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HomeMy WebLinkAbout0324 HIGH STREET - Health 324 HIGH ST., LOT 2, W. BARNSTABLE A=111-028 4 1 A y4 !i� Date: ' - ,c ' v L/ TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: �c �o�" we�li C/ecc n t 4 BUSINESS LOCATION: 3.-;;)-4 S MAILING ADDRESS: L--). e" , 0-3-6 6 e Mail To: Board of Health TELEPHONE NUMBER: - - �`aP • 600j_•s S—�q Town of Barnstable CONTACT PERSON: j_j,I j j-_ A , lu,c-Lk ( � P.O. Box 534 EMERGENCY CONTACT TELEPHONE NUMBER: Sz�le• GJ'S- Hyannis, MA 02601 TYPEOFBUSINESS: GI Does your firm store an the toxic or hazardous materials listed below, either for sale or for you own use? YES NO This form must be returned to the Board of Health regardless of a yes or no answer. Use the enclosed envelope for your convenience. If you answered YES above,please indicate if the materials are stored at a site other than your mailing address: ADDRESS: TELEPHONE: LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health has determined that the following products exhibit toxic or hazardous character- istics and must be registered regardless of volume. Please estimate the quantity beside the product that you store. NOTE: LIST IN TOTAL LIQUID VOLUME OR POUNDS. Quantity Quantity Antif reeze(for gasoline or coolant systems) Drain cleaners NEW USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road Salt (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor oils Pesticides NEW USED (insecticides, herbicides, rodenticides) Gasoline, Jet Fuel Photochemicals (Fixers) Diesel fuel, kerosene, #2 heating oil NEW USED Other petroleum products: grease, Photochemicals (Developer) lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Battery acid (electrolyte) Swimming pool chlorine Rustproofers Lye or caustic soda Car wash detergents Jewelry cleaners Car waxes and polishes Leather dyes Asphalt & roofing tar Fertilizers Paints, varnishes, stains, dyes PCB's Lacquer thinners Other chlorinated hydrocarbons, NEW USED (inc. carbon tetrachloride) Paint & varnish removers, deglossers Any other products with "poison" labels int brush cleaners (including chloroform, formaldehyde, loor)k furniture strippers hydrochloric acid, other acids) Metal polishes Laundry soil & stain removers Other products not listed which you feel (including bleach) may be toxic or hazardous (please list): Spo-removers & cleaning fluids ry cleaners) Other cleaning solvents Bug and tar removers WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS TOWN OF BARNSTABLE LOCATION 2 z q %cG Sr�4-- SEWAGE # VILLAGE VV —b&jn!4 ,L1t ASSESSOR'S MAP INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /-rc'(5 LEACHING FACILITY: (type) Go_�� (size) -3.3 X J9A ' NO.OF BEDROOMS OR OWNERSIA- PERMU DATE: I' %) -)J COMPLIANCE DATE:- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 0N� , 63 If C-�L 3 No. t Fee C V THE COMMONWEALTH OF MASSACHUSETTt Entered in computer: s PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS yZipplication for �Diz ogal * stem Construction Permit 4pplication for a Permit to Construct( J4Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. y I��^�^ �6-r` � Owner's Name,Address and Tel.No."A,1",A,*,,,A,*,. t" Cvt Ae, Assessor'sMap/Parcel I j 3a4 14,5k at W- aR+!t��YJ.