HomeMy WebLinkAbout1675 MAIN ST./RTE 6A(W.BARN.) - Health Y 1675 Mein Street/Rte 6AJBWW
Barnstable W.
A = 196 025
o e {
M
No. V
Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION-TOWN OF BARNSTABLE, MASSACHUSETTS
ZippYication for Migogar *p5tem Construction Permit
Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) El Complete System El Individual Components
Location Address or Lot No. /407 -R fb.4 Owner's Name,Address and Tel.No.
�QlC6i�� .e o y.e�s
Assessor's Map/Parcel 19b 10—/L.
w�Jf /V
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
Sox 4/92 7
ied�dQ/e x4w- Z 177
Type of Building:
Dwelling No.of Bedrooms S Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow S30 gallons per day. Calculated daily flow 3 7S gallons.
Plan Date /b -Z 7—o Y' Number of sheets / Revision Date AJON e
Title
Size of Septic Tank ez'esl- /000 Type of S.A.S. ,r�f><��G� L',�,0 �.v / .a 7o rJ
Description of Soil 'Te e
Nature of Repairs or Alterations(Answer when applicable)RIF lrzr.1-eW L-a
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this Board of Health.
Signe G Date
Application Approved by Date
Application Disapproved for the following reas&n
Permit No. Date Issued
V Fee
j06�
_ THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIppYication for Digpogar *pgtem Congtruction Permit
Application for a Permit to Construct( . )Repair(X)Upgrade( )Abandon( ) El Complete System ❑Individual Components
Location Address or Lot No. ��`7S RT6A !�/'aiN' Owner's Name,Address and Tel.No.
�Qic�a�d �d9t.S
Assessor's Map/Parcel 19b
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
lJ J_.a"A4.y f'P�c.,�e live &f< Div v. /
3nJe V9 ems 7 f.1.r 0w.f�7
A_6i3Of-jd.4/e 4W_ 0265/'/ *3;? 2177
Type of Building:
�\ Dwelling No.of Bedrooms '3 Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
`Other Fixtures
Design Flow T30 gallons per day. Calculated daily flow 373 (1 , gallons.
Plan Date /0 —2 7— y Number of sheets Revision Date AJOy e
Title
Size of Septic Tank P is'`' �ooa Type of S.A.S. S /0��� l'.¢.o �'.vr4 ll e 70�J
Description of Soil TOQ �014 4
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by s Boar f H al
Date y
g
Application Approved by 1/�/ _ v n /%� � C >1��� Date
Application Disapproved for the following reas nv V
'/
Permit No. _ Date Issued t/
lr
------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO C$ TIFY,that the On-site Sewage Disposal System Constructed( )Repaired (X)Upgraded
Abandoned( )by �tiSlff ie /d fA I-e/"r -e- �7"C-
at /& 75 AY 614 61219,N f7") ttefy .#"fV— h b constructed in accordance
with the provisions of Title 5 and a for tsposal System Construction Permit N . dated
Installer 2�-'s����O� � y Designer ��^
The issuance of this permit shall of be construed as a guarantee that the ystem
Date ���gG 5 Inspector
--
�---------- -------------
No. Fee
r /
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS
ligogal *pgtem Construction Permit
Permission is hereby granted to Construct 4 )Repair(,A")Up de( )Abandon( /
System located at �6 7� IQf 6 (�/l14/.� l?� _ WpS� �*�.��y 1��� /-e—
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided:Con one u�st be c,mpleted within three years of the date of th*
Date: e it.
�>� /t/� Approved by I
r/,, TOWN OFnB-,A�RNSTABLE
LOCATION 105 5 mAptvl sr a4&A SEWAGE # 200�'�Z/
VILLAGE IA1 a-T 640 ASSESSOR'S MAP& LOT
INSTALLER'S NAME&PHONE NO. 1201 fie I8 f1pi-L o/0
SEPTIC TANK CAPACITY '0 0® -
LEACHING FACILITY: (type) +✓A!16'S (size) X 3G -Je Z_
NO.OF BEDROOMS ��_
BUILDER OR OWNER it-kArd P--Uc,AP v-!g
PERMITDATE: 11'Z 2 O N COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 feet of leaching facility) Z 8 Feet
Edge of Wetland and Leaching Facility (If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by T e J EI I S
F� c�
Town of Barnstable
`"ET°yti° Regulatory Services
Thomas F. Geiler, Director
* sAxrisrnsLE,
9$A . .39. � Public Health Division
16
Thomas McKean,Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Installer& Designer Certification Form
Date:
Designer: Installer: &,See /ol y441 -1XI'll f e.l-cv
Address: SA4d CU1&G1 ,.17n Address: ge)X (f7.�2_
On I1- Z Z was issued a permit to install a
(date) (installer)
septic system at 16 41,�, f 7 C27b,4 based on a design drawn by
(address)
M e- Z/A(14 dated O
(designer)
I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distribution box and/or septic tank.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow.
(Installer's Signature
0,tlse;
(Des' is Signature) (Affix' ¢:.;amp Here)
PLEASE RETURN TO BARNSTABLE PUBLIC.HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:Health/Septic/Designer Certification Form
TOWN OF BARNSTABLE
LOCATION
t1�i�t A SEWAGE# 2'00
VILLAGE fay 2ST' ASSESSOR'S MAP &LOT
kLo10
INSTALLER'S NAME&PHONE NO:'
i SEPTIC TANK CAPACITY 0
I LEACH NG FACILITY: (type)
1 N{�t ✓a iS (size) 1 �• '.3 X 3 6 le Z
NO.OF BEDROOMS r
--------------
BUILDER OR OWNER
Ark �o
PERMTTDATE: I/ ZZ 0� COMPLIANCE DATE:
Separation Distance Between the: Feet
_ Zarteu
im Adjusted Groundwater Table to the Bottom of Leaching Facility
Water Supply Well and Leaching Facility (If any wells exist ---� Z b./- - Feeton site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist Feet
within.300 feet of leaching facility)
Furnished by EI t S
13
w �
I ��
9/16/03
Notice: This Form Is To Be Used For the Repair.Of Failed
Septic Systems.Only
PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM
I, y 3, OW hereby certify that the engineered plan signed by me
dated 10 27 (D4 ,concerning the property located at
meets . all of the.
following criteria:
• This failed system is connected to a residential dwelling only. There are no commercial or
business uses associated with the dwelling.
