HomeMy WebLinkAbout2464 MEETINGHOUSE WAY/RTE 149 - Health �2464 Meetinghouse Way=
{ W: Barnstable
1 1� .155 -028
I
T
r r TOWN OF BARNSTABLE
LOCATION �t�� P� �(��Cltl S�r $WAGE#
VILLAGE ASSESSOR'S MAP&PARCEL
INSTALLER'S NAME&PHONE NO. S G"� On �r�,� �S��d��{ 006J
SEPTIC TANK CAPACITY t / G,�@,\ fir( 0� \S�t� �t,�S c. Z 1�r Ka
LEACHING FACILITY:(type) LO QQ<s15, 6C 9— (size) I-?X-"L!�'Y-
NO.OF BEDROOMS LJ QS A,`L
OWNER
PERMIT DATE: ka l l 116 COMPLIANCE DATE: a 4 1/�
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) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility)c r Feet
FURNISHED BY VLe P[6a
spcoi o,. Fori 14
I
No. �D lf� Fee 01
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
Tipplitatlon for Disposal *- pstrm Constr LtIOt� permit z
N
Application for a Permit to Construct( ) Repair(/Upgrade( ) Abandon( ) Complete System ❑Individual ComponeniP(''
Location Address or Lot No. l.� MC,�� r•�l�•(>v b{ Owner's Name,Address,and Tel.No.Assessor's Map/Parcel ,$$'_ U.3 CXY W9_s4C 'rr��hc. �' ��C k S "f- 1�/
Installer's dame,Address,and Tel.No.S'6a a?c)Lf 66(0 �Designer's Name,Address, Tel.No.elf\47 313
Sco k���t,✓� (� _� c
\ L� �rNLvU �tcl ,1 "Ci Cro:5 G
Type of Building: a,
Dwelling No.of Bedrooms _` Lot Size S�� O sq.ft. Garbage Grinder(N
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided—�3 g,d
Plan Date to 19.S 1 Number of sheets Revision Date y Oj
Title
Size of Septic Tank \! CbO GG,,L VI , kC k, Type of S.A.S._ (ZOU s GS� 3 6
Description of Soil r-, n0 S /\.
(")ejS 1 G `1 n� CJe e
Nature of Repairs or Alterations(Answer when applicable) ' 2(ZAC U_ e,xt SN kn i CC 30 6 d 1 S
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 f Health.
Signed rr Date
Application Approved by a Date
Application Disapproved by Date
for the following reasons
Permit No. ).l) Date Issued
_ 'Z w r .F `' n w....„ .,I, F s �`) h. F L�.Af ltr-ram ".l ids,9^• a< .., ' -['
41
ul
No. 411✓!1l/ /, •�tr t�_ .1 H Fee
THE COMMONWEALTH OF MASSACHUSETTS - Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS I'`es
�Ippflcatlon for -M4po8a1 ,*pstPm Constr '`ctlon Permit
Q
Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ®Complete System ❑Individual Component'O
Location Address or Lot No. a (�y Mc ,LN%ny kOv St -Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel 1$S_ U may t�ey�t( ►rr4�c �'•'" �r�lCn 5 ����
.�
Installer's Name,Address,and Tel.No. ., a5 4 ah io y Designer's Name,Address,and Tel.No.svk,q-7-7
\� r r^0UA01INd ka C�r,nt Mcl kZL k,�< S1'i (.,r05 ,--etd O '�:c>et-*j_u rnc,
Type of Building: ^^ ��.�"r,3
Dwelling No.of Bedrooms _1 Lot Size of S C sq.ft. Garbage Grinder N t�
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) It U gpd Design flow provided " gpd
Plan Date Number of sheets Revision Date 1.0,iir_ 1 j /)/j 7J,/('
Title
Size of Septic Tank Ge,,L P(c.sks s Type of S.A.S. L (I o, c, a� /a r)-s 3 6 H.C
k Description of Soil V ni k`S c..c%N,1y_ rNo SAo/-p---
- 1 �
Nature of Repairs or Alterations(Answer when applicable) �{J�GC¢ P.X S� �, Cc.SS42 0 0 t S
t
I'
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 Boar f Health.
Signed A Date
Application Approved b nn
PP PP Y i A. (� 1- Date
Application Disapproved by Date r
for the following reasons
Permit No. Date Issued )2.- ( —l
r ,
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(/) Upgraded( )
Abandoned( )by "; _^V�_
- at C.� Lr�r t�..i �.G u C U � L/ has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. DOI b - da e
Installer 5COkk c-L.�V f, Designer '[A C s M C:cx�-t�
#bedrooms Approved design
jflow f
S gpd
The issuance of this permit shall not be construed as a guarantee that the system will !" ctiaj esigned.
Date �l1 Inspector / Q�
1 1
--------- --------------- - --------------------------------------------------
No. 26 l b ' M I� Fee dU'
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Disposal 6pstem Construction JPrmit
Permission is hereby granted to Construct( ) Repair((' Upgrade( ) Abandon( )
System located at 0 L((.(,t M� tc>n p �V y �+-��� 1 ��� f jG A Si-Cl
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 ust be completed within three years of the date of this permit.
