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HomeMy WebLinkAbout0075 OLD TOLL ROAD - Health 75 OLD TOLL RD., W.BARNSTABLE A= o e I i e o k f d SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION 75 Old Toll Road *`, Property Address:West Barnstable,Ma Address of Owner: (if different) Date of Inspection:2/23/2000 �y s Inspected by: James Holler o` o O0 I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(31,01CMR I S 000)� Company Name:Holler& Son Construction LLC Mailing Address:P.O.Box 702,Marstons Mills,Ma 02648 ' Telephone: (508)420-0280 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: 1 ®Passes ❑Conditionally Passes []Needs Further Evaluation by the Local Approving Authority ❑Fails Inspectors Signature Date: "2.3 ,00 The system inspector shall su a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: A) SYSTEM PASSES: El I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below: Comments: B) 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. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. ❑The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Property Address:75 Old Toll Road,West Barnstable,Ma Owner:A.Barrett Date of Inspection:2/23/2000 B) SYSTEM CONDITIONALLY PASSES (continued) ❑Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. The system will pass inspection if (with approval of the Board of Health). Describe observations: ❑ broken pipe(s)are replaced ❑ obstruction is removed ❑distribution box is leveled or replaced []The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ❑Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT. ❑Cesspool or privy is within 50 feet of a surface water Q Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: ❑The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. ❑The system has a septic tank and soil absorption system and the SAS is with 50 feet of a private water supply well. ❑The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance _..--.----------------. ..-.— _--..(approximation not valid). 3) OTHER I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:75 Old Toll Road,West Barnstable,Ma Owner:A.Barrett Date of Inspection:2/23/2000 D) SYSTEM FAILS You must indicate either"Yes"or"No"as to each of the following: ❑I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR' 15.303.The basis for this determination is identified below. The Board of Health should be contacted to 15.304.determine what will be necessary to correct the failure. 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. ❑ ❑ 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''/s 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. ❑. ❑. Any portion of a cesspool or privy is with 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 well.. ❑ ❑ Any portion of a cesspool or privy is with 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E) LARGE"SYSTEM FAILS: You must indicate either"Yes"or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: ❑. The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No ❑- ❑- the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑. ©. the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well. The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:75 Old Toll Road;West Barnstable;Ma Owner:A.Barrett Date of Inspection:2/23/2000 Check if the foilowing have been,done: You must indicate either"Yes"or"No"as to each of Owfallowing: Yes No 0 ❑ Pumping information was provided by the owner,occupant,or Board of Health. ® ❑ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. ® ❑ As built plans have been obtained and examined. Note ifthey are not available with N/A. ® ❑ The facility or dwelling was inspected for signs of sewage back-up: ® ❑ The system does not receive,non-sanitary or industrial waste flow. ® ❑ The site was itt o6d ed for sigrtia ofbitak`off. �( Q All system components;excluding the Soil Absorption System;have been located on the site. ® ❑ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location or the Soil Absorption System on the site has been determined based on: ❑ The facility owner(and occupants;if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal System. ® ❑ Existing information,Ex.Plan at BOH. ® ❑ Determined in the field Ofany of the failure criteria related to hart C is at issue,approximation of distance is unacceptable) (15.302(3)(b)] SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property address:IS Old'fofl lload,West Barnstable,Ma Owner:A.Barrett Date of Inspection:2/23/2000 FLOW CONDITIONS RESIDENTIAL Design flow: 110 gpd/bedroom for SAS Number of bedrooms 4 Number of current residents:) Garbage Grinder:No Laundry connected to system-Yes Seasonal use-No Water meter readings,if available (last 2 years usage in gpd):No Sump pump:No Last date of occupancy:Current COMMERCIAL 1 INDUSTRIAL: Type of establishment Design flow: gpd Grease trap present: Industrial Waste holding tank;present:. Non-sanitary waste discharged to the Title 5 system Water meter readings,if available Last date of occupancy OTHER (describe) GENERAL INFORMATION PUMPING RECORDS atd'source'Owner` System pumped as part of inspection No Volume pumped: Reason for pumping- TYPE OF SYSTEM- 0 Septic tank/distribution box/soil absorption system ❑Single cesspool p Overfl6w oess0601 n Privy ❑Shared system(y/n)(if yes,attach previous inspection records,if any) 0 I/A Technology etc.Copy ofup to date contract? Other APPROXIMATE AGE of all components,date installed(if known)and source of information: 1987,BOH Sewer odors detected when arriving at the site:No SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION,FORM, PART C