�2 / oe a-7J,5 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No 40eQ •r =451t4*_310 ewe 4 RY 'a8 Mrs k f<e Type of Building: Dwelling No.of Bedrooms Lot Size 113 a"s sq. ft. Garbage Grinder( ) Other Type of Building cgl&- P-_ No. of Persons T_Showers( Cafeteria( ) Other Fixtures /� Design Flow �J gallons per day. Calculated daily flow 7 y o gallons. Plan Date - Number of sheets Revision Date Title %,Aj Ran. Rc3\1J e •t &,a [- Size of Septic Tank ]] Type of S.A.S. D�.tC��:t Description of Soil k- �� a hon!n4 aH - 56" --T�5h� St l ►., 3.0m.- 6 "- 1 tly " :tee (M.a a','.o Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by is oard of Health. Signed I41Y7 Date Application Approved by Date Application Disapproved for the following reason Permit No. "'bid Date Issued .,,a Fee l✓ ` 'R, . T�H�E COMMONWE4LTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS U ction ermit g �,.Appftcatton for �t�pogar *pztetu.�Congtru � pplication for a Permit to Construct( Repair( )Upgrade( )Abandon( ) ElComplete System ElIndividual Components T � Location Address or Lot No. Z,y H\ Si Owner's Name,Address and Tel.No.W,I I[A Assessor's Map/Parcel 3a4 �4, St R_ W . I ► ►" 2� y� - a�aS - E Installer's Name,Addre s,and Tel No. Designer's Name,Address and Tel.No. -ce Type of Building: Dwelling 'No.of Bedrooms Lot Size O afAs so.ft' Garbage Grinder( ) Other Type of Building ey No.of Persons �' Showers( ) Cafeteria( ) Other Fixtures L' Design Flow gallons per day. Calculated daily.flow 7 y 0 gallons. Plan Date t�_' ,oi ' 7 Number of sheets Revision Date c� r Title �+� 'e F�s+•�. cJ�cQ r -r nc �1 C 1..�A ®ts Size of Septic Tank of S.A.S. .S0,0 �UL, Dom` Z, L- Description of Soil Q _ a o�T� a°- d y �� o��.Y � ay - 56 Ttiy h Si fhea ,�� i Nature of Repairs or Alterations(Answer when applicable) � a _ Date last inspected: Agreement: The undersigned agre�sure the construction and maintenance of the afore described on-site sewage disposal system in cordance with the provisions of Title 5 o the Environmental Code and not to place the system in operation until a Certifi- cate Compliance has been issued by is oard of Health. Signed `�13 Date /V d b ? Application Approved by d Date Application Disapproved for the following reasons ' Permit No. Date.Issued r. ———————— ————————— ——— ——————— —————— t THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS 4 Certificate of Compliance { THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ✓)Repaired ( )Upgraded( ) Abandoned( by at L4a-r !�N%-ra CLe as constructed in accordance ' with the pro 'sions of Title 5 and the for Disposal System Construction Permit No. dated Installer deue��fuceo Designer E The issuance of this permit shall not be cowed a g grantee that the system . ill f�un�ction as designed. Date `� -. �? r. -!�Inspector ! l� 1----------------------- No. 0 - _ Fee THE COMMONWEALTH OF MASSACHUSETTS' PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS XMpoga l*pztem Construction Permit Permission is hereby granted to Construct( )Repair( )Upgrade( LAbandon "C' ( ) System located at 3dW N tS� St 1,o-t -&J. V 1I W e and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be c plated within three years of the date of thi e y.