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HomeMy WebLinkAbout0016 LOTHROP'S LANE - Health 16 LOTHROTS LANE,W. BARNSTABLE A= 109 005.007 TOWN OF BARNSTABLE O0 D7 LOCATI N Lo—ylwop UQ- SEWAGE# VILLAGELg2���#L-5 ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. —OG -� �c�tQ SEPTIC TANK CAPACITY 1C� LEACHING FACILITY: (type) 'PfZ `fil J�P``S (size) L>-,-6 &,-(3 NO.OF BEDROOMS 3 BUILDER OR OWNER �' -r PERMIT DATE: 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 r. +F J 0 j 0oo sT( o d S EP e 8 f0 k, e ' b0S, 00� 9 # . 1 OU98URFACE sEWAGE D SP?SAL sYBTZX XNSPECTZON ,DORM Address-.of property Owner's name aA e-Niq 3 D.ate of Inspection - a -� • 9 DART A CRZCKLXST , }Check if the following have been done: . i ' Pumping information was requested of the owner ccupant, .and Board of a :! Health. None 'of the system components have been pumped for at least two Meeks and the system has been receiving normal flow rates during that ; . e period . Large volumes of water have not been introduced into the rR, U. system recently or as part of this inspection. fr � 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:site was inspected for signs of breakout. t i fw; ^AlV system components, excluding the SAS, have been located on ` < site jsx 4¢ �y . = The..septic tank manholes were uncovered, opened, and 'the interior�of ,} r�, the se p tic tank was inspected for condition of baffles or',.tees, r ;� r material of construction, dimensions, depth of liquid; depth"of wl. "°»�:, ep,? s ud a depth of scum. � • p 1 g • The size and location of the SAS on the site has .been determined'.�based on existing information.or approximated by non-intrusive' methods. ; y The:facility owner .(and occupants, if different from owner)``a�►ere r> , R } � provided with information on the proper maintenance_ of SSDS.` X .1 ;ft e' r w,c ia+°i•4pz�4�' �*Y`U�,7. t 1C, 4d1t 1 *-"•+`' `;. �'�"ry ��*;,ar a�w- 4h» {4�.�`�{ �r per�• . � w 3 t}may SUBSURFACE SEAAGE DIBPOBAL SYBTEX INSPECTION VORM PART B SYBT$M IN]FOSNATION C FLOW CONDITIONS. If 'residential t number of bedrooms - > ' �r number of current residents j, garbage grinder, yes or no' laundry, connected to system, yes .or no , seasonal use, yes or no 'W", If nonresidential, calculated flow: 14 - f ait rS• _ • a ..F dl• C ° Water meter readings, if available: , �� d .. � � • • fig.. Last date. of occupancy t 1 GENERAL INFORMATION Pumping records and source of information: `rt� System pumped as art of inspection, es or no ;' ` * ` t --� y p P p P , yes if yes, volume pumped F , � ; x* Reason for pumping: '� sw .. �Y N -r - �.. •..m}+ ,#; s .f...,,,��n 7?�`�,fys"aY�,yj!$�'.' e{ s stem t } 0, V. t Septic tank distribution box soil absorptionsystem"'*- s stem 't a�i St a � +3 •A it .y�x 5 3r ,Single cesspool ' overflow cesspool t1� ig33ry t. Privy . .:w t.Y:j�} 'zq try t ty �sr�`i. ` tt , i v Shared system (yes or 'no) (if yes, attach previous inspection records, if any) other (explain) ,t ` }Approximate age o'f all components. Date installed, if known., Source� of ' : E formation: nc y tZ5TY it „f Sewage odors detected when arriving at the site, yes or no a x SUBSURFACE SEVAGE DISPOSAL BYSTEN IN8PECTION FORK PART 8 I�r SYSTEM XNFORHATION aontinuod 3` ' SSIL ABSORPTION SYSTEM (SAS) : �• (locate on site plan, if possible; excavation not required,. but may bey approximated by non-intrusive methods) If not determined to be present, explain: M 4' leaching pits and number 62L°(a Q1 T3 leaching chambers and number ` ` ` "$"''" ' °• ` + ` leaching galleries and number 6,i f ; , ,4, �•..;� �,ft-mow; Teaching trenches, number, jength leaching fields, _number, dimensions overflow cesspool,. number w-f .Comments: (note;condition ,of soil, signs of hydraulic failure, level' ofk•pondinq; condition of vegetation, recommendations fob• maintenance nor repairs etc:) ➢�! � r # 'CESSPOOLS (locate on site plan) : I ' � umber. and configuration depth-top of liquid to `inlet invert of solids layer •• � �•� F� r� depth of scum layer dimensions of cesspool.