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0009 LOCUST AVENUE - Health
9 LOCUST AVENUE, W.BARNSTABLE A= e a Massachusetts Department of Environmental Protection Bureau of Resource Protection Well Completion Reports Well Driller Please specify work performed: Address at well location: New Well Street Number: Street Name: 9 LOCUST AVE Please specify well type: Building Lot#: Assessor's Map#: Domestic —- 197 Assessor's Lot#: ZIP Code: Number Of Wells: 026 02668 CitylTown: Well Location BARNSTABLE In public right-of-way: GPS f Yes (.,No North: West: 41.69731 70.35339 Subdivision/Property/Description: Mailing Address: click here if same as well location address Property Owner: Street Number: Street Name: CONNOR THOMAS 9 LOCUST AVE City/Town: State: Engineering Firm: BARNSTABLE MASSACHUSETTS ZIP Code: 02668 Board of health permit obtained: Yes 9"Not Required Permit Number: Date Issued: W21069 12/27/2021 .......................................................................................... Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program ° Well Completion Reports(General) Well Driller - General Well Form DRILLING METHOD Overburden Bedrock ................._. ........._........ .__.._.__._._ Auger -Choose Bedrock— ? ......................................................................................................................................... ............._; WELL LOG OVERBURDEN LITHOLOGY € From(ft) To(ft) Code Color Comment Drop in drill Extra fast or slow Loss or addition stem drill rate of fluid __....e_ ........... _. — _ ..................................... _ _ _ - i0..... 20 �Cla �( Brown � LYES � .I �Fast� Slflss Addition_. y_ _ _. -... _...__..........._...___....._....__.._... _ �.�.._..�. r ........................................ — ZO (40 I Clay Brawn C Fast r Slow �_ 1 _------__ 1Tmm YES NO Loss Addison 40 45 i Clay Brawn +� �Fast r Slow YES NO Loss Addition _.__ .` f _._ ....... E _..___.._,......._..,...«....«3 ... (45 65 9;Silty Sand f,Brown r Fast t Slow i �,,.......,.,_.._.._ YES NO __.. I Loss Addition ...............................................................� YES NO I Loss I (65 75 [;Silty Sand Brown r Fast r Slow ? ..............._........................................_ �[€. ... . . ss Addition I E i75 95 Cla Brown # t +Fast C`Slow r Y ..._,..__.....__ :A- i` ---- YES NO Loss Addition . . _ 9 110 I F€ To Coarse S { Brown + Fast Slow E.. �� YES NO __, Loss Addition i .. ........ i... .. ............................................... ....,.. .. .... ........:. :II't ......................... .... WELL LOG BEDROCK LITHOLOGY I Loss or Extra Drop in Extra fast or Visible Rust From(ft) TOM ;Code Comment addition of drill stem slow drill rate Staining j Large fluid Chips .. . Choose Cade YES NO Fast Slow loss Addition € Yes Ye ADDITIONAL WELL INFORMATION Developed I t--Yes f"No Disinfected Total Well Depth 110 Depth to Bedrock Surface Seal Type lNone Fracture Enhancement Yes f:No CASING irl Is Casing above ground?. From: 1 To: 0 From To — Type i Thickness Diameter Driveshoe ._......_...... ._ 0 106 Polyvinyl Chloride €Schedule 40 SCREEN T No Screen'I From To Type Slot Size (Diameter ..............................._...._.__..................................................__....................... ........... ........................_........................._............................................................. 106 110 !Stainless Steel Well Point WATER-BEARING ZONES r DRY WELL Massachusetts Department of Environmental Protection Bureau of Resource Protection—Well Driller Program Well Completion Reports(General) 1 From To Yield(gpm) _........ �� _. j20 3110 12 _____--- PERMANENT PUMP(IF AVAILABLE) ..................................._..._..................... Pump Description 2 Wire Constant Speed Horsepower Submersible 3!4 Pump Intake Depth(ft) 50 Nominal Pump Capacity(gpm) 10 ANNULAR SEAL i FILTER PACK, .. ............... a _ Water Batches 'Method Of From To Material 1 Weight Material 2 Weight (gal) (count) Placement ._ Choose Material e Material COne� WELL TEST DATA ... ................ Date Method Yield I Time Pumped Pumping Level(ft Time To Recover Recovery(ft (gpm) (HH:MM) BGS) (HH:MM) BGS) 01l1812022 t Constant Rate Pump �� 12 01 30 124 00 01 d 20 m._.... __ .. WATER LEVEL W..,,..,...w_.� Date . ___ .Measured Static Depth BGS(ft) Flowing Rate(gpm) i 01/18J202220 12 ......... a 3........... .... ............ ............. 7 3 ............. .......� .... .......... _... _...... ....... COMMENTS WELL DRILLERS STATEMENT This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete and accurate to the best of my knowledge. DESMOND THOMAS E Monitoring(M) Supervising Driller Signature Ill DrillerDESMOND Ill Registration# 764 THOMAS,E DESMOND WELL Date Job Complete - Firm DRILLING INC. Rig Permit# 0089 W/1612022 NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion. ENVIROTECHLABORATORIES,INC. MA CERT.NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-33 9-64 60 FAX(508)888-6446 Client Name: Desmond lYell Drilling Location: Address: PO Box 2783 9 Locust Ave Orleans, MA W Barnstable,MA 02653 Lab Number: DW-220241 Collected By: D Desmond Date Received: 01/25/22 Sample Type: New well Well Specs: 110'120' Location,Sri�crce Date Collected Tltne Collectedarnttiets '�;� Q A u0 Il?4122 11:30;., . . Analysis Requested Units Recommended Limits; Analysis Result i Method Date Analyzed Analyzed by . Total Coliform. CFU/100mL 0 0 SM92226 01/25/2022 AC/ET @ 1415 w: -_......_. _w_ .._� _.....: ....._. ...._..�.. .:...:- tea: ——— _ pH pH units 6.5-8.5. 6.9 SM 4500-H-B 01/25/2622 SD Specific Conductances umhoslcm 500 116 EPA 120.11 01/25/2022 SD _.._..._�,.. ._ _.�...—..w------------ Nitrite-N mg/L 1.00. .. .... ....... .._. .�..�.._._,__ --- <0.006 EPA 300.0 1 01125/2022 SD Ndrate-N mg/L 10.0 0.07 EPA 300.0 01/25l2022 SD Sodium mg/L 20.0 12 EPA 200.7 01/26/2022 KB .......:::: . Total Iron mg/L 0.3 5.88 EPA 200.7 01126/2022 KB Manganese mg/L 0.05 0.236 EPA 200.7 01126/2022 KB Volatile Organic Compounds ug/L See comment. None Detected EPA 524.2 01/26/2022 NEC* Comments: Consult local Board of Health regulations concerning Iron level. Over a lifetime,the EPA recommends that people drink water with manganese levels less than 0.3 mg/L and over the short term,EPA recommends that people limit their consumption of water with levels over 1.0 mg/L All samples were analyzed within the established guidelines of US EPA approved methods with all requirements met, unless otherwise noted at the end of a given sample's analytical results. We certify that the following results are true and accurate to the best of our knowledge. Date 1/29/2022 ...............- ....... -_ _............. ..w_....:.......... Ronald J.Saari Laboratory.Director BRL=Below Reportable Limits *See Attached Page 1 Of 1 oCertification is not available for this analyte./or potable water samples.. New England Chromachem 6 Nichols Street Salem,MA 01970 978-744-6600 4 Sample Information EPA Method 524.2 Rev 4.1 Volatile Or anic Compounds in Water Lab ID: 201526 Client: " Envirotech Laboratory,Inc. Client ID: DW-220241 State: Liquid Date Sampled: 01/24/22 Date Received: 01/26/22 Date Analyzed: 01/26/22 MCL Regulated VOC's Results ug/L (ug/L) Unregulated VOC's Results(ug/L) Benzene NO 5 Acetone` NO Carbon Tetrachloride NO 5 Bromobenzene NO 1,1-Dichloroethane NO 7 Bromochloromethane NO 1,2-Dichloroethane ND 5 Bromodichloromethane NO 1,2-Dichlorobenzene NO 600 , Bromoform NO 1,4-Dichlorobenzene NO 5 Bromomethane ND Trichloroethene NO 5 2-Butanone.__. NO 1,1,1-Trichooroethane NO.- 200 N-Butylbenzene ND Vinyl Chloride .ND 2 Sec-But benzene NO Chlorobenzene NO 100 Tert-Butylbenzene NO cis-1,2-dichloroethene ND 70 Chloroethane NO trans-1,2-dichloroethene NO 100 Chloroform ND.. 1,2-Dichloropropane__ NO 5 Chloromethane NO Eth, benzene NO 700 2-Chlorotoluene NO Styrene NO 100 4-Chlorotoluene Tetrachloroethene NO 7 5 Dibromochloromethane .NO Toluene NO n70 j: 1,2-Dibromo-3-Chloro "ro pane NO Xylenes(Total) ND 1,2-Dibromoethane NO Methylene Chloride ND Dibromomethane ND 1,2,4-Trichlorobenzene ND 1,3-Dichlorobenzene NO.1,1,2-Tiichooroethane ND Dichlorodifluoromethane NO 1,1,-Dichloroethane NO 'Acetone Detection Limit=10 ug/L 1,3-Dichloropropane NO NO=<Method Detection Limit 2,2-Dichloro ro ane NO NA=Not Analyzed 1,1-Dichloropropene ........ NO MRL=0.5 ug/L cis-1,3-Dichloropro ene NO Dilution Factor= 1 trans-1,3-Dichloro ropene NO Hexachlorobutadiene NO lso rop benzene NO P-Iso ro toluene...= NO Methyl-tert=butyl ether NO Naphthalene NO N-Pro ylbenzene ND 1,1,1,2-Tetrachloroethane NO . 