P�®r�
Date 7 /,// Approved by oell
r
Town of Barnstable
Regulatory Services
o�
Richard V. Scali, Interim Director
* BARNSfABLE,
MASS. Public Health Division
i639•
p'FD3,�A Thomas McKean, Director
200 Main Street,Hyannis,MA 02601
Office: 508-862-4644 Pax: 508-790-6304
Installer & Designer Certification Form l
Date: ��1� �� Sewage Permit# ZC�It��-� ���Assessor's Map\Parcel 1s-, 62'9
Designer: v.c�;v, E �,; € � -Ls 1 t Installer: 5CC4+ vy(/C-
Address: i C Gv, C.(-X. s`-� 1 I«� Address: Z�3 C (d �a-��
0�41tj ww, S
On Lk was issued a pen-nit to install a
(date) ' (installer)
nn
septic system at �� t'" 4'L-40-� based on a design drawn by
(address)
L L,n He-t. f 0= dated Z -7
(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. Strip out (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. Ilan. revision. or
certified as-built by design r to follow. Strip out (if required)was inspected and the soils
were found satisfactory. (_a ,�,�.ecf l 19l4(n f'U(c-� ) .Z'-7 1 S t
1 certify that the system referenced above was constructed in con Hance with the terms
of the 11A approval letters (if applicable) of Ado,
os
o PETER T.
EN
(Installer's Signature) o M c vi E�
No. 35109
xP" �'£GIsjvv',
�F S
(Designer's Signature) (Affix Desig Here)
PLEASE RETURN TO BAR.NSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTA,BLE PUBLIC HEALTH DIVISION.
THANK YOU.
Q:\Septic\Designer Certification Form Rev 8-14-13.doe
Town of Barnstable
oFn�erat Regulatory Services
m
Richard V.Scali,Interim Director
Public Health Division
—�k
p�E8 psA9A•y p�0� Thomas McKean,Director
200 Main Street,Hyannis,NIA 02601
Office: 508-862-4644 Fax. 508-790-6304
Romeowner Certification Form for Alternative Systems
Property Address:, Z 'ty 6*1 m ee- rrY, kou s, g "� 0
Assessor's Map\PF-rcel: i j�_ � f '♦
Property Owners lame:
Ili accordance with Massachusetts DEP alternative system approval letters, the following certification
information is regt:u-ed by the Owner of record. The Owner of record must place an `Y" in the
applicable box next to each line certifying the information.
Yes N\A
r�'_- ❑ I have been provided a copy of the Title 5 I/A technology Approval letters.
(15 page Standard Conditions letter and the specific technology letter)
—' I have been provided with the Owner's Manual
J I have been.provided with the Operation and Maintenance Manual
0 For Systems installed under a Remedial Use Approval,I agree to fulfill my
responsibilities to provide a Deed Notice as required by 310 CMR 15.287(10)
and the Approval
❑ For Systems installed under a Remedial Use Approval,I agree to fulfill my responsibilities to
provide written notification,of the Approval to any new Owner,as required by
310 CMr_15.287(5)
10 If the des'.gn does not provide for the use of garbage grinders,the restriction is understood
and accepted.
❑ Whether or not covered by a warranty,I understand the requirement to repair,replace,modify
or take any other action as required by the Department or the LAA,if the Department or the
LAA determines the System to be failing to protect public health and safety and the
environment,as defined in 310 CMR 15.303
I V G-rb t�, S �� < agree to comply with all terms and conditions above.
Property Owners printed name
e,Gl 11-10-16
Owners Signature Date
Note This C. must be submitted along with the septic system disposal works permit
aoolication for all I\A systems including new construction repairs\upgrades, with and
without a•22reLmte (stone) and with conventional design criteria or credited design
criteria.
Q:\Septic\IA homeowner certiHcation.doc
Town of Barnstable. r# /0-4 26
' Department of Regulatory:Services
Public Health Division Hate. z 11 w
200 Main Street,Hyannis MA 02601
DiMKf
Date Scheduled f Time
Fee Pd
lc� - .
Soil Suitability Assessment for Sew ge Dspostal
Performed By: Pe,4e C 01C C,4"e'e Witnessed By:
LOCATION& GENERAL INFORMATION
Location Address r Owner's Name
ate. uQ� �0.g
Ui
Address 2 Co
LW . B s 54 v Z.G C9
Assessor's Map/Pt=l: 1,j 51 t Engineer's Name � (IC
NEW CONS a�RUC rION 1 REPAIR Telephone# 56 F" 7 3-7—Y 7 C 5r_
Land Use 1� 4 t it-`Cam_ Slopes(%) 2%t Surface Stones IVOA- ,
Distances from: Open Water Body tom/ ft Possible Wet Area 4� A ft Drinking Water Well ft
Drainage Way ft Property Line 15-J-za ft .Other` t}
SKETCH:(Street name,dimensions of lot,exact locations of testholes&Pere tests,locate wetlands in proximity to holes)
ee ; � '�`y
Parent material I �r�l(geo ogic) /"W''G /+ Depth to Bedrock, n
Depth to Groundwater. Standing Water in Hole: W Weeping from Pit Face
Estimated Seasonal High Groundwater
1 3
DETERMINATION FOR SEASONAL HIGH WATER TABLE
Method Used:
Depth Observed standing in obs.iroie: in. Depth to loll mottles:
Depth to weeping from side of obs.hole: in, Oroundwater Adjustment ft.
