HomeMy WebLinkAbout0968 OAK STREET (CENT./W.BARN) - Health ,68 Oak Street
West Barnstable
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Barnstable County Health Laboratory (M-MA009)
CERTIFICATE OF ANALYSIS
Report Prepared for:
812 Main St
Osterville, MA, 02655
Amanda DeFazio
Order #:
Report Dated:
G25001236
Description:Real Estate- 968 Oak Street,
W. Barnstable
5/6/2025
Laboratory ID#:Matrix:Drinking Water
Sampled:4/30/2025 11:36:00 By:Sample #: G25001236-001 AD
Received:4/30/2025 12:09:00 By:Collection Address:968 Oak Street, West Barnstable, MA zswift
Turn Around:Sample Location:968 Oak Street 4 days
Analysis for residential well testing
ITEM RESULT UNITS RL MCL METHOD #ANALYST TESTED TIME
Nitrate 1.2 mg/L 0.10 10 EPA 300.0 CL 4/30/2025 07:49
Copper ND mg/L 0.10 1 EPA 200.8 CL 5/1/2025 10:51
Iron ND mg/L 0.10 0.3 EPA 200.8 CL 5/1/2025 10:51
Manganese ND mg/L 0.025 0.05 EPA 200.8 CL 5/1/2025 10:51
Sodium 140 mg/L 2.5 20 EPA 200.8 CL 5/6/2025 11:03
Total Coliform Absent Present/Absent 0 0 SM9223B RL 4/30/2025 14:53
Conductance 660 umhos/cm 2.0 EPA 120.1 LX 4/30/2025 15:02
pH 7.0 pH AT 25C N/A SM 4500-H-B LX 4/30/2025 15:02
Sample Results Summary :
The sodium concentration of the water exceeds the MassDEP guideline limit (ORSG) and those on a low sodium diet may wish to consult a physician. The
water may present aesthetic problems due to sodium.
3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 - www.capecod.gov Page 1 of 3
MDL = Minimum Detection LimitMCL= Maximum Contaminant LevelRL= Reporting LimitND = None Detected
Barnstable County Health Laboratory (M-MA009)
CERTIFICATE OF ANALYSIS
Report Prepared for:
812 Main St
Osterville, MA, 02655
Amanda DeFazio
Order #:
Report Dated:
G25001236
5/6/2025
Description:Real Estate- 968 Oak Street,
W. Barnstable
Laboratory ID#:Matrix:Drinking Water
Sampled:4/30/2025 12:15:00 By:Sample #: G25001236-002 AD
Received:4/30/2025 12:41:00 By:Collection Address:968 Oak Street, West Barnstable, MA zswift
Turn Around:Sample Location:968 Oak Street 4 days
Analyst:Analyzed:VOLATILE ORGANIC COMPOUND (VOC) analysis 4/30/2025 LX
Parameter Result MCL MRL MRLMCLResultParameter
ug/L ug/L ug/L ug/Lug/Lug/L
Benzene ND 5 0.50 CARBON TETRACHLORIDE ND 5 0.50
1,1-DICHLOROETHYLENE ND 7 0.50 1,2-DICHLOROETHANE ND 5 0.50
PARA-DICHLOROBENZENE ND 5 0.50 TRICHLOROETHYLENE ND 5 0.50
1,1,1-TRICHLOROETHANE ND 200 0.50 VINYL CHLORIDE ND 2 0.50
MONOCHLOROBENZENE ND 100 0.50 O-DICHLOROBENZENE ND 600 0.50
TRANS-1,2-DICHLOROETHYLENE ND 100 0.50 CIS-1,2-DICHLOROETHYLENE ND 70 0.50
1,2-DICHLOROPROPANE ND 5 0.50 ETHYLBENZENE ND 700 0.50
STYRENE ND 100 0.50 TETRACHLOROETHYLENE ND 5 0.50
TOLUENE ND 1000 0.50 XYLENES (TOTAL)ND 10000 0.50
DICHLOROMETHANE ND 5 0.50 1,2,4-TRICHLOROBENZENE ND 5 0.50
1,1,2-TRICHLOROETHANE ND 5 0.50 CHLOROFORM ND 70 0.50
