--------- w ---------------------------............................................................................................................................................................................ U Nature of Repairs or Alterations—Answer when applicable.................................................. -•••----•-------------------•------------•-------•---••---••••--------------------•••-•-............-•-•••--•------••----------•---------------•----•-•-----.._.........__....................-•-------- Agreement: The undersigned agrees to install the of ibed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Envir me al Code— e undersigned further agrees not to place the system in operation until a Certificate of Com lia h been ssued the boa f health. Signed ......... .............. . ................... .... ... .... ........ . ............... .......7 ..1�5.....1:...-. Date Application Approved By ...... ... ...... ----- �..:��.�/--.-te Application Disapproved for the following reasons: .................... . ......................... ............. ....................... . ...............--......... ---- -------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ........................................ Dare Permit No. ... ...t ' ''/y/\J_ _- - -- -- ... --.. '- -- -- -----... Issued ................................. --.......................l..K. ...... Date -- r.,.rti+^.f..ti`w�.....--�.�.., '-:y•..,,, ,,:•ti,.- .„�,. .-14f-•.-__Nl..� .' �.rw_.•- s.�...�.;�...✓. �,,-- .t r � i�: . �.. "—.--r -- • .l x _ THE COMMONWEALTH OF MASSACHUSETTS P gna'� BOAR"D OF HEALTH w 9y - f TOWN OF BARNSTABLE Appliration for Di►ipwiul Wnrkii Towitrnrtiun "anti: Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: & L01 r. C * .................. -. ----_.l.v....... ... -- - ---•- ((�� Location•:\ddress or Lot No CJ . Owner Address Installer f v � Address Type of Building Size Lot-----Wr6QO_........Sq. feet ., Dwelling—No. of Bedrooms.--,_•_-_-__--J---•-•------------------ ----Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ..................................................................................................................................................... W Design Flow..............55.......................gallons per person per day. Total daily flow.........._`���.....................gallons. WSeptic Tank—Liquid capacity.j.Q6_�__gallons Length__R_`1 _.__ Width...`f�r�_... Diameter................ Depth...4:EFF- x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.___.Cl.r.4_C------ Diameter._.-. ...... Depth below inlet.._..�!......... Total leaching area59#..(.V�..sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by..�l�h1z�5_.������w__.p�................ Date..._:I).:�3_..._............. ,.� Test Pit No. l.��*.__z-..minutes per,inch Depth of Test Pit---1_4t-___._-• Depth to ground water...�!)l.V1 (i Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --------------------- -------------•-------•----•------------......-•-----------•---...•-•-•--•-.---......................................................... 0 Description of Soil... ...... k . .. 5 --� SA 914.................... x w --•-•------------------------------------------------------------------------------------------•-------------......._.......----------•-------------------------------..............-•---------.._..... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •.........................................•--••----••---•--•------••---•-----•----.................----••-•--------------•----------•-•-------•-------•----..__......-•--------................_....... Agreement: The undersigned agrees to install the afo•redescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code— )ze undersigned further agrees not to place the system in operation until a Certificate of Compliance h s been Issued by the boa dAof health. Signed �- -e•Li�......... r ` / Dace Application Approved By ............... .,. ....' '�...,. . ............... .- ----------------......-------- ....... ...-.-7..y '..,....�- Dace Application Disapproved for the following reafons: .......... .................................................. .................................................................. D�te Permit No. ... /............7/�.................................. Issued ................ --....................................... ..... �! Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE 01,Ertifirate of Complianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by .......................5* ..---- ......---..----------------------- ------------ ............. ...........-----......_......................-----------*..............---------- at .............. ......... ^-------- A/------------tv-,-..._I/t�- ,��.,�QD�........ --.......... ..........:................. ......... has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in the application for Disposal Works Construction Permit No. ._...Yot�__... �d............... dated ............... ...................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. --------- Inspector ......... � -' .-r7 DATE .1 .... - .. ............. _.._ ...--------------_... .... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.-A,6-76L FEE..../n r'l......... RsVosal Workii �unntr r#inn rrntit Permission is hereby granted........53 -.r-_-.--------cf�q-------------------------------•---•-------------------••------------•-----.-.-_--__--_---- to Construct (>C) or Repair ( ) an In�dividual Sewage Dispo(s�al System ..--•/ •.... /` _r _.,Ya t,- �.-tl--------------- i t �d ^" �r �t! jStreet as shown on the application for Disposal Works Construction Permit No.���-__-. Dated............................... ---------------------------•- '�� ....................... V Board of Health DATE............... y................................. FORM 36508 HOBBS&WARREN,INC..PUBLISHERS I 'aJ ENVIROTECH LABORATORIES' Mass. Cert.#:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: Reef Realty LOCATION: Lot #6 Coventry Lane ADDRESS: P.O. Box 186 W. Barnstable, MA W. Dennis, MA 02670 COLLECTED BY. Fred Clifford SAMPLE DATE: 2-2-94 TIME: 3:OOP.M. DATE RECEIVED: 2-2-94 SAMPLE ID. 6-C JOB#: New Well WELL DEPTH: 63' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.26 Conductance umhos/cm 500 74 Sodium mg/L 28.0 8.1 Nitrate-N mg/L 10.0 0.05 Iron mg/L 0.3 <0.05 Manganese mg/L 0.05 Hardness mg/L as CaCO, 500 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 Background bacteria/100 ml (MF method) 200 EPA 601/602* ug L N.D. COMMENT: * See report attached. YES NO ❑ WATER IS SUITABLE FOR DRINKING PURPOSE OR P ETERS TESTED. DATE 1WATER T1CAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: GC Lab ID: 6941-01 Batch ID: VG2-0316-W 'Project: Reef Realty Lot 6 Sampled: 02-02-94 Client: Envirotech Received: 02-03-94 Cont/Prsv: 40mL VOA Vial/NaHSO4 Cool Analyzed: 02-09-94 Matrix: Aqueous PARAMETER CONCENTRATION REPORTING LIMIT ( 9/ ) Dichlorodifluoromethane BRL 5BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL I trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane 1 cis-1,2-Dichloroethene * BRLBRL 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 5 2-Chloroethyy BRL 1 Vinyl Ether B 1 cis-1,3-Dichloropropene BRL 1 Toluene 1 trans-1,3-Dichloropropene BRL I 1,1 ,2-Trichloroethane BRLBRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene 1 meta-and Para-Xylene * BRL 1 o ^tho-X.ylene * BRL 1 Bromoform BRL 1 1,1,2;2-Tetrachloroethane BRL I 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 30 102 % 87 - 1130 gg % 83 - 113 1,2-Dichloroethane-d4 30 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). 10 00 00(9- No. __ ------ Fee--- --------------- BOARD OF HEALTH TOWN OF BARNSTAB LE Zppfication-*rVell Cootruction3permit A�plic do is hereby, m,ad,e.�2°r a permit to Construct I), Alter ( ), or Repair ( )an individual Well at: Location/ Address A lessors Map and Parcel �. tee OSvner Address Installer — Driller Address Type of Building Dwelling----__ -!_1_ �`�___-----------___--- Other - Type of Building----------_________________ No. of Persons----- ----------------------- c Type of Well-_—� �L��' -- - —- Capacity- -- Purpose of Well -7 'g- �"—'---- ----- 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 un ' a ertif' a in iance has been issued by the Board of Health. Signed - — —__ date Application Approved By__-- ------------____=- _ ____-- _-- _____ —date --- Application Disapproved for the following reasons:----------- -- — — — date --�- _-- r Permit No. Issued - - ----- --- Ate ------------------ _ 0 BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( . ), or Repaired ( ) by— -------- - -- —_—____-- —-- - --- ------ -------------------------- Installer at - - --_ --- ---- --- --- ------------ - --- -- --- -- --- --- --has been installed in accordance with the provisions of the Town of Barnstable Boar of th Ijrivate Well Protection i Regulation as described in the application for Well Construction Permit No. -- Dated- ------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------ _____—__ Inspector----------_—__-- -- —_—_--____-- No / -------- Fee--- ------------- BOARD OF HEALTH TOWN OF BARNSTABLE ' Application-for Vell Cmtruction3permit Application is hereby made€ r a p� to Construct (�X Alter ( ), or Repair ( )an individual Well at: n)` - 6 C�tr��` ----------------------------------------- Location— Address / Assessors Map and Parcel ----------------------------------------- S ----------------- -- Owne/ Address y Installer — Driller A dress Type of Building L� `� Dwelling--- -- G� - - ----------------------- Other - Type of Building - No. of Persons------------- Type ----------------------;------- of