1,1,2,2-Tetrachloroethane NO 1,2,3-Trichlorobenzene NO Trichloro8uoromethane NO .1,2,3-Trichloro ro ane NO 1,2,4-Thmeth lbenzene NO _ 1,3,5-Trimeth (benzene `ND Surrogate Standard Recoveries % Benzene-d6 98 ;; MCL TTHM's=80 ug/L 4-8,., romofluorobenzene 96 Method Detection Limit=0.5 ug/L „1,2-Dichlorobenzene-d4 '101 Analysis performed per 31 OCMR42 Electronically signed and approved by Mr.Bruce A.Bornstein,Lab Director Date: 1/27/2022 Town of Barnstable ' . $ Board of Health 639.#1 200 Main Street, Hyannis MA 02601 IAOd Office: 508-8624644 John Norman,Chairrman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. F.P.(Thomas)Lee,P.E. Daniel Luczkow,M.D.Alt. March 7 2022 Mr. Peter McEntee Engineering Works Inc. 12 W. Crossfield Road Forestdale, MA 02644 Locust Avenue,EWest Barnstable` A' $4 026 a ar. Dear Mr. McEntee, You are granted variances on behalf of your client, MIG Realty Trust, to construct an onsite sewage disposal system at 9 Locust Avenue West Barnstable. The following variances were granted: Section 397-8 (E) of the Town of Barnstable Code: To install a soil absorption system 105 feet away from an onsite private well, in lieu of the 150 feet minimum separation distance required. Section 397-8 (E) of the Town of Barnstable Code: To install a pump chamber 85 feet away from an onsite private well, in lieu of the 150 feet minimum separation distance required. Section 397-8 (E) of the Town of Barnstable Code: To install a soil absorption system 104 feet away from an abutter's private well (#1636 Main Street), in lieu of the 150 feet minimum separation distance required. Section 397-8 (E) of the Town of Barnstable Code: To install a pump chamber 92 feet away from an abutter's private well (#1636 Main Street), in lieu of the 150 feet minimum separation distance required. Section 397-8 (E) of the Town of Barnstable Code: To install a soil absorption system 111 feet away F om an abutter's private well (#26 Locus Ave), in lieu of the 150 feet minimum separation distance required. 310 CMR 15.405 (1): To provide less than 12 inches of separation between the pump chamber inlet and outlet. Q:\WPFILES\McEntee 9 Locust Ave Septic Variances August 2021.docx These variances were granted because the physical constraints at the site restrict the design and placement of the new septic system components due to the locations of existing private wells in the area. Sincerely, Jo Norman airman Q:\WPFILES\McEntee 9 Locust Ave Septic Variances August 2021.docx DATE: c?► $95.00 FEE*: /�► t S. t,�. ` 'down of Barnstable REC.BY: .. � z i639. > d of Hea Boarlth Q� / SCIiFD.DATE: ® 1 200 Main Street,Hyannis MA 02601 Office: 508-8624644 John T.Norman FAX: 508-790-6304 Donald A.Guadagnoli,M.D. Paul J.Canniff,D.M.D. F.P.(Thomas)Lee,Alternate VARIANCE REQUEST FORM LOCATION /� Property Address: Lo c.0 S*- NV4— W. S Assessor's Map and Parcel Number: 1,97--07-& Size of Lot: t " Wetlands Within 300 Ft. Yes Business Name: Subdivision Name: APPLICANT'S NAME: e r ���n �� Phone -4 Rr?3 —Ar 7 �8 Did the owner of the property authorize you to represent him or her? Yes _ No PROPERTY OWNER'S NAME CONTACT PERSON Name: 1 l.C24 �, in r S " Name: �k Address:.?,�!.0 ex t � �,.0 e..�A��*�� Address: l2 Phone: ,e-6q®�q` Phone: 7 3 7 47 EMAIL: f?kk-Qr.MCAV\ <2 2�0^-O k CO VARIANCE FROM REGULATION(incr.Reg Code a) REASON FOR VARIANCE'(May attach separate sheet if more space needed) �r4.5a��,�> C ,o hc3 �t- 3 ci r-�a, tc te. ok-v d, NATURE OF WORK: House Addition U House Renovation U Repair of Failed Septic System Checklist (to be completed by of ce staff-person receiving variance request application) Please submit,Pst four on list as 5 collated packets A. Five(5)copies of the completed variance request form g2.g B. Five(5)copies of MA DEP approval letters for Innovative/Alternative septic system(when proposing an I/A system or secondary treatment unit(S.T.U.). C. Five(5)hard copies of engineered plan submitted(e.g.septic system plans)and one(1)electronic version submitted to email: �../ health 4town.bamstable.ma us *(Pool Plan-5 hard copies) D.Five(5)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans)and one(1)electronic version. 0^ p A completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or PLS. Signed letter stating that the property or business owner authorized you to represent him/her for this request Applicant must notify abutters by certified mail at least ten days prior to meeting date at applicant's expense(for Title V and/or local sewage regulation variances only)_ Full menu-Five(5)copies of full menu submitted(for grease trap variance requests only). Fee Submitted*S95.00 for the following variances: 1)New construction, 2)Septic repairs with increase in flows,and 3)New owner/new lessee applying for food, pool or body an variances. Exemptions from Variance Fee: 1)Septic repair withou an increase in flow and variances granted at the counter,2)Monitoring Plans,and 3)Temporary Food(not a"variance"). _ Variance-request submitted at least 15 days prior to meeting date VARIANCE APPROVED John T.Norman NOT APPROVED Donald A.Guadagnoli,M.D. REASON FOR DISAPPROVAL Paul J.Camriff,D.M.D. Q:\Application Forms\VARIREQ Rev. Jan 1-2020.docx Engineering Works, Inc. 12 West Crossfield Road, Forestdale, MA 02644 Tel/Fax(508)477-5313 August 9, 2021 Town of Barnstable Board of Health 200 Main Street Barnstable, MA 02601 Re: 9 Locust Avenue, West Barnstable (Parcel ID: 197-026) Dear Members of the Board, On behalf of my client, Christopher Maki, the following request for variances related to a septic system upgrade, is being made. A new soil absorption system is being proposed to replace the failed leach pit. Variance Requests are as follows: o 310 CMR 15.4050) —CONTENTS OF LOCAL UPGRADE APPROVAL 1. A variance between the separation between the pump chamber inlet and outlet pipes, for less than 12" of separation. O LOCAL REGULATION, Chaptar 397-8, E (e)&(f) —WELL LOCATION 2. A 15' variance, pump chamber to private well (locus), for an 85' setback. 3. An 8' variance, pump chamber to private well (#1636 Main St.), for a 92' setback. 4. A 45' variance, S.A.S. to private well (locus), for a 105' setback. 5. A 46' variance, S.A.S. to private well (#1636 Main St.)), for a 104' setback. 6. A 39' variance, S.A.S. to private well (#26 Locus Ave,), for a 111' setback. Variance requests are being made to maximum feasible compliance, considering available suitable location. Si cerely, Peter T. McEntee P.E. _ v rrri �' y1 rrrish.g.21y �, Curmntly se aw 3 r / r� a �,�+.may. `,.►® _ �4'._ �.,� We Kom '�:'b'7' :N.a�`'; 'O sue'.I�• ✓� ��/"I', � � � --.ICI,►=`�S ig.ri N� ,7,p jIJ�'" ij•I:� ILA-,( :� t 5" :�,� .r- ii�I`':.' 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M .. ❑Return Receipt(nantcopy) $ '. r-, Certilled Mall Fee C3 ❑Retum.Receipt(electronic) $- - J �: '� co 0 ❑certified Mall Restricted Delius Postmark `_;' Er $ ry $ , � I Extre Services&Fees(cneckr»,4 add lee as r Here I�' I, appropriate) C] ❑Ad-tt Sig nature Required $ i r� ❑Return Receipt(hardoopy) $ , ❑Adult Signature Restricted Delivery$ C3 ❑Return Receipt(electronic) $ Postage C3 ❑Certified Mail RastrictedDelivery $ ' Postmark (3 ❑Adult signature Required Here C3 Total' QAdult Signature RestrictedDelivery$ o Property ID: 197047 \\� L-J Postage Q 0 $ GAGE.RICHARD $ � ,u Sent .J] / 26 LOCUST AVE C3 Toll _ �iree WEST BARNSTABLE.MA I"- Property $ pertyID: 197025 02668 Ltl, 1636 NARD.TIMOTHY P&ERIN E Giry. !1J ----- " MAIN STREET N T BARNSTABLE.MA 02668 --------------- eTM XCERTIFIED o RECEIPT N i. st�c Mail Only ru 12 CoI. M _ `c ! certified Mail Fee fTL • .- . . , i c0 M1 . Er $ Extra Services&Fees(checkbaK add tee as eppropgete) rq ❑Return Receipt(herdcopy) - _ $ �.... i,\*� .0 Certified Mail Fee 0 ❑Return Receipt(electronic) $ $ M ❑certined Mail Restricted Delivery $ :."� )�Postmark,Here Rl Extra Services&Fees(checkbai4 addles as �~. (3 ❑Adult Signature Required $ ( i c L�;�; ❑Return Receipt(hardcopy) $ fee ,f' []Adult Signature Restricted Delivery$ tU ❑Return Receipt(electronic C y 0 Postage f= ❑Certified Mail Restricted Delivery $ CPOSUrINk�°F,-' $ -_ C3ftSignatureRequired $ Here❑Adu . 0 Total" - - �`V.a ❑Adult signature Resmcted Delivery$ $ C3 Postage p ru Sent Property ID: 197033 ruTot PERRY.MICHAEL T&NICOLE D ---- --- -- ___,_ M1 �' %HUNT.HENRY&ANNA K ME'AGHER -_ ru $ Property I_D: 197027 10 LOCUST AVENUE rq se SPERRY.FREDERICK W&LAURIE PROTHERO WEST BARNSTABLE.MA r� 56 FORBES AVENUE 02668 -.NORTHAMPTON.MA '------"- M1 01060-2804 cri . Ln r-:I . Q^ m m Certified Meal Fee • • • • Certified Mail Fse AL US tU $ iL $ .._. M M Extra services& Extra Services&Fees(cneckbox add fee as box add les ee \❑Karam Receipt manlc°p!4 $. eppreadereJ ,^ .