� Date: CT Approved by ro f ' No - ------- ----- Fee------ ---------------- BOARD OF HEALTH TOWN OF BARNSTABLE ApplicationjorlVe[[ Congtruct ion Permit Application is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: H15 4 ST �t � Lo — A& a 8- LQ?' c), /I/ ------------ ---------- p ---------------------------------------------- Location — Address e G— Assessors Ma and Parcel / / 3) S/� %�lt6fl 0`4 tG4, �. N/# �/ L.� ' o, --------------------------------------- / Owner Q Address A ,b d /6 0 /k u S .-eA- A,-c. O T C �/ 7 - - - - - - -° --------------------------------------- =- Installer — Driller j .Address Type of Building Dwelling ------------------------------------------------ Other - Type of Building ---------------- No. of Persons-----------------, ---------------------------- . �r Typeof Well`I------ ------------------------------------------ Capacity-------------------------------------------------------------------- Purpose of Well�pnsc3l�c _(,sue �c/ --------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Ce ific a .of Compliance has been issued by the Board of Health. G, Job /5 � Sign ------ - - -- ------ - --------------------------- -- date Application Approved By --- -P-- - ------- ---- ------------ date Application Disapproved for the following reaso s:------------------------------------------------------------------------_--------------------------- - —-- --- --- ------------------------------------------------------- �— © � date Permit No. - ------------------- Issued - --- ------------- -- da e BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ('I, Altered ( ), or Repaired ( ) �- ----------------------------------------------------- Installer at- -- -------- - - - -- - has been installed in accordance with the provisions of the Town of Barnstable Bq,a` ealt � •vate Well Protection Regulation as described in the application for Well Construction Permit No.J�-- t-- ------------- ated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------- ------ --- — ----- Inspector-----------------------------------------—- - ----------- 6 1 NO ----- - Y° 17 -+ �� Fee------ ------------- /r BOARD OF HEALTH` ``• TOWN OF BARNSTABLE ApplicationArVel[ Congtruct ion Permit Applicatio is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: — ,'�C� H, fIJ/ Location -i Address ; / Assessors Map and Parcel n Owner Address -- - - ---- ------ - '� r) i 'Installer - Driller j Address Type of Building �- ti�� t Dwelling--. -- e= - '1Othier,,-Type of Building ---- -- -------------= No.. of Persons------------------------------------------------- ft Typeof Well'- • Capacity---------------------------------------------------------------------- Purpose Hof Well� " �' T,c____1,-�c - - - - 4 ------ 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 Cer ific a .of Compliance has been issued by the Board of Health. F Sign ('�` --- -- - - ----- - /-/ - (. .- date Application Approved By date Application Disapproved for the following reaso s:------------------------------------------------------ -----------------------------—---- - date ..Permit No.—� — --- -------- Issued --' - - - 7 i Zl.Tik NAM'wNwancrav 7t�'Aa�l. P7i�L396 - .Q1 4'Y4s:Y9H43"�e9wS aCC�t' 's Y4 1r "` r` 1` BOARD,O.F HEALTH . 'T.wO VIGGPei O,rF BEAR N S T A YB L E i Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well. Constructed ( '�, Altered ( ), or Repaired ( ) QA�cu,.