BROMODICHLOROMETHANE ND 0.50 CHLORODIBROMOMETHANE ND 0.50
BROMOFORM ND 0.50 M-DICHLOROBENZENE ND 0.50
DIBROMOMETHANE ND 0.50 1,1-DICHLOROPROPENE ND 0.50
1,1-DICHLOROETHANE ND 70 0.50 1,1,2,2-TETRACHLOROETHANE ND 0.50
1,3-DICHLOROPROPANE ND 0.50 CHLOROMETHANE ND 0.50
BROMOMETHANE ND 10 0.50 1,2,3-TRICHLOROPROPANE ND 0.50
1,1,1,2-TETRACHLOROETHANE ND 0.50 CHLOROETHANE ND 0.50
2,2-DICHLOROPROPANE ND 0.50 O-CHLOROTOLUENE ND 0.50
P-CHLOROTOLUENE ND 0.50 BROMOBENZENE ND 0.50
1,3-DICHLOROPROPENE ND 0.4 0.50 1,2,4-TRIMETHYLBENZENE ND 0.50
1,2,3-TRICHLOROBENZENE ND 0.50 N-PROPYLBENZENE ND 0.50
N-BUTYLBENZENE ND 0.50 NAPHTHALENE ND 140 0.50
HEXACHLOROBUTADIENE ND 0.50 1,3,5-TRIMETHYLBENZENE ND 0.50
P-ISOPROPYLTOLUENE ND 0.50 ISOPROPYLBENZENE ND 0.50
TERT-BUTYLBENZENE ND 0.50 SEC-BUTYLBENZENE ND 0.50
FLUOROTRICHLOROMETHANE ND 0.50 DICHLORODIFLUOROMETHANE ND 1400 0.50
BROMOCHLOROMETHANE ND 0.50 METHYL TERTIARY BUTYL ETHER ND 70 0.50
VOC Surrogates
Compound Recovery (%)Low Limit High Limit
p-Bromofluorobenzene 93.3 70 130
1,2-Dichlorobenzene-d4 88.8 70 130
Approved By:
On:5/6/2025
Dan White
3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 - www.capecod.gov Page 2 of 3
MDL = Minimum Detection LimitMCL= Maximum Contaminant LevelRL= Reporting LimitND = None Detected
Barnstable County Health Laboratory (M-MA009)
CERTIFICATE OF ANALYSIS
Report Prepared for:
812 Main St
Osterville, MA, 02655
Amanda DeFazio
Order #:
Report Dated:
G25001236
5/6/2025
Description:Real Estate- 968 Oak Street,
W. Barnstable
3195 Main Street, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 - www.capecod.gov Page 3 of 3
MDL = Minimum Detection LimitMCL= Maximum Contaminant LevelRL= Reporting LimitND = None Detected
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TOWN OF BARNSTABLE F�
LOt Y.TTON 969 6�. ��. SEWAGE # awl- -;if
VILLAGE . UU- 3,4-i�� ASSESSOR'S MAP & LOT.J-16—6 7
INSTALLER'S NAME&PHONE NOrZ�aZ
SEPTIC TANK CAPACITY 14nn AA1_ _
LEACHING FACILITY: (typef444-Gl4.t�ut3�� (size
NO.OF BEDROOMS 3cc,�
BUILDER q9 O t�tG�G
PERMIT DATE:"'
ATE: LJ-- 1 r,61 COMPLIANCE DATE:
Separation Distance Between the: .
�Maximum Adjusted GPoundwater Table to the Bottom of Leaching FacilityFeet
Private Water Supply Well and Leaching Facility (If any wells exist �J
on site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by 1edkl C R/e f ✓l�/rs ,��
o
0
�4k Sk
3a,
No. �o .. �s) / t Fee �V
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
Zipplication for Mi0p0ar *pgtem Construction Permit
Application for a Permit to Construct( )Repair(✓)Upgrade( )Abandon( ) O Complete System I individual Components
Location Address or Lot No. Owner's Name,Address and Tel.No.
Assessor's Map/Parcel
Installer's Name,Address,and Tel.No. / /J Designer's Name,Address and Tel.No.
