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Home My WebLink About2439 MEETINGHOUSE WAY/RTE 149 - Health -- - --� 2439 Meetinghouse Way/RTE 149 West Barnstable A = 155 - 038 i i i - S NO.4210113 OLU Interior Folders ESSEM MADEcNUSA ® 0 m 5 f Commonwealth of Massachusetts /� 1 Title 5 Official Inspection Form ! C�1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C, � . 0 :- ` 2439 Meetinghouse Way ' Property Address !Q"~ Barnstable Housing Authority Owner Owner's Name k information is required for every W. Barnstable g= MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information 5n14 Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number - License Number B. Certification I certify that:) am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);l have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes - 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 10-26-18 Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth of Massachusetts 3 Title 5 Official Inspection Form - h.. i�l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments `�•;_ �< 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete'1, 2, 3, or 5-and all of 4 and 6. 1) System Passes: I have not found an information which indicates that an of the failure criteria described ® Y Y in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in good working order with no sign of failure. 2) System Conditionally Passes: ❑ '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. Check the box for"yes", "no"or"not determined" (Y, N, ND)for 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. ❑ Y ON ❑ ND (Explain below): t, f , t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 f c 4� Commonwealth of Massachusetts ,,, Title 5 Official Inspection Form h. 1,41 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ 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 ❑Y ❑N ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 161 Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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. w❑The system has a septic tank and SAS and the SAS is within a Zone 1 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 a septic 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 fecal coliform bacteria indicates absent 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. c. 'Other: 4) System Failure Criteria`Applicable to All Systems: You must indicate "Yes"or."iNo"to each of the following for all inspections: Yes . No . ❑ ® Backup of sewage into facility or system component due to 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts 1� Title 5 Official Inspection Fora '•-1 i-ll Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure.Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 Y2 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 SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. '® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. 5) 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. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. 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 II of a public.water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts 3 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r S... 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is W. Barnstable required for every �ti'" MA 02668 10=26-18 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ft If you have answered "yes"to'any question'in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall,upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate'regional office of the Department. . . , . t 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health 9 El ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the,system obtained and examined? (If they were not available note as N/A) ® •• ❑ Was the facility or dwelling inspected for signs of sewage back up? = x E ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ z 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? Wasthe 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: 0 ❑ Existing information For example, a plan at the Board of Health. t ® E] *° 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(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 I f Commonwealth of Massachusetts ,a Title 5 Official Inspection Form i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information . 