�\ ru ❑Return Receipt(hebc p» ❑Return Receipt(electronic) $�— ��.` _ \ 0 ❑Return Receipt(at C3 C3 ❑Certified Mail Restricted Delivery $— Postmark \�-�' C3 ❑Certified Mail Restricted Delhrery -$ f( A Postmark ❑Adult Sl ature C3 9n Required $�— I Here d' G ❑Adult Signature Required Here ❑Adult Signature Restricted Deliv —�� �� ��•' ❑Adult Signature Restricted Del $ o Postage ary$�_ / C3 Postage �p :` eO ni $ ru Total ru Tr — - $ Property ID:--197038 $ Property ID: 197026--.. Er sent DEDOMING.DANYEL r-1 S MAKI.SUSAN A TR rq 1645 MAIN STREET M I G REALTY TRUST C3 SY�ee �WEST BARNSTABLE.MA _ PO BOX 143 city; C WEST BARNSTABLE.MA ----- 02668 -- row SENDER: COAff-LETE THIS"SECTION 'F.,< A Signatu ■ Complete items , ;?end 3 AN Agent ® Print your name and address on the reverse �( Q� M ressee so that we can return the card`o you: ?: g, Date 'Ilvery i a Attach this card to the back of the mailpiece, �.or on the front if space permits. 'r t2� ' 1.,Article Addressed.to: D. IsAphllvery�addiess diffe tit m 1? ❑Y s if YES,enter delivery a re below: ❑ o? a PropertylD: 197027 �^ SPERRY.FREDERICK W&LAURIE PROTHERO `"a 56 FORBES AVENUE 'NORTHAMPTON.MA 01060-2804 I '_ 3. Service Type ❑Pdorlty Mail Express® Il.lililil;IIIIIIIIIIIIIIIIDIIIIIIIIIIIIII1iLIIIT ❑Aduft Sig nature ❑ReglsteredMallTM._ ❑Adult Signature Restricted Delive ry ❑ROlstered Mail Restricted �Certifled Mail® Delivery 9590.9402'5040 9092 3381'53 ❑car ed Mall Restri°tea"oelroery ElM nod lit°` j ❑Collect on Delivery O Collect on Delivery Restricted Delivery ❑Signature Confirmation* 2._Article Number;(Transler from service laben ,_ red Mail O Signature Confirmation ' �ed Mail Restricted Delivery Restricted Delivery 7019 22.80 0002 3206 7388 r9500)_; Domestic Return Recel t i PS Form 3811 JUIy.2015 PSN 7530-02-000 p i • TE THIS • • DELIVERY 0Complet8 items -- ,.Ar►d 3 A Si• ture 1 . ❑Agent - i ® Print your name and address on the reverse X ❑Addressee` so that we can return the card to YOU.' — ® Attach this card to.the back of the'lnailpiece, B. R ived by(Printed ame) C Date of Detiv� or on the+mnt.ilLspace permits. s: I 1. Article Ado to` D. Is delivery address Iifferent from item 17 ❑Yes -- - --- If YES,enter deliv,' ad.r"ss below_ No Property ID: 197047 I .i GAGE. RICHARD 26 L OCUST AVE f WEST BARNSTABLE.MA 02668 i IIII III II I�IIII II I I�III Ill 11 111 3. Service Type ❑PriorityMaifExpress® i e Ii I'lll'I IIII l0 ❑Adult Signature 10Registered MailTM j 17 Cdutt Signature Restricted Delivery ❑Registered Mail Restricted; •rtifled Malle NJIVery 3 9590 9402 5040,9092 3381 46 ❑certified Mail Restricted Delivery O Retum Receipt for ❑Collect on Delivery Merchandise € 2. Article Number(Transfer fromservlCe/abeD. ❑Collect on Delivery Restricted Delivery q Signature::ConfinnatlonT"+ Mall ❑.Signature ifirmatio,,n Marl Restricted Delivery Restricted,✓eery 7020, 0.64,0. 0001: ,9813 28,85. _ . oo r• PS Fom13811,July°20f5 'S�N 730-02-000-9053 j Domestic Return Receipt e Complete items 1,2,and 3. ' u I Agent . . i o Print your name and address on the reverse E3 Addressee 1 so that we can return the card to You. R: Received by(Pdn ed Name) C.D to of Delivery j o Attach this card to the back of the mailpiece; vAirk g t��a or on the front if space.0irri ts. - _ D. Is delivery address different from item 1? r Yes I I If YES,enter delivery address below: p No fi -- rope rty ID '197025 1! LEONAR IMNFAW P&ERIN E 1636 MAIVTREET I WEST BAI�NSTABLE.MA 02668 l i 3: Service Type ❑Priority Mail,Express® a Iilllli�llpll1011ll8lglllliillll IIIIIII I011111 ❑AdultSignature ❑RegsteredMal ❑Adult Signature Restricted Delivery• -O Registered Mall Restricted Restricted i Certified Mail® 9590 9402 6086 0125 61' 69 ❑certified Mall Restricted delivery ❑-M%1n Receipt for j ❑Collect on Delivery. Merchandise ❑Collect on Delive Restricted Delivery O Signature GonfirmationTr" 2. Article Number(Transfer from service label). 1�ured Mall Confirmation .I 7:0 2 0: 0 6.4 0 . 0 0 01 9 813 2564. cured Mail Restricted Delivery Delivery 1 'er$500) �Restricted 1 Domestic Return Receipt 08 Form 3811;July 2015 PSN 7530--02-000=9053 Engineering Works, Inc. 9 9 USA 12 West Crossfield Road Forestdale, MA 02644 ° 2 7019 2280 0002 3206 726551 113-16-0-R dD SIVERTSEN FRANCIS S ET AL 's �� _ USA SIVERTSEN ANN E = c PO BOX 1203 _Y„ r DENNISPORT,MA 02639 1 r NzxiE �1s R:E �.�OS/z0z1 'UNCLAIMED UNABLE TO FORWARD UNC BC; 026442910881' *lfa�69-1a5 $'84=2.>P9!-aii 02544>2008; L/No.w, Fee L . BOARD OF HEALTH TOWN[ OF BARN( STABLE 01pplicatiou jFor Vern Cougtructiou Permit Application is hereby made for a permit to Construct Alter( ), or Repair( ) an individual well at: Location-Address Assessors Map and Parcel Owner Address litc _ f o box 9-793 - S. MA d2Co Installer-Driller Addr ss Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 4 Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described 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 o Compliance ha een issued by the Board of Health. Signed /,)- D to Application Approved By -2 ate Application Disapproved for the following reasons: Date Permit No. Issued �— Date -------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNISTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructedy), Altered( ), or Repaired( by L : m on c_f. Lk-y I I Or i(� Installer at Ol �_O(AhGf AVI>, Ro 1m bl j2z 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 SATISFACTORILY. Date Inspector -----� r n 6"1 No Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2ppIttattou _for Vern Cou0tructtou Permit Application is hereby made for a permit to Construct fXj, Alter( ), or Repair( an individual well at: Location-Address Assessors Map and Parcel -Cobnor LoCuSi Ave , W)-n r,zin1,IF' MA, Owner Address �Srnon (t)all 1J)Ylffwn , lhc. . �'U 6bY a783 f lofw\ . KAA 02roG3 Installer-Driller J Address Type of Building Dwelling Other-Type of Building No. of Persons Type of Well 4'1 GC- 1 Ll Q '2\/C, Capacity Purpose of Well d-Drnc s�,l C Agreement:The undersigned agrees to install the afore described 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 Compliances^hass-been issued by the Board of Health. t Signed �. G.• _ �.nG- .�.�.,, �c � �c� 1 v c Date Application Approved BY � lei i Date Application Disapproved for the following reasons: Date Permit No. Issued. I v 1 Date s BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed), Altered( ), or Repaired( ) by Zf-c r' cC n(' . �t � i t 1(1 . In(,. j Installer at G 1 _ L li��- Alf,. , W . 'P,q[N.�iq �)f P l 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 SATISFACTORILY. Date Inspector BOARD OF HEALTH TOWN OF BARNSTABLE t Verr Cou�tructtou Permit No. W Z I , 061 Fee Ll F Permission is hereby granted to .( cal fly Y7�� �1\011 b y 1�h ro, �Vy _ Installer to Construct ), Alter( ), or Repair( an individual well at: No. R o c Y1 a I �. Street as shown on the application for a Well Construction Permit No. 1,k) 0b n Dated Date r 1 'a -7 �� l Approved By r LEGEND Hoes 98 - EXISTING CONTOUR T x 100.98 EXISTING SPOT GRADE t00J PROPOSED SPOT GRADE ' EXISTING WELL EXISTING GAS SERVICE S 1tFi".... �L4Jfh,Y CN¢,.dA D2{.5$ ..•.. �-^- „ ---6.14AY.. OVERHEAD WIRES TEST PR CB 98.35 BENCHMARK / s ss�� LOCUS MAP gfb. o ^1 l h ! 2 { x 97.67 / INSTALL A 40 MIL POLY LINER x 98.85 TOP OF LINER, EL.=102.6 f ! BOTT. OF LINER, EL=101.1 STiI=vUT EOUNDIRY x 8 / 100.35 SEE NOTE 11, Si IEET 2 h 99. 1 ?B 100 111 LOCUS AVE RADIUS O HSE#26 . i 100' WELL1 r E Y ~` : J NS �` 630 93 98 DO..,,.._.-=�•` o. 100.58 100.06x o TP z � x 9. �P0 .JE• 11x ' TP 0 �E�oG�S P 4v , `0 46 1. 99 104'- 92 100.75 EX. WELL O HSE11636 x 99. 0 99.3 X ' 3 PROPOSED SEPTIC TANK/ PUMP CHAMBER EXIST. SEPTIC TANK 9963 IV 1500/500 CAPACITIES (H-20) (TO BE REMOVED) "` .93 ��• A�\ TOP, EL.=98.33 99 9 x J ry ti� 1NV.(0UT), EL.=97.00-t ' 103.19 ENTRY �� ,y1 • x 100. �' BEN HMARK x / MAG. NAIL SET 10 .05• :'.GRAB$..`; 101.30 100.83 "-rm 0,�,..•-••"`.../�% � \/ 101. .:' 104.34 x .J,\�1�-r.-•'""�r.l"'r 104:.J3 `\ EX/STING./ "" x 103.9 t 101.66 'HOU9f.9) O. � 1D4- F.-f ) twY F fl=106.Jt 03.6 PARCEL AREA 104.55 s ! °� 16106tS.F. ? C• / 102.66 pv � 104.45 x x10 104,601 + 04.44// ,04.67x 03 ALTERNATE PLAN W 1500 500 103.81 ST PC AND 19' x 31' ADDITION a) 105.z�o v•. s� pp 104.66 `:`:OR%VEWAY*;. ;'104.3Q',;.'