7 71- 3 342- Sal/
Type of Building: �
Dwelling No.of Bedrooms Lot Size-- sq.ft. Garbage Grinder(/ ®
Other Type of Building k& m G'2 No. of Persons a Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow 340 gallons.
Plan Date Z Number of sheets l Revision Date
Title S/
Size of Septic Tank IM?D �4� mil`/.9�J�9 Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) lL� /�i lejewy- A-0
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this Warofeal
Signed Date
Application Approved by Date ` 1 A00/
Application Disapproved for the following reasons
Permit No. U 7 Date Issued iz I 0
r No. Doo 1 I ? z�._.,r, Fee 50
' r '"-t�E�OMMONWEALTII OF MASSACHUSETTS Entered in computer:
Yes
PUBLIC\HEALTH DIVISION =TOWN OF BARNSTABLE., MASSACHUSETTS
Zipprication for Migooal *pgtem Conotruction Permit
Application for a Permit to Construct( . )Repair(✓)Upgrade( )Abandon( ) El Complete System lil h lividual Components
Location Address or Lot �No. Owner's Name,Address and Tel.No.g �`: is ,rig
Assessor's Map/Parcel ��/, /Qn � 4le
Installer's Name,Address,and Tel.No. / lJtf r Designer's Name,Address and Tel.No.
7 7/ 3W
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( D
Other TI pe of Building Kr�SIGrC'��'�° No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow 1/4� gallons per day. Calculated daily flow .330 gallons.
Plan Date o/ Number of sheets Revision Date
Title 1- ilP Lf S/
Size of Septic Tank /11V 94/ �t'�>`ia� Type of S.A.S. J`r149�/Cf9l)�►ld
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
P
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued by this ayr of Realt
Signed ' Date /Z 17`�1
Application Approved by �`�v Date
Application Disapproved for the following reasons
Permit No. U 17 7S7 Date Issued 12 Ig 0
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of (Compliance
THIS IS TO CER,, FY, that the On-site Sf wage Disposal System Constructed( )Repaired(ti)Upgraded( )
Abandoned( )by Zl'el le 7,r //
at ��? �6 /Y 57�. /�/ �l'1�'S !!� has been constructed in a cordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. 20 D 1 -75-7 dated /a /V U/
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the syst will//function:,ddeMid
Date M al�:v 1 Inspector
V
No. 01 l - 75- / Fee �O_
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE} MASSACHUSETTS
Mi,�pozal *pstem Construction Permit
Permission is hereby granted to Construct( )Repair(✓)Upgrade )Abandon )
System located atIN �/ ✓`��'�
and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to
comply with Title 5 and the following local provisions or special conditions.
Provided: Construction must be completed within three years of the date of this errrut.
Date: I llrio I Approved by
i
TOWN OF BARNSTABLE Ee
LOCATION SEWAGE #
VILLAGE ASSESSOR.$M.acP`&:LOT.J-16—6 7
INSTALLER'S NAME&PHONE NOZr'dZtt [S -'t7-1-9 �
T
SEPTIC TANK CAPACITY ieetn,6&
LEACHING FACILITY: :S
(typeT—(-6?xTrG94- GlcA4A3qf
NO. OF BEDROOMS
BUILDER OLGIL�-fit
PERMIT DATE: 1 of COMPLIANCE DATE: 1�I ®
Separation Distance Between the::
Maximum Adjusted.Groun'dwater 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) Feet
Furnished by 1Jk1 ��/��✓�iy-s�,��
q3 1 3 '
0
0
{
d�k s�
LrO CATION SEWAGE PERMIT NO.
: VILLAGE
,1k)f 5t Q(�1L115�A b INSTALLER'S NAME i ADDRESS
6UILDER OR 0_ wtLEQ
f
DATE PERMIT ISSUED
OAT E COMPLIANCE ISSUED
q
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No82 .� o...... Fss...... ...5.00.....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Town Barnstable
...........0 F..........................................................................................