>,.,�- � 11 dJi, 1--------------------- ------------------------------------ by- -- ------------------------------- �Installer zor at- -- ----- --- — --—----------------------------------------------------------------------------------------------- hasbeen installed in accordance with the provisions of the Town of Barnstable B a ealt vale Well Protection Regulation as described in the application for Well Construction Permit No. - -- ---------- ated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED A6 A,,OLIARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY: ' DATE- --- —- —-- —--------------- --' Inspector------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Yell Construct ion Permit V d -----_ Fee-.---------- g Ca/vl Permission is herebyranted OI1S---------------/-------------------------------------------------------------------------------------------------- to Construct ( y,'Alter ( ), or Repair ( ) an Individual Well at:Street as shown o t a p lion or Well Construction Permit - - - - - - Datea�!fi-------- ---j ----� ---------- ------------------------------ . ! J ' '� ------ —— —�----- �. /7 , 1 Board of Health , DATE ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 ' 449 Rte.130 Sandwich, MA 02563 (508) 888-6460 1800-339-6460 FAX(508) 888-6446 CLIENT: Agracola Construction LOCATION: Lot 2 ADDRESS: PO Box 765 324 High.St. Mashpee MA 02649 W. Barnstable MA COLLECTED BY: DA Scannell SAMPLE DATE: 10-7-97 SAMPLE TIME: 2:00 WATER SAMPLE TYPE: New Well DATE RECEIVED: 10-8-97 LAB I.D.#: 9710149 WELL SPECS.: 120' RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Limits Coliform bacteria /100ml 0 0 9222 B pH pH units 6.5-8.5 5.89 4500 H+ Conductance umhos/cm 500 118 120.1 Sodium mg/L 28.0 12.2 200.7 Nitrate-N/Nitrite-N mg/L 10.0 0.22 4500-NO3 E Iron mg/L 0.3 0.24 200.7 Manganese mg/L 0.05 0.017 200.7 Volatile Organics ug/L See Attached Report ND EPA 524.2 4 COMMENTS: Low pH indicates high corrosive characteristics. YES WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date d Ro ald J. Saa Laboratory Di4 cfor <=less than >=greater than TNTC=too numerous to count s} --- _ _ page 2:--of 3 - R.I.-Analytical Laboratories, Inc. f CERTIFICATE OF ANALYSIS F_nvirotech Laboratories, Inc. Date Received: 10/10/97 Work Order# 9710-04534 Sample #: 1 SAMPLE DESCRIPTION: #9710149 10/08/97 SAMPLE ANALYZED PARAMETER RESULTS/UNITS METHOD DATE/TIME ANALYST Volatile Organic Compounds Bromodichloromethane <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Bromoform <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Dibromochloromethane <0.$ ug/l EPA 524.2 10/17/97 18:48 MED Chloroform <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,2-Dbromoethane <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED Benzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Carbon Tetrachloride <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,2-Dichloroethane <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED Trichloroethene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,4-Dichlorobenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,1-Dichloroethane <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,1,1-Trichloroethane <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED Vinyl Chloride <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Bromobenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Bromomethane <10 ug/l EPA 524.2 10/17/97 18:48 MED Chlorobenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Chloroethane <5 ug/1 EPA 524.2 10/17/97 18:48 MED Chloromethane <5 ug/l EPA 524.2 10/17/97 18:48 MED 2-Chlorotoluene <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED 4-Chlorotoluene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Dibromomed=e <2 ug/1 EPA 524.2 10/17/97 18:48 MED 1,3-Dichlorobenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,2-Dichlorobenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED trans-1,2-Dichloroethene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED cis-1,2-Dichloroethene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Methylene Chloride <0.5 u9/1 EPA 524.2 10/17/97 18:48 MED 1,1-Dichloroethene <0.5 ug/l EPA 524.2 10/17/97 18,48 MED 1,1-Dichloropropene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,2-Dichloropropane <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED 1,3-Dichloropropane <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1.3-Dichloropropene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 2,2-Dichloropropane <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Bthylbenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Styrene <0.5 ug/l EPA 524-2 10/17/97 18:48 MED 1,1,2-Trichloroethane <0.5 ug/i EPA 524.2 10/17/97 18:48 MED Page 3 of 3 R.I. Analytical Laboratories, Inc. CERTIFICATE OF ANALYSIS Envirotech Laboratories, Inc. Date Received: 10/10/97 Work Order# 9710-04534 Sample #: 1 #9710149 10/08/97 SAMPLE ANALYZED PARAMETER RESULTS/IJNffS METHOD DATE/TBIE ANALYST 1,1,1,2-Tetrachloroethane <0.5 u9/1 EPA 524.2 10/17/97 18:48 MED 1,1,2,2-Tetrachloroetbane <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Tetrachloroethene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,2,3-Trichloropropane <0.5 u9/1 EPA 524.2 10/17/97 18:48 MED Toluene <0.5 u8A EPA 524.2 10/17/97 18:48 MED Xylenes <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED 1,2-Dibromo-3-Chloropropane <10 ug/l EPA 524.2 10/17/97 18:48 MED Bromochloromethane <1 ug/l EPA 524.2 10/17/97 18:48 MED u-Butylbenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Dichlorodifluoromethane <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Trichlorofluoromethane <0.5 ug/1 EPA 524.2 10/17/97 18:48 MED Hexachlorobutadiene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Isopropylbenzene <0.5 ug/i EPA 524.2 10/17/97 18:48 MED p-Isopropyltoluene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Naphthalene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED n-Propylbenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED sec-Butylbenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED tert-Butylbet== <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,2,3-Trichlorobenzene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED 1,24-Trichlorobenzene <0.5 ug/f EPA 524.2 10/17/97 18:48 MED 1,2,4-Trimethylbenzene <0.5 u9/1 EPA 524.2 10/17/97 18:48 MED 1,3,5-Trimethylbenrene <0.5 ug/l EPA 524.2 10/17/97 18:48 MED Methyl Tertiary Buthyl Ether <1 ug/l EPA 524.2 10/17/97 18:48 MED Hexane <10 ug/1 EPA 524.2 10/17/97 18:48 MED 4-Bromofluorobenzene(SUR) 102 `/o EPA 524.2 10/17/97 18:48 MED 1,2-Dichlorobeumne-d4(SUR) 82 % EPA 524.2 10/17/97 18:48 MED TOWN OF BARNSTABLE ' LOCATION 2�/ /t�'�,li•S + SEWAGE# /5 VILLAGE ,� 'L ASSESSOR'S MAP //1 -C 2 y —�- * INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /j!;� LEACHING FACILITY: (type) G0 -t-e kT (size) 3.3 A'/-?A .''NO.OF BEDROOMS 4VIED R OR OWNER �o /7/ /)?t'/i C:b64. PERMITDATE: %C' -)j `f COMPLIANCE DATE: Separation Distance Between the: >: .Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of.leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 8, oh T 9 V J, y, v Town of Barnstable I'# - /5 DepartmenQ of Health,Safety,and Environmental Services Public Health Division Date ,- ' 367 Main Street,I Iyannis MA 02601 $ 9ARMA®LE J Y MARS 'a P 1639. Date Scheduled I z— l 7 Time ( I ' Fee Pd. �MUO C Soil Suitability Assessment for Sewage Disposal Performed By: Witnessed By: 4� rrr LOCATION& GENERAL;INFORM A ON Lt-P✓I Location Address Owner's Name 3z4 H� h Vws Wahgr:itisF Address, Assessor's Map/Parcel: (I (Zg I Ci Engineer's Name )�,4 Uc Q, NEW CONSTRUCTION ✓ REPAIR Telephone tY ►.tom')—�.27.2... Q h S Land Use V a e-a.. fi Slopes(0/0) ?'9 7o Surface Stones-- Distances from: Open Water Body f It Possible Wet Area . R Drinking Water Well /, � * II t Drainage Way R Property Line it Other R i �jKEy 1�,rn..ry&(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) /. fGs-� Z 6, Parent material(geologic) " Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face 1.4-44 Estimated Seasonal High Groundwater go f l�"Y'ER. IN 'x'riavn�»Z avAQO>vA>K_ rr>rar vcimEuEE. Method.Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: In. Depth to weeping from side of obs.hoie: in. Groun6water Adjusimerk Index Well N Reading Date: Index Well level Adj.factor Adj.Groundwater Level_ ;'PERCOLATION TEST Dateg/y97Tirne ilk Observation Hole# Z 2 Time at 9" Depth of Perc /0 8 Time at 6" Start Pre-soak Time© �/ a3' Time(9"-6") End Pre-soak Rate Min./inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back Copy: Applicant DEEP OBSERVATION HOLE LOG Hole# / Depth I}om Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.%Gravel) O - L " 14 Loam tOY1Z Z/'- t,,f 6 f f../raj, 2 y': q6 N C s ,✓ e fi�v..t t b y 2 Sj s""�° s vl-° 9� ✓yy cz Jr trZ r • yo w r DEEP OBSERVATION HOLE LOG Hole# . 2— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in J (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistency.° r O - 2- /� L O 4 w t 0Y/L 2-1L Z'- 2y " $ LoC,4. 54».1 I6Y2WC C, "`f' -64 S'✓� lb y p 5 5-21 V C c,ar-.44 a t° Y/L 6/6 Ia DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. Consistencv.° Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. on i tene ravel I Flood Insurance Rate Mao: Above 500 year flood hcundwy No— Yes J Within 500 year boundary No � Yes Within 100 year flood boundary No A"" Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? �S If not, what is the depth of naturally occurring pervious material? Certification I certify that on 8-19—9 (date) I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 3 10 CMR 15.017. 177 1��.