= t 104.84 �4jy : ., .', . LOCUS: PARCEL ID: 197-026 f� c� 105.32 R=1 ��� PROPOSED SEPTIC SYSTEM UPGRADE PLAN �492 rr a 104s1 9 LOCUST AVENUE WEST BARNSTABLE, MA eO� 105:00 Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 02673 '9J SCALE DRAWN JOB.NO. - OWNER OF RECORD �(� Engineering by: MAKI SUSAN A TR V� 13ERM105.09 Engineedng Works,Inc. 1'-20' P.T.M. 152-21 MIG REALTY TRUST 12 West Croeefleld Rood, Foreetdole, MA 02644 DATE CHECKED SHEET NO, P.O. BOX 143 WEST BARNSTABLE, MA 02668 (508) 477-5313 8/9/21 P.T.M. 1 of 3 07/30/2009 THU 15: 35 FAX 5083627103 Barnstable CTY HealthLab Barnstable Health 0001/003 CERTIFICATJUJ E OFANALYSIS Page: 1 . . Barnstable County Health Laboratory nattis Report Prepared For: Report Dated: 7/30/2009 Sally Desmond Desmond Well Drilling Order No.: G0953565 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0953565-01 Description: Water-Drinking Water Sample€/: Sampling Location Locust Way__West Barnstable,MA .2 Collected: 7/28/2009 Collected by: Customer Received: 7/28/2009 Routine+Ammonia ! ITEM RESULT UNITS RL MCL Method# Tested Ammonia ND mg/L 0.20 EPA 350.1 M 7/28/2009 ••-- - Nitrate as Nitrogen 0.33 mg/L 0.10 10 EPA 300.0 7/28/2009 l Copper:; ND mg/l, 0.10 1.3 EPA 200.8 7/30/2009 Iron ND mg/L 0.10 0.3 EPA 200.8 7/30/2009 Sodium 15 mg/L 0.10 20 EPA 200.8 7/30/2009 Total Coliform Absent P/A 0 0 SM9223 7/28/2009 Conductance 150 umohs/cm 2.0 EPA 120.1 7/28/2009 pH 6.8 pH-units 0 SM 4500 H-B 7/28/2009 Water sample meets the recommended limits far drinking water of all the above tested parameters 3 Attached lease find the laboratory certified parameter list. Approved B . P rY P PP Y E (Iab erector) i t f� L. ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 si ' f 07/30/2009 THU 15: 35 FAX 5083627103 Barnstable CTY HealthLab --- Barnstable Health ®002/003 I � a oF,a, tea: CERTI FICATL OF ANALYSIS Page: 1 Report For: Barnstable County Health Laboratory steyus Sally Desmond Report Dated: 7/30/2009 Desmond Well Drilling Order No.: G0953565 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0953565-01 Description: Water-Drinking Water Sample#: Sampling Location, Uocust Way West Barnstable,MA "{' Collected: 7/28/2009 Collected by: Customer Received: 7/28/2009' " EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Dichlorodifluoromethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 h Chloromethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 -'- Vinyl chloride ND ug/L 0.50 2.0 EPA 524.2 yn 7/28/2009 3 Bromomethane ND ug/L 0.50 EPA 524.2 yn 7/29/2009 r 1,1,1,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,1,1-Trichloroethane ND ug/L 0.50 200 EPA 524.2 yn 7/28/2009 1,1,2,2-Tetrachloroethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,1,2-Trichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 1,1-Dichloroethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 ],I-Dichloroethene ND ug/L 0.50 7.0 EPA 524.2 yn 7/28/2009 1,1-Dichloropropee ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,2,3-Trichlorobenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,2,3-Trichloropropane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,2,4-Trichlorobenzene ND ug/L 0.50 70 EPA 524.2 yn 7/28/2009 1,2,4-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,2-Dibromo-3-chloropropane ND ug/l, 0.50 EPA 524.2 yn 7/28/2009 1,2-Dibromoethane(EDB) ND ug/L 0.50 EPA 524.2 yn 7/28/2009 9 1,2-Dichlorobenzene ND ug/L 0.50 600 EPA 524.2 yn 7/28/2009 is 1,2-Dichloroethane ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 d 1,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,3,5-Trimethylbenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,3-Dichlorobenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,3-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 1,4-Dichlorobenzene ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 2,2-Dichloropropane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 2-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 4-Chlorotoluene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Benzene ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 Bromobenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 f Bromochloromethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Bromodichloromethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 ....._._Bromoform ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Carbon tetrachloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 r ND.=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 'Ph:508-375-6605 07/30/2009 THU 15: 35 FAX 5083627103 Barnstable CTY HealthLab --- Barnstable Health 0003/003 � +5 °F CERTIFICATE OF ANALYSIS Page: 2 Report For: Barnstable County Health Laboratory h ��s�Gt3t2$k Sally Desmond Report Dated: 7/30/2009 Desmond Well Drilling Order No.: G0953565 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0953565-01 Description: Water-Drinking Water Sample#: Sampling Location Locust Way.West Barnstable,MA �,' Collected: 7/28/2009 Collected by: Customer Received: 7/28/2009 EPA 524.2- Volatile Organics by GC/MS I ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Chlorobenzene ND ug/L 0.50 100 EPA 524.2 yn 7/28/2009 Chloroethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Chloroform 0.63 ug/L 0.50 80 EPA 524.2 yn 7/28/2009 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn 7/28/2009 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Dibromochloromethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Dibromomethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Ethylbenzene ND ug/L 0.50 700 EPA 524.2 yn 7/28/2009 Hexac lorobutadiene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Isopropylbenzene ND ug/L 0.50 EPA 524.2 yn 7/29/2009 Methylene chloride ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 Methyl-tert-butyl ether ND ug/L 0.50 EPA 524.2 yn 7/28/2009 I Naphthalene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 n-Butylbenzene ND ug(L 0.50 EPA 524.2 yn 7/28/2009 n-Propylbenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 p-Isopropyltoluene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 sec-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Styrene ND ug/L 0.50 100 EPA 524.2 yn 7/28/2009 tert-Butylbenzene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Tetrachloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 Toluene ND ug/L 0.50 1000 EPA 524.2 yn 7/28/2009 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 1/28/2009 trans-1,2-Dichloroethene ND ug/L 0.50 100 EPA 524.2 yn 7/28/2009 trans-l,3-Dichloropropene ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Trichloroethene ND ug/L 0.50 5.0 EPA 524.2 yn 7/28/2009 Trichlorofluoromethane ND ug/L 0.50 EPA 524.2 yn 7/28/2009 Water sample meets the recommended limits for drinking water of all the above tested parameters Attached please find the laboratory certified parameter list. Approved By- (Lab irector)) 7A��� ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Health Complaints 29-Jul-02 Time: 9:10:00 AM Date: 7/24/02 Complaint Number: 3570 Referred To: SAM WHITE Taken By: KARYN DACE Complaint Type: CHAPTER II HOUSING Article X Detail: UNSANITARY CONDITIONS Business Name: Number: 9 Street: Locust Ave. Village: WEST BARNSTABLE Assessors Map Parcel: Complaint Description: Landlord (Sue Maki) has been notified of all these problems- 1959 toilet is broken (seat is broken,will not flush - must lift heavy lid to manually flush it). Plumbers have told her it needs to be replaced. This has been ongoing for the last 3 months. Plumbing is generally not good -when she turns kitchen sink, bathroom sink, showers on, rust flakes & rust colored water are coming out. Tub/shower tiles are falling out. Floor surfaces are warped & bubbling up. Rust sediment is settled in back of the toilet. Landlord will not provide tenant with a key to the home. Landlord has increased rent by$350 per month. PLEASE CALL PRIOR TO ARRIVAL- DOES NOT WANT TO LEAVE CHILD HOME ALONE WHEN INSPECTION IS PENDING. Actions Taken/Results: After four(4) calls were made to the residence, Ms. Doherty called back to let the Health Dept. know that the landlord had contacted her to let her know that all problems were going to be fixed as soon as possible. Ms. Doherty will call back 8/5/2002 if further problems arise. 1 � l - Al 1p._ 0,,6 -, TROY WILLIAMS ftu SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508) 385-1300 19 Hummel Drive South Dennis, MA 02660 COPY COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION _ ONE WINTER STREET, BOSTON MA 02108 (617)292-5500 1 Ihl{� � qA TRU Yc oxE . eLwy ARGEO PAUL CELLUCCI �UI�/ DO D B. STRUHS Governor 8 20o/n�Commissioner SUBSURFACE SEWAGE DISPOSALPPART A SYSTEM INSPECTION FORM '0"0'r V CERTIFICATION A(7}���T Property Address: L oc-is 4 fFJ e. Name of Owner ,/�d,�.K �rq;�.