Index.Will# Reading Date: Index Well level,� �..,, Adi.ihetor Adj-..flroundwater'Levgl
PERCOLATION TEST We Time
Observation
Hole# J
Depth-of Perc 4 1 Time at V.
Start Pre-soak Time @ Pima(9"=6")
End Pre-soak
1�r
Rate Min./Inch 2 "
Site Suitability Assessment: Site Passed_�„� Site Failed: Additional Testing Needed(Y/N)
Original: Public Health Division Observation Hole Data To Be Completed on Back-----------
If percolation test is to be.conducted within 100 of wetland,you must first notify the.
Barnstable Conseirvation Division at least one(1)week prior to beginning.
Q:ISEPTICIPERCFORM.DOC
DEEP.OBSERVATION'HOLE`LOG Hole# f
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders.,
Consistency v
4 j)Z hut.
8 lam, 2y�z
(o®�10 ems, N+5 s a/
f3.
•
DEEP`OBSERVATION HOI:E°LOG Hole# 2
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders.
s• %Gravell
2 G5 � �
C Z �pe►��e e Z� `C �7 vws
DEEP OBSERVATION'HOLE LOG Hole#
Depth from Soil Horizon Soil Texture .. Soil Color. Soil Other
Surface(in.)" (USDA) (Mansell) Mottling (Structure,Stones,Boulders.
CM t to e
w
DEEP OBSERVATION HOLE LOG Hole#
Depth from. Soil Horizon Soil Texture Soil Color Soil Other
Surface(in:) (USDA) (Munsell) Mottling (Structure,.Stones,Boulders.
o
Flood Insurance--Rate Map:
Above 500-year flood boundary No Yes
Wittiio 50l)'year'boundary No. es
Within.100 year flood boundary No.!?�-- Yes
Depth of Naturafly Oeeurrine Pervious Materf al_
Does at l tIr ur�•feet of nit tually occurring pervious^G r►al existin all areas observed throughout.the_
area proposed for the soil absorption system?
If not,whafis the depth'of naturally occurring pervious material?
Certification
I cernfy that on (date)I have passed'.the-soil evaluator examination approved by the
Department of Environmental Protection and that the above analysis was performed by-me.consistent with
the requir wining;expertise and experience described in�10`CMR'15.017.
Signatur Date
Q'\4BPTICIPBRCFORM•DOC
t
a 'M CERTIFICATE OF ANALYSIS Page: 1
L RECEIVE®
Barnstable County Health Laboratory
''�crnrtcvs�/
Report Prepared For: Report Dated: 7/15/2003
JUL 2 3 2003
���� SAj Order Number: 0320699
TOWN OF BARNSTABLE
David Flagg PARCEL - o Z% HEALTH DEPT.
PO Box 74
West Barnstable, MA 02668 LOT _
Laboratory ID#: 0320699-01 Description: Water-Drinking Water "y
Sample#: 20699 Sampling Location: 2464 Meetinghouse Way W Barnstable MA Collected 6/25/2003
Collected by: D Flagg 155-028 Received 6/25/2003
Test Parameters
ITEM RESULT UNITS MCL Method# Tested
LAB: Microbiology
Total Coliform Absent CFU/looms. 0 307 6/25/2003
Note: Water sample meets the recommended limits for drinking water of all above tested parameters.
Approved By: _
(Iab Director)
a
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
^1 �`i pE NARKS
jO CERTIFICATE OF ANALYS Page: 1
�3'✓ A[CHl',s,�ti`"� Barnstable County Health Laboratory RE�E11�E®
Report Dated: 07/18/2003 JUL
Resort Prepared For: J �3
Order Num e_r: G0329��
David Flagg Yuri''r�.Apw
HE�iLT' GE:;r�BtE
PO Box 74
West Barnstable, MA 02668
Laboratory ID#: 0320919-01 Description: Water-Drinking Water
Sample#: 2091901 Sampling Location: 2464 Meetinghouse Way,W.Barnstable Collected: 07/02/2003
Collected by: D Flagg 155-028 Received: 07/02/2003
Routine+Ammonia
ITEM RESULT UNITS MDL MCL Method# Tested
LAB:IC Lab
Ammonia <0.1 mg/L 0.1 EPA 350.1 07/02/2003
Nitrates 0.9 _ mg/L 0.1 10 EPA 300.0 07/07/2003
LAB:Metals
Copper <0.1 mg/L 0.1 1.3 SM 3111B 07/10/2003
Iron <0.I mg/L 0.1 0.3 SM 3 111 B 07/10/2003
Sodium 12 mg/L 1.0 20 SM 3111B 07/10/2003
LAB: Microbiology
Total Coliform Absent P/A 0 Absent 309 07/02/2003
LAB: Physical Chemistry
Conductance 148 umohs/cm I EPA 120.1 07/02/2003
pH 6.6 pH-units 0.1 EPA 150.1 07/02/2003
Note: Water sample meets the recommended limits for drinking water of all above tested parameters.
t
. ..