` materials of constructions indication of groundwater � f w.inflow, (cesspool must be pumped as ` rx part of inspection) ip pr a i Fk ti# 'jy 31XAMt$li q ^. t- 1y.. .y. N` :y4 AM+'i'%vk lh '+F3[F!inG '• �N1(Ky i fh,IMp ehi.Comments: , • . ,... � «'nw ry,•�4lYrt.P4+.f4k+*� �, ����'. g, (note condition of soil, signs of hydraulic failure, , level.•of:.ponding;�, " ryy ti5 ,condition of vegetation, recommendations for maintenance, or.trepairs,ate:) - t�ljY Z', 2' % + PRIVY: ry (locate on site plan) : [[ 'materials of construction id 1 wkar dimensions e SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 8 SYSTEM INFORMATION aontinuod .SEPTIC TANK. (locate on site plan) depth below grade: r material of construction: concrete metal FRP _other(explain) dimensions: yr, k{ sludge depth n{ g . . distance from top of sludge to bottom of outlet tee or scum thickness j distance from top of scum to top of outlet tee or baffle , . ; distance from bottom of scum to bottom of outlet tee or baffle , a h Comments: x?S< (recommendation for pumping, condition of inlet and outlet tees. orrbaffles; depth of liquid level in relation to outlet. invert, structural g , inte rit , 4. k t evidence of leakage, recommen ations for repairs, etc. ) {ThY 4 DISTRIBUTION BOX: t��� �- �W i�^�Ca.1���` �i �-�a�" �. .. ,3 • � = r. ' (locate on site plan) a depth of liquid level above outlet invert ,. € +ta b . 'Je3.Ri : ;Comments: adi � if level and distribution is equal, - evidence of solidsAcarryover," "evidence of leakage into or out of box, recommendation for repairs, ,.®tC. z " }swP Y 4 7 c 7 �� PUMP'-CHAMHER: h `qE (locate on site plan) pumps in working order, yes or no y v p s� 4, Ora 4 •'. w #Comments:' � x ., (note condition of pump. chamber, condition of pumps and appurtena,.t,� .. <' x Cat ,Uhclude ties to at least two permanent references lan arks or benchmarks s �R. locate all 4wells within 100'Aeo Pf fz 2���y 09 IV iI r 4, V A Y.y �4p�•t7jCk:r �F .< 'h R t', t �� i s ,dux ,�., �a� i� • f (aY }s. ' 6 a' ,DEPTH.. TO GROUNDWATER NoK - '.f depth to groundwater ';�O�i WVV\ 0 S(Sl-ey't method of determination or approximation: ��" `Ai°`'"s�`�`�``� Iv xS 'a .,. N�� �Ind date yes, no, or not determined (Y, N,. or VD) . Desdribs basis determinatidn in all instances. If "not dete=mined". explain why' not) ' np L E� , Backup of, sewage into facility? ' i uf �.�'' F' L 1e.}Cry ION"j5t as^an S is Discharge . or ponding of effluent to the surface. of the. ground or s ;mow { F 'surface ,waters? V , � � Static. liquid level ;in the distribution box above outlet invert?mv �M ' `Liquid depth in cesspool <6" below invert or available volume< 1/2 days � f low? Required pumping 4 ,times or more in the last year. r �� py �fnumber of times pumpedt 4t C ` }Se tic tank is metal? cracked? structurally unsound? substantial p , t o * { -infiltration? substantial exfiltration? tank failure imminent? s s rig w z. �j Is any portion of the SAS, cesspool or privy: F below the high groundwater elevation? within 50 feet of a surface water? , 'y within 100 feet of a surface water