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No 1 yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage Well water 9 ( Y g (9Pd)}: Detail: Sump pump? ® Yes ❑ No Last date of occupancy: 2018 Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �- Title 5 Official. l ns ection Form d w rl Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149 .t - �, T: ) Property Address Barnstable Housing Authority { Owner Owner's Name information is required forW. Barnstable MA 02668 10-26=18 ' v eery page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: 4. Type of Establishment:' Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: ,,, Last date of occupancy/use: Date ` Other(describe below): 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? - Reason for pumping: t5ins .doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 P P 9 p Y 9 r Commonwealth of Massachusetts Title 5 Official Inspection Form i'1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � ?J ' 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) r 4. 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2009 Were sewage odors detected when arriving at the site? - ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ® cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form w 10'i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: - ' - 12" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) t If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal two compartment Sludge depth: 1211 Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 6" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 r - Commonwealth of Massachusetts 1� 3, Title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. 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 per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �w Title 5 official Inspection Form i3OI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): 4 *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 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.): Good condition with water at working level and no sign of back-up from field. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sevaage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 6� 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching'pits number: ® leaching chambers number: 3-500's ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 + c Commonwealth of Massachusetts Title 5 Official Inspection Form Q Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149 Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach chambers in good condition and empty at inspection with stain line at 6"off bottom of chamber. 12. 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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 f Commonwealth of Massachusetts 3� Title 5 Official Inspection F o rm f 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,;.. ., 2439 Meetinghouse Way (Rte 149) • Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. Cityrrown State Zip Code Date of Inspection D. Systems Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Ili Subsurface Sewage Disposal System Form Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is W. Barnstable - €.`r required for every MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ®hand-sketch in the area below ❑ drawing attached separately I. 6 µif - - ' 17 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts II Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way Rte 149 Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date.of design.plan reviewed: Date ® 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: Original design plans show no groundwater at 10'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form �i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2439 Meetinghouse Way (Rte 149) Property Address Barnstable Housing Authority Owner Owner's Name information is required for every W. Barnstable MA 02668 10-26-18 page. City/Town . State Zip Code Date of Inspection E. Report Completeness Checklist-- complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: . . I . For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 (4 A �� oN a3 ,� fe l jF- q rn � AGfi ASFsSS4R'S MAP LOT�3� 0. INSTA 1,M'S NAM&PROM NO I r h fi I SE C TANK CAPACI.T'Y S. �{ � �''`e ....... LEACHtI+TCI PAICR l'1'Y':.(type) `C'�Q�"�La (size) 3 ^SGU S f 'Dot OR o ER P'�RR/l�TDATE = CfA/Li'11R►S�TCE 5a�niratic�i9esEatt�$aEvrean kt,7a� Availmumt'uBtetlCnputtdwutc'Cabtetotlla$crttamafLaa;htn vaga,�1la►t r +yr la}1 swd d�eaa�ing aci#aty .iIf"y.welts ax4st a gtta Ar..wltbu► .Aff fcst of tatutt�ftlity).. ca9 �Fd�i of�Netland o►lat L.eHc�lA��a�c�dity.