•�wv� 4'-' W. Address of Owner: Date of Inspection: 6 /,Z pU M a.s ems,.s Ott;l if Ott a. Name of Inspector:(Please Print) Trey Williams O26 y�1 am a DEP approved system inspector pursuant to section 15.340 of Title 5(31 O CMR 15.000) Company Name: Troy Williams Ge t.. ln$nections Mailing Address: 18 Hummel Drive. So. Dennis. MA 02660 Telephone Number: (508) 385-1300 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority _ Fails krspectors Signatiwe:— J�wr.v Date: 6 12 0o The System Inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. NOTES AND COMMENTS Although system meets the minimum requirements set forth by the Massachusetts Department of Environmental Protection,cartification is not to be construed as a guarantee of future working condition of system,piping or components. This inspection represents the conditions of the system on the Date of Inspection noted above. revised 9/2/9R SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Prey Address: 9 Locust Avenue, West Barnstable,MA OWFW: Mark Braman Date of kwpection: June 21 2000 INSPECTION SUMMARY: Check A, B, C, o/ D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below. COMMENTS: B. SYSTEM CONDITIONALLY PASSES: IV14 , One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass. Indicate yes, no,or not determined(Y, N:or NO). Describe basis of determination in all instances. If "not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached indicating that the tank was installed within twenty(20) years prior to the date of the inspection; or the septic tank, whether.or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health)• broken pipe(s) are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed revised 9/2/98 Page 2of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 9 Locust Avenue,West Barnstable,MA Property Address: Mark Braman Owe: June 2, 2000 Date of Inspection: C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: IV14 Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b)THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONME NT: The system h_ y as a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. . The systefh has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) 9 Locust Avenue,West Barnstable,MA Mark Braman Property Address: June 2, 2000 Owner: Date of Inspection: D. SYSTEM FAILS:1V1i9 You must indicate either "Yes" or "No" to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due-to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 106 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 SYSTEM FAILS: IN119 You must indicate either "Yes" or "No" to each of the following: The following criteria apply to.large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greeter(Large System) and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area=IWPA)or a mapped Zone 11 of a public water supply well) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of 11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTS CHECKLIST 9 Locust Avenue,West Barnstable,MA Property Address: Mark Braman Owner: Date of Irtspection: June 2, 2000 , Check if the following have been done: You must indicate either "Yes" or "No' as to each of the following: Yes, No - Pumping information was provided by the owner, occupant, or Board of Health. __V _ None of the system components have been pumped-for-at least two weeks and-the system has teen•receivhV IM anal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. sL _ 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. JL _ 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: _ Existing information. For example, Plan at B.O.H. �L _ 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)) _ The facility owner (and occupants,if different from owner) were provided with information on the proper lnaintenanceof Subsurface Disposal Systems. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 9 Locust Avenue,West Barnstable,MA Owner: Mark Braman Date of Inspection: June 2,2000 RESIDENTIAL: FLOW CONDITIONS Design flow: //O g.p,d./bedroom. Number of bedrooms(design):3 Number of bedrooms(actual):a Total DESIGN flow 33,0 Number of current residents: f Garbage grinder(yes or no): No Laundry(separate system) (yes or no):/Va ; If yes, separate inspection required ✓/V► 4j14..4t Laundry system inspected (yes or no) Seasonal use(yes or no):�t/o Water meter readings,if available(last two year's usage(gpd): _Pr v�,�� fnJ�Il . C,✓c✓ /O U+-/ Sump Pump(yes or no): Yr S Last date of occupancy: ,L COMMERCIALfINDUSTRIAL: N/1 Type of establishment: Design flow:_ qpd (Based on 15.203) Basis of design flow Grease trap present:(yes or no)_ Industrial Waste Holding Tank present: (yes or no)_ Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings,if available: Last date of occupancy: OTHER:(Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: �9 0 74 O 1. htdt jN. Is.i n aJ�-at✓ . System pumped as part of inspection: (yes or no)_NC If yes, volume pumped: gallons Reason for pumping: TYPE OF SYSTEM 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) 1/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components, date installed(if known)and source of information: __ / r.�.,k i h s f��/c A S/f 2 �( W',11 oldt.v c-vl-o6;r d_ba S. Nc Nam. j7-13uc u.h x in�i l �t✓ GAS- ,A bil�• �Ta-�vrS LJcr� ewage odors detected when arriving at the site: (yes or no) /Vo revised 9/2/98 Page 6ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(confirmed) Property Address: 9 Locust Avenue, West Barnstable,MA °M/11w: Mark Braman Date of,Inspection: June 2, 2000 BUILDING SEWER: (Locate on site plan) Depth below grade: Material of construction:•/cast iron__V/40 PVC_other(explain) Distance from private water supply well or suction line_ A114 Diameter 9 If Comments:(condition of joints, venting evidence of leakage,etc.) . l;d2 LL�661 SEPTIC TANK:_ (locate on site plan) Depth below grade: Material of construction:-j"concrete_metal_Fiberglass _Polyethylene_other(explain) If tank is metal,list age_ ls.age confirmed by Certificate of Compliance_(Yes/No) Dimensions: S ")CC/ ,X 6 Sludge depth: !� Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: NONE Distance from top of scum to top of outlet tee or baffle: No Distance from bottom of scum to bottom of outlet tee or baffle:No S�- •++ How dimensions were determined: p v L-e , Comments: (recommendation for pumping condition of inlet and outlet tees or baffles,depth of liquid level in relate to outlet invert,structur&Hntegrityh evidence of leakage,etc.) "r, —f- c.. 4 o", ti�+-/ - ,",( .,, 4,,,0,•:!i_: �, o.�JCe✓. U GU r c-✓1 c.-�.. .C C.� ca. U.� w rh- L-1—,L . .4 ..$•ar.-,� ✓ii.> ,! .Jy J c� t S ✓ JA; -c. r-G.N 4 IL / O L GREASE TRAP: (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass _Polyethylene_other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) ftope"Address: 9 Locust Avenue, West Barnstable,MA Ownw: Mark Braman Date of 4upection: June 2, 2000 TIGHT OR HOLDING TANK:A119 (Tank must be pumped prior to, or at time of, inspection) (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_Fiberglass_Polyethylene_other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present Alarm level: Alarm in working order:Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches,etc.) DISTRIBUTION BOX-_V (locate on site plan) Depth of liquid level above outlet invert: '— Comments: (no .if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.) ��(��h: L.:/r� L 'Or—I1 ✓A y CAV-'JL•Lr— PUMP CHAMBER:_ (locate on site plan) Pumps in working order:(Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 9 Locust Avenue, West Barnstable,MA Owner' Mark Braman Date of Inspection: June 2, 2000 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan, if possible; excavation not required,location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number:_ �-^ leeching chambers, number:�.1h'i j�+�Y/t +,s 6.J`: 3 r S-h. .e% , leeching galleries,number: F/�,+�.Ty ass i s w"leaching trenches,number, length: leaching fields, number, dimensions: overflow cesspool,number:_ Alternative system: Name of Technology: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.) V.S Y S N !�✓l cit /,n✓t 4 v� ma e ✓, 4JL 41 J✓� • � i V o rw ti t v,.