supply or tributary to a surface:` T ; r water supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh: `' M (cesspools and privies only, IL4 the SAS)? k within 50' feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water , ,, ,. . supply well with no acceptable water quality analysis? . If the well z;. has been analyzed to be acceptable, attach copy, of well water analy for coliform bacteria, volatile organic compounds, ammonia nitrogen ' x and. nitrate nitrogen. , `r BtTBSURFACE SBWAGE DISPOSAL BYBTBM INSPZCTI69 FORM x, UFF, PART D 3 fi;,. s CERTIFICATION ��, _ Name of Inspector � •� `P ;Company Name GAf e-.�,a #,r � ) ' 45} ii. Comp!any Address �o �jb9toV 'r # WA ( 'Certification Statement " " �x ,�,-�,,I�certifY �that=xI .have personally inspected the sex4a a disposal system- at" hits4'address'and' that the information° reported is• true, accurate and :complete'1 as of xthe time of inspection. The inspection was performed andX any, re commendations regarding upgrade, maintehance and repair are a Ncco�sistent •with my training and experience in the, proper function and ;maintenance of on-site sewage disposal systems. , a., 4 .. Chec ne: L:i vy I have not found any information which indicates that the system fails A ° to 'adequately protect public health or the environment as defined in h ; > 310 CMR 15.303 . Any failure criteria not evaluated are as stated in 5t the FAILVRE .CRITERIA section of this form. I have determined that the system fails to protect public health and , uw the- environment as defined in 310 CMR 15.303. The basis for this f k determination is provided in the FAILURE CR ERiA section of this ` form. .�`IInspector's Signature #, ,., (-Date ­Original .to system owner Copies to: lot Buyer (if applicable) } Approving authority '. 7-'r1�SBSOR-S-MAP v0. PARCEL L-P CAT ION-0 I& SEWAGE PERMIT NO. Lo4 l"2 ' Lo+Nrops C. we"s-p 0r,.rylsir bl.- , VILLAGE 50n5 vtC1 3 �O�CUvh IV�Cc� �i INSTA LLER'S NAME L' ADDAE`SS > nn+ 5 ,Q. 61 B UILDER ' OR OWN ER 4 DATE PE RIM IT, ISSUED /�C / � �• `. DATA, Gs0.MPLIANCE ISSUED �I rn !yr � ZT-3 e e J I � I No. - / FEB... . THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ............ l; Y v..........OF..... ............................... Appliration for Uispoii al Workii Tnnitructinn rautit Application is hereby made for a Permit to Construct (L--T or Repair ( ) an Individual Sewage Disposal System at: ............... .... --......................---••-•--•--..----•- -•-•-•-•--- ..... .. �^ Location-A or Lot No. ca��i:�ilrel� �!51...._..: '1//N.......................... .•--••----• .-•---------•--G' ...-----•-----...------.......--------------....------ ......................... ......... Owner tS� Address Installer Address Q Type of Building /� Size Lot---- -------Sq. feet U Dwelling—No. of Bedrooms.............`...............-... .Expansion Attic ( ) Garbage Grinder ( ) ....._..... No. of ............................ Showers —pa., Other—Type of Building _________________ persons ( ) Cafeteria ( ) Q' Other fixtures _________________________________ W Design Flow.............._` .........gallons per person per day. Total daily flow____.........' a gallons. W Septic Tank—Liquid capacity-Is4r gallons Length._w"�.'.. Width.._-`_'©'... Diameter................ Depth,,- Disposal ig .. x Trench—No..................... Width.................... Total Length......g........ Total leaching area_____----..-___-----sq. ft. Seepage Pit No.........;�i-------- Diameter.._.6 ,....... Depth below inlet...... ............ Total leaching area...s ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation '-' olation Test Results Performed b D�.GL�_._.��' !'� !' 'C........ Date.. %._ y �'•--- ,W� Test Pit No. l..G__ ....minutes per inch Depth of Test Pit../4`_`_--- Depth to ground water-._1__________________ fi Test Pit No. 2................minutes per inch . Depth of Test Pit.................... Depth to ground water--._--_.-__-_____._____- P -•-•-•-•--••-•--------------•-•------•-•--•---••---•-•----•-••-••-------•-•.........------------•-----...---------••----.................................... O Description of Soil...... y- y 5c ram=Se��� � 551 `..�'-"o INsyhi V � �-------------'s�rr=1 �....... . -561-w.... L1liT1..."" -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 I THE p5 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 of health. Signed................•.---._.... a...................0.........---•-----• --- Application Approved By-_....... . ••..... --............. •- f ----•--- Application Disapproved for the following reasons:-------•.....-••-•--------------------•---------------••-------•-••............................................ ...................................... (� /I Date................ --.--------•--•----------------------------------------- ------ -- --------------------------- Pe ._�-------T----------------•--- Issued-------- -•-•-•--- A 00��_00 No................J / Fxs.. THE, COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH ......... /G Ir/N...-------OF.....el) 57'eP 1 G E: .......................------------------------- .M' Applirta#ion for Ui,ipoii al lViarkii Towi ratr#ion Prrutit Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 7 ---• o r tr .. . .?2.�' l .......................................... Location-A&iess 4. or Lot No. ---•--...-. ............•--....---•-•----•----•----- -•--......•-••-------•-•----------••-•--•------•.........................................•------•- Owner Address W SG A2s Sra�. 5 G—`�1_.r Installer Address UType of Building Size Lot.......�¢r. ..............Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) dOther fixtures ---------------•--------•-----------------------.....-----•••••••••--•---•--------._.._...-•••-•-••••-•-•---. ----•-••.........-••------------•••- W Design Flow..................�..._.._.._._.....•..gallons per person per day. Total daily flow____.........`5f..`�a ..................gallons. WSeptic Tank—Liquid capacity!.s!�?"gallons Length.! 'G Width__.5.' Diameter________________ Depth__:'_ x Disposal Trench—No..................... Width............ Total Length....__;........ Total leaching area--------------------sq. ft. Seepage Pit No...................... Diameter___-- ...... Depth below inlet...... ... Total leaching area... 'l ...sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed b `' �..� � C .. ..................... Date..................... G Test Pit No. 1.. .. ____minutes per inch Depth of Test Pit._ _. Depth to ground water...._""'------------ li, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water------.................. •----•-----•-----------•-----••-••............................••••••-----...............------........................................... ------- D Description of Soil----- rJ�� :y : 77;P ?' av�_Sc�iG-... L4 '- .`�ram• SiG7•'y x f UvG/Jc72 5 .` ... "_/ W., W /��G G.t2.c1 VC Z. U --•---•----•...... ..... .. --••............ . ......•. •---•-•• -----••• ........ ---•-••. •-••---•---•............