(ti's�ty:wi;ttancls exist vltlat1 300 faet f leua,Ing�`ucllxty} 1 a� -by:C r� 3 �so� ya� 37'9 3—33"P 3clf Ni T WN OAF BARNSTABLE 60CATION J /9, 5 SEWAGE# CaC�`3 VILLAGE ASSESSOR'S MAP&PARCEL t5S t74n73 INSTALLER'S NAME&PHONE NO. Co A&IT' SEPTIC TANK CAPACITY j ,sw Itcyp « � LEACHING FACILITY:(type) �3 •VM cOryw LS (size) /&<` q Y NO.OF BEDROOMS ` 1�Q-, V a P71 �— OWNERs �� l PERMIT DATE: 1,A it, ipS COMPLIANCE DATE: Separation Distance Between th : 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) /0(j Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY .5 3/09 No. Fee �O v THE COMMONWEALTH OF MASSACHUSE17S Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARN TABLE, MASSACHUSETTS Yes 01pphration for 3D1st108al 6p �onstCULtion 3permit Application for a Permit to Construct( ) Rep ''( ) Upgrade(Abandon( ) ❑Complete System El Individual Components Location Address or Lot No.1024:1 ��`at t V`� Owner's Name,Address,and Tel.No. 3 1..? Assessor's Map/Parcel �cel 'j � Zo l o Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 21 Lot Size \ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil 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 lace the system p y in operation until a Certificate of Compliance has been issued by this Bo of Health. Si Date�Z ([ S Application Approved by Date`D I O"-,\ Application Disapproved by Date for the following reasons Permit No. Date Issued �'— _"ia+"'t^'��lFr':."�wHk�srf�.'vYR.+ni te- •a�.;.w,•rm.r«c. r. ;.�,✓,.,�..-,..r-.r' .r-al..,10) G No. C7-l�a l 4P i .:"� " Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes Y, appfiration for Misposal *Ps M Construrtion Permit Application for a Permit t9 Construct( ) Repa('ir( ) Upgrade`(_ Abandon( ) El complete System El Individual Components M 71 fr6 a j 1// u Location Address or Lot No. �ZO_J L t A Owner's Name,Address,and Tel.No. Assessor's Map/Parcel I T j 3� ;� � � l Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �YB-gsoZ Type of Building: Dwelling No.of Bedrooms 2— Lot Size n _sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date /0 -65 Title Size of Septic Tank Type of S.A.S. Description of Soil r1 Nature of Repairs or Alterations(Answer when applicable) 4 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 Certificate of Compliance has been issued by this Board of Health. Datevz-- ( i b Application Approved by� Dater 1 a Application Disapproved by Date for the following reasons Permit No. 1O Date Issued i C THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (ertifirate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned( )by kA.e`cQy c� at < kI N W .\-'S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.aXq 410(pdated ra, C, Installer omits •Q`' Designer owe mc✓ 2\\ #bedrooms _Z_ Approved design flow^ .3 gpd The issuance of this permit'shall not be construed as a guarantee that the system wi I�fun tiion as designel Date a-Ilcdd Inspector v No. � f•'-� `� �. G !� Fee •�Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Bisposal 6pstem Construrtion Prmit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at 2y 3-k '\2—WNr_ k-k`t W and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. ` Provided:Construction must be completed within three years of the date of this 7by Date I � I Approved Dec 11 09 05:19p DESMOND WELL DRILLING 508-240-1003 p.1 . . ri E:VVIR0 TECH LABORATORIES, INC. MA CERT. NO.:M-14A 063 8 Jan Sebastian Drive Unit 12 Sartdwicb,MA 02563 (508)R88-6460 1-800-339-6460 FAX(508)888-6446 Client Name Desmond Well Drilling Location Barnstable Housing Dept.,2439 Meetinahouse Address PO Box 2783 W.Barnstable,MA Orleans MA 02653 Sample Date 11/13/09 Collected By Desmond Welts Sample Time 13:15 Strntple Type Drinking Water Date Received 11113/09 Lah Order Ninnher DW-93375 Well Specs 4"SCH40 PVC 60731' F- Location Source Date Collected Time Collected Comments q 11/13109 13:15 :1nn1}•sis Requested !lints Recommended Lintits Ana lysis ResnlJ Vfethod Date Analyzed Arrah d B} Total Coliform 1100m] 0 0 SM9222B 1 1/1 312 0 09 MC pH pH units 6.5-8.5 5.81 SM4500-H-8 11/1312009 LL Specific Conductancen umhos/cm 500 405 EPA 120.1 11113=9 LL Nbte-N mg/L 1.00 <0.004 EPA 300.0 11/1312009 LL Nitrate-N mg/L 10.0 0.74 EPA 300.0 11113QO09 LL Sodium mglL 20.0 68.0 EPA 200.7 11116/2009 MC Total Ironn mgfL 0.3 0.05 EPA 200.7 11/1612009 MC Manganesen mg/L 0.05 <0.008 EPA 200.7 11/16/2009 MC Corrrments: Low pH indicates high corrosive characteristics. Sodium level is not a heaRh hazard,but if on a low soduim diet,consult a physician before drinking Water meets EPA standards and is suitable for drinking for parameters tested. • Date RonalJr. ari Laboratory Director BRL=Below Reportable Limits *See Attached Page 1 of 1 oCereifieation is not available for this analyse for non potable water samples.. Dec 11 09 05:19p DESMOND WELL DRILLING 508-240-1003 p.2 CERTIFICATE OF ANALYSIS Page: 1 I Reaort For: Barnstable County Health Laboratory Report Dated: 1 I!16/2009 r,,�.