• The soil is classified as CLASS I and the percolation rate is less than or equal to 5 minutes
per inch. The applicant may use historical data to conclude this fact or may conduct deep
test holes and percolation tests at the site without a health agent present.
• There is no increase in flow and/or change in use proposed
• There are no variances requested or needed.
• The bottom of the proposed leaching facility will-be located no less than five feet above the
maximum adjusted groundwater table elevation. [Adjust the groundwater table using the
Frimptor method when applicable]
Please complete the following:
A) Top of Ground Surface Elevation(using GIS information). S�►�V
B) G.W.Elevation +adjustr t for high G.W. b _ ►
DIFFERENCE BETWEEN A and B �►
SIGNED : DATE: Z8
7-13
NOTICE
Based upon the above information;a repair permit will be issued for bedrooms
maximum. No additional bedrooms are authorized in the future without engineered septic system
plans.
Lor-LL,; Z5Z WVex", 6z), C zcc56)
gASepdc\percexmM.doc
r
Page: 1
CERTIFICATE OF ANALYSIS
,o
` '' Barnstable County Health Laboratory
Report Prepared For:
Report Dated: 3/15/2004
Order Number: G0424398
Vanessa Rogers
1675 Main Street
West Barnstable, MA 02668
Laboratory ID#: 0424398-01 Description: Water-Drinking Water
Sample#: 24398 Sampline Location: 1675 Main St W Barnstable MA Collected 3/5/2004
Collected by: V Rogers Received: 3/5/2004
Test Parameters
ITEM RESULT UNITS 1V MCL Method# Tested
LAB: IC Lab
Nitrates <0.1 mg/L 0.1 10 EPA 300.0 3/9/2004
LAB: Metals
Copper <0.1 mg/L 0.1 3111B 3/12/2004
Iron <0.1 mg(L C SM 111B 3/12/2004
Sodium 10 mg/L 1.0 20 204SM 3 11B 3/12/2004
LAB: Physical Chemistry OR 1 I
Conductance 197 umohs/cm IiOWN or-H UEVT BP .1 3/5/2004
pH 7.5 pH-units EPA 150.1 3/5/2004
Note: Water sample meets the recommended limits for drinking water of all the above tested parameters.
Approved By:
Director)
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
i'OF NAR,4'
:j CERTIFICATE OF ANALYSIS page: 1
,.
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 03/15/2004 RECE `a
ED
Order Number: G0424 06
Vanessa Rogers 2004
1675 Main Street MAR 1.7
West Barnstable, MA 02668 TOWN OF BAKNSTABLE
HEALTH DEBT.
Laboratory ID#: 0424406-01 Description: Water-Drinking Water
Sample#: 24406 Sampling Location: 1675 Main Street W Barnstable MA Collected: 03/08/2004
Collected by: V Rogers Received: 03/08/2004
Test Parameters
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: Microbiology
Total Coliform Absent CFU/100mL 0 Absent 307 03/08/2004
Note: Water sample meets the recommended limits for drinking water of all the above tested parameters.
Approved By:
(Lab rector) '
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
ASSESSORS MAP:-- TEST HOLE LOGS
PARCEL: -4� Z_s- _ __-- =--------- NOTES:
FLOOD ZONE: N /C AGE SOIL EVALUATOR:- A I , yV(I� G
- WITNESS:
'g �'4 r~/ BGbL /8�'S � '� /Z
REFERENCE: ------ DATE:- 1) The installation shall comply with Title V and Town of Barnstable Board of
PERCOLAT I ON RATE: .L 2 M t 1 " Health Regulations.
4G� \I f✓j�,,?�j w, 2) The installer shall verify the location of utilities, sewer inverts and septic
G�� TH- 1 TH-2 components prior to installation.
3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot.
4) This plan is not to be utilized for r
p operty line determination nor any other
Purpose other than the proposed system installation.
g M 5) All septic components must meet Title V specifications.
/� oT 6) Parking shall not be constructed over H1�i `L� 1.0� 0 septic components.
LOCATION MAP�A/7:.5� �
/ � g) The Property is bounded by property corners and property lines as depicted.
) Property owner shall review design considerations to approve of total
i number of bedrooms to be considered for design. Receipt of payment for the
t,� plan and installation based on the plan shall be deemed approval of the
1 Vv4, �� number of bedrooms.
L Z 9) The existing leaching system shall be pumped and backfilled per Title V
Abandonment Procedures.
10)System components to be 10 feet from water line.
O 4044t?, wL4•(t?f, 11)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal.,
- then replace with 1500GST.
U) 140 f t +- _ 12)Excavate 5 feet around the proposed leaching system and below to approx.
SEPTIC: SYSTEM DESIGN elevation 50.93 and fill with clean washed sand per Title V specs.