----------- W ----- ------- ---------------------------------------------------------------------------------------------------------------------------------...................................................... 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 TILT . p 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 of health. Signedd ...-•---------- -----•---------- Application Approved BY �!. - .---"•----. . ....!1_:a ... --• { D ---- ejz \ ate Application Disapproved for the following reasons---------------••-----------------•---------------------•--------------------------------------------------•••--- --------- ------ .................-............----................................................................---/�/� --•--• --•-•---------••--•------- Date Permit No. - Issued----------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...................... ........................................_..._............ T.F. rrtifirFatr of TontpliFatta THI I TO CERTI Y hat t eJndividual Sewage Disposal System constructed (t�or Repaired ( ) by._.. ��... � .J... .......... . -------- ---------- _ n .... at 6{ f'`L1 i I 1 ...-------- -------------- .. -�----- ------ has been installed in accordance with the provisions of TI 5 of Zh State Sanitary Code s d in the application for Disposal Works Construction Permit No•-__t�• 6= 7 dated I! THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE HAT THE SYSTEM WILL FUNCTION SATISFACTORY. / DATE......... /••.�`�`�/�p-zl.............................. Inspector...._..._•==A...........-----•----------••---....-----•------....--•--.-...__. r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.z.�'� �bcr"f...........OF........4��'...?�' ............................... FEE uh1poli al IV, T n inn rrmi# Permission is hereby granted.....- ' _---- -- �?---............. ................................................. ._._ to Construct r palr ) In Ivid A Sena 3- ZAIs s ejn' 1® / ----------- $treet i as shown on the application for Disposal Works Construction,P�ernut �Nv1o.._�_.... �._ Dated.____.�� ___�.•�_- •.-----..-. ................................................................ .................................... DATE................................................................................ Board of Health t FORM 1255 HOBBS & WARREN, INC., PUBLISHERS No.� �-^--e-y Fee- --��-'�------- BOARD OF HEALTH TOWN OF BARNSTABLE 2pplitation fibrVell Con5truction3permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: Irle1-7 Location — Address ess��p and P0ce 7"0 KZ V I^LL pL -------------- J— ,/ Owner Address L- ------------ l/ i-z`� _ -r?gD_ �13��- _--------P— -WLS---- Installer — Driller — Address Type of Building Dwelling 4--- Other - Type of Building--------------------------------- / No. of Persons------------ ------------------------------------- Type of Well — Purpose of Well _-_________-. Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certific to of ComM;'7,&6aJ as been issued by the Board of Health. Signed - 73 - -------- date Application Approved By-= '- - -��/�-- - - - r Application Disapproved for the following reasons:---------------------- -------------------_____________________—_________________ ------------------------ date Permit No. -'-- - __-- Issued d'7 --------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f Compliance THIS IS TO C ARTIF.), That the Individual Well Constructed ( ) Altered ( ) or Repairedby----- - ��-- -- --- - - - --- - --- -- - --------------------------- Installer 10 at--- `" '_ ��Y--�-- --------------------- 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. JIX— ,'-'ZL�ed THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------------------------------------------------------- Inspector---------------------------------- ------------------------ No.