Appliratiou for Uispnsa1 Workii Tomifrurtinn ami#
Application is hereby made for a Permit to Construct ( ) or Repair (x ) an Individual Sewage Disposal
System at:
.268 Oak Street West Barnstable PA 02668
................................. �..................... - -
Location-Address or Lot No.
Keith Pickering ,,,,, „ „ 968 Oak St., West Barnstable; MA 02668
......................--- ---- .... ..........-•------..............
.................
Owner Address
W A & B Cesspool 128 Bishops Terrace , Hyanni s, TA 02601
Installer Address
Q Type of Building Size Lot.... ......... .........Sq. feet
Dwelling—No. of Bedrooms.__.....:..................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type of Building ............................ No. of persons....................... Showers ( ) — Cafeteria ( )
Q' Other fixtures -------••--•---------------•--. -
W
Design Flow............................................gallons per person per day. Total daily flow..............................._............gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
Disposal Trench—No..................... Width.................... Total Length.........._......... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
Test Pit No. 2................minutes per inch Depth of Test Pit______-_-...__-_-_-- Depth to ground water........................
a -------------------------------------------------------------------------------•-------
..... ...........
.. --------•-------------
. "..................
W Sand
Descriptionof Soil........................................................................................................................................................................
W -•-••--------------- -----------------------------------•-•-------•------•--•-------•-••----•-•---•---••-•-•-•-------...----------------•----•--•-•••-•••--------•-•---••------•••--..............-----
UNature of Repairs or Alterations—Answer when applicable..installatifln.._of.a..1,00.0..ga11Qr. ,...pre-east,
-stone.-pa ked----.leach__pdt...(oarerSlow)-•---••-•----•---------•-----------------------------•----------------------------•-------------------•------••-•--•-.
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of H'A iL 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been iss>4ed by the board of ealth.
. _,Signed.VZ'K/'_.a. C...............•---------•-••--••.. 8�31�82......
Date
Application Approved By......... .la...../��/`►��,y $yjij82.-•-..
Date
Application Disapproved for the following reasons:......................................•---•-••...•..-•••---••............................... .._...._.__.._
--------------•-----•--......--------•--.......-•--••---.......--•-----•-----------------•-•---..........-•-•-•-----•--......_
Date
PermitW=.................'.................................... Issued.........8/-31A2.............................
Date
f
No. 2-.y o. Fis.......�....5, 00....
"THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.oW11 Farnstable
.-----.....OF.........................................
ApplirFation for R_qpnsFal Works Tomitratrtion Vamit
Application 'is hereby made for a Permit to Construct ( ) or Repair ( X) an Individual Sewage Disposal
System at:
968 Oak Street, West Parnstable, !,A 02668
................-......•......................................................................... •---•-------------------.._.......-•-••-..........-------•--•------•------•--..........------..._.
Location,"_Address Lot No
Keith Pickerinp , 968 Oak St., West Barnstable, 1^.A 0�2668
.................................................•--.....---•-••-•----•--------•----•--........... ..................................................................................................
W A & E Cesspool Service 128 Bishops Terrace;d isyanni s, M 026�01
14 ...................•---_:...................................................................... •......••---•------------•-•--.....----•-............................---------------•-...........
M Installer Address
d Type of Building Size Lot............................Sq. feet
Dwelling—No. of Bedrooms._..._.....................................Expansion tic ( ) Garbage Grinder ( )
P-4 Other—Type of Building ............................ No. of persons....._.._.�..__.__._._. Showers ( ) — Cafeteria ( )
dOther fixtures -------------------------------------------------------------••••••••••------•-----•---...•-••••...._....•--•--••....•-•-•-••----•-----•-•-•-.........
WDesign Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid*capacity_...........gallons Length................ Width................ Diameter---.._.---___-__ Depth..............
x Disposal Trench—No.................... Width.................... Total Length.................... Total leaching area--------------------Sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I...............minutes per inch Depth of Test Pit.................... Depth to ground water........................ ;
Gz, Test Pit No. 2................minutesper inch Depth of Test Pit.................... Depth to ground water........................
Sax
a --- ------------------- ----------- --------------------•----------------- ...------------------------- ------
iq: ,
O Description of Soil........................................................................................................................................................................