� ✓t c. 7Lc r.n CESSPOOLS: (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: t/ l (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) revised 9/2/98 Page 9ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:Owner 9 Locust Avenue, West Barnstable,MA Date of Inspection: Mark Braman June 2,2000 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) A .22� A r = 70 i3 r �� A G = q�r 136 29 ' A .H =3y (3 fa ; 34' O v r ' ♦ F11 t sue„ ♦ e revised 9/2/98 Page 10orll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(cmfintied) Property Address: 9 Locust Avenue,West Barnstable,MA Owner: Mark Braman Date of Inspection: June 2,2000 NRCS Report name A//9 Soil Type_ Typical depth to groundwater USGS Date website visited s Q[n0 Zs— Z 7_01wr /4 Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Y Surface water Check Cellar Shallow wells r Estimated Depth to Groundwater lot Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record y/Observed SitelAbutting property, observation hole, basement sump etc.) / Determined from local conditions Checked with local Board of health Checked FEMA Maps Checked pumping records Checked local excavators,installers Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) H J (.�IGVj w �iJ [l�ti !i•J:.��/ r��/0. e.�.oft W i / t ,f L�h c.� C7�'r�•�j.�s� fiJ�J"�✓ .1.. j) •J 1 4`4sn_.c ,•► r � ✓� G✓'.C...•o. ��� '- �7��+.� Ci � i k S �'c-��h a L-, l+a/�t S / , V /. ��J��U rN — r CST �Q !!L!✓t� l�.g �'d�•l � �. S p�/rr_ � KJ Ct S �t O � 1�v C� a-T"i-✓t i revised 9/2/98 Page 1;1 of II TOWN OF BARNSTABLE LOCATION �����,y{f�+ 4y� SEWAGE # VILLAGE �Je. f� ASSESSOR'S MAP & LOT t _d'l INSTALLER'S NAME & PHONE NO. J, L? r`�r.� �� �; vy� 'TZ; SEPTIC TANK CAPACITY o ma LEACHING FACILITY:(type)y,/# -LA LLJ Ire-.e0/ (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER CA DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes Not ,i � � b a S c� p ,� d 30.00 No...!�_..13Y" � Fim$.............................. THE COMMONWEALTHOF MASSACHUSETTS BOAR® OF HEALTH APPROVED TOWN OF BARNSTABLIEnstable Conservation Appliration for Bispvii al 10orks Application is hereby made for as Permit to Construct ( ) or Repair Q( �X an Individual Sewagsposal System at: RC a Locust Lane West Barnstable ................-----•--------•-----•--•---•---------------•-•------------------------•---------. --••--------•------------••.......---------------------------•--------------------•--.........---- Location-Address or Lot No. Mark B ra i11a --•-•-- Owner Address a .J P.:M c omb e r Jr. .......... -----•-• ............ Installer Address dType of Building Size Lot----------------------------Sq. feet Dwelling X-No. of Bedrooms........... ...............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria P4 Other fixtures ------•------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter__-_____-____- Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) W Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water--_____-_____-____--._-. 4, Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water........................ Description of Soil_._____-_Clay,___Wll___be__re_placed__.with.__sand:::_: __c�_ig::__:_T '::..::.:.:.:::...:...::::: W U -----•---••--•--••-••-•-•-•---•-•----•-•-----------------------------------------•-••..........---•••---•---•-------------------------------------------------------------.._........_------------------ W U Nature of Repairs or Alterations—Answer when l-1JJJ { applicable.___-_-__t o -------------------------------------•-_-_--•-----._---------.---.-----.............. ---Flon___1e_achinpitpackedin...s----------e.............................................................................. - Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compli nce has eey�issued by t e b rd of health. / / Signe --- - ------ -=1-�/? 1.......................92 Date Application Approved B �-----------------------...------------------------------------------ - . PP PP Y "'--t---�--------... .... .. ..' l - Application Disapproved for the following reasons: ---------------------...........----------------------------------------...-----........-....-------------------------------------..---- ---------------------------------------------------------------------------------------------------------------------------------------------................................................................. --------------------------------------- Date PermitNo. J 13- -------------------------- Issued -- -- -- ---- ---- -- ........--------------------------- Date r - No.. 0. -THE-COMMONWEALTH-OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Apphratilan for Btsp l aal arks T n�ar f.Wthrmijt c/- Application is hereby made for a Permit to Construct or Repair X `an Individual Sewage Disposal System at: K;C e�A 9 Locust Lane West Barnstable ................--.............................................................................. ....-•------..................................................................................... -Address or Lot No. -Mark Brame, ...........................•----....---.........------•-----•---- -----••----••----............---------------------•-------------------•-._.----..--------•-------- ...... . Owner Address a ._,7,,P.Ma,comber Jr. Installer Address Type of Building Size Lot............................Sq. feet Dwelling )( No. of Bedrooms___....... ...............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type T e of Building No. of persons............................ Showers a YP g ------•-•------------------- P ( ) — Cafeteria ( ) QI Other fixtures ------------------------------- -- --•--- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No..................... Width-------............. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-----_-_--------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-------------- ........................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ f14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 04 -------- ------------•-------- D Description of Soil.......... Will be replaced with sand. '"'a g""'I '........................... x --------------------------------------------------------------------------------------------- v -----•-----•-•----••-••••••--••-----------•-••-------------------------•--...------------......-•---••---------•-------..... Nature of Repairs or Alterations—Answer when a licable.__............. v . ------.... ............ 1-1QOQ gallon leachin it acWepd in stone. -------•------------------------------------------------•--•------......----•---------------------------------------------................................................. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the t e b rd of health. system In operation until a Certificate of Compliance has eez��tled��d�y�l�— �+/1/92 . Y P p ) Y Signed ..-- . . '- ----- --------------------- - -- - Date Application Approved B PP PP Yte j -- p-c � Application Disapproved for the following reasons: ................................. ............................... .............. ........................................ ----- -- --------------- ----------------------------------------------------------- p� Date PermitNo. ....... ----L3-9--------------------------- Issued ........................................................ ------- Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE CEertifira#e of Tomplianre T J.P IS .1 - �IE�Zu,XjFYj What the Individual Sewage Disposal System constructed ( ) or Repaired (XX ) by...._- ---- ---------------------- .......------...-----------..................................---........................__........................ .................................................... .......... Installer at -.------7----- oc-u..st---Lane...Wes_t--.-Barnstable Xass . ------ ------------------------------------------------------------------------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. -.-. ------1- ....... dated --- ------------------- - -------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. --� DATE---------------------------------------- -1 ---------------------------------- Inspector ..........-------------------i ,,,a------- --- . . ----------...------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH q TOWN OF BARNSTABLE $ 30.00 No.../ =...11 FEE........................ Disposal ,nrkn TrAanstrudion amit Permission is hereby granted........ -'P-'-...aeomber-•-Jr......-•------••-----. ...•-- ••-----------••-•......................... ............... to Construct ( ) or Repair TXl) an Individual Sewage Disposal System at No..i7--Locust Lane West_ Barnstable. . -...... • ----.-•----------------------•---------------••-----------•-••-•----------•--...................... Street as shown on the application for Disposal Works Construction Permit Noj� 4 ,�'_ Dated.......................................... li a\•I------------------------------------_--------------- Board of Health DATE......... -- ---� FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS Fizz THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f�l..........OF...... ���• , r//....