-� �-------`� Fee—�-------- ---- BOARD OF HEALTH z TOWN OF BARNSTABLE Z.ppritation-for Verr Conetruction3permit Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: _- _- -- -- .- -- -- — r1/ — -- --- -- --- - - - Location - Address` Assessors map and Parcel-7 z 1 j Owner (' Address' .. 4 — - — -— Installer -Driller Address Type of Building f Dwelling 'Ufa j '� = i��l- ( d!�p12' = - Other'- Type of Building-------------y------------------- No. of Persons------------ ----- ----- Type of Well------� -- -�-`-��--- -- - - Capacity --- - ----__----------------------------------- Purpose of Well- --------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate of Compliance-has been issued by the Board of Health. Signed-- - fo . :_ v-- -- ------ date Application Approved BL /°6o/wY- • - date Application Disapproved for-the following reasons:---___________________ ------------------------- ----------------------------------------------------------------- ----— --- -- ------ -------------- date ��/may �//,,y► Permit No.- =- - - " ---------------- Issued-- - 'fir----------- BOARD OF HEALTH TOWNS OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) 4'�1 a '------------------------------------ Installer at -----' /"� Ea------�°' ° c ..._=- _� `--------------------; " has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described.in -n the application for Well Construction Permit No. -- An -- D d--'''�' '! **4 % THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE----------------------------------------------------------- ------------------------- Inspector- - ----— - - --- - ------------------ BOARD OF HEALTH TOWN OF BARN\NSTABLE Yell Con5truct ion 3permit ��_ __ -�- '- Fee--------------- Permission is hereby granted---------------_--- — - - ----------------------- to Construct Alter ( ), or Repair ( ) anJndividual Well at: Street f as shown on the application for a Well Construction Permit No. ---d" ----------------- Dated----- ;/f r`e� /------------------------------ � r �, Board of Health DATE-------=----�--/--1----- ------------------------------------- � �,. C TANK INVERT INVERT "p e w PiT CR 6V t. DI ST. 70 43 EQUIV• \\ r \ EL..?/r7?. . BOX EL: �_ .+� GAL. INVERT INVERT '• � 0~ 4: ww :�. 3/4"T011/2' EL7o.6o �0 0 WASHED EL....r.... w STONE /,ol DIA.:q 4 Cs PROR LE OF GROUND WATER TABLE ` Lt' _� —' p�p��-�' /AGE DISPOSAL SYSTEM 76 / r ' NO SCALE � WITNESSED BY : � �'�° � I ° � • BOARD OF HEALTH \ ENGINEER �l 78' hZiSTi.�G DESIGN DATA : \ 461 S�nK SPACE NUMBER OF BEDROOMS TOTAL ESTIMATED FLOWS . . . GALLONS/DAY /r BOTTOM LEACHING AREA 78:So. SQ.FT. /PIT/C.P.D. / t of O sea 1 1 �4 SIDE LEACHING AREA . . . SQ.FT./ PIT GARBAGE DISPOSAL .Al--le. .(A % AREA INCREASE) TOTAL LEACHING AREA SQ.FT PERCOLATION RATE MIN/INCH48 ,,q� \ � B•,� LEACHING AREA PER PERCOLATION RATE /IIDy/.. SQ.FT.1G•JoD• NUMBER OF LEACHING PITS A/7= W.1771 Two Jczr--&T O,c"�r7DN o.v A-ze .S/ E3 ` \� ID OF HEALTH . . . . . . . . .D 'Z $�'� /"��`;'� \\ \ •- ' f. �\ LCAr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ter- �� of /s/ .1 . . . . . . . . . . . \ 3� , \\\J�\ � — ;d 2 INSPECTOR , ,Ap K' i 7C r, Massachusetts Water Resources Commission/Division of Water Resources WATER WELL COMPLETION REPORT WELL LOCATION Address '� City/Town G.S.Quadrangle Map Grid Location Owner f•r, r s ;i r Address WELL USE CONSOLIDATED WELL Domestic