V --_..----•------------------•----•------------------------------- -••••••-
UW ----•-•-•--•............................•----•-----------••----•---••--•---•...•-----...........••••------•--•----_..------------------•----••-•••--•------...-----------------.............•---.._......
Nature of Repairs or Alterations—Answer when applicable..3.nstallati-on- of a. 1.000 Mal Ion, pro-Cast,
s nP._nacic d._...1. �.eh.._?� --(-ovary' �w)-'---------------------------- - ------ -------- -------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITiZ- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issiAed by the bo rd of h alt . ,
Signed _ ',.............rnr
---•---•- .
f t.�., !...........
Application Approved By.--....---- _• ?•... Z•".---•--•-••-•-•-•------ ---•••.................�jf-�?
' Date
Application Disapproved for.the following reasons:-------•----------=---------------------------------------------------
ti.. -
--•--•--•--...-•------------------------------- ----------------•-•---•-----------.......---------.....------------•---•-•---•-•----••-----••-•--•-•----.------------••--•-••-------------...........
Date
Permit N%2...................................................... Issued_..........
8/31/82............................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
Town Barnstable
..........................................O F.....................................................................................
Trrtifiratr of ToutpliFanrr
THIS IS TO CERTIFY,. That the I idual Sewage Dis osal stem constru•te or Repaired ( �`)
A P Ces spool Service, G Bishops �'err�ce, yannis; Y 0 50
by .. ........ ---•-•-••-----------------•-•------_------------------.----.-------------------
er
968 Oak St„ West Fare-stable, 14A 0266�SInstallEei.th Pickering
at--••--------:..•-------- -------- --•-••-• --•••--•---•------------------------------------ •-•••-•••••----------------•---•---------•---- ................................................
has been installed in accordance with the provisions of TIT 5 of The State Sanitary C1idescribed in the
application for Disposal Works Construction Permit No.......... _$.Ro gd.............. dated.......... -- "_�
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
8/31/82
Inspector ` �
DATE--•--••--•-•...............•----------•-----............_••.---- __ 1 . ---_----••-
THE COMMONWEALTH OF MASSACHUSETTS 1
BOARD OF HEALTH
F 2_ TO W'1z.....OF........�Barnsta,ble C0
'5. { 1
No......................... FEE........................
. �
lif filtos al 10orkii T11mitrnrtion ramit
Permission is hereby granted..................................................... poolx '� Ces3 Service
•
to Construct ( ) or Repair (X) an Individual Sewage D,i posal System
at No.......9rF� Cak t , hest Parnstable, 1A 02. - Keith Pickering
• • • .................................................................... -•..............................................
Street S.
as shown on the application for Disposal Works Construction Permit No.R� `lf�.�... Dated..._...�.............................
•.......... . ._.:�._ .. /' ...................................
8/3 82 Board of ealth
DATE........................ ..............................................
FORM 1255 HOBBS & WARREN, INC., PUBLISHERS
LOa,CA TION . SEWA PERMIT N0.
VILLAGE
INSTALLER'S NAME i ADDRESS �. CRAIG MEDEIROS
Trucking e BullA ing
142 Corporation Street
';TanniS, AArvm 775-0828
0 U I L D E R OR DOWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED � d��Z2 �p
C
i .
i
y 3r -
kb
Sao d
S� a�,� foes
i° .r.
..
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.7=74q.1V.......................OF....0if.K.N.X I—YYh.(X_ :.:...-...
Appliratiou-for Uhiposal Works Totikrurftott thrutit
Application is hereby made for a Permit to Construct.:(,�.() or Repair- ( ) an Individual Sewage Disposal
System at:
......�_S 1 .... _. .........6................................
orot
................
L tion Ad ress 9 LNo. s
�L� ..... :_... �� x. - -----..-•----•----.....- .P :o:_... � . �.r ••,r: > ...... .
Owner Address
.0.... -, f�/��' 'l tvd P..............................................
Installer Address
d Type of Buildin Size Lot...
feet
Dwelling No. of Bedrooms._._.: dL ................:__Expansion Attic ( ) Garbage Grinder (A,.)
p, Other—Type of Building .............. ._ .. No. of persons............................ Showers ( ) — Cafeteria ( )
w Other fixtures .----•-••--•-•• -•------------------------------- ----• --=
W Design Flow............ ......................gallons per person per day. Total daily low............................................gallons.