FLOW E!,T I MATE
t t 3 -BECROOMS AT Ib GAL/DAY/BEDROOM GAL/DAY -
" SEPTIC TANK
Ln
�—
i / \ \ C Ii GAL/DAY x 2 DAYS - 0 GAL
USE 1000GALLON SEPTIC TANK S j 1 t
(0
1 EXISTING AC&&qalwoe-q ►► 0T !6,111 \ SOI L ATION SYSTEM
3 BEDROOM M y5f,15 HZo 01 G[qp IWALT&1ZQ.-5 to �I' SDWr,
DWELLING \
' TOP OF FNDN
ca i EL -5T75+- \ I \ •7
Q `t 1 DE AREA: Z x �m.Zr,+ iD,6'� XZ DC Iob IZD DAV.1J i
BOTTOM AREA: ��25 � ID�$ZJ�: � Z w UAM=
\ >_ O tt3
1 N
SEPTIC SYSTEM SECT IONLn
►.t�:s.
t i IL►�'4 wax. '►
0 y �rA 9 ft lGt��7 GAL t ,g7 BO �Z d e
. . F
12 z Q SEPTIC TANKLij
ED �A- 0
ozz
PA RKI` t,I RE �0T1C>wI GG �� 1�1✓ 1r�-1/. '35
LLO<
t P
U o<o
t \ z >
/ 4395 {t EDGE OF PAVEMENT m �w� SITE AND SEWAGE PLAN
16.47 fi TO MAIN STREET LOCATION : :0 1415 4A
PREPARED FOR : �3006FIFL D crE-bvL
M a
0
SCALE:
DAV I D B . MASON,25 DATE: is 27
z DBC ENVIRONMENTAL DESIGNS
- DATE HEALTH AGENT
EAST SANDWICH . MA
W ( 508 ) 833- 2177
ASSESSORS MAP: TEST HOLE LOGS
-- i
PARCEL: � Z i�________ _ NOTES:
�n � FLOOD ZONE: _Nam- ����/G-�13GE _ _ SOIL EVALUATOR:- )�1 I , 1'vl�t
� WITNESS: �-16r
REFERENCE: _- _ �— DATE: _ 1) The installation shall comply with Title V and Town of Barnstable Board of
PERCOLATION RAT: : .L 2 Mt4.41w , Health Regulations.
aGt�l lay. 2) The installer shall verify the location of utilities, sewer inverts and septic
G�� components prior to installation.
TH- 1 TH-2
I 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot.
4) This plan is not to be utilized for property
p perry line determination nor any other
ti Pose Other than the proposed system installation.
�g AM 0 5) All septic components must meet Title V specifications.
6 Park') mg shall not be constructed over H10 septic components.
I 7) The property is bounded by property corners and property lines as depicted.
LOCATION MAP /' t,T �"�� LIG 8 The Property I' G iv�uq 1 ) p perty owner shall review design considerations to approve of total
J,0.3 number of bedrooms to be considered for design. Receipt of payment for the `
(r ; 7" plan and installation based on the plan shall be deemed approval of the if
number of bedrooms.
9) The existing leaching system shall be pumped and backfilled per Title V
Abandonment Procedures.
10)System components to be 10 feet from water line.
11)Septic tank to be a minimum of 1000 gallons. If tank is less than 1000 gal.,
then replace with 1500GST. f
14O f1 12)Excavate 5 feet around the proposed leaching system and below to approx.
�`— - SEPT i C SYSTEM DESIGN elevation 50.93 and fill with clean washed sand per Title V specs.
- - -
FLOW E TIMATE
BEi ROO- IS AT I Ib GAL/DAY/BEDROOM -3?1a GAL/DAY 4
- _ I
un -_�_ - J SEPTIC TAti'9C
� Q � � h
� �G, L/DAY x 2 DAYS - 1000 GAL
I 1 Q I �
USE IC SEPT I C TANK (q,)<�151^l t�
\ EXISTING 1 - �
SOIL AIS�RPTION SYSTEM
3 BEDROOM i
I5 HZo NI GIMP IWr L70g1D2-5 tO �I %Wl
I I TOP OF FNDN �i 1RQV� .l� U►, LVV, • `--J,. ° u ..,
/ EL I
-says+- Q : l 3t,zr, + 10. xZ K , �ti = IZD r ah
`D I 1 w i:OTTOMRAREA:
X. l0.$
/ P o 3
' v
SEPT If" SYSTEM SECT ION (►.ems)
LnLij
c.
I I cry F _ M I
'.SZ►fo�1� 3/ _ ' k
`�
_,. _• � rid � f
;i L D-BOX5Z. a ,
15 fr � / c
I - ,� 27 79 Gt�O GAL 7 uhge TW ` , i
o o SEPTIC TANK 1'LU
b4-
s �� 31.25 "x 10.63
. Q J 0z37 I
I PARK I G :/1tREf1, P / _ o
I— Q UC XE#f H:)IlE
i U/ 0< o Z > cr)
4395 f� EDGE OF PAVEMENT W o�� SITE AND SEWAGE PLAN
i
CD � w�
7 f t TO MAIN STREET
LOCATION : 11,15 _P!0k31-F_ 4.41
PREPARED FOR : 7R006F/CL D SAC..
S�}w�wlGhFL ��
w
O
SCALE: �_ZO
DAV I D B . MASON,es DATE:
DBC ENVIRONMENTAL DESIGNS
— EAST SANDWICH . MA
DATE HEALTH AGENT ( 508 ) 833-2 1 77
1673 Main Street Rt 6A
West Barnstable
A= 196 026
1
i
Mal-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF, HEALTH
_77�.PAQ.iN.......OF.....,• c v (vS'� `-� ....................................
Appl ration for Disposal Marks Tonstrnrtinn 11amft
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: e® �5
) ..
..--•--�- ..... . .... ..._ _!t.....------••. --v ............
Location•Address or Lot No.
............................. ...................... .........................................................
�� Ow er 1 Address
Installer Address
Type of Building Size Lot............................Sq. feet
�-, Dwelling AL No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures
W Design Flow._...S.: ..........................gallons per person per day. Total daisy flow.... _ .................gallons.
WSeptic Tank Liquid ca.pacity.tf.00.gallons Length._.`.t....... Width...5-____._--- Diameter---------------- Depth................
x Disposal Trench—No. .................... Width.................... Total Length:................... Total leaching area....................sq. ft.