Y t
t
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
i
Page: 2
CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory
Report Prepared For:
Report Dated: 07/18/2003
Order Number: G0320919
David Flagg
PO Box 74
West Barnstable, MA 02668
Laboratory ID#: 0320919-02 Description: Water-Drinking Water
Sample#: P338 339 340 Sampling Location: 2464 Meetinghouse Rd.,W.Barnstable Collected: 07/02/2003
Collected by: D Flagg 155-028 Received: 07/02/2003
EPA 524.2- Volatile Organics by GUMS
ITEM RESULT UNITS MDL MCL Method# Tested
LAB: GUMS
1,1,1,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 07/07/2003
1,1,1-Trichloroethane BRL ug/L 0.5 200 EPA 524.2 07/07/2003
1,1,2,2-Tetrachloroethane BRL ug/L 0.5 EPA 524.2 07/07/2003
1,1,2-Trichloroethane BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
1,1-Dichloroethane BRL ug/L 0.5 EPA 524.2 07/07/2003
1,1-Dichloroethene BRL ug/L 0.5 7.0 EPA 524.2 07/07/2003
1,1-Dichloropropene BRL ug/L 0.5 EPA 524.2 07/07/2003
1,2,3-Trichlorobenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
1,2,3-Trichloropropane BRL ug/L 0.5 EPA 524.2 07/07/2003
1,2,4-Trichlorobenzene BRL ug/L 0.5 70 EPA 524.2 07/07/2003
1,2,4-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
1,2-Dibromo-3-chloropropan BRL ug/L 0.5 EPA 524.2 07/07/2003
1,2-Dibromoethane(EDB) BRL ug/L 0.5 EPA 524.2 07/07/2003
1,2-Dichlorobenzene BRL ug/L 0.5 600 EPA 524.2 07/07/2003
1,2-Dichloroethane BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
1,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 07/07/2003
1,3,5-Trimethylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
1,3-Dichlorobenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
1,3-Dichloropropane BRL ug/L 0.5 EPA 524.2 07/07/2003
1,4-Dichlorobenzene BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
2,2-Dichloropropane BRL ug/L 0.5 EPA 524.2 07/07/2003
2-Chlorotoluene BRL ug/L 0.5 EPA 524.2 07/07/2003
4-Chlorotoluene BRL ug/L 0.5 EPA 524.2 07/07/2003
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
f
Page. 3
CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory
Report Prepared For:
Report Dated: 07/18/2003
Order Number: G0320919
David Flagg
PO Box 74
West Barnstable, MA 02668
Laboratory ID#: 0320919-02 Description: Water-Drinking Water
Sample#: P338 339 340 Sampling Location: 2464 Meetinghouse Rd.,W.Barnstable Collected: 07/02/2003
Collected b D Fla 155-028
Y� Flagg Received: 07/02/2003
Benzene BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
Bromobenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
Bromochloromethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Bromodichloromethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Bromoform BRL ug/L 0.5 EPA 524.2 07/07/2003
Bromomethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Carbon tetrachloride BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
Chloro u 0.5 100 benzene BRL EPA 524.2 07/ 7�- 0 /2003
Chloroethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Chloroform BRL ug/L 0.5 EPA 524.2 07/07/2003
Chloromethane BRL ug/L 0.5 EPA 524.2 07/07/2003
cis-1,2-Dichloroethene BRL ug/L 0.5 70 EPA 524.2 07/07/2003
cis-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 07/07/2003
Dibromochloromethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Dibromomethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Dichlorodifluoromethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Ethylbenzene BRL ug/L 0.5 700 EPA 524.2 07/07/2003
Hexachlorobutadiene BRL ug/L 0.5 EPA 524.2 07/07/2003
Isopropylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
Methyl-tert-butyl ether BRL ug/L 0.5 EPA 524.2 07/07/2003
Methylene chloride BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
n-Butylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
n-Propylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
Naphthalene BRL ug/L 0.5 EPA 524.2 07/07/2003
p-Isopropyltoluene BRL ug/L 0.5 EPA 524.2 07/07/2003
sec-Butylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
Styrene BRL ug/L 0.5 100 EPA 524.2 07/07/2003
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
f
i0
s?, CERTIFICATE OF ANALYSIS Page. 4
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 07/18/2003
Order Number: G0320919
David Flagg
PO Box 74
West Barnstable, MA 02668
Laboratory m#: 0320919-02 Description: Water-Drinking Water
Sample#: P338 339 340 Sampling Location: 2464 Meetinghouse Rd.,W.Barnstable Collected: 07/02/2003
Collected by: D Flagg 155-028 Received: 07/02/2003
tert-Butylbenzene BRL ug/L 0.5 EPA 524.2 07/07/2003
Tetrachloroethene BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
Toluene BRL ug/L 0.5 1000 EPA 524.2 07/07/2003
Total xylenes BRL ug/L, 0.5 10000 EPA 524.2 07/07/2003
trans-1,2-Dichloroethene BRL ug/L 0.5 100 EPA 524.2 07/07/2003
trans-1,3-Dichloropropene BRL ug/L 0.5 EPA 524.2 07/07/2003
Trichloroethene BRL ug/L 0.5 5.0 EPA 524.2 07/07/2003
Trichlorolluoromethane BRL ug/L 0.5 EPA 524.2 07/07/2003
Vinyl chloride BRL ug/L 0.5 2.0 EPA 524.2 07/07/2003
Note:
Approved By:
ab irector)
d�
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
r
ENVIROTECHLABORATORIES,INC.