WSeptic Tank—Liquid capacity/A _gallons Length.._�,:...._? Width.............?:-Diameter............?.. Depth............. --
x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....._..............sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( ) e
~' Percolation Test Results Performed by....................................................1..........._._...._... DateJV0—e.....�4.....1.2.2-0..
If
,aa Test Pit No. 1 a.!.l......minutes per inch Depth of Test Pit__�............... Depth to ground water.._...�7..........
Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
a .................................•................................. ............... ....................................................
O Description off Soil.....Q.r• ........ .Qilf m.....y6 y V.Lys ..t5�4_---I----------- y �. ....... .t�_i /.............. ..
V ...................L1.I................._46+.�.G.L-!`M1JB'.[ 1 ---'----..(.:_2:�Ir.°?..4/.7-a�"Y_'FrF�}_._...a7. '. 2. .'. �------'�i�&.4- .....
W p 11
---------------•-w :. f
U Nature of Repairs or Alterations—Answer when applicable.........:..............................................................................:.......
..............•-----------------....--••--••---•-•----------------------------.............---•--------•---------------------------•••----•-----------------------------------------------------.-----
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TI',LE 5 of the-State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has been issued by the board of health.
Signed.............4 .......................••-•-•-----....................-------••--•. ...............................
.:' /I Date
Application Approved By.... � -� �Li!L/?. --- --...--••--••.•-•-• d� y
Date
Application Disapproved for the following reasons:---------------•----•-•------------------------•----•----- .....................................................
...-----•---•-•-----•..............••--.....------........-------•-------....................--------•-----------•--•---•--......------------...........--------------------------------._...--•--------
Date
Permit No.................................................:: Issued.�Ll ®` ............................ ----
Date
f/ Y 1
N rp:--- �...t.��. r•. rt.. F
�' � • . FEs...�.....`.....
.•• fi' THE C MMONWEALTH OF MASSACHUSETTS "
� .¢
BOARD �10F HEALTH
., ..:..O F (3..A.K.N.S..rft..h C
i y <...... ... ................................... �.
Applirallan for DisposFa1 Works Cho'nsirurfiOn VVIr,min '
F Application is hereby made for a Permit to.Construct O or Repair .( ) an Individual Sewage Disposal
' 'System at
... "._..OAxk...... .... ?,1 1; 9 ..: .... ...44 .........A.► .......
•----- • ......
Leon fidn Address r Lot No
.... .'.:... �_c:k ............... a . z s . ...11 pfA . ..�t
q Owner Address
...:....... ...........•--•----• Ycr,�s., _.r�r ,! ---
p� Installer Address
" Type'of BuildinE Size Lot.-_" QI-.............{Sq. feet
U Dwelling ' .No. ,of, Bedrooms_ : ! # _.. ._____.<__Expansioo
n Attic ( ) Garbage Grinder
Other—Type e of-Building No. of ersons__________________________ Showers — Cafeteria . )
f�, s YP g P ( ) ( )
Other,fixtures ..•----•--• .... .••--•- --- ----- ---------------------------••--•- ----------.._....-•---- ------
W Design Flow__... C"!,______ __ ._gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquld capacity�OW_.gallons Length ___ r___.�'_Width__.__.___._.?.:Diameter............ Depth____________ __
x Disposal Trench No Width__ _Total Lent Total leaching area........ ft.
P g g q
Seepage Pit No '_._............. Diameter__________ _______ Depth•below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ), Dosing tank ( )
Percolation Test Results Performed by .................................. ............................. "DateAAA....S't 1.It.7-8..
,aa Test Pit No 1 ,+ minutes per inch' Depth`of Test`Pit Depth.to ground water '
' _.__...____minut s und Minutes per inch Depth of Tet Pit __________________ Depth 'to gro water.'.......................
(_, Test Pit, 0 2
x s r
Description oil '" �_ 4[�A'9 +• a'o_E,t_lo.9&►>L _ ;• 4� t ! S.M?4t b f
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Nature of,Re ears or Alterations—Answer when applicable_________________________
U p.