Seepage Pit No........... ...... Diameter.....4-�_._....... Depth below inlet._... N........ 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........................
44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W .....-•----------------------------•----••-•-------•-----------••-------••-•-........7......._••.............................................................
0 Description of Soil........
---------•------------------•-------------••----------...............•---..---•-
V .........-•-----•-------•--•.....------•--••---.....•--•--•-----••........-•-------••-•--••-•••--•--••••••------•----•---•--••---•-•--••••--•------------•••......................•••--•..............•--
••-•---•---•-----------------------•----------.......----------...----------------------•---------------------------------------------••---•---•--
--------------------•-
U Nature of Repairs or Alterations—Answer when applicable----_. t^�G.--`�_._____i? �I,-_...�_. ���DqA ................:
......•..._ ..........._ , . �Ss-�z� ..........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of A.'IT1.% 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance hash d by the board of hea tb,.
Application Approved By--•--------- G: ...................................•--•• ------.........�7�� e�-.
ate
Application Disapproved for the following reasons:.....................................:..........................................................................
..........--•••-••••-•-•-.....-•--•--•........•------•--.••---...-•--••-•--•-----•-----••-••••--•-------••-----•--•---....--•-•---------•--••----•--••-----•----••------................................
Date
PermitNo........... ........ Issued_....................................................._
Date
No..
THE COMMONWEALTH OF MASSACHUSETTS
- BOARD OF HEALTH
<......................................
Appliration for Disposal Works Tonstrnrtiinn Fermi#
Application is hereby made for a Permit to Construct ( ) or Repair ( -) an Individual Sewage Disposal
System at:
eo i r S
- Loc-atio�n-Address or Lot No. ..............
----�••-
............ ....... ........................ .. ! ..
......._..----....................................W , ��� `\A_Ow er t ` Address
..............1•�.---•------�-:_.-!.'. ........._.__......_.__.._. Cy
Installer .................-..................................................
Type of Building Address
`Size Lot...........................Sq. feet
Dwelling / No. of Bedrooms......... ............................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building •--------------------------- No. of persons............................ Showers ( ) — Cafeteria ( )
d Other fixtures `
Design Flow....... .. .........................gallons per person per day. Total daily flow......._.. - . . gallons.
WW / r� P P �P t l ..� ----•-----•-------.
Septic Tank . Liquid capacity.f�&t._.gallons Length-_-`�----__- Width...0a..._.._.. Diameter................ Depth'_...........
x Disposal Trench—No. .................... Width.................... Total Length-------_............ Total leaching area...
.................sq. ft.
i s
3 Seepage Pit No............. ....... Diameter--_--1. .... Depth below inlet.....U.l....... Total leaching area..................sq. ft.
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........._..............
4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
0 Description of Soil................................................................... ---•-----...----------------...----•--------•-------------......_..:
x
c, -...----------------------------------------- ----:-----._...-•----•--•--------••----•-------•--------------•---•---•-•---••-------•-•--
w
U Nature of Repairs or Alterations—Answer when applicable.-___� +�_�'._.._`r4«..-... .z~S4vpc�-_-. --_-•--.
..........
-� ... rruti�5. 1-QISf� Va{v _C -T i
S......... . 1 W
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITIs: 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been_issu.ed by the board of health,
Application Approved By...............C `M� :.%/- ....'... .= . / Date......................................
Date
Application Disapproved for the following reasons-----------------------------•-•------------•--------- ...................... ....................
-------------------•----•---------------•---------------•-•---- ---••-•----.......--
Date
PermitNo..--------- rz.. ------ --•--........ ,- Issued.........................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
..0.. .Y`�....oF......4` .•r.,v„LKrG
Trr#ifiratr of hum li�inre
THIS IS TO CERTJF_Y_, That the JI_n�dividual Sewage Disposal System constructed ( ) or Repaired
-�
Installer
at........... -------! `"-t..\r_.. ....a .. .C'T T ? 5 J- ..==!`,fi 4c,
. • ..
application installed in
osalcWorkseConstructicn Permit
with the
of TITLE 5 of 'The State Sanitary Code as described in the
t No--- - --57 ..._. dated-------� �- ` . ............
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE_..... J l I`J
�_....---•-•. Inspector....---•...............
THE COMMONWEALTH OF MASSACHUSETTS �•� -r.l ylAL(ST J5.e_
BOARD OF HEALTH �1vav'�+�
L TFf
-Q.. .�........OF. c. ts-:.-v- � �. ' ..................
No..�.�.......... FEE........................
Disposal Works-- Tono#rnt, riinn Prrmit
Permission is hereby granted.... ��...........\ -C.��`-!-r-----•-••-----•-•---------------------•------•------..................._....
to Construct ( ) or Repair ( Q_a.n Individual Sewage Disposal System
at No........1.Ia.`7L........tn : ...:5fT------f2_1_lam •..---------•-,Cr7??- _ ---------- W.
` Street
-ti
as shown on the application for Disposal Works Construction Permit No.-�-- J�Dated_._.....(/_.�_.��_ ...........
C—r lloanl of lfcalth
DATE....... ; ''----_
m
TOWN OF BARNSTABLE
LOCATION SEWAGE #
VILLAGEW; AR f�6TABI.E ASSESSOR'S MAP & LOT
INSTALLER'S NAME & PHONE NO. , ,i-1�6� --
SEPTIC TANK CAPACITY 00 n 4i�V N ct),G�\ u w i
LEACHING FACILITY:(type) 1L.�eccc.�% ±t S (size) ({ r,6 315�?N
NO. OF BEDROOMS PRIVATE WEL R PUBLIC WATER
BUILDER OR OWNER ��
DATE PERMIT ISSUED: 1D--R:
DATE .COLIPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
i
i
O
000
TOWN OF BARNSTABLE
l _
Flil
CATION � / I ILLI'/�l�J L / SEWAGE #
LAGE 1,�(j r� ASSESSOR'S MAP LOTb
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY ( b 00 G-H 1
�eG�C 1n P`Ff5 (size) C1 >-1 cuj 7!