MA CERT.NO.:M-MA 063
449 Rte. 130
Sandwich, MA 02963
508(888-6460) 1-800-339-6460
FAX(908)888-6446
CLIENT. David Flagg LOCATION: 2464 Route 149
ADDRESS: 323 Willmore Place W Barnstable MA
Syracuse NY 13208
COLLECTED BY. DA Scannell SAMPLE DATE: 4/28/2000
SAMPLE TIME: 3:00
WATER SAMPLE TYPE: New Well Repair DATE RECEIVED: 5/1/2000
LAB I.D. #. 0005005
WELL SPECS.: 48'
RESULTS OF ANALYSIS:
Parameters Units Recommended Results Method Date Analyzed
Limits
Coliform bacteria /100ml 0 0 9222 B 5/1/2000
pH pH units 6.5-8.5 6.53 4500 H+ 5/1/2000
Conductance umhos/cm 500 139 120.1 5/1/2000
Nitrate-N mg/L 10.0 0.768 300.0 5/1/2000
Nitrite-N mg/L 1.00 < 0.003 300.0 5/1/2000
Sodium mg/L 28.0 10.6 200.7 5/3/2000
Iron mg/L 0.3 < 0.005 200.7 5/3/2000
Manganese mg/L 0.05 < 0.001 200.7 5/3/2000
COMMENTS:
WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES
FOR PARAMETERS TESTED.
<=less than Date S l ZO
>=greater than Ronald J. Sa #
TNTC=too numerous to count Laboratory Wector
i
+ Department of.Environmental Manage ment/Division of Water Resources
WELL COMPLETION REPORT
' WELL LOCATION. GEOGRAPHIC DESCRIPTION
dress S E W of
` (feet) (circle)
GiCy/Town A_* �abtp A,T( 9
o Well owner �. (road)
Address21P,J��t► N E W of
(mi.in tenths) (circle)
r Soard o f H alth permit obtained: yes 'no El Intersect.
(road)
WELL USE WELL DATA
t DomesticEVPublio❑ Industrial❑ Total well depth YLft.
Monitoring'❑ :Other Depth to bedrock ft.
Water-bearing rock/unconsolidated material:
Method drilled.
L Description _Kj— _Arse��.4lJ
Date drilled - — Water-bearing zones:
CASING 1) From To
Type �C 2) From To
LengYhft:.Dia(LD:) _in. 3) From To
Length into bedrock. ft. Gravel pack well: dia.
Protective well seal: C a.
Screen:
Grout ❑. Other Slot#115—length from to
STATIC.:WATER LEVEL(all Wells)
Static wafer. level.below%land surface _A. Date 116
WELL`TEST,(production wells)
Drawdown _ ft after pumping hr. in. at gpm
How.measured���_Recovery 2is.; after - hr.—min.
LOG of FQRMATIONS COMMENTS
0
;Materials` ':' .From To
CD
Driller-Q ®i�wAyO
Firm. — �AriAMO `� ��/,�-(
Arl Address Ie-
City/Town f
Supervising,Driller Reg.#
Signature of supervising registered well driller
?lease pint firmly BOARD OF HEALTH COPY
Lv 2 '
No.-------------------- Fee----------- -------...--
BOARD OF HEALTH
TOWN OF BARNSTABLE t�
Appiicat ion,forlVell Cootructionpermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair (&/fan individual Well at:
---� Y =---'^' __ �. _-- ---- -- l X-S"- D Z �
---- - --------------- -----------------------------------------------------
Location — Address Assessors Map and Parcel
Owner Address
-----------—--------------------------------------------------- t4 _ C° — ``r(,/ ,'
Installer — Driller Address
Type of Building
Dwelling--------------------------------------------------------------
Other - Type of Building--------------------------------- No. of
Persons--------------------------------------------
Type of Well ------
----------- Capacity
Purpose of Well -----------------------------------------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
r➢/Ob
Signed D ..�.f - - ------------------- - --5�--------------------
date
Application Approved By , - --------- — �3 v/Uy
Application Disapproved for the following reasons:--------------------------------------------------------------------t--------------
---------------------------------------------------------------------------------------------------------------------------------------------------------
�_ date
Z _
-3 d — 7,va�
Permit No. -�--- -------------------------- Issued-----------5 -------------------------------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certifttate ®f (Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( A4-
bY---------------- --- -1-A Sc. ---------------------------------------------------------------------------------------- --- --
A Installer
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection
Regulation as described in the application for Well Construction Permit No. 2 Dated--r--=-30= '
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
i
SYSTEM WILL FUNCTION SATISFACTORY.