�-�/ Signature /.9 — r, 4 'J'own of Barnstable r a Department of Health,Safety,and Environmental Services C19 Public Health Division Date -� � � 367 Main Street,Ilyannis MA 02601 BARMABIA NAM ' Fee Pd. I ® d ric lk Date Scheduled Time Soil Suitability Assessme�zt for Sewage Disposal /p owN C^I'E 1C6J&V CMr+itnessed By: Jc-r � �v/.1Ntr\C-►�30H� Performed By: ��N OJ A 1�+ t LOCATION & GENERAL INFORMATION I.,ocation Address Ltrf y C^\4A LOT`-) L-°\L ter') Owner's Name '6nuoC 2-gtPt^^J Address 130,- rFyt q��Mn1ra ail` rLO Engineer's Name gyp„+N 4.,AVP-G' �rtb1rJttfttNV Assessor's Map/Parcel: 2\, ��-0 NEW CONSTRUCTION ✓ REPAIR Telephone# 3(01 4S H\ Land Use V A G A P�\ i- Slopes(%) 0 -5 Surface Stones It Possible Wet Area 1010' + n Drinking Water Well � 15 O fl Distances from: Open Water Body e-.at Drainage Way ft Property Line Sl�r�y` R Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) L�07 LA Zo tzow 3 ZI ,I �GA� Depth to Bedrock Parent material(gcologrc) GLf► Depth to Groundwater: Standing Water in I101e: N Weeping from Pit Face Estimated Seasonal I ligh Groundwater N ZA D!,11TERMINATION FOR SEASONAL HIGH WATER TABLE Mcthud Used: _ t /8--- in, Depth to soil mottles: NDW/�TEf D ep NO Depth Observed standing in ohs.hole: R. 690V I)gpth to weeping from side of ohs.hole: in. Groundwater Adjustment FOVND index Wcll#_ Rcading Date:_ Index Well level• Adj.factor Adj.Groundwater Level PERCOLATION TEST bete gh 27hime 11=3°r,,, Observation Time at9" O'.0 O lole# get, Time at 6 Depth of Perc Start Pre-soak Time End Pre-soak 00 Rate Min./Inch Site Suitability Assessment: Site Passed V/ Site Failed: Additional Testing Needed(Y/N) IV Original: Puhfrc health Division Observation Hole Data To Be Completed on Back—� Copy: Applicant Hole # -7-" 1' 1 ULCI ORSCRVATION MOLE LOG Dcplh from Soil I lorizon Soil Tcxlurc Soil Color Soil (lllrer Surface(in.) (USDA) (Munsell,) Mottling (Structure,Stones,noulderes. % A. 5t_ -7.5'(0'S/-z- ej L_ [•e DEEP OBSERVATION IIOLE LOG Hole# TWL Depth from Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,noulderes. Consistency,%Gravel) 0-10 r-lr<M /y 101)/t, c��>b�e, DEEP OBSERVATION HOLE LOG Hole# Dcplh from Soil Ilorizon Soil Texture Soil Color -Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. Consistency,%Gravch DEEP OBSERVATION HOLE LOG "Hole-# Depth from Soil Ilorizon Soil'hcxhuc Soil Color Soil Other Surliice,(iri.) (USDA) (Munsell) Mottling (Structure,Stones,noulderes. % — I Flood Insurance Kate Man: / Above 500 year flood boundary No_ Yes ✓ Within 500 year boundary No Yes Within f00 year flood boundary No Yes rt 2M MR t' eL 4;00o ooOzi-D L AL Depth of Naturally Occurring,Pervious Material Does at least four feet of naturally occurring pervious material exist in-all.areas observed throughout the-- arca proposed for the soil absorption system? Ye - If not, what is the depth of naturally occurring pervious material? Certification I certify that on /vOy (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise an/d' experience described in 310 CMR 15.017. Signature .'-� `�I Date $-7-01 . �:.:�: ._ . . .ems,.� • _ . ...: ,.. .>,: :. i S Y S TEM i PROFILE NOT 7°0 � AL E TOP FNON. " FINISH GRADE OVER FINISH GRADE OVER TRENCHES _9 2 �f EL . =' FINISH GRADE 9 z. o FINISH GRADE OVER DIS T. BOX SEPTIC TANK 71 9 z• O.Db •O i. O etQ� ,o.' .oa,.• ��"�`�� 12" MAX. � ^ o o:;o Ap C o:4 Q. �:...o::; ;' :04;Q�D b•D 9:vo pl+.ya�0p''�.q e.•r.� D o. v.o'.• TO TAL LENGTH OF TRENCH �" 3 /�z- :o•.o:Pe •a „ �. OUTLET PIPE; LEVEL _ 3 :a' - �+ FOR 2 FT. MIN. l y p;•e:00 ib,., Da• '' .: o: ..v• :. ''•A:' ' ':d• b' ' -c .o• bb;• p�'!U O OG"A 60�'�'�' q9 Dp; i. oo a:: qQ ::� O fo pA:a 90 9�� . 