;.a,... ..
Agreement:,r
='The under..signed ag`f ees .to"install the..aforedescribed.Individual Sewage Disposal System in accordance with
c o the provisions of TIT L... �5 of the State Sanitary<.Code The undersigned further agrees'not to place the system in
operation until a Certificate of.Compliance.has been issued by the board of health.
Signed-.. --••-------- ... -
,F APPli cation ApProvedB ___
..
Date
d fo t reasons:Disapprove'
e follo ing}
Date
Permit No.................. ----•.... .......... Issued . .
•,r '• N _ ................................................
Date �
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEA TH
.............OF, ..... . �a�� �......................
�.
Tertifirtt#o'Of TOm4ftAnrr
TH I O CERT, , T t the Individual Sew ge Disposal System constructed ( or Repaired ( )
b .......... . y.
ri
_ at... �...._..... --
has been installed in,acc rdance with the provis ns o T F of The State Sanitary Code as descr bed in the
application for Disposal Works Construction Permit No . ___� _.__ ___._.__ ..........
THE ISSUANCE OF THIS CERTIFICATE SHALL;NOT..BE CONSTRUE® AS A GUARANTEE THAT.THE
' SYSTEDATE.. ILL-��N�� I SAT SFACTORY.
O ................................. nspector.... e ../.
THE COFdb4ONWEALTH OF MASSACHUSETTS
�' R D O HEJ.
ALTH 1
No.--_:--_:! /. FEE
�i OOVorkg To nrt : n .p rmit
Permission is her granted '� '+ ...•--•-- :. a„� .. ...................
to Const t ( or epair ( ) •Individu Se ge D;wosal .System
Street
as shown on the application for Disp a1 Works Construction P No_._. .F_ .._____ ated:._
oard o eal)3 th
t DATE. - C =a2`..... ....................................
FORM 1255 HOBBS & WARREN, INC-,:PUBLISHERS ,
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' SYSTEM PROFILE T E S T H❑L E L.0 6�
TOP FNDN AT EL 78.5
ACCESS COVER 70 WITHIN 6" OF FIN. GRADE CNgT TO SCALE)
/ ACCESS COVER (WATERTIGHT) TO ENGINEER; AH OJALA, PE II
MINIMUM .75' Or COVER LIVER PRECAST WITHIN 6' OF FIN. GRADE 2% SLOPE REQUIRED OVER SYSTEM 70•4'
WITNESS DAVE STANTON
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2" DOUBLE WASHED PEASTONE� DATE; 11IZO �1] I RourF i
RUN PIPE LEVEL \ I
r�aR FIRST 2' 3' MAX. PERC. RATE = < 2 MIN/INCH Focus `J,
EXISTING 67.83' I 1011t3
GALLON SEPTIC 475.2� "f CLASS SOILS P#
1�. ITEC
' TANK (H- 10 ) __ ~
GAs 67,50' C� f� CI CJ 0 CJ m
BAFFLE 67,67' 4 67.0' CI E 0 Cl 0 E 0 0 0 a
C� C) C7Cl O CJC] 01� ELEV.
6' CRUSHED STONE OR MECHANICAL ��,'��, 2' ED ED 0 0 CI 0 L] 0 -D � Q"
DEPTH OF FLOW = 4 5 ao`d8 0 65.0
COMPACTION. (i�221 C2)) A
TEE SIZES, 3/4 T❑ 1" 1/2" DOUBLE WASHEL STONE SL
INLET DEPTH 10" ( 16 % SLOPE)
. 10YR 2/1
14 3
'. OUTLET DEPTH = "
ING
FOUNDATION---- EXIST. SEPTIC TANK - 48' D' BOX 14' LEACH
FAC;LITY B LOCATION MAP ^NT S
TY
4.17' LS ASSESSORS MAP 216 PARCEL 67
IOYR 5/6
32" 68.8'
9� 4
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60.83'
LOT 6 BENCH MARK - TOP OF C-)NCRETE 2.5Y 6/6
33,992± SQ. FT. '` BOUND. ELEVATION = 61.8 (ASSMD)
0.78t ACRES
128" 60.83
NO WATER ENCOUNTERED
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4 / 1 NOTES:
. / _. _v
,, / � _ �j `:, 1, DATUM IS _._._ �.