SYSTEM INFORMATION (Continued) Property Address:75 Old Toll Road;West Barnstable,Ma Owner:A.Barrett Date ofinspecfion:2/21/2000 BUILDING SEWER (Locate on site plan) Depth below grade 30 inches Material of construction Q Cast Iron 0 40 PVC Q other Distance from private water supply well or suction-lineN/A Nameter 4 inch Comments:(condition of joints,venting,evidence of leakage,etc.) Sl~P�fI�TANk (locate bn site plan) Depth below grade 24 inches Material of construction®concrete Q metal Q Fiberglass Q Polyethylene Q other If metal list age is age confirmed by certificate of compliance Dimensions: 1000 gal Sludge depth: 14 inches Iistance from top of sludge to bottom of tee or baffle 26 inches Scum thickness 2 inches Distance from top of scum to top of outlet tee or baffle,1 inch Comments: GREASE-TRAP (locate on site plan) Depth below grade Material of construction Q concrete Q metal Q Fiberglass Q Polyethylene❑other Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle Date of last pumping- Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leak,etc.) i II I i SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM• PART C SYSTEM INFORMATION (Continued) Property Address:75 Old Toll Road,Vilest Barnstable,Ma Owner:A.Barrett Oate of tnspectfon:WV2660 TIGHT OR HOLDING TANK.Q(Tank must be-pumped prior to,or at time,of inspection) (locate on site plan) Depth below grade: Material of construction: Q concrete-0 metal 0 Fiberglass QPolyethylene 0 other(explain) Dimensions: Capacity: gallons Design flow: GPD Alarm levek Alarm.working?[yes[]no Date of previous pumping Comments: (condition of inlet tee,conditiorrof alarm and float switches,etc.) DISTRIBUTION BOX: (locate on site-plan) Depth of liquid lever above outlet invert.Zero' Comments(note if level,-and,distribution is equal;evidence of leaks or solids%car yoveryetc.y PUMP CHAMBER:0 (locate on site plan) Pumps iti-working order: (yes or no) Alarms in working-order:-(yes or.no) Comments:(note condition of pump chamber,pumps,and appurtenances,etc.) SUBSURFACE SEWAGE DISPOSAL SYSTEM-INSPECTION FORM PART C SYSTEM INFORMATION(Continued) Property Address:73 Old Toll Road,West Barnstable,Ma Owner:A.Barrett Date of Inspection:2/23/2000 SOIL ABSORPTION SYSTEM (SAS)z• (locate on site plan,if possible,excavation not required,but may be approximated by non-intrusive methods) if not determined to be present;explain: Type; leaching pits,number 1, 1000 gal leaching chambers,number leaching galleries,number leaching trenches,number&length leaching fields;number&dimensions overflow cesspool,number: Alternative system: Name of technology Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation,etc.) CESSPOOLS: (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: Material of construction Indication of ground-water inflow(must be pumped as part of inspection) Comments¢(note condition of soil,sib of hydraulic-failure,ponding.andvegetation etc:) PRIVY Q (locate on site plan) Materials-of construction: Dimensions- Depth of solids Comments:(note condition of soil,signs of hydraulic failure,ponding,vegetation etc.) v� SUBSURFACE SEWAGE DISPOSAL SYSTEMINSPECTIONFORM, PART C SYSTEM INFORMATION(Continued) Property Address:73 Old Tolt Road,west Barnstable,IvU Owner:A.Barrett Date of Inspection:2/23/2000 SKETCH OF SEWAGE DISPOSAL SYSTEM Include ties to at least two permanent references,or benchmarks,locate wells within 100'and where public water supply enters house. II l �r v 30-a 3 3�° i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (Continued) PropetV Address:75 Old Toll Road,West Barnstable,Ma Owner:A.Barrett Date of Inspection:2/23/2000 Depth to Groundwater 114 feet Please indicate all the methods used to determine High Groundwater> levation: ❑ observed from design plans on record observation of site(abutting property,observation hole,basement sump) ❑ determines it from local-conditions ® check with local Board of Health check FEMA maps ❑ check pumping records ❑ check local excavators,installers C use USGS-data Describe in your own works how you established the High Groundwater'Elevation. (Must be completed) U) hGus� � TOWN OF BARNSTABLE A 109 U3 LOCATION [77, SEWAGE VILLAGE jk. ( ASSESSOR'S MAP & LOT J. E. KEN EDY TRUC G INSTALLER'S NAME &,PHONE NO. 75 �,VILLOW STREET 'v';''ST �s R�NSTAB.;, MASS. 06,' SEPTIC TANK CAPACITY 1,0 b :! p LEACHING FACILITY:(type) (size) elo NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER . BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE'GRANTED: Yes No � 1�< �; r ,� ,�� � � / "/ f, � � 6 0 �o a , � b ago i �. w ��0 __.� �{ ,� . _ - SESSORS MAP gVU: PARCEL NO.: ca Now. .I .�........... THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH .- o.V N.....---...OF..... � ��.S GGs------------- Applira#iou for Uiipuiial Workii Tomitrurfinra ramit Application is hereby made for a Permit to Construct (c/j or Repair ( ) an Individual Sewage Disposal System at: .. GD...T� -��'ae�1 -••-•-------•--•---•-------•---•---------- --•--•................•-•--��' ---------7 7------•-------------------...._..........--- Location-Address or Lot No. -........--•---•---------•-•-------------------------- -- Owner Address � Ins a,ier Address d Type of Building Size Lot-:3 .a.7—3_....Sq. feet .� Dwelling—No. of Bedrooms.............`3._.•.-.......................Expansion Attic ( )' Garbage Grinder ( ) pa•, Other—Type of Building ............................ No. of persons.....--...--.........------. Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ . W Design Flow..............�---............_._..gallons per person er day. Total daily flow.......... �.........