DATE- --- —- —-- ---- ------ -- Inspector-----------------------------------------------------------------------
BOARD OF HEALTH
-Azg TOWN OF BARNSTABLE
)Vr11 congtruct ion Permit
No Z Fee
Permission is hereby granted O A-Jca l�---------------------------------------------------------------------------
to Construct ( ), Alter ( ), or Repair (4-1 an Individual Well at:
--------------------------------------------------------------------------------------
Street
as shown on the application for a Well Construction Permit
w LcziL -Z �►' S= -- ------------------------
------------ Dated------------------- ------7- -v 7--------------------------------------------- -----
Board of Health
DATE---- - ---- - -- ----- -
-No.-------------------- BOARD OF HEALT Fee------
. H / (1 ��
TOWN OF BARNSTi�#� v�l
�p�tication,�'or�e[r �on�� �uct�io �rmit �
Application is hereby made for a permit o Construct ( ), Alter ( ), or Repair (VTan i ndivi u Dell-atk�
/S' ZI
------------------- -----
Location Address Assessors Mad and Parcel —
t f/f�- L. S (; v r e -) ---r y-,-G--5--
Owner Address
i
_A-S wr --------------------------------------- _ __ r -� y �J
Installer Driller Address
--Type of Building N,C� JJC
Dwelling------—------------------------------------------------------
Other - Type of Building ------------------ No. of Persons-----;----------------------------_-------------
r, ;, u
Type of Well--4--%�4---=--- - ----- -- Capacity--- -- - - - - --—
Purpose of Well--QQ-n1.S r's- -- - - ---------
( Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of Compliance has been issued by the Board of Health.
Signed --------
✓/ s f�a/cu
---- -- �, -----------date ----------
--
Application Approved By -- ----- - - !------- J ate
Application Disapproved for the following reasons: ---------`- ------ --- -------------------
{
--------------------------------=-- ------------------------------------------------------------------------------------------------------
date
2 3
Permit No. -�—i��------ ----—-------- Issued---------�--- ---------------G - e4wl>---------------------------------
` date
1' :i�sas�sseat'�saraeass�eae�.mcearswas,=am==+nmM=9MMU IMAMM I _.
BOARD OF HEALTH
/Ss=oZB TOWN OF BARNSTABLE
(Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( o4-
- - �cu.r----- /--------------------bY- ------- -- - --- L-
--------------------------------------------------------------------------------------
Installer n
has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection r
Regulation as described in the application for Well Construction Permit No.4! R-zyDated `-'> "
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE--------- ---- -- - --- -- Inspector---------------------------------------------------------------------------
\ � r
No"T S i.
V
LEGEND
- 98-- EXISTING CONTOUR N
gg PROPOSED CONTOUR ® Rom
x 100.98 EXISTING SPOT GRADE �9p Eq
99.6 PROPOSED SPOT GRADE
WELL ♦ EXISTING WELL �` �� °HyeV
H.W.- OVERHEAD WIRES �00 c v�F o LOCUS
W EXISTING WATER SERVICE edOr o,
TEST PIT (oPProx.) Sri
PPf
Ben chm ark No.2 BENCHMARK
e1 TOP OF CONCRETE BOUND x 91.46 church S1
VG EL.=92.04 (Assumed datum)
01$�
x 91.53
x 91.23 91s7 N 36'10'30" E x 93.22 LOCUS MAP
CB NOT TO SCALE
92.04 /i 91.64-
x 92.09 9 .42 x /� CONVENTIONAL S.A.S.
-- �<78 FOR ILLUSTRATION ONLY-DO NOT INSTALL
S.A.S. WAS MOVED TO ALTERNATE FORM0R \.�' LEACH FIELD: LENGTH=30', WIDTH=20'
LOCATION DUE TO UNSUITABLE SOILS o J\ BOTTOM AREA ONLY = 600 SF
ENCOUNTERED DURING INSTALLA;ION \
x /i �OCPZ�O�, TOTAL CAPACITY = 0.74 GPD/SF(600 SF) = 444 GPD
92.19 // � �-
94.93 / x 97.93
o
c� x 98.52
6)
PROPOSED x 24"Z�25
SEPTIC TANK 94.85 / o � VENT
o �J INSPECTION PORT
EXISTING LEACH PIT- 1 o
TO BE PUMPED, FILLED co
W/ SAND & ABANDONED Di TP-3 /
97.14 +99.01 fence / x 100.73
x
EXISTING CESSPOOL
TO BE PUMPED, FILLEG � x 99.80 CABANA 29'
x 99.61
W/ SAND & ABANDONED 99. _.
99.94 _ 100.02 (SLAB)
PROPOSED SEWER CONNECTIONS '. `x 99.94 102,28
LOWEST PIPE INV.=95.9±(VERIFY) INGROUND '. GARAGE WELL
SWIMMING POOL .
99.9 d: I
GONG.:: t x 101.73
Z ;
100.47 'PA TIO ..99.96
99.97.._ 1 0.81
N J 1 0.93 00.96
co Cn N 100.50:-'
L4 9a 00 Z
t�
1 N 1
QRI VEWA Y v co
cn
i
N11101.76 S614' :' O
X 101.35`
102.44 Q
103.0 ,P 102.64 "+
103.23
x < 0 60 10 71 102.4 �o.» Ben ch m ark No. 1
2.