><xlsr WELL " %7.8 \ �1.,7 ,4 '� �o APPROXIMATED FROM QUAD
\ \ ,•� 0,9 SE--TIC DESIGN: (GARBAGE DISPOSER is NOL ALILOWED >
\ 75. 69 NOT AVAILABLE
I 77. 74 2• MUNICIPAL WATER IS
G \ DESIGN FLOW; 3 BEDROOMS (110 GPD) 330_GPD
r 1 0 V D RIVE US A 330 GPD DESIGN FLOW . a t iF T-, t 0
4, DESIGN LOADING FOR ALL PRECAST UNITS fU r,l_ AAS11❑ J_r
EXIST. DWEL _.
TF 78.5' 7 .3 Exl T. S 4 �.`a ,9 SEIITIC TANK; 330 GPD ( 2 ) = 660 5, ;WIPE JOINTS TO BE MADE WATEPTIG-1T.
(RE USE 3 \ 8.12
1 \ 6,�7o UST A 1000 GALLON SEPTIC TANK (EXIST) 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE: WITH MASS,
T
6 " L 9.t �86 +-s'~ 67.3 671 LEACHING
ENVIRONMENTAL CODE TITLE V.
0 6, N �2.4n „ \ / 2(30 + 9.83) 2 (.74) - 118 7. THIS PLAN IS FOR PROPOSED SEPTIC SYSTEM ONLY AND IS NOT
78 77 ^ 2 68.4 "ADES; TO BE USED FOR ANY OTHER PURPOSE.
C AR 1 / 00 30 x 9,83 (.74) _ 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4' PVC.
UL �FR T o �7 BC'I�TOM:
77.9 �a ' 6' IST. LEACH PIT 9, COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITI--11:1UT
�9S G 0 00 ts�E NOTE to) TOTAL; 454 S,F, 336 GPD INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
S) ^ + 7 + 4• 69.4 USE (2) 500 GAL. LEACHING CHAMBERS (ACME OR FROM BOARD OF HEALTH,
20" OAK ��� / EQUAL) WITH 2.5' STONE AT SIDES, 4' AT ENDS AND 5' 10, PUMP & REMOVE (OR FILL W/CLEAN SAND) FYISTING LFOCs-I PIT
+\78. ,L // 0 V�� BETWEEN UNITS 11, NO KNOWN POTABLE WELLS WITHIN 150' I_lF LEACH FACILITY.
.4 /
9 /
9.3 / �hEGENI T I pE�^^�
^ .8 7 0 PROPOSED SPOT ELEVATION OF
/ REMOVE ANY CONTAMINATED SOIL WITHIN 5' OF 968 O A K STREET
/ NEW LEACHING FACILITY 10OX0 EXISTING SPOT ELEVATION
� .1 / - IN THE TOWN OF: L� f�
64 / 100 0 PROPOSED CONTOUR ( WEST) B A P N J TA B LE
100 EXISTING CONTOUR
EXIST WELL ^ , PREPARED FOR: BORTOLOT-1-1
74.1 CONSTRUCTION/BICKERING
150'
30 0 3p
- _ --- -60 _ 90
- BOARD OF HEALTH
APPROVED DATE ' MA SCALE: 1 = 30' GATE: DECEMBER 1, 2001 _
off 508-362-4541
fax 508 362-9880
TOWN OF BARNSTABLE VARIANCE REQUIRED: SAS TO BE 120' TO LOCUS' WELL I wP��1N OF
dOWn CO pe engineering, inc. ARNE r?; �� ARNE H.
H. OJAI.A
CIVIL ENGINEERS t; QJALA x' CI VI.,
o. 26348 3a
LAND SURVEYORS yo�� 1 R� ` U sllik �/
nN IslpN� At /c� "( ,
939 thin st, yarmouth, ma 02675 ARNE H. O.IAL P.L.S. l)A'rh
o l-274
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