LEACHING FACILITY:(type) j
NO. OF BEDROOMS (R:I:VA:T:E�WELLR PUBLIC WATER
BUILDER OR OWNER c yim,,A L-0
DATE PERMIT ISSUED: ff --
DATE .COUPLIANCE ISSUED;_T��I��
VARIANCE GRANTED: Yes No �C
j 06 12 vl ic.a Via.t
PTIS Lu-'075TONr-
�� J
ptST 3olct5
I
COMMONWEALTH OF MASSACHUSETTS
' f EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i•
TITLE 5
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address:44W RT 6A
W-BARNSTABLE �/0 0,5
Owners Name: RODGERS r
Owner's Address: SAME
Date of Inspection: 10/8/06 '�-
Name of Inspector: {please print) Douglas A.Brown
Company Name: Douglas A.Brown Septic Inspections
Mailing Address:P.0 Box 145
Centerville,MA 02632
Telephone Number: 508-420-4534 c, =
CERTIFICATION STATEMENT �n `
I certify that I have personally inspected the sewage disposal system at this address and thaw a informon repbrted
below is true,accurate and complete as of the time of the inspection. The inspection was perf rmed ba ed on cry
training and experience in the proper function and maintenance of on site sewage disposal sy tems.I a DEP
approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system:p
X Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signatur Date: 10/8/06
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or
DEP)within 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
DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving,
authority.
Notes and Comments
SYSTEM APPEARS TO MEET MINIMUM PASSING REQUIltMENTS AT THIS'TIME.
SYSTEM VERY OLD, 1970 APPROX
""This report only describes conditions at the time of inspection and under the conditions of use at that
time. This inspection does not address how the system will perform in the future under the same or different
Conditions of use.
t
Title 5 Inspection Form 6/15/2000 page 1 Revised on 10/31/2000
Page 2 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. System Passes:
X I have not found any information winch indicates that any of the failure criteria described in 3 10 CMR
15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
SYSTEM VERY OLD, 1970 APPROX NO RECORDS AT B.O.H OR BUILDING DEPT
B. System Conditionally Passes:
one or more system components as described in the"Conditional Pase'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.
Answer yes,no or not determined(Y,N,ND)in the following statements. If"not determined"please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health,
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
The system required pumping more than 4 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
Page 3 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
C.Further Evaluation is Required by the Board of Health:
Conditions exist which require further evaluation by the Board of Health in order to determine if the system
is failing to protect public health, safety or 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 public health,safety and the environment:
Cesspool or privy is within 50 feet of a 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,safety and environment:
_ the system has 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 SAS and the SAS is within a Zone I of a public water supply.
The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
The system has aseptic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**.Method used to determine distance
**This system passes if the well water analysis,performed at a DEP certified laboratory,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,provided that no other
failure criteria are triggered. A copy of the analysis must be attached to this form.
3. Other:
Page 4 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
D.System Failure Criteria applicable to all systems:
You must indicate"yes or no to each of the following for all inspections:
Yes No
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool
X 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
X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow
_ X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped
X Any portion of the SAS,cesspool or privy is below high ground water elevation.
X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X Any portion of a cesspool or privy is within a Zone 1 of a public well.
X Any portion of a cesspool or privy is within 50 feet of a private water supply well.
X 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. [This system passes if the well water analysis,
performed at a DEP certified laboratory,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,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
NO (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 3 10 CMR 15.303,therefore the system fails. The system owner should contact the Board of
Health to determine what will be necessary to correct the failure,
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd•
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)
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
If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered
yes'm Section D above the large system has failed.The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
Page 5 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: 1671 RT 6A
W-BARN
Owner: RODGERS
Date of Inspection: 10/8/06
Check if the following have been done. You must indicate"yes"or"no" as to each of the following:
Yes No
X Pumping information was provided by the owner, occupant,or Board of Health
X Were any of the system components pumped out in the previous two weeks ?
X _ Has the system received normal flows in the previous two week period?
X Have large volumes of water been introduced to the system recently or as part of this inspection?
X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A)
X _ Was the facility or dwelling inspected for signs of sewage back up?
X _ Was the site inspected for signs of break out?
X _ Were all system components,excluding,the SAS,located on site?
X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition
of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum?
_ X Was the facility owner(and occupants if different from owner)provided with information on the proper
maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
X _ Existing information. For example, a plan at the Board of Health.
_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) [310 CMR 15.302(3 ))(b)]
5
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection. 10/8/06
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): 3 Number of bedrooms(actual): 3
DESIGN How based on 3 10 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330
Number of current residents: 3
Does residence have a garbage grinder(yes or no): NO
Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required]
Laundry system inspected(yes or no): NA
Seasonal use: (yes or no): NO
Water meter readings,if available(last 2 years usage(gpd)):
Sump pump(yes or no):
Last date of occupancy: cL x NT
COMMERCIAL/INDUSTRIAL:
Type of establishment:
Design flow(based on 310 CMR 15.203): gpd
Basis of design flow(seats/persons/sgft,etc.):
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/use:
OTHER(describe):
GENERAL INFORMATION
Pumping Records
Source of information:
Was system pumped as part of the inspection(yes or no): NO
If yes, volume pumped: gallons--How was quantity pumped determined?