Well------_� ,.L� /ram /,D/� -- ;�'---- ------------------------------------------- Capacity----------------------o--------------------------------------------------- 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 ertifi.t of- rripliance has been issued by the Board of Health. Signed — ——— date 17 Application Approved By- :--------- -- --- - - - '� 7 GY date f Application Disapproved for the following reasons:---------------------------------------------------------------------------------------- ` date ------------------------------ Permit No. ---t1 - -� -- -- - --- Issued----------r - 7 - - 7 date BOARD'OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) ---------------------------------------------------------------------------------------------------- Installer at------------------------------------------------------------------------------------------------------------------------------------------------ has been installed in accordance with the provisions of the Town of Barnstable Board,of Health rivate Well Protection Regulation as described in the application for Well Construction Permit No. - P---- ---------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 )"pit Con5truction3permit No. ----- ------------>� Fee------------------- Permission is hereby granted-----�:--.---=--=--------- -- . ----------------------------- to Construct ( t Alter,(s ), or�Repairr L ) an:Individual Well t:r No. ----- ---- ' ( -���_� �l._,t _ `r------ - Street as shown on the application for a Well Construction Permit No.----------- / / �" - - ------------- 4 -r - - Dated = -/ `- -----1q, - e I j{ /DATE L� Board of Health AP '"xK pagc.r �• 4-2 • GvezeNT ZONIIJCs f- c FUILPINtr 5eT5AC-K5' -� F: 30' S. IS' �r- J AP P.Jx AT 5ouD CAT<44 BASK coVEA.11,` 7514 6 1 - ` �7' 78 79 96 as CY 44 6I57' TO MSZVE L44C+ PIT) wo _�• b I too TN-2 64 (`'oT�Z� 1 coyTDue. .— — — / ED&F- of ovep-*W" 4 'BC 40gTo4.)rL --� SPOT Elt1(' 74.5 ; I fIDT FJJEy' 75 i J N4 i i i F h l: ENVIROTECH LABORATORIES Mass. Cert.#:MA063 ��✓ '�` 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 — CLIENT: Reef Realty LOCATION: Lot #6 Coventry Lane ADDRESS: P.O. Box 186 W. Barnstable, MA W. Dennis, MA 02670 COLLECTED BY: Fred Clifford SAMPLE DATE: 2-2-94 TIME: 3:OOP.M. DATE RECEIVED: 2-2-94 SAMPLE ID. 6-C JOB#: New Well WELL,DEPTH: 63' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 6.26 Conductance umhos/cm 500 74 Sodium mg/L 28.0 8.1 Nitrate-N mg/L 10.0 0.05 Iron mg/L 0.3 <0.05 Manganese mg/L 0.05 Hardness mg/L as CaCO, 500 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 Background bacteria/100 ml (MF method) 200 EPA 601/602* ug L N.D. COMMENT: * See report attached. YES NO p WATER IS SUITABLE FOR DRINKING PURPOSE OR P ETERS TESTED. DATE _ ,jWATER tICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/E1_CD) Lab ID: 6941-01 Batch ID: V62-0316-W 6C Field ID: Lot 6 Sampled: 02-02'94 Project: Reef Realty Received: 02-03-94 Client: Envirotech Analyzed: 02-09-94 Cont/Prsv: 40mL. VOA Vial/NaHSO4 Cool Marix: Aqueous MIT CONCENTRATION REPORTING(U /L, PARAMETER (ug/L) 5 BRL 5 Dichlorodifluoromethane BRL 5 ; Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 1 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1 ,1-Dichloroethene BRL I Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 I .1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 BRL Chloroform 1 hane BRL 1,1,1-Trichloroet I Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 5 Bromodichloromethane 1 2-Chlor oeth 1 Vinyl Ether BRLBRL 1 cis-1,3-Dic loropropene BRL 1BRL Toluene 1 trans-1,3-Dichloropropene BRL 1 1,1 ,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 meta-and para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1,1 ,2;2-Tetrachloroethane BRL 1 Dichlorobenzene 1 1,4-Dichlorobenzene BRL 1,2-Dichlorobenzene RECOVERY QC LIMITS SPIKED MEASURED QC SURROGATE COMPOUND 102 % 87 - 113 Ya 30 30 gg % 83 - 117 % a,a,a-TrifIuorotoluene 30 30 1,2-Dichloroethane-d4 Limit. * Non-target compound. Method References: Method 601 - Purgeable nni - aPlow Reporting ,,� a0 C.F.R. 136, Appendix A (1986). 55 t550tZ5 MAP: 110 _ E a O - H L �5 N T S _ u N 5 � v tw A t�: fiZo Art t7E I. YE�t'1cA� t�?V M THOMAS M Gt-EL V � �vt7 t7 c HtT ZoN t Ll -t �. 5 0 1 T N .: CIZ� �NKi � Z Mc�t�ticlF'AL WRTE /-� ul I e_ � 1TNESS J Y R t� N is S T BILKS �l x / � , !1 TO USED _ _ 3 g3 3 5 , E _�•E 40 4 Wc: PIPE BE _ 5 1 b�TE GH tw 15 Z S 2 c. S TE PAT 11 0 r I R � -O U(%N OU SEPTIC YS M - - - �o G ki r S � D .4L:L_ t,.E.utS UNt?s `To GDtJTOtZ 1 H LOGv 4. P T M 8 -lad N i o T GI�IU� I 7�f7,/,.) 'A�.s H LO/L� LI G SPE T N S. >, 1-H 2 . 74 7 5. T� PEP Gk-�,: P R � T t�1LE THE Ise tJOT E• - e roP --4 . P Off•` O E hE.VE L !o F't LST Z Ot~- t PE. OvT D G�X T B .. AIL ua T SEPT S STt Fh T EEC DEsI GiJ E� 7 t 7 7. 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