- .----------•----- ,� rlirtt#i�an for Uiipnial Works Tomolrn.r#iun Frrutit Application is hereby made for a Permit to Construct ( ) or Repair (Yja.n Individual Sewage Disposal Syste/meat ZQ6_'�`1_-_` ",A—.... ..Z�/�� ...1..1.[. !Qi s '� .................. 1 -•-•• ...............................•---- Locat Address or Lot No. -• Vr%!°iz •—......r,�',tv .... ... -........... ---•------._.._._... ;. . ................................................................. ........................................................ W �� p e ® ��• Address a F_..� Address............................. Installer dType of Building Size Lot............................Sq. feet Dwelling�o. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons____________________________ Showers — Cafeteria A Other fixtures ...._•--•---•••••-•••-••--••--•- W Design Flow............_...............................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No_ ____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. ----------------------------------------•--------•-•---...-•---•------------•--......---..._.....-•-......................................................... ODescription of Soil.........................................................--•----........--•-•-•--•--------------------•------------------------•--------•---•--••-...••--••-----....-•- U ------•-------------•--- ----------------------- _------------ -----•------•-----•------------•-•-••-----------------•--------•-------------•------•---___--------•--•----------------------__---- W --------------------------------------------------------------------------------------------------------------•----------------------- ---•••- VNature of Repairs or Alterations—Answer when applicable__-,/ _>440-T /C____--__ .j .......... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been • sued by the and fe. Z4 Signed -`-'� "—P&-AK -•---- •••-- .... ••-•---•----••-- ••••----._.._... Date Application Approved By-••••-----•---- r =r� r '-:__::: l� l . Date Application Disapproved for the following reasons:---•---•...---•------------••--•-------•---------------•----------------------------------------------------•-- _.....•••••••-•••--•----•••----•---•-••••--••---•------•..-...-•••••••••••••--•••-------•----•-----•--•-••••-•---•-•-•----------••--•-•-------•--••-------•••••••-••-•-•••--------------•-•-•-..__...._. Date Permit No. ...._...�©.!--------------- Issued - Date THE COMMONWEALTH OF MASSACHUSETTS ,. BOARD OF HEALTH, Appliration for Dispood Works Tonstrur#inn lrrutit Application is hereby made fora Permit to Construct ( ) or Repair (k j"'an Individual Sewage Disposal System} at: ...............». ._..:.......................... ........:. : ..,- ......................................................... .......... Locan- Address or Lot No. .................... ............ ........................ .._.........................-.............. n�� � f� �"� � Address Installer Address Type of Building Size Lot................ Sq. feet aDwelling: No. of Bedrooms.......................:....................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) QI Other fixtures ..........7............... Design Flow............................................gallons per person per day. Total daily flow............................................gallons. Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No--------------------- Width.................... Total Length.................... Total leaching area...................sq. ft. Seepage Pit No..................... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by--------•---•---•••..........--•--••---•••••----•••...................... Date........................................ 7 ,-a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a --•-._...------•-•-••-•--•-........-•-••--•••--•-•---•-•-----•-•-•--•-••..................................................................0.................. 0 Description of Soil........................................................................................................................................................................ U -•--•----•...................•------•---------.----- W x :Z.. ........................ .............. ....... . 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 TAIT IS 5 of the State Sanitary Code—.The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the•board,bf health. Signed r `` �� .�.. ` !.¢ ,e,s�1 ............... . ------ late Application Approved By..........•-•....:::': .(' . ..�`'.�4 ......._ �� 1. .§ •................ Date Application Disapproved for the following reasons:.............................................................................0................................ -•---•-----•----•-----••-•-----•--------------------------•-•--...-------------•------.-......--------------....--..................-------•------.......--------------...............----•--------•--- ,,,,� Date Permit No... o....._..:,�?.p-� -....... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ............-:' 'j % O ' J:-'f t rxc A e t' farrtif utttle of Toutplittnrr sSr ' aKERTIFYlThat the Individual Sewage Disposal System constructed ( ) or Repaired ...........................................•----..............::....................................................................... at.....G .... ........... ' ":fit.. ._.... `r� �'°s�'v i .1.... has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......... .2 SZ.t.. dated.".. j:; 3tg6.................. THE?ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. .1 ? `.` .. .............----....-•----. Inspector....---.1.�1 .............. :.-.........---•-------............................. DATE..............:.. - THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 51 la...r. ��> PJ'1.........OF........ ' ,Q...... `.;O�.`. ............................ - } . ....... �io�os�t1:. for �on�#�ur#ion �rrutit nted..._.t�r :�.��f :'''� �°" � � ..�......-•............................................................ Permission is hereby gra .._.... to Construct ( ) or Repair { an Individual Sewage Dis �Systern ,�- r� at No.. ...............-&2 f .r -.....- ..... ................' �' a j� � '%.., ........... Street _ as shown on the application for Disposal Works Construction 'permit No. ��.��� Dated.. ) 7/ ........... .................................................. Board of Health DATE....... -�-�. .. ..�.........:.:.-----... FORM 1255 A. M. SULKIN, INC., BOSTON 1 ASSE SSOR'S MAP N0. /0/ PARCEL _ SEWAGE PE t3RlIT aQ- VILLAGE I14ST E FlA 1 6: AD DR E S i i e U I OR OWN Fa DATE PERMIT ISSUED DATE COMPLIANCE ISSUED �Gzi 67t — t. LEGEND iHwe , -- 98 -- EXISTING CONTOUR . x 100.98 EXISTING SPOT GRADE " yr Rd° e i 100.1 PROPOSED SPOT GRADE EXISTING WELL QY 9 Locwst West EXISTING GAS SERVICE tWORKS O Ave, - - 8amstable,MA02668 -C' echnofogyServices'. d.H. OVERHEAD WIRES TEST PIT / CB BENCHMARK / 98.35 First Lutheran Church r }} Q 2ss. 13 2 '5 LOCUS MAP o o s�' F / m 9111, o � tlj0 1 INSTALL A 40 MIL POLY LINER x 98 85 1 / 7 TOP OF LINER, EL.=102.6 / BOTT. OF LINER, EL.=101.1 STIPOUT BOUNDARY SEE NOTE 11, SHEET 2 x 8. 8 / 100.35 x 99• 1 100 28. i / WELL 00 / 11 1' To US AVE' ' WELL RADIUS HSE#26 LO 100 HSE#j 630 9.3 1 98.7 100.58 x / .J!O100.06 ff. o CD SE# / /)X' C) x . R ¢P� PJE• ,il TP i p0 �0 3ro 104'- EX. WELL 92' _J 100.75 HSE#1636 x 99.3K) PROPOSED x PUMP CHAMBER 99.6 EXIST. SEPTIC TANK (TO REMAIN) 9.93 /. \ TOP, EL.=98.33 x N INV.(OUT), EL.=97.00E oh 99.79 69 103.19 ENTRY x x 100• BENCHMARK x MAG, NAIL SET' 100.05 100.83 9 10 ::.GRASS::' 101.30 v�\ x h 'DRIVEWAY. 104.34 x � 10 . 3 E /STING x 103.9 101.66 HQ�SE(#9) T. F.-105.4E 104.44/ 0 FF EL.=106.3.t / 103.E PARCEL AREA / °Q 16,106fS.F. ? 104.55 � / 102.66 "V '\% 0F MgssgcyG �. � o PETER T. 104.45 x 103• ° McENTEE CIVIL / q No. 35109 x 10 6 104.60 + 04.44/ �a° G/� 104.67 x ? 03, (� 105.2i�o 0 104.66 '- QRIVEWA 0' 104.84 �� :•;:.off.: : LOCUS: PARCEL ID: 197 026 ox 105.32 A 104.92 R=1 �1 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 104.51 9 LOCUST AVENUE, WEST BARNSTABLE, MA 105.00 Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 02673 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. MAKI SUSAN A TR V� BERM 105.09 Engineering Works, Inc. 1'=20' P.T.M. 152-21 MIG REALTY TRUST P.O. BOX 143 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. WEST BARNSTABLE, MA 02668 (508) 477-5313 1 8/9/21 P.T.M. 1 of 3 EXISTING SEPTIC TANK & NOTE: TO PREVENT BREAKOUT, INSTALL A 40 MIL PROPOSED PUMP CHAMBER POLY LINER AS SHOWN ON SHEET 1. PROVIDE RISERS & COVERS AS DESCRIBED: TOP OF LINER, EL.