Q Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones METHOD DRILLED 1) From-To- Rotary(type) `✓ Cable❑ 2) From TO Other 3) From Tc 4) From To CASING Depth to Bedrock Length Diameter. Type r UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface Sand: fine❑ medium❑ coarse❑ i Date measured -' Gravel: fine❑ medium❑ coarse[] Screen: GRAVEL PACK WELL Sloth length r from// to' - Yes ❑ No ❑ Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Slot# length from tq_ Chemical ❑ Biological ❑ Depth To Bedrock PUMP TEST Drawdown feet after pumping days -j hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To 0 / r_ DRILLER Firmr- Address City Registration No. operator's Signaturg Please print irm y 10M-8181.164843 ', �11i.; 'ititllttiitlititltittttttttitttiTt{ttifttititlfiitttiiAtttiitiilT<fltititltttilt#RitfltittttiTitittitltititiiitiit►tflttttttti�t(ttitttittittitltttliltltitimtttttitttittittitititiittiiititiltittflittttfiltitittil(tii11(till/i� ENVIROTECH (LABORATORIES 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 `- CLIENT: i.i nda Gavin LOCATION: Lot 12 Lothru P Lane ADDRESS: W. Barnstable,MA - >r � COLLECTED BY: N. Kapolis SAMPLE DATE: 10/24/89 TIME: 1 PM DATE RECEIVED-10 24 89 SAMPLE ID: ET 404 JOB #: New Well WELL DEPTH: 120 ft RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 O ;^ - PH pH units 6.0-8.5 6.93 Conductance umhos/cm 500 138 Sodium mg/L 20.0 = 15.7 Nitrate-N mg/L 10.0 - 0.80 Iron mg/L 0.3 - 0.24 Manganese g mg/L 0.05 Hardness mg/L as CaCO 3 500 Sulfate mg/L 250 Potassium mg/L 20.0 > ' Alkalinity mg/L 200 i✓ Chloride mg/L 250 _ Turbidity NTU 5.0 Color APC units 15.0 Background bacteria COMMENT: SEE ATTACHED FOR EPA Method 502.2 for Volatile organics. C t i YES% NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS ESTED. X%XX El DATE 11 ENVIROTECH (LABORATORIES 449 Rte. 130 • Sandwich, MA 02563 • (508) 888-6460 10/31/89 Blue Rock Well Drilling ATT: Nick Kapolis SAMPLE: New Well LOCATION: Lot 12 Lothrup Lane W. Barnstable COLLECTION DATE: 10/24/89 COLLECTED BY: Nick Kapolis SAMPLE ID #: ET404 RESULTS OF ANALYSIS EPA Method 502.2T Substance Result MCL** Benzene 3.0 UG/L 5.0 Toluene 3.0 UG/L 340 Chloroform 30.0 UG/L 100 Bromodichloromethane 8.0 UG/L 150 Dibromochloromethane 2.0 UG/L 150 Meta & Para Xylene 1.0 UG/L 620 Ortho Xylene 0.6 UG/L 620 Ethyl Benzene Trace 620 Tertyl-butyl benzene Trace 620 See attached report T MCL= Maximun Contaminant Level for drinking waters. All organics detected in sample fall below MCL's for drinking water. on ld J. S ri Director r _-_ _ v.. a ... vLrsllVLu '1GJ1 t1iV1J VLSJL.I<Vr�'L'lULV YIi LOCATION LoT' 2 ( ASS�Sx2S /�/A/° /�3 ��C /2/ ( G LoT L� O.P o- VILLAGE DATE `I _ APPLICANT�, /t//X/ IAII,4 6- ,,9///�(/ FEE /Uv -`-' ADDRESS1$Lf}7',lL/20"S 4/4 G0,1j412,A15;W&Z. TELEPHONE NO . (Non-refundable) ENGINEER_ 4J// �.q/�� � Q�(� _TELEPHONE NO.�_ 2'y5;_y1 DATE SCHEDULED' Z/yj� — (ApplicantIs signature) SOIL LOG SUB-DIVISION NAME DATE ���/�� TIME EXPANSION AREA: YES NO _124Z4 1A 4-- ENGINEER TOWN WATER PRIVATE WELL X L`f J e-4 BOARD OF HEALTH Tom-e;?OL0 7r/ EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location of test holes and J percolation tests, locate wetlands in proximity to test holes ) f/ NOTES : D I T7-- Lod ZZ J, vi/� - �4/0 PERCOLATION RATE: Z4eW 4., TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 (� 0 '11 1 ✓4'� ' 2 �i N `' 3 3 L vA Lv 4 M�rR��' ` 1���� G/b 5 6 24 `�� s 6 � S 7a 7 36 9 G� � �D`�f2��N 9 Z, S�(�1j 10 L1v 10 , 11 a 1 d 12 ►L� M 2 5oic. 6� SG"�J �2 S t/Uy 13 ,51� �� 0/35�/Z!/�� 14 S�,rr� 2 sY�/3 14 I Z�'' 15 !