0—" 3 t'a:n;�::d:. :b::!:a.° I :D e e o`OD o p. �;/7 € 3o g� OR P VC TEES o :. b , b• C. I. n� a�•7 0� ,d oa b d'•'b :� �jqs Z3��•`'�c pt� , REMOVE ALL A. B G 01 UNSUITABLE MATERIAL WITHIN FT. •,4'.J. r a i ;p o-•�c, ,• �, �., OF LEACHING FACILITY AND REPLACE WITH CLEAN SAND 0 1500 GA L L ON BSMT FL . � , _ L • G ;o:•: o: �: 9° • ; "NSTALL- ON LEVEL BASE cz ��711 - "500 GALLON DRYWEL L S " a•:•.o: o °•o o ; PRECAST .CONCRS TE Q bi:4•;'DA H- h 0 REINFORCED °pb �• ao a. D. f TION �a i s�v'�a'o;•c p'4�u b.:O�.:.p'o eQ`.p,�°�'rvAa'f'Q•04 a.Cp7+Q: TR NC / SEC SEPTIC TANK INSTALL ON LEVEL BASE NOTE' EXCA VA TE TO ELEV. s', o OR L'Ok✓ER TO REMOVE ALL IMPERVIDUS qA TERIA L BENEA TH THE LEACHING AREA .a" DIAM. 12" MIN. 3" OF 1/8"_1/2,w ' REPLACE EXCA VA TED MA TERIAL 1rI!I TH q: Q„-•a•,:a•;'�:••;.d b''� ':o;� ',ti i WASHED PEASTONE. CL EAN, CLAY FREE SAND _. _ -' { -' S3 9 � _ s 5/ i y'�o L= S S-c• oS, , 3/4 1-1/2 SASHED �o � , '•': ` Q �e CRUSHED STONE '""-3, z/' � I 9 y.moo' a S3 --••-------. may, , �-�x ., ,{r• �' - TRENCH NlD TH GENERA NOTES --_ -- _ — ------ V ONS °SHOI�1r°J A RE BASED ON A SSUMEL� C� K✓' 'NUMBER OF TRENCHES 1 J. ALL ELE A TI — -- ----------- 2. ALL PIPES IN T,':E SYSTEM MUST BE CAST IRON. NU1�OE.R OF DRYWEL L S 3 • 7 OR SCHEDULE 40 PVC... OBS ER VA TION PIT Tt.c ,�.a cP� -- '.�L TH MUST BE NOTIFIED —B98S RHEN �:ONST�•-®Uc®,"ON_. IS COAPLETE PRIOR,.4 PERCOL A TION RA TE.' 1 M I TO BA CKFIL L SNC <2 MIN./IN. o 1� 0 4. ANY CHANGES IN THIS PLAN MUST BE APPROVED za _�,,,, 1 .- HEA`t TH AND CAPE 6 ISL ANDS NI TNESSEO B Y.' � ,ye , 7W 2 �i _8a,o I (� BY THE BOARD C.{ , SURVEYING CO., .ANC. GERRY DUNNING t"i 5. MA TERIALS-AND �'NSTALLA TION SHALL BE IN_ BARNS TABLE BRD. OF HEALTH DESIGN DA TA COMPL IANCE MI Ti e THE S TA TE SANI TAR Y ,4UG. 19, 1997 CODE — TITLE V - AND LOCAL APPLICABLEDA TE rim _..._L�-�.,:.- 0 RULES AND REGU.ATIONS � - NUMBER OF BEDROOMS '4 6. NORTH APRON IS FROM RECORD PLANS AND z ��~+ � m �^y�� z!Z NO r 8 GARBAGE DISPOSAL \� IS NOT TO BE U,E5 FOR ,sOLAR PURPOSES I y/� �.�R,�,y � �� ,oy�e 440 GAL . T�po A " /L �, G. 7. FLOOD HAZARD ZE�NE NON-HAZARD 2 " —_. _. — -- - DA IL Y FL ON 8. RA TER SUPPL Y_ -PRI VA TE WELL �' SEPTIC TANK RE® 'D. 1500 GAL . 1500 GAL . .SEPTIC TANK PROVIDED l a ._._Y "' - -s r LEACHING REQUIRED 440 GPD. ALL •- ••B- 6 -Cl- UNSUITABLE MA TE 9G, 186 SIDE�9ALt AREA = S.F. y _ jVrTgrN 5 FT• OF THE LEACHING FACILITY IS TO - — 186 0. 74 137 .- I BE RE OVED AND REPLACED WITH.CLEAN SAND � c z S.F.X G/S.F. = GPD. n-�F �� < ,.•,..., BOTTOM AREA = 441 S. F. L EGEN �� rd s �� 441 S.F.X . '4 G/S.F. = 326 GPD \ '"''�' `'e L EA CHING PRO VIDED 463 GPD 9 _ P — � 9n PR POSED EL EVA TION TT3.n-r l Ex�STING CONTOUR _ SINGLE FA MIL Y RESIDENCE G Od:3ERVA TION PI7' i 1 s O s1 L% _�_ 9��- ® -Dh.i TRIBUTION BOA' r r 70- ' '' } C r \• PROPOSE OPOSi./ SEAM GE DSPOV L S YS TEM PREPARED FOR o o SEi'7TIC TANK :�.��� -`- A EL f' A✓IL L IA MICR li ¢ LOT 2 � (HOUSE NO. 324) HIGH S T �' !_.! RESERVE AREA c O` � 1 . hIES T BA RNS TA EL E — MA SS. PjpE INVERT ELEVATION r CHA I Es ` `1 ' sar�Icxi DA TE.'•4a� %', ✓�%�� CAPE' 6 ISLANDS ENGINEERING .3�2 84 26085 PLOT PLAN 9fcrstE �° % SCALE AS NOTED 133 FALMOUTH ROAD — SUITE 2E SCALE.• 1 "_ -�v ' �/✓s 2� �.- '.�y, �r�, , i �+�`�;�r . P PLAN NO E, MA SH E MASS I I