�t��• Sally Desmond Order No.: G0955272 Desmond Well Drilling P O Box 2783 Orleans, MA 026-r3 Laboratory ID#t: 0955272-01 Description: Water-Drinking Water Sample tl: Sampling Location: 2439 Meetinghouse Rd.West Barnstable,MA Collected: 1113i2009 Rt:cc ivcd: 1 I 1 J 13!:009 Collected by: Customer EPA 524.2- Volatile Organics by GC/MS ITEM RESULT UNITS RL ;VICE Method# .Analv'st Tested ;Vote Dichlorodifluoromethane ND uet 0.50 CPA 524? yn 11/1312009 Chloromethane ND ug/L 0.50 EPA 524.2 yn I';13/2G09 Vinyl chloride ND uF/L 0.50 2.0 EPA 524.2 )m 1 1!13i2009 Bromomethane ND U2)L 0.50 EPA 524.2 yn 1111312009 1,}?-Tetrachioroetltane ND ug/L 0.50 EPA.524.2 yn 11/13!2009 1,!-Trichloroetttane ND - ugjL 0.50 300 EPA 5242 yn 11J13/2009 1, 1;1,2?-Tetrachloroethane ND uglL 0.50 EI'A.524.2 yn 1111312009 > > > yn 11113+2009 1,1,2-Trichloroethane ND ut:/l- U.50 5.0 EPA 524._ ND ug/L 0.30 SPA 524.2 yn 11,11312009 1,1-Dichioroethane , l v1312o09 !,I-Dichloroeth ene ND ug/L 0.50 7A EPA 524.2 yn 1,l-Dichloropropene ND uglL 0.50 EPA 524.2 yn 11/13/2009 l,2,3-Trick lorobenzene ND uy'L 0.50 EPA 324.2 yn 11/13/2009 1,2,3-Tri chi oropropane ND ug!L 0.50 EPA 534.2 yn 1]J;312UU9 l,2,4-Trichlorobenzene ND uC-/L 0.50 70 EPA 524.2 y't� I?13'_'U09 ug/L 0.50 EPA 524.2 yn 1P_009 1,2,4-Trimethylbenzene ND EPA 5'4 2 v 1113n 1 It1312oa9 uA 0.50 1,2-Dibromo-3-chloropropane ND EPA S,a 2 yn 11/13/2009 0.50 600 EPA 5- 1 2-Dibromoethane(EDB) ND U� 0.50 ,4_, yn I I/13/_009 1,2-Dichlorobenzene ND ugtL 1,2-Dichloroethane ND uglL 0.50 5.0 EPA 524.2 yn 1 1/1 312009 1,2-Dichioropropane ND u&(L 0.50 EPA 524.2 yn 1 ill 3)2009 ND ug/L 0.50 EPA 524.2. yn 1 1113lZU09 !,3,5-Trimethylbenzene EPA 524, yn 1 t113;2W9 1,3-Dichlorobenzene ND uZ 0.50 l,3-Dichioropropane ND ug/L 0.50 EPA 524? yn 11/13'2009 1,4-Qichlorobenzene ND ub/L 0.50 5.0 EPA,524.2 }n 1 1/13/2009 1-Dichioropropane ND uF'L OSO EPA 524.2 yn I U13/2UU9 ug/L 0.50 EPA 524.2 }n Ilil3^009 2-Chlorotoluene ND ND uglt. 0.50 GPA 524.2 yn 1'.1132009 4-Chlorotoluene yn 11113i200 Benzene ND uU'L 0.50 5.0 EPA 524.2 9 IND u&L 0.50 EPA 524.2 yn 1 E/1312009 Bromobenzene 0 Bromochloromethane ND ury'L .5D EP.15242 yn11l1312UU9 Bromodichloromethane ND u&!L 0.50 EP.45242 yn 11J13l2D09 ND uFft, 0.50 EPA 524.2 5`n l I11312C09 Bromoform u,L 0.50 4.0 L'•?A 524.2 yn t 1/1311-004 Carbon tetrachloride ND ND=None Detected RL = Reporting Limit \1CL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Dec 11 09 05;19p DESMOND WELL DRILLING 508-240-1003 p.3 CERTIFICATE OF ANALYSIS Page: 2 Report For: Barnstable County Health Laboratory Sally Desmond Report Dated: IM6,2009 Desmond Well Drilling Order No.: G0955272 P O Box 2783 Orleans, MA 02653 Laboratory ID#: 0955272-01 Description: Water-Drinking Water Sample I$: Sampling Location: 2439 Meetinghouse Rd.West 13arnsluble,MA Collected; 11113f2009 Collected by: Customer Received: 11/1312009 EPA 524.2- Volatile Organics by GUMS ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Chlorobenzene ND ug/L 0.50 l00 EPA 524.2 yn I I!13!2009 Chloroethane ND ug/L u.50 EPA 524.2 yn 1143/2009 Chloroform ND ug/L 0.50 80 EPA 524.2 yn 1 I/l3/2009 cis-1,2-Dichloroethene ND ug/L 0.50 70 EPA 524.2 yn I I/13/2009 cis-1,3-Dichloropropene ND ug/L 0.50 EPA 52e.2 yn I1/13/2009 DibromochIoromethane ND uWL 0.50 EPA 524.2 yr: I1A312C09 Dibrornomeihane ND ug/L 0.50 EPA 524.2 yr, 11/13r--009 Ethvlbenzene ND ug/l, 0.50 700 EPA 524.2 yn 11/1312009 Hexachlorobutadiene ND uF1L 0.50 EPA 524.2 yn 11/13n009 Isopropylbenzene ND ugiL 0.50 EPA 524.2 yn I 111312009 Methylene chloride ND ugiL 0.50 5.0 EPA 524.2 yn 11/13;2009 Methyl-tert-buLyl ether ND ulpL 0.50 EPA 52=.2 yn iIi1312009 Naphthalene ND ue1L 0.50 EPA 524.2 yn 1 ul2/2009 n-Butylbenzene ND uG'L 0.50 EPA 524.2 yn 1]/13)2009 n-Propylbenzene ND ug!L 0.50 EPA 524.2 yn I1/t312009 p-lsopropyltoluene ND u&'L 0.50 EPA 524.2 yn 11/13/2009 sec-Butylbenzene ND uglt. 0.50 EPA 524.2 yn 11/13/2009 Styrene ND ug/L 0.50 100 EPA 524.2 yn 1 U1312009 tert-Buty-lbenzene ND ub'L 0.50 EPA 524.2 yn 1 I/13/2)009 Tetrachloroethene ND uglt. 0.50 5.0 EPA 524.2 yn I I!1312009 Toluene ND urn 0.50 1000 EPA 524.2 yn 1 1!1312009 Total xylenes ND ug/L 0.50 10000 EPA 524.2 yn 11113l2009 trans-1,2-Dichloroethene ND uWL 0.50 100 EPA 524.2 yn 1 1/1 312009 trans-1,3-Dichloropropene ND ug/L 0.50 EPA 524.2 ya '.1113/2009 Trichloroethene ND uWL 0.50 5.0 EPA 524.2 yn 11/13/2009 Trichlorofluoromethane ND tiEJL 0.50 EPA 5242 yn 11/13/2009 Aaached