� , . . 15 ySUITABLE FOR SUB-SURFACE _SEWAGE: LEACHING FIELD x LEACHING PITS__ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE . REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC `PEST APPLICATION ORIGINAL: COMPLETED IN ENTIRETY BY P . F . AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT FL. ,Ba,So. . . ... . � �►s7�•tG •. TOP OF FOUNDATION ► - W�u" _ CONCRETE COVER ° CONCRETE COVERS "0 4' CAST IRON X 1 \ ,°•° OR SCHEDULE 402 MAX. 12"MAX. 4"SCHEDULE 40 PVC.(ONLY) I ! P.V.C. PIPE PIPE- MIN. LEACH t , ° -PITCH 1/4"PER.FT PITCH 1/4"PER.FT. P17 4f PRECAST S �o. -� LEACHING INVERT F'17 OR EL..7.�'r INVERT INVERT ° - w Q'� °., SEPTIC TANK Z DIST. t70,.�,3 : . EQUIV. \� �' / ► ° INVERT EL..7/r7 . . . EL _ / CB \ /5t�o BOX , �� 4. •°. 1. / 7� GAL. INVERT INVERT U n O: :•i; 3/4"TO I V2 S8 �\ o; EL....f57.. EL7o.4o ww LoT /Z w WASHED / L o`► EL.7a./a w STONE , L.* ° & 6 D I A. —*� ►vo.�� \ ► D IA.--� r►�cna.�ra Gt' / PROR LE OF GROUND WATER TABLEdel SEWAGE DISPOSAL SYSTEM 76 NO SCALE �O � ?v SOIL LOG WITNESSED BY : DATE OGT �q86 TIME. . . . . . . . . . . T!S�oh!s)s .�Y4�ERr/ BOARD OF HEALTH I! \ IN TEST HOLE I TEST HOLE 2 ENGINEER ( � , ELEV. . 72../0, . . ELEV. .. .. . . . . . . ToP ` 78,s�Q6--S7oC�L.I C DESIGN DATA hTiST 24 s .,gGcE� + sick sq�o J' NUMBER OF BEDROOMS . . . . . // <. .� 1G BauGDEw-S. TOTAL ESTIMATED FLOW ' � . . GALLONS/DAY =r- i a + G7�ra BOTTOM LEACHING AREA � � p I a 4 +tu vy 74, CZ. SIDE LEACHING AREA . . . SO.FT./ PIT/ )Nits/ /VoN� o GARBAGE DISPOSAL . . . . . . .(50 /o AREA INCREASE) 1� + - neat►+- - - , \ TOTAL LEACHING AREA . . . . . . SQ.FT PERCOLATION RATE 43S.771ea?,. . MIN/INCH LEACHING AREA PER PERCOLATION RAIL ioyy. Su.FT.��'•pD. .Nc'. .WATER ENCOUNTERED NUMBER OF LEACHING PITS Z APPROVED BOARD OF HEALTH DATE . . . . . EZGN ?ap of \ /`r/`7� \ 7'¢ ' AGENT OR INSPECTOR pi^�� ► �k4s'r N OF MA So o ED?C+F+i � age y 'i�,� ju At 1 ( -I " 1 G No. �100 � .5z� ate\a2, sew c� v � PETITIONER 1 / SANITAR\�A� G��v.v �•G..v�.� G,�+oi�i TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS � ' e e 4 CAST IRON ••12"MAX. 12"MAX. ' - OR SCHEDULE 40 ,e. 4"SCHEDULE 40 PV.C.(ONLY) f P.V.C. PIPE 1 ° PIPE- MIN. LEACH PITCH 1/4"PER.FT PITCH 1/4 PER.FT PIT PRECAST LEA H I N 1► INVERT c C G `� / r o EL..7?•7G.,• INVERT INVER a.. PIT OR yZ� LR °•, SEPTIC IAIVK EL.lh7.4.. UISI. EL7v, 3 . EQUIV. ,.e ItvVERT . .�5db. . BOX �:- , GAL. INVERT 6 Un ;�; 3/4"TOIvi, o; EL.7/.�1�L.. EL7o.6o_ INS R� :-: u- 0 ,,. WASHED \ �L LOT�/Z / L � EL......... �•; w �: '>• STONE �.SQ «•io 6e � �J ID posev PROFILE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE 7O' \ I t / 'z �-- f� SOIL LOG WITNESSED BY : DATE 8� T!�o�!iJS �`1G�fCE�A?✓ BOARD OF HEALTH \ TIME. . ... . . . . - . lie- TEST HOLE I TEST HOLE 2 ENGINEER ` \\ ELEV. .7Z•/a. . . ELEV. .. .. . . . . . . 78. S e w� DESIGN DATA * \ \s�nKs cE scary SA�o NUMBER OF BEDROOMS Bat.+GDS TOTAL ESTIMATED FLOW . GALLONS/DAY /f- 0 BOTTOM LEACHING AREA . / I�8:S oi�p,srn eL,C7�o SIDE LEACHING AREA . . . �88• 45 . SQ.FT./ PIT W/ram Ne.�� o . / i t i , GARBAGE DISPOSAL . . . . (50 /o AREA INCREASE) neaeN_ 537". TOTAL LEACHING AREA . . . . . . SQ.FTBox � ,\ ` � �• .��� � � ,7z PERCOLATION RATE 771e MIN/INCH LEACHING AREA PER PERCOLATION RATE /.a%9. SQ.FT.,G•PD, No WAI EH ENCOUNTERED -5 NUMBER OF LEACHING PITS APPROVED . .. . . . . . . BOARD OF HEALTH DATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Qom/ 7ap Cp^tC. DouNA' AGENT OR INSPECTOR 0F OFEDWA LLEYlar o 26100 7y \ 74, s ' er 'Q£CiSSf.Fti© AL L iN c/STER / 1 PETITIONER sANITAR�a` c�tlsTh/G f