=102.6 f 1) INLET COVER SET TO 6" OF GRADE. BOTT. OF LINER, EL.=100.1 2) 20" OUTLET COVER SET TO GRADE PROPOSED D-BOX MANHOLE COVER SHALL BE SECURED INSTALL WATERTIGHT RISER & PROPOSED S.A.S. TO PREVENT UNAUTHORIZED ACCESS. COVER SET TO 6" OF GRADE INSTALL INSPECTION PORT OUTSIDE DRIVEWAY FOOTPRINT F.G. EL.=100.0t F.G. EL.=103.5t F.G. EL.=103.5(MIN.) to 103.3t F.G. EL.=99.6(EXISTING) PROVIDE ENOUGH WIRE MAINTAIN 2% GRADE MIN.) OVER S.A.S. SLACK TO REMOVE PUMP ( 4" DIAM. INSPECTION PORT, L = 8'(MAX) IM 13' x 35' LEACHING FIELD W/2-4" 'ERFORATED IN S.A.S., SOLID L = 4' pVO ® S=1� (MIN.) ABOVE S.A.S., WITH SCREW CAP ® S=1% (MIN.) TOP EL=98.4 210SC�A HRUBENpS CKS 4"SCH40 PVC SET TO WITHIN 3' OF GRA E. 4"SCH40 PVC PRo At sv� CAPPED ENDS 6" 6" EFF.DEPTH 14" 10" INV.=102.30 I SLOPE OF PERF. PIPE = 0.5% I -INV. EL=102.00(END) INSTALL SEALED INV.=102.47 -, RUBBER BOOT �96.5 PROPOSED D-BOX 35' EFFECTIVE LENGTH ADD 3z 96.5 INSTALL SEALED 3 OUTLETS MIN. EFFLUENT INV.=96.90 2 FLOATS RUBBER BOOT (MIN.) S I AB SORPTION SYSTEM (PROFILE FILTER INV.=97.15t USE OUTLET INV.=102.18 EXISTING KNOCK OUTMM BOTT. EL.=92.4 SEPTIC TANK 1000 GALLON MONOLITHIC INV.=97.00t PUMP CHAMBER (H-20 RATED) ESTABLISH VEGETATIVE COVER EXISTING (See Pump Detail, Sheet 3) (FIELD VERIFY) FINISH GRADE APPROVED EL.=103.5t NOTES: FILTER FABRIC 1) PUMP CHAMBER & D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT ELEV.=102.53 GRADE ON A MECHANICALLY COMPACTED STABLE BASE OR 6" CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). BOTTOM ELEV.=101.50 2) INSTALL INLET & OUTLET TEES AS REQUIRED. 3) MAX. COVER OVER SEPTIC TANK, D-BOX & S.A.S. SHALL BE 36". 5' MIN. SEPARATION TO G.W. 3.5 6 �•.5' 4) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE INVERTS PRIOR AND 4' OF NATURALLY 13' EFFECTIVE WIDTH TO CONSTRUCTION. AND PERVIOUS SOILSSH 3/4NA1 STDBLE 5) EFFLUENT FILTER SHALL BE INSTALLED ON OUTLET EST. HIGH G.W. EL: 96.5 SOIL ABSORPTION SYSTEM (SECTION) TEE AS MANUFACTURED BY ZABEL OR EQUAL. FILTER SHALL BE INSPECTED AND CLEANED ANNUALLY. SEPTIC SYSTEM PROFILE GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN =NGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: -310 CMR 15.405(1)0): LOCAL UPGRADE APPROVAL 1) A variance to the separation between pump chamber inlet & outlet, for less than 12" of sepataion. KIT. BATH BEDROOM CELLAR -LOCAL REG. Chapter 397-8, E (e)&(f) WELL LOCATION DIN. RM. ENTRY 180±SF 1) A 15' variance, pump chamber to private, well (locus), for an 85' setback. 2) An 8' variance,,pump chamber to private well (#1636 Main St), for a 92' setback. LIV. RM. 3) A 45' variance, S.A.S. to private well(locus), for a 105' setback. BEDROOM 4) A 46' variance, S.A.S. to private well, (#1636 Main St) for a. 180tSF 104' setback. 5) A 39' variance, S.A.S. to private well (#26 Locus Ave), for a 111' setback. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN FLOOR PLAN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF SOIL LOG THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY PRIVATE WELL. DATE: MARCH 23, 2021 (REF. TPT-21-68) 8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. SOIL EVALUATOR: PETER McENTEE SE#1542 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS WITNESS: DONALD DESMARAIS IRS HEALTH AGENT AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE ELEV. DEPTH ELEV. DEPTH DIRECTED BY THE APPROVING AUTHORITIES. TP- TP-2 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY 100.0 0" 100.0 0" THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO .BEGINNING FILL FILL CONSTRUCTION. HIGH G.W. HIGH 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 96.5 q PERCHED - 42 96.5 A PERCHED = 42 IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND SANDY LOAM SANDY LOAM REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 10YR 10 2 10YR 10 2 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 95.0 B 60" 95.0 B 60" INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL SANDY LOAM SANDY LOAM 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 10YR 5/4 10YR 5/4 NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. 93.2 82" 93.3 80" 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC C1 CLAY C1 CLAY SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. 90.0 C2 5Y 5/3 120" 90.0 C2 5Y 5/3 120" DESIGN CRITERIA MED. SAND MED. SAND NUMBER OF BEDROOMS: 3 (AS PERMITTED) 2.5Y 6/4 2.5Y 6/4 SOIL TEXTURAL CLASS: CLASS I SAMPLED DESIGN PERCOLATION RATE: <2 MIN/IN 86.0 168" 86.0 168" DAILY FLOW: 330 GPD PERC RATE 2 MIN/IN. PER SIEVE ANALYSIS IN "C2" HORIZON DESIGN FLOW: 330 GPD LIGHT WEEPING PERCHED GROUNDWATER OVER A HORIZON 42" (EL.=96.5) GARBAGE GRINDER: NO HEAVY WEEPING PERCHED GROUNDWATER OVER A HORIZON 82" (EL.=93.2) LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 74 GPD/SFPROPOSED SEPTIC SYSTEM UPGRADE PLAN EXISTING SEPTIC TANK: 1000 GALLONNCAPACITY PROPOSED PUMP CHAMBER: 1000 GALLON CAPACITY, H-20 9 LOCUST AVENUE, WEST BARNSTABLE, MA PROPOSED D-BOX: 1 INLET, 3 OUTLET (MIN.), H-10 INSTALL AN 13' x 35' LEACH FIELD Prepared for: Cape Cod _Septic Services, 350 Main St, W. Yarmouth, MA 02673 SIDEWALL AREA: NOT APPLICABLE Engineering by: SCALE DRAWN JOB. NO. BOTTOM AREA: 13' x 35' = 455 S.F. N.T.S. P.T.M. 152-21 � ,455 S.F. Engineering Works, Inc. TOTAL AREA: 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. LEACHING CAPACITY = 0.74 GPD/SF x 455 SF = 336.7 GPD (508) 477-5313 8/9/21 P.T.M. 2 Of 3 i NEMA 4 JUNCTION BOX CORROSION RESISTANT PROVIDE WATERTIGHT RISER, FRAME & LIQUID-TIGHT CABLE CONNECTORS SUPPORTED & SECURED COVER SET TO GRADE BY 1-1/4" PVC CONDUIT. JOINTS TO BE MADE WATERTIGHT. USE SJE RHOMBUS-JB PLUGGER OR EQUAL. PROVIDE ENOUGH WIRE SLACK TO REMOVE PUMP INSTALL 1' PVC CONDUIT TO HOUSE FOR WIRING HOISTING CABLE �7x19 STAINLESS STEEL WITH WATERTIGHT JOINTS. WIRE HIGH WATER ALARM 1/8" DIAMETER. ENOUGH WIRE,. STRENGTH. FLOAT TO SJE RHOMBUS TANK ALERT XT ALARM PANEL SLACK TO OUCH PUMP ON CIRCUIT SEPARATE FROM CIRCUIT TO THE PUMP. INO REM=96.9 2" BALL VALVE (FIELD ADJUST FOR 20 GPM RATE) (INSTALL QUICK DISCONNECT FOR EASY REMOVAL) ALARM ON EL: 94.40 2"SCH. 40 DISCHARGE (THROUGH RISER-SEE PROFILE) PUMP ON EL: 93.90 2" 90- ELBOW W/ 1/4" WEEP HOLE FOR SELF-DRAINING FORCE MAIN BOTTOM OF PUMP OFF EL: 93.57 18 12„ 2" SWING CHECK VALVE PUMP CHAMBER 1 8" 2" SCH. 40 PVC DISCHARGE PIPE ELEV.= 92.4 ADDITIONAL 3/16" VENT HOLE (MIN.) ABOVE PUMP FLANGE PROVIDE 2 FLOATS: 6" (TO PREVENT PREMATURE PUMP BURNOUT) FLOAT NOA: PUMP ON/OFF-SJ RHOMBUS (PROVIDED WITH PUMP) FLOAT NO.2: ALARM ACTIVATION FLOAT-PROVIDED WITH ALARM PANEL LIBERTY LE40 SERIES PUMP .4 H.P. 115 V (ON SEPARATE CIRCUIT FROM PUMP SPECIFIED) WITH 2" DISCHARGE, OR EQUAL PUMP AND ACCESSORIES AVAILABLE AT: CAPE COD WINWATER WORKS CO., HYANNIS, MA. (508) 862-0166 NOTE: APPROVED ALTERNATE MAY BE SUBSTITUTED. PUMP DETAIL �73. 1 � � r f r Q I 'a r ACME-$H REY NdTES:� 1.)SEAM SEALEDWIMFLEMBLE i tK* p� BUTYL RUBBER SEALANT. a , 2.)PROVIDE POLYMER WATERPROOFING 3.)INSTALL RUBBER BOOT ON INLET& OUTLET.LOWER KNOCKOUT TO BE D^ O USED AS INLET END. a:. C h (2)024•CONCRETE,COVERS t ENTRY % / EXISTING (3)-OW INLET (3).or OUTLET HOUSE(#9) KNOCKOUTS KNOCKOUTS T.0.F.=105.4± FF EL.=106.3t SLAB TOP S.A.S. LAYOUT WIUFnw mooKs �• DOSING & STORAGE REQUIREMENTS DESIGN FLOW: 330 GPD 8'-U" UOU10 S DOSING REQUIRED: 4 CYCLES/DAY (SAND) 4. LEr+EL , 330 - 4 = 82.5 GALLONS/CYCLE �_ INV OUT DISTANCE REQUIRED BETWEEN PUMP .--.-- ON AND PUMP OFF FLOATS: e. s 6" 82.5 GAL/CYCLE _ 250 GAL//FT = 0.33 FT/CYCLE (SAY 4") STORAGE REQUIRED ABOVE WORKING LEVEL: 330 GALLONS STORAGE PROVIDED: INV.(IN) EL: 96.90 - PUMP CN EL: 93.9 = 3.0' STORAGE PROVIDED = 3.00 x 250 GAL/FT = 750.0 GALLONS NAME:PuMP CHAMBEk 1000 Gallon,Mono H•201TEM#PC102M BUOYANCY CALCULATIONS Corgi MinimumBast5AW pslat28 dap s TOP 3,100 Lbs A I DATE:i0-2-2oi8 Sled RekftanwLAZM AB15,Graft BD Dnsijn Lain%%_standard urda-AASWO-H2O BOTTOM 13,400 Lbs Ch g PaS.1 Std2 of 2 1000 GALLON MONOLITHIC PUMP CHAMBER BOTTOM of UNIT EL.= 92.40 PROPOSED SEPTIC SYSTEM UPGRADE PLAN HIGH GROUNDWATER EL.=96.5 BUOYANCY FORCE PER FOOT OF DEPTH: 9 LOCUST AVENUE, WEST BARNSTABLE, MA 7.7' x 6.0' x 1' x 62.4 Ibs./cu.ft. = 2882.9 lbs. Prepared for: Cape Cod Septic Services, 350 Main St, W. Yarmouth, MA 02673 MAX. DISPLACEMENT = 96.5 - 92.40 = 4.1' MAX. UPLIFT PRESSURE = 4.1' x 2882.9 Ibs/ft = 11,819.9 lbs. Engineering by: SCALE DRAWN JOB. NO. WEIGHT OF UNIT EMPTY = 16,500 lbs. Engineering Works, Inc. N.T.S. P.T.M. 152-21 16,500 lbs > 11,820 lbs O.K. 12 West Crossfield Road, Forestdale, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 8/9/21 P.T.M. 3 Of 3 I