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)
_Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
_Tight tank _Attach a copy of the DEP approval
Other(describe): I OOOGAL TANK LEACH FIELD
Approximate age of all components, date installed(if known)and source of information:
1970 ACCORDING TO OWNER,INSTALLED BY CARL LAMPI
Were sewage odors detected when arriving at the site(yes or no)? NO
Page 7 of 11
•� i
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
BUILDING SEWER(locate on site plan)
Depth below grade:
Materials of construction: cast iron _40 PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_ (locate on site plan)
Depth below grade: 6°
Material of construction: X concrete_metal_fiberglass _polyethylene
other(explain)
If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): _(attach a copy of
certificate)
Dimensions: APPEARS TO BE 1000 GAL
Sludge depth: '8°
Distance from top of sludge to bottom of outlet tee or baffle: 30"
Scum thickness: TRACE
Distance from top of scum to top of outlet tee or baffle: 0
Distance from bottom of scum to bottom of outlet tee or baffle:
How were dimensions determined: WOODEN POLE
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.)-
TANK LOOKS STRUCTUALLY SOUND AT THIS TIME,RECOMMEND PUMPING
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(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
Page 8 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1671 RT 6A
W-BAIRN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
TIGHT or HOLDING TANK: (tank must be pumped 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(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: (if present must be opened)(locate on site plan)
Depth of liquid level above outlet invert:
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage into or out of box,etc.): NO T-)4�0 K
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.):
I
i
Page 9 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/OE
SOIL ABSORPTION SYSTEM(SAS): _(locate on site plan,excavation not required)
If SAS not located explain why:
FIELD SYSTEM PROBED IN AREA OF FIELD NO SIGNS OF HYDRAULIC FAILURE
Type
leaching pits,number:
leaching chambers,number:
leaching galleries,number:
leaching trenches,number,length:
X leaching fields,number;,dimensions: UNKNOWN
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.):
OWNER HAD ROUGH PLAN WITH VERY LITTLE DIMENTIONS,PROBED IN AREA OF FIELD AND
FOUND NO SIGNS OF HYDRAULIC FAILURE.
CESSPOOLS: (cesspool must be pumped as part of inspection)(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(yes or no):
Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY: (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.):
l
Page 10 of 11
OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
0 0 �
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Pageldlaof 11
j/
OFFICIAL INSPECTION DORM—NOT FOR VOLUNTARY ASSESSMENTS
` SUBSURFACE SEWAGE DISPOSAL SYSTEM j INSPECTION FORM
t, PART C
SYSTEM INFORMATION (continued)
Property Address: 1671 RT 6A
W-BARN
Owner's Name: RODGERS
Owner's Address: SAME
Date of Inspection: 10/8/06
SITE EXAM
Slope:
Surface water:
Check cellar:
Shallow wells
Estimated depth to ground water feet
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
_ Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
' Rodger Roberts
k
,1671 Main St.
-�W: Barnstable
t =r + 1 ., y a } t'.� .. �: t r �, <it.� as2:. t� *v'f.•� .1 ,°f S, k
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f �' •°. +. '�, T i+ ' f .r r'�� v 4 x = '�"`.,' .� = t `z,�-_S J< J�t `n•J X. r ,
f�f•�tix '^: �,: a ,,,,4,t + _.� ..;Ct r s, "` ^^ �•.' .t. J� � x r +.� _' �' .t
+aJ `4 .• • r ,.�:' + E ra +re 4a - +}'{ ,� a# 4, rr -.e Ea}^,t`.v= '. F
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� TF,n r +5f .4� •�.a.a s y,.-` j {., ry k., �. z<-'e�,._ + Ra � x< tK.,:r.^f a,ft�. �T � i; �4� y.: j .
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.•"ry Ronald S:Roger'
167'1','Main Street
Y � t+ :• �� ,.. f '`+. r T ,y .r� `r -err '1 ; + �` r >.� }S,
West Barnstable 1via,0.2668 -;ti / t` ,� r{ ry 3: K �R 4 t;
f
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Dear. Mr. Rogers �t� �+� ►:' ...� ,. Jay �. f , ' .,,z M �- t . � � �` � n t''
!' t. °` s .:*. .. �,a !' :v.` .. ��v S:� ~.t 9 ��.;x�•x ttt�.•�=�_+ k fir_ s .fie.- R ti...a r 1•'t•{�" � " �!.
You:'will;be all
todup-grade,°,your-on-site,sewa a dis sal s stems for,fourx(4) Gotta es
'g Po y 8 ,
f owned by�you,at+"Yb71 Main St„ 'R 6A, Barnstablet: In aacordance: with` the.'design-
`IN r�submitted by.Rodger Roberts the'folltiwin <conditi` umet:,' *x r 4+ one IIl st,be
gJf _y �yyt.�
•+ i L y, ' f'. ./J' , `'r. � r R t • { A�i d�,1�+E +4 X� i-. �.w-.:'.
(1)7he'water servicing cottages must bet tested by, an'a roved laboiatdr inonthi °1:� R�•-
with,r pP y ... y
1• �
w esuits submitted ,to° the 1oatda of Health. If the .sodiumt coneent is 2Q,`ppmor overi
' 'signs must bey' posted" .each' cottage�•informin , `P g g .the,_occupant 'that the ,water has,a +htgfi'
�--Jsodlum�content a d:should aot,be.ingested bq per',sorlson a sodium'-free or sodium,trestiricted;',, .,
dietaf+z 14S;r r� �3.!'Z.,{L { N. 6�,J *r., SFr .f'K,- hr 4 ky;+: k?s'`:,� � •4� 4"' 3r'S. ..4 z �' Y '"'r F '�+ .K,:
r4;, Y ;. 4' 1 r dye.. .. .Y s . . ,, f �{y V;°'^«' "+c <`P C- ✓vj . - �,'s ,ei..