TOP/FOUNDA TION AT BULKHED
1 102,81 PORCH x 102.12 :v`,.;;3 EL.=103.72 (Assumed datum)
x EX._ SEWER
10 62
x 3 x
47
102.58 CELLAR DE _,�;/WELL
x 102.84
SEWER
V.=102.0±
102.34 T.O.F.=103.72± CRAWL '`''' x 101.9
SPACE
102.1 PORCH EXIS77NG '
102.18 HOUSE 2.13-
- (#2464)
+ , CRAWL SPACE 3
101.88 \\ x ,30
101.97 / 100.95
O yx'102.01
MBLU 155-028
♦ 25,330 S.F.± -c.:.: O
WELL 101.01 io0i.41. Sg O
+100,32 a91.61' 101.01 101,3T
160- S 37'40'10" W x
SIDE0LK-4-00 - PK SET P
0.00 100.00
P
99.27 99.52 99.59
97.98
MASS, MEETINGHOUSE WAY PLAN REVISION - 12/7/16
cyG 1) MOVED TANK & S.A.S. LOCATION
PETERET.E (Route 149) DUE TO UNSUITABLE SOILS
MIEN 2) ADDED SOIL LOG (TP-3)
CD
CIVIL
0. 35109 PROPOSED SEPTIC SYSTEM UPGRADE PLAN
A90F Ip j Ao 2464 MEETINGHOUSE WAY, W. BARNSTABLE, MA
Prepared for: Kenneth Skelley, 2464 Meetinghouse Way, W. Barnstable, MA 02668
Engineering by: SCALE DRAWN JOB. NO.
OWNER OF RECORD i Works, Inc. 1"=30' P.T.M. 235-16
SKELLEY, KENNETH R & DOROTHY S Engineering
2464 MEETINGHOUSE WAY 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
WEST BARNSTABLE, MA 02668 (508) 477-5313 10/25/16 P.T.M. 1 of 2
NOTE: TO PREVENT BREAKOUT, THE PROPOSED
FINISH GRADE SHALL NOT BE < EL.94.1
FOR A DISTANCE OF 15' AROUND THE
SEPTIC TANK PROPOSED S.A.S.
PERIMETER OF THE S.A.S.
INSTALL RISERS & COVERS OVER INLET & PROPOSED D-BOX INSTALL INSPECTION PORT OVER END UNIT
OUTLET AND SET TO 6' OF FINISH GRADE
INSTALL RISER & WATERTIGHT
T.O.F.=103.72t COVER SET TO 6" OF GRADE CHARCOAL
F.G. EL.=102.6t F.G. EL.=97.3t F.G. EL.= 98.5t F.G. 98.0 to 99.5 (MAX.) VENT
MAINTAIN 2% GRADE (MIN.) OVER S.A.S.
u•D.aA u•io.oia
L = 18' _ INSPECTION
S=I% (MIN.) TOP OF TANK=95.41 p SL 1% (MIN.) ® S=1% (MIN.) PORT
4'SCH40 PVC za•nncow+ 4"SCH40 PVC
4"SCH40 PVC
13'
10 14- s 10.75" TO
44" LIQUID LEVEL
INVERT
ADD (6 ROWS OF 5 UNITS AT 5.0'/UNIT) = 25.0'
c S BAFFLE INV/ r%1"1, .=94.50 PROPOSED INV.=94.33
BOTT. OF TANK=90.87 INV.=94.59 D-BOX UNITS MUST BE STAMPED HD
PROPOSED 1500 GALLON SEPTIC TANK INV.=94.10 SOIL ABSORPTION SYSTEM (PROFILE)
INFILTRATOR IM1530 GALLON PLASTIC TANK
INV.=94.84 ESTABLISH VEGETATIVE COVER
CONNECT TO EXISTING SEWERS BACKFILL WITH CLEAN NATIVE OR
LOWEST PIPE INV.=95.9 (VERIFY) PERC SAND TO TOP OF CHAMBERS
BREAKOUT=TOP
NOTES: TOP ELEV.=94.58
INV. ELEV.=94.10
1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE
INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=93.50-a
2) SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND 4' (MIN.) OF NATURALLY 2.83'
TRUE TO GRADE ON A MECHANICALLY COMPACTED OCCURING PERVIOUS MATERIAL
SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN EFFECTIVE WIDTH=17.0'
310 CMR 15.221(2). 5' (MIN.) ABOVE HIGH G.W.
3) INSTALL INLET & OUTLET TEES AS REQUIRED. EXISTING SUITABLE
NO G.W., EL.=84.0 = MATERIAL
4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE
AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. USE 6 ROWS OF 5-ADS Arc 36HC HD UNITS WITH
NO SEPARATION BETWEEN EACH ROW & NO STONE
SEPTIC SYSTEM PROFILE TYPICAL SECTION
N.T.S.
GENERAL NOTES:
1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL LOG - SOIL LOG
BOARD OF HEALTH AND THE DESIGN ENGINEER.
2• ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS
OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE DATE: JUNE 26, 2012 (REF#13,675) DATE: DECEMBER 7, 2016
LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: PETER McENTEE (SE#1542) DURING INSTALLATION
-310 CMR 15.405(1)(b): CONTENTS OF LOCAL UPGRADE APPROVAL WITNESS: DONALD DESMARAIS R.S. BY PETER McENTEE SE
1) A 2' variance to the 3' maximum cover requirement, for a total HEALTH AGENT
of 5' max. cover. SAS shall be HD and vented. ELEV. TP-1 DEPTH ELEv. TP-2 DEPTH ELEv. TP-3 DEPTH
-LOCAL REGULATION: 150' SETBACK REQUIREMENT-WELL TO S.A.S.
.2) A 22' variance, private well (subject site) to proposed S.A.S., 97.0 0 95.0 A LOAMY SAND 0 99.0 A 0"
for a 128' setback. LOAM FILL 10YR 4/2 LOAMY SAND
3) A 21' variance, private well (House#2454) to proposed S.A.S., 96.0 12" 93.5 18" 10YR 4/2
fora 129' setback. A B 97.5 181,
LOAMY SAND LOAMY SAND B
3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 10YR 4/2 10YR 5/8 LOAMY SAND
30„
'TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 945 B 10YR 5/8
DESIGN ENGINEER. 92.5 30" 96.0
LOAMY SAND 36"
4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 10YR 5/8 PERC C1 C
FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 0 36 /54"
ENGINEER BEFORE CONSTRUCTION CONTINUES. MED. SAND
5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 92 0 C1 60 2.5Y 6/4
6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF MED. SAND MED. SAND
THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF 2.5Y 6/4 89 0 2.5Y 6/4
HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 88.0 108'
7. WATER SUPPLY PROVIDED BY PRIVATE WELL. C2 DENSE C? 72"
DENSE
8. THERE ARE NO WELLS WITHIN 100' OF THE PROPOSED S.A.S. COARSE SAND COARSE SAND
& GRAVEL & GRAVEL
9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS 87.0 2.5Y 5 3 120" 84.0 2.5Y 5 3 132" 87.0 120"
AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE PERC RATE <2 MIN/IN.("B" HORIZON) PERC RATE <2 MIN IN.
DIRECTED BY THE APPROVING AUTHORITIES. NO GROUNDWATER ENCOUNTERED NO GROUNDWATER
10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY
THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING
CONSTRUCTION.
11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS
IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND
REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3).
12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE 63.25"
INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL.
13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 16"
IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY.
14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED PIPES 34.5"
OR SEPTIC SYSTEM COMPONENTS NOT SHOWN ON THIS PLAN.
15. THE CONTRACTOR SHALL VERIFY THAT ALL SEWAGE FLOW FROM BOTH
BUILDINGS IS CONNECTED TO THE PROPOSED SEPTIC SYSTEM.
DESIGN CRITERIA TOP VIEW
NUMBER OF BEDROOMS: 4 BEDROOMS 60"
SOIL TEXTURAL CLASS: CLASS I END CAP END CAP
FRONT VIEW SIDE VIEW
DESIGN PERCOLATION RATE: <2 MIN/IN END CAP
DAILY FLOW: 440 GPD REAR/TOP VIEW
DESIGN FLOW: 440 GPD NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SIDE VIEW
TO WITHUT NOTICE. DETAIL MAY
GARBAGE GRINDER: NO AND NOT DESIGNED FOR USE OF A DIIFFERA SLIGHTLY FROM ACTUALRODUCT PRODUCT APPEARANCE.
GARBAGE GRINDER.
LEACHING AREA REQUIRED: GPD 440 = 594.6 SF 4640 TRUEMAN BLVD
( ) HILLIARD, OHIO 43026 Are 36HC HD DETAIL a
74 GPD/SF ADVANCED DRAINAGE SYSTEMS.INC.® UNITS MUST BE STAMPED HD
PROPOSED SEPTIC TANK: 1500 GALLON CAPACITY
INFILTRATOR IM1530 GALLON PLASTIC TANK PROPOSED SEPTIC SYSTEM UPGRADE PLAN
PROPOSED D-BOX: 1 INLET, 6 OUTLET (MINIMUM), H-10 RATED
USE 6 ROWS OF 5-ADS Arc 36HC HD UNITS WITH 2464 MEETINGHOUSE WAY, W. BARNSTABLE, MA
NO SEPARATION BETWEEN EACH ROW & NO STONE Prepared for: Kenneth Skelley, 2464 Meetinghouse Way, W. Barnstable, MA 02668
BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF UNIT) Engineering by: SCALE DRAWN JOB. NO.
(Arc36HC Units) 30 UNITS x 5.0 LF x 4.80 SF/LF = 720.0 SF Engineering Works, Inc. N.T.S. P.T.M. 235-16
DESIGN FLOW PROVIDED: 0.74 GPD/SF(720.0 SF) = 532.8 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO.
NOMINAL AREA OF S.A.S. = 17' x 25' = 425 SF (508) 477-5313 10/25/16 P.T.M. 2 Of 2