please find the laboratory certified parameter list. Approved By' (I Direclor)i KID=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Town of Barnstable Barnstable FTHE Tp� Board of Health 1 BARNSTABLE, : 200 Main Street,Hyannis MA 02601 y MASS. 0390 ,�� 2007 OFFICE: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 JunichiSawayanagi Paul Canniff,D.M.D. BOARD OF HEALTH MEETING RESULTS Tuesday, October 13, 2009 at 4:00 PM, School Administrative Building, Conference Room 230 South Street, Basement Level, Hyannis, MA I. Hearinq — Underground Storage Tanks: GRANTED Peter Doyle and Dale Saad, Water Pollution Control One Year Ext. Division, Town of Barnstable, owner— 382 Falmouth Road (a.k.a. 617 Bearse's Way), Hyannis, Map/Parcel 293-001, request for a year extension. The Board voted to approve a one year extension. Peter Doyle explained that the tanks are in a self contained vault and only six inches of them are actually below ground. The replacement of the tanks is very costly. The Board would consider this an above ground tank. 11. Septic Variance: GRANTED Thomas McLellan, Bass River Engineering, representing WITH Barnstable. Housing Authority, owner— 2439 Meetinghouse CONDITIONS Way. (Rte. 149), West Barnstable, Map/Parcel 155-038, 0.41 acre lot, requesting setback variances from wells. The Board voted to approve the three setback variances to wells with the following conditions: . 1) revised plans will be submitted showing a two_ compartment tank and must show the water line from the well to the house,:and 2) must test the water before receiving a septic permit. .Z III. Variance — Food (New): GRANTED A. Neia Moore, owner, Neia's Appetizers —459 (rear unit) / 2-1 /a� WITH 461 Main Street, Hyannis, grease trap variance. CONDITIONS The Board voted to approve a grease trap.variance with the menu dated 10/13/09 with the following conditions: 1) it passes a health inspector's inspection to operate, and 2) a grease trap log of weekly cleaning must be kept. Page 1 of 3 Town of Barnstable WE Regulatory Services Thomas F. Geiler,Director & Public Health Division 639.A�� Thomas McKean,Director Ma+ ' 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 17-'��'4� Sewage Permit# AGM- Mo Assessor's Map/Parcel (55 Installer&Designer Certification Form Designer: TH OMAJ M(,LZUA N ,P.`E, Installer: -Me- '.J Address: BOX )43 Address: Jt SSG- B L� GAS l PEW A/)) . !" �?� � j�� 1.�`y4h1lr",I On lZ- •�� ' was issued a permit to install a (d te) ('(nstaller) septic system at Z y 3 9 Ro vY E 1 4 q based on a design drawn by (address) THbmAS AAWFulAN R-F dated KEVISO 1'0'2, (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. Stripout (if required) was inspected and the soils were found satisfactory. 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. Stripout(if req i cd spected and the soils were found satisfactory. N�NOFMg4 c o THC%VkS J. McLELLA(V o CIVIL (Installers Si attire) v 9 r10-364710 STEQZ �S�IONRI��' (Designer's S ture), (Affix Desig s Stamp 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. gAoffrce forms\designercer ification form.doc • , f l' t No. - v Fee--'-------------- �-., BOARD OF HEALTH TOWN OF BARNSTABLE Application,forlVe1l ConaructionVermit Application is hereby made for a permit to Construct ( tom, Alter ( ), or Repair ( )an individual Well at: Location Address 4ssessars Map and Parcel Owne Address Installer — Driller Address Type of Building ✓ Dwelling-- ---_---------_------.Other -- Type of Building—=---__--__— No. of Persons-- Type of Well � X0 Capacity— Purpose of Well 'd Z-e- ---- 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 ertificate .of C mpliance has been issued by the Board of Health. Sig 2 -20v 9 Application Approved B 7 A � PP PP Y — ------------ date Application Disapproved for the following reasons: date Permit No. — ___ Issued--- ----------- -_ ______ date BOARD OF HEALTH T*OWWOF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( rj, Altered ( ), or Repaired ( ) Installer at—_—_ '��--- @eTi �vl� �u 5�sZ-,"- ------------------------------------------------------------ has been installed in accordance wit the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. _---------__---Dated----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE -- -- Inspector------_---- ---- -------- s°}NL1 No.-- -I--- 1 Fee--'f-------------- I� ,,w o BOARD OF HEALTH TOWN OF BARNSTABLE Application for Well Con0ruction 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— J ZJ/t T'9.t.cY /�!l �l�i cin I_ 0 1vv� i� �_.__o_R'GC=/��vs ��i•4� aJGa�---_�__-_---_�1L -------------------- - ---___._------------ installer — Driller r Address Type of Building ✓ Dwelling Other - Type of Building—=—---__—______ No. of Persons---_.-.--_----__..____—__�_ Type of Well�-",�C1i yd %_L _ Capacity YP ------ 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 ertificate.of C mpliance has been issued by the Board of Health. AR I _ }--� IdatT ) jlT� Application Approved By — ______-__--_— date Application Disapproved for the following reasons: ----------_------__—_____�_—�f__—_-_- M�� l date Q— Permit No. w ___ --— Issued----- -i I-- — --- ----- - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( ✓')', Altered ( ), or Repaired ( ) by ---�------------- -��,.----------------------------- --------_---_.____----- --—installer .J// /� /UGC-•dL /(/ at has been installed in accordance wit the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. ----_---------Dated----------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - ---- -_ Inspector h BOARD OF HEALTH 1 TOWN OF BARNSTABLE Well Con5truct ion Permit No.•�t��=�>�j'� - � Fee Permission is hereby granted — i! to Construct ( vy, Alter ( ), or Repair ( ) an Individual Well at: No- a?5�39' r�JP�T,n o,.�ee�� Gc/��iSt�� C� Street as shown on the application for a Well Construction Permit No. —__- -—- - -1-"�=- - ----------------------.... Board of Health DATE---�—,'—� I r, -4c r Massachusetts Department of Conservation and Recreation M--h—tts Office of Water Resources CID Well Completion Report 20-NOV-09 10:03:03 WELL LOCATION 267390 GPS North: 410 42.3871 GPS West: -700 22.478' Address: 2439, Meetinghouse Road? Property Owner/Client: Barnstable Housing Authority Subdivision Name: Mailing Address: 146 South Street City/Town: Barnstable City/Town, State:Hya -MA kfFr-S Assessors Map: Assessors Lot #: Permit Number:W2009-028 Board of Health permit obtained: Y Date Issued: 11/12/2009 Work Performed Proposed use Drilling Method Overburden Drilling Method Bedrock New Well Domestic Auger CASING From (ft) To (ft) Type Thickness Diameter 1.00 -57.00 PVC Schedule 40 4.00 SCREEN From (ft) To (ft) Type Slot Size Diameter -57.00 -60.00 Stainless Steel Well .012 4.00 Point WELL SEAL / FILTER PACK / ABANDONMENT MATERIAL From (ft) To (ft) Material Description Purpose WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) Date Method Yield Time Pumped Pumping Level Time to Recover Recovery (GPM) (hrs & min) (Ft. BGS) (Hrs & Min) (Ft. BGS) 11/13/2009 Constant Rate Pump 15.0000 1:30 34.0000 0:01 31 STATIC WATER LEVEL (ALL WELLS) PERMANENT PUMP (IF AVAILABLE) Date Depth Below Ground Pump Description: Measured Surface (ft) Type: Intake Depth: 11/13/2009 31 Nominal Pump Capacity: Horsepower: WELL DRILLER'.S STATEMENT ADDITIONAL WELL INFORMATION Driller: Thomas E Desmond III Developed: Yes Fracture Enhancement:No Supervisor: Thomas Desmond III Rig #: 100 Disinfected: Yes Well Seal Type:None Firm: Desmond Well Drilling Inc. Total Well Depth: 60.000 Depth to Bedrock: Registration #: 764 Date Complete:11/13/2009 Comments: OVERBURDEN From To Description Color Comment Water Loss/Add Drill Drill (ft) (ft) Zone of Fluid Stem Drop Rate .00 5.00 Silty Clay Brown No N/A 5.00 35.00 Fine to Coarse Sand Brown Yes N/A 35.00 45.00 Medium Sand Brown Yes N/A 45.00 60.00 Fine to Coarse Sand Brown Yes N/A BEDROCK From To Code Comment Water Drill Extra Drill Rust Loss/ # of (ft) (ft) Zone Stem Large Rate Stain Add of Frac ENiVIROTECII LABORATORIES, INC MA CERT. NO.:M-MA 063 8 Jan Sebastian Drive Unit 12 Sandwich,MA 02563 (508)888-6460 1-800-339-6460 FAX(508)888-6446 Client Name Desmond Well Drilling Location Barnstable Housing Dept.,2439 Meetinahouse Address PO Box 2783 W.Barnstable,MA Orleans MA 02653 Sample Date 11/13/09 Collected By Desmond Wells Sample Time 13:15 Sample Type Drinking Water Date Received 11/13/09 Lab Order Number DW-93375 Well Specs 4"SCH40 PVC 60731' Location Source Date Collected) Time Collected Comments A 11113/09 ,. 13:15 Analysis Requested Units Recommended Limits Analysis Result Method Date Analyzed Analyzed By Total Coliform /100m1 0 0 SM9222B 11/13/2009 MC pH pH units 6.5-8.5 5.81 SM4500-H-B 11/13/2009 LL Speck Conductancen umhos/cm 500 405 EPA 120.1 11/13/2009 LL Nitrite-N mg/L 1.00 <0.004 EPA 300.0 11/13/2009 LL _.._. - ----- — - - ---- - .-. ---- Nitrate-N mg/L 10.0 0.74 EPA 300.0 11/13/2009 LL Sodium mg/L 20.0 68.0 EPA 200.7 11/16/2009 MC Total Irons mg/L 0.3 0.05 EPA 200.7 11/16/2009 MC Manganese= mg/L 0.05 <0.008 EPA 200.7 11/16/2009 MC Continents: ---- ---- - Low pH indicates high corrosive characteristics. Sodium level is not a health hazard,but if on a low soduim diet,consult a physician before drinking Water meets EPA standards and is suitable for drinking for parameters tested. • Date i/ /g D ----- --- Ronal J.Saari Laboratory Director BRL=Below Reportable Limits 'See Attached Page 1 of 1 aCertifreation is not available for this analyte for non potable water samples.. N °GrF KEY:TING CONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION 4 PROPOSED CONTOUR:•-••=••• ••• 2"PEASTONE R.4 FLOW ESTIMATE:EXISTING SPOT ELEVATION:25.53/4"2 BEDROOMS AT 110 GAL/DAY=220 GAL/DAY COVERS WITHIN 6" PROPOSED SPOT ELEVATION:25.5 WA -1 1/2" 99.78 OF FINISHED GRAD WASHED STONE TEST HOLE: 1022 SF OFFICE x 75 GAU1000 SF=77 GAL/DAY TOP OF „, INSPECTION PORT LOCUS UTILITY POLE:- TOTAL=297 GAUDAY, (USE 330 MINIMUM DESIGN FLOW) ° FOUNDATION `' -- �.t„ ELEV=94.0 FENCE LINE: HYDRANT:-6 SEPTIC TANK: 6 MAX. VE RETAINING WALL:® 330 GAL/DAY x 2 DAYS=660 GAL 97.4 (1qM NR q'Qp�G �oJ USE 1500 GALLON SEPTIC TANK ELEV, a 95.75 ) F` 1000 500 ELEV. 5 95.38 LEACHING AREA: 96.0 GAL GAL ELEV. ELEV. 91.0 LOCATION MAP USE 3-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH)WITH ELEV. D-BOX F. H 4 ELEV. PARCEL 38 (17,977 SF) 1500 GAL (6"STONE UNDER) ASSESSORS MAP: 155 PARCEL:38 2'OF STONE AROUND SIDES AND 4'AT ENDS (33.5'x 8.8'x 2'DEEP) 2 COMPARTMENT E 3.5'x 8.8 LAND COURT CASE#35274A SEPTIC TANK 93 0 3-500 GALLON CHAMBERS WITH FLOOD ZONE:C SIDE AREA: (33.5'+8.8')x 2 x 2= 169 SF (0.74)7 125 GAUDAY 2'OF STONE AROUND SIDES AND 4' (6"OF STONE UNDER OR ELEV. AT ENDS (33.5'x 8.8'x 2'DEEP) BOTTOM AREA: 33.5'x 8.8'=295 SF (0.74)=218 GAUDAY MECHANICALLY COMPACTED) �H-20) B V TEE SIZES: GAS BAFFLE (TO ENNTED) CAPACITY=343 GAUDAY INLET:6"UP 14"DOWN AT OUTLET TEES(2) OUTLET&CLNTER(3):6"UP, 14"DOWN BVW-4 '` 93 0 �,:� WORK LIMIT LINE(SEE NOTE 17) 2 TH 1 TH 2 �Q Q / PROPOSED WELL 98.0 -V BVW 3 X 94 '?�u"�o�V /r 102'FROM PROPOSED SEPTIC TANK KITCHEN BATH KITCHEN BATH TEST HOLE LOGS O/A HORIZON ELEV. O/A HORIZON ELEV. N r <v� 6 108'FROM PROPOSED LEACH AREA _ LOAMY SAND LOAMY SAND / �2 Avg ✓9 55'FROM EDGE OF WETLAND ENGINEER: THOMAS McLELLAN,P.E. 10YR 5/3 10YR 5/3 6" 97.5 9" 98.3 / tit$ r LIVING AREA LIVING AREA WITNESS: DAVID STANTON,R.S. B HORIZON B HORIZON / oo i/ r/ -BEDROOM -BEDROOM LOAMY SAND LOAMY SAND DATE: 8 28-09 30" 10YR 5/8 95.5 32" 10YR 5/8 96.3 1 / r PERCOLATION RATE: <2 MIN/IN Cl HORIZON Cl HORIZON SILT LOAM SILT LOAM / g6 2.5Y 6/4 2.5Y 6/4 BATH BARNSTABLE GROUND WATER CONTOUR 60" 93.0 72' 93.0 / r C2 HORIZON C2 HORIZON / MAPS AND QUAD SHEET SHOW GROUND MED-FINE SAND MED-FINE SAND BVW-2 / / Y r _ WATER AT APPROXIMATLEY 26'DEEP 2.5Y 7/3 2.5Y 7/3 °� / / Q 9� \ OFFICE OFFICE OFFICE OFFICE 144' 86.0 144" 87.0 SPACE SPACE SPACE SPACE NO GROUND WATER ENCOUNTERED �; / aLu // / �� / / LLU) W I 1st FLOOR 2nd FLOOR NOTES: p i / / � $w // EXISTING FLOOR PLAN 1.VERTICAL DATUM: ASSUMED / � 2a` �' `O / �` / ^�O //��0�v / g�i 0 2.MUNICAPAL WATER IS NOT AVAILABLE. III BVW-1�X � 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 700,E 4.ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. _ 5.PIPE PITCH 1/4 PER FOOT(UNLESS;NOTED OTHERWISE). i of wFT // 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE.SET LEVEL. 95 / / ENO // EXISTING RE-LOCATED WELL TO BE 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. OWN 0� 8.ALL CONSTRUCTION DETAILS ARE TO IBE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL / oo T CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 9.CONTRACTOR TO VERIFY LOCATIONS OF ALCUTILITIES PRIOR TO CONSTRUCTION. 0o; j �a` 7N9ti1 �Q m 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. OA �a� q?,/"�,/ e�`.9, �a �� g`a 11. FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND IS SUBJECT TO CHANGE UNTIL SUCH TIME. Cj 13.EXISTING LEACH PITS ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. �G� ^ 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. TH-1 Q / ` 15.WETLAND DELIEATION BY HAMLYN CONSULTING,HYANNIS,MA. °1 750 /// �� ' LP 1 _ r/ J 16.THIS PLAN REQUIRES THE APPROVAL OF A VARIANCE FROM THE BARNSTABLE BOARD OF HEALTH REGULATION 397-8(E)(1 . DISTANCES BETWEEN WELLS AND SEPTIC SYSTEMS TO BE LESS THAN 150'. 17.WORK LIMIT LINE TO BE DOUBLE STAKED HAY BALES OR SILT FENCE. ��\ ti sf°' BENCHMARK AT 04, 1 e0,• ^ LEFT CORNER a /o, 0 OF BULKHEAD apj y 40 �/ LOCATION: ELEVATION=99.13 a T,e ` LP i GJ 2439 MEETINGHOUSE WAY, es�O J W. BARNSTABLE,MA PREPARED FOR: oaf. THEVIAS J 0 �1 °o�� ```v (' McLELLp �� THE BARNSTABLE HOUSING AUTHORITY- eJ � o CIVIL r DATE:9-3-09 SCALE: 1"-20 TH-2 v �h!v.364710 REVISED:9-23-09(WORK LIMIT LINE) vrn ��` /,, FO ST��4 REVISED: 10-23-09(2 COMPARTMEN SEPTIC TANK) lJj�ry `` v ��siJNAIEt` *- oBASS RIVER ENGINEERING ors THOMAS J. MCI N,P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 508-385-3426 �o M9-17 N °GrF EXSTINGCONTOUR:---- SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION 4 sq PROPOSED CONTOUR:............. '4R FLOW ESTIMATE: 2"PEASTONE EXISTING SPOT ELEVATION:25.5 2 BEDROOMS AT 110 GAL/DAY=220 GAL/DAY COVERS WITHIN 6" 3/4"-1 1/2" PROPOSED SPOT ELEVATION:575 99.78 OF FINISHED GRAD WASHED STONE TEST HOLE:+ 1022 SF OFFICE x 75 GAU1000 SF=77 GAUDAY TOP OF TOTAL=297 GAUDAY, USE 330 MINIMUM DESIGN FLOW) ° FOUNDATION `'' '"` ' m-; INSPECTION PORT LOCUS UTILITY POLE:-O•- ( �� \�, a."'�' Rya ELEV.=94.0 FENCE LINE: �r,as ��, HYDRANT: SEPTIC TANK: -�� O - 6'MAX. RETAINING WALL. / DAY -660 GAL 330 GAL DAY x 2 S 7.4 V �eqQ OJ�� SEPTIC TANK ELEV. a (C1 M N) O� Q USE 1500 GALLON SE T C ° 95.75 LEACHING AREA: 96.0 1000 500 ELEV. 5.55 95.38 GAL GAL ELEV. ELEV. 91.0 LOCATION MAP USE 3-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH)WITH ELEV. D-BOX H . . . , H ELEV. PARCEL 38 (17,977 SF) ° 1500 GAL (6"STONE UNDER) 2'-4' 2'-4' ASSESSORS MAP:155 PARCEL:38 2'OF STONE AROUND SIDES AND 4'AT ENDS (33.5'x 8.8'x 2'DEEP) 2 COMPARTMENT le3.5'x 8.8' LAND COURT CASE#35274A SEPTIC TANK 3-500 GALLON CHAMBERS WITH FLOOD ZONE:C SIDE AREA: (33.5'+8.8')x 2 x 2=169 SF (0.74)=125 GAL/DAY OR 93.0 2'OF STONE AROUND SIDES AND 4' BOTTOM AREA: 33.5'x 8.8'=295 SF (0.74)=218 GAUDAY 6' CH STONE UNDER ALLY COMPACTED) ELEV. AT ENDS (33H'208.8'x 2'DEEP) TEE SIZES: GAS BAFFLE (F ) CAPACITY=343 GAUDAY INLET:6"UP 14"DOWN AT OUTLET TEES(2) (TO BE VENTED) OUTLET&CLNTER(3):6"UP, 14"DOWN 13VW-4 N` _,g3 ?O �� WORK LIMIT LINE(SEE NOTE 17) PROPOSED WELL TH-1 TH-2 x g4 o�V , 102'FROM PROPOSED SEPTIC TANK KITCHEN BATH KITCHEN BATH TEST HOLE LOGS ELEV. ELEV. BVW-3 4 O/A HORIZON O/A HORIZON i i 4 y 108'FROM PROPOSED LEACH AREA N �S a ig 55'FROM EDGE OF WETLAND LOAMY SAND LOAMY SAND / OU o i ENGINEER: THOMAS McLELLAN,P.E. 10YR 5/3 10YR 5/3 i Q ^�O i 6" 97.5 9" 98.3 LIVING AREA LIVING AREA WITNESS: DAVID STANTON,R.S. B HORIZON B HORIZON -BEDROOM -BEDROOM LOAMY SAND LOAMY SAND / / DATE: 8-28-09 30' 10YR 518 95.5 32" 10YR 5/8 96.3 PERCOLATION RATE: <2 MIN/IN Cl HORIZON Cl HORIZON / gro SILT LOAM SILT LOAM 55' , BATHI Hill 60 2.5Y 6/4 93.0 72" 2.5Y 6/4 93.0 / BARNSTABLE GROUND WATER CONTOUR / C2 HORIZON C2 HORIZON BVW-2 MAPS AND QUAD SHEET SHOW GROUND MED-FINE SAND MED-FINE SAND Z ,� i _ WATER AT APPROXIMATLEY 26'DEEP 2.5Y 7/3 2.5Y 7/3 xc?i / / Q g ''J \ OFFICE OFFICE OFFICE OFFICE 144' 86.0 144' 87.0 SPACE SPACE SPACE SPACE NO GROUND WATER ENCOUNTERED I Xz% ,� / / u W I 1st FLOOR 2nd FLOOR NOTES: O/ / / o N / EXISTING FLOOR PLAN ry09 /�O�G.rQ\ S / 0 1.VERTICAL DATUM: ASSUMED 1 // ^ / h 3� // a g0' 2.MUNICAPAL WATER IS NOT AVAILABLE. BVW ' 1 x 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 4.ALL PRECAST 1/4'UNITS PER FOOT(UNLESS NOTED OTHERWISE). WITH AASHTO H-20 SPECIFICATIONS. 5.PIPE PITCH i R O 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL. RE-LOCATED AS SHOWN EXISTING WELL TO 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. O 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS. ENVIRONMENTAL T CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 4$'+ 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. �7 Tti2C0 Q- / 10.GROUND COVER OVER ALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 3'. /016 ) to �l 5`a 11. FIELD SURVEY PROVIDED BY TERRY A.WARNER, P.L.S., HARWICH,MA. p��aT 9�T�Oi�Oi OJ�OO a40 12 SHIS PLAN REQUIRES THE SUB ECT O CHANGE UNTELISEW AND CH TIME APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND O 13. EXISTING LEACH PITS ARE TO BE PUMPED AND FILLED WITH SAND OR REMOVED. �� O�Vlt �, 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. / \*TH-1 �� Q Q `V 15.WETLAND DELIEATION BY HAMLYN CONSULTING,HYANNIS,MA. Sp, / LP to i / 16.THIS PLAN REQUIRES THE APPROVAL OF A VARIANCE FROM THE BARNSTABLE BOARD OF _Jx // �� ^. �"'�� s' HEALTH REGULATION 397-8(E)(I). DISTANCES BETWEEN WELLS AND SEPTIC SYSTEMS TO BE LESS THAN 150'. 17.WORK LIMIT LINE TO BE DOUBLE STAKED HAY BALES OR SILT FENCE. o `'- �� `sfO�ie / ^ti°� a ,� SITE PLAN BENCHMARK AT h, LEFT CORNER °f �� m e o, OF BULKHEAD �4(/ LOCATION: ELEVATION=99.13 eT� 1 LP �' 2439 MEETINGHOUSE WAY,W.BARNSTABLE,MA yes ,` '�•� J + `A ? �` � , PREPARED FOR: McL ELLRlV co THETHE BARNSTABLE HOUSING AUTHORITY- TH-2 o CiviL y DATE:9-3-09 SCALE: ll -20 am`ST4�<O REVISED:J, REVISED:10-23--09�(20RK COMPARTMLIMIT EN)) T SEPTIC TANK) NA 0�14u �� / �0 BASS RIVER ENGINEERING �� ° I / O Vz p0 (Z�O� P.O.BOX 1163, EAST DENNIS,MA 02641 THOMAS J. McLE L N, P.E. 508-385-3426 M9-17 `