+� s (2)'In the jevent the drinking wafer does,not. meet 4 the standards of, the,Safe,,' A ing Acts mot }��
and` Massachusetts Wi•inking s Water��tanda ds� ia,;other, parameters, a anew�pwell�;must be
4 . .ti, f � installed. The..vater 'fromv, the`new°fie*ell`4rnustr{meet- all Massachusetts,. ]atinkingr Waterf
e Standards: r i,.•f v&. +� �� �. T.. ,� JF.+ k i°+ - r'f t I.r ; z•-'.Fti T..� r + { .�r. ;� ,
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cf� �c r (,) The units° must ,remain under. the 'same ownership.'or,;separate;.wwelis,,,Wi st'•:be'-inetalled;
,r. for each+cottage unity rRg� , ��✓ .: l a. .� +
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M�4 k ;+Mr. Rodger R'oberwhas +informed us'that the well furnishin .w 1 g ate"r' to ttie cottages,is 20
, ; feet away. rom the M proposed-septic,.leaching area ;;�,4(� ,'� ' '' Fh � 1 • � `d: t�
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VeryFTtruly:'yours,
TW'Zaig
zf}-.�p,tAnn Janh Acting ,�
t BOARD OF;HEALTH IZ
J,•{,��� r . TOWN OP BARi,4STAI LE , ' f ,• �+, "4 ,/ : , <r r i
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yo*THE TO� TOWN OF BARNSTABLE
OFFICE OF p rr1q EI �G"OVA
! Bsa STkBL
ABL MMl t : BOARD OF HEALTH G
�
039. 4 Es�,��,�� 367 MAIN STREET k, � ,.
HYANNIS, MASS. 02601
October 8, 1986
Mr. Rodger Roberts
23 Jennie's Path
Hyannis, Ma 02601
Dear Mr. Roberts:
You are granted a variance to install 3 leaching pits, 100, 110, and 130 feet from
an existing well servicing cottages numbered 1, 2 and 3, at 1671 Main st., Rt. 6A;
West Barnstable, with the following conditions:
(1) The well water must be tested and must meet all of the standards set forth in
the "Safe Drinking Act", and the Massachusetts Drinking Water Standards prior
to issuance of a sewage permit.
(2) The on-site sewage systems must be installed in strict accordance with the submitted
plans.
(3) The units must remain under the same ownership, or separate wells must be installed
for each cottage unit.
(4) Variance expires. November 1, 1987. _
This variance is granted because the existing cesspools are failing. One cesspool
is 30 feet from the well. The upgrading at this property can only be beneficial to
the environment.
k—L—
BOARD rs,
lds, airman
F HEALTH
TOWN OF BARNSTABLE
JMK/bs
I
Log' Number: 6766 Bottle # 704 Date: December 23, 1 86
��°f SARtisa BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
SUPERIOR COURT HOUSE
7
V BARNSTABLE, MASSACHUSETTS 02630
o •
MASS DRINKING WATER LABORATORY ANALYSIS PHONE: 362-251,
Ext. 337
Client: Donald S. Rogers Collector: Donald S. Rogers
Mailing Address: 1671 Main Street Affiliation: owner
West Barnstable, MA 02668 Time & Date of
Collection: 12/22/86 6:00 a.m.
Telephone: . . 362-6185 after 4:00p.m.) Type of Supply: well _
Sample Location: Off1671 Main Street Well Depth: 100'
West Barnstable, MA 02668 Date of Analysis: 12122186 8.40 a.m.
PARAMETER SAMPLE RESULT RECOMMENDED LIMITS
Total Coliform Bacteria/100 ml 0 0
pH 6.6
Conductivity (micromhos/cm) 118.0 500.0
Iron ( m) 0.3
Nitrate-Nitro en ( m) 10.0
Sodium ( m) 30A 20.0
I
I . _Water sample meets the recommended limits for drinking of all above tested parameters .
II . XX Based only on results of the parameters tested for this sample, the water is
suitable for drinking but may present the problems checked below:
A. Water sample has higher than average levels of. Nitrate. Future monitoring is
recommended (2-3 times per year) to establish any upward trends.
B. The low pH of the water may shorten the useful life of the house's plumbing.
C. X Water may present aesthetic problems (taste, odor, staining) due to iron
D__X _Water sample has high levels of sodium. Persons on low sodium diets should
consult their doctor.
III. Due to one or more of the reasons checked below, this water sample is unfit for
human consumption: A. High Bacteria B. High Nitrates
REMARKS: The Barnstable County Health and. Environnitinkil
Department shall not endorse any statements,
interpret ions or conclusions made by anyone
else co ern' g t ese results without written consent
CC: Barnstable Board. of Health
CC:
1 /7/85
La ra ry Director
Explanation of Test Results
Total Coliform.Bacteria
Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become
contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero
indicates that your water supply is safe and approved for human consumption. A total coliform count of greater than
zero is most often the result of accidental contamination of the sample bottle through improper sampling methods.
For this reason, it would be advisable to retest any well water that is not approved.
pH
pH is the measure of acidity or alkalinityof the water. On the pH scale,the number 7 is neutral, less than 7 is acidic
and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5.
Conductivity
Conductivity is a measure of the dissolved salts in solution. Amounts in excess of 500 micromhos/cm are.generally
considered unacceptable and may have a laxative effect upon users.
Iron
The presence of iron in water in concentration of .3 ppm or greater may: give the water a bittersweet astringent
taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain.
The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water may
cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron
removal system.
Nitrate-nitrogen
The Massachusetts Drinking Water Regulations have set a maximum contaminant level for nitrates at 10 ppm.
Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested to form
potentially carcinogenic nitrosamines. Contamination sources include fertilizers, cesspools and industrial wastes.
Copper
Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not
present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a
bluish-green stain on porcelain fixtures.
Sodium
A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water
supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking
o water or contact their doctor to determine if consuming the water is advisable. Concentrations exceeding 50 ppm
indicate that there may be ocea n-water,or road salt runoff water getting into the well.
ut Vj.r 3 _
fit,�PCI 1C el �•, c: it , • 7'„ ,
Lo*Number: Bottle # D365 Date: December 8, 1986
F
sARti�a BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
SUPERIOR COURT HOUSE
V BARNSTABLE. MASSACHUSETTS 02630
o •
ArAg9 DRINKING WATER LABORATORY ANALYSIS PHONE: 362-2311
Ext. 337
Client: Rodger Roberts Collector: Donald S. Rogers
Mailing Address: 23 Jennies Path Affiliation: owner
Hyannis, MA 02601 Time & Date of
Collection: 12/2/86 5:00 p.m.
Telephone: 362=6185 Type of Supply: well
Sample Location: 1671 Main Street Well Depth: 100,
West Barnstable, MA Date of Analysis: 1p.13.IR6 1 :00 p.m.
PARAMETER SAMPLE RESULT RECOMMENDED LIMITS
Total Coliform Bacteria/100 ml 0 0
H 6.0
Conductivity (micromhos/cm) 330.0 500.0
Iron ( m) 0.3 0.3
Nitrate-Nitro en ( m) 0.7 10.0
Sodium ( m) 46.0 20.0
I . Water sample meets the recommended limits for drinking of all above tested parameters.
II .XXX Based only on results of the parameters tested for this sample, the water is
suitable for drinking but may present .the problems checked below:
%TIow
A. sample has higher than average levels of Nitrate. Future monitoring is
(2-3 times per year) to establish any upward trends.
B. pH of the water may shorten. the useful life of the house's plumbing.
C. Water may present -aesthetic problems (taste, odor, staining) due to
D. X Water sample has high levels of sodium. Persons on low sodium diets should
consult their doctor.
III. Due to one or more of the reasons checked below, this water sample is unfit for
human consumption: A. High Bacteria B. High Nitrates
The Barnstable County Health and Environmental
REMARKS: The iron level is at the limit. Department shall not endorse any statements,
interpretations or conclusions made by anyone
else con ruing these results without written consent.
CC: Barnstable Board of>1t alth
CC:
1 /7/85 a oratory Di ector
�1
Explanation of Test Results
Total Coliform Bacteria
Coliform bacteria are an indicator of the sanitary quality of a water supply. Water supplies may become
contaminated from malfunctioning septic systems, cesspools and surface runoff. A total coliform count of zero
indicates that your water supply is safe and approved for human consumption. A-total coliform count of greater than
zero is most often the result of accidental contamination of the sample bottle through improper sampling methods.
For this reason, it would be advisable to retest any well water that is not approved.
PH
pH is the measure of acidity or alkalinityof the water. On the pH scale, the number 7 is neutral,less than 7 is acidic
and more than 7 is alkaline. The pH of water on Cape Cod tends to be acidic in the range of 5.0 to 6.5.
Conductivity
Conductivity is a measure of the dissolved salts in solution.Amounts in excess of 500 rnicromhos./cm are generally
considered unacceptable and may have a laxative effect upon users.
Iron
The presence of iron in water.in concentration of .3 ppm or greater may: give the water a bittersweet astringent
taste, cause an unpleasant odor, often gives the water a brownish color and cause staining of laundry and porcelain.
The average concentration of iron in Cape Cod's water is .2 - .6 ppm. Although the presence of iron in water .nay
cause the problems listed above, it is not considered deleterious to health. Iron may be removed by use of an iron
removal system.
Nitrate-nitrogen
r
The Massachusetts Drinking Water Regulations have set a maximum`contaminant level for nitrates at 10 ppm.
Excessive concentrations may cause methemoglobinemia (an infant disease) and have been suggested m
potentially carcinogenic nitrosamines.'Contamination sources include fertilizers, cesspools and industri
Copper + ,
Due to the acidic nature of the water on Cape Cod, copper tends to leach from pipes. This normally does not
present a health hazard; however, concentrations in excess of 1.0 ppm may cause a metallic taste and/or a
bluish-green stain on porcelain fixtures. ,
Sodium
A concentration of sodium over 20 ppm is only of concern to people who are on a low sodium diet. If the water
supply has more than 20 ppm sodium, it is up to the people who are on such a diet to find another source of drinking
water or;contact'aheir doctor;to determine`if`dAsuming the water is advisable. Concentrations exceeding 50 ppm
indicate that there may be ocean water or-road.salt runoff water getting into the well.
env,<nn
Jr--rno: r;t)lt:' v .'Crl ;W 24� .ea e 9 ..,t! ur:.m,t -.moa a,J9
NO.
TOWN OF BARNSTABLE
P�oFTNero�4 DATE (1 - a
d� o" OFFICE OF
HAHMABIL L BOARD OF HEALTH FEE
� MMl
oo t639. `e�
367 MAIN STREET
HYANNIS, MASS. 02601
VARIANCE REQUEST FORM
All variance requests must be submitted FIFTEEN (15) days prior to the scheduled Board of Health
meeting
NAME OF APPLICANT 1'� c���.,�e t�� � 4��A,tU'(, TEL.
ADDRESS OF APPLICANT .
NAME OF OWNER OF PROPERTY
SUBDIVISION NAME DATE APPROVED
ASSESSORS MAP AND PARCEL NUMBER
LOCATION OF REQUEST I L I I 6\- 42- 2�- ua--
VARIANCE FROM REGULATION (List Regulation) U-�
REASON FOR VARIANCE (May attach letter if more space is needed) - yln wov-�ck n2
'ems- 5 IDti G
C\--SS j2c A— i -S yi uuJ B vv / `r=-L.' uy\ ce-6v n.w
PLAN - TWO COPIES OF PLAN MUST BE SUBMITTED CLEARLY OUTLINING VARIANCE REQUEST.
VARIANCE APPROVED
NOT APPROVED
REASON FOR DISAPPROVAL
Robert L. Childs, Chairman
Ann Jane Eshbaugh
Grover C.M. Farrish, M: D.
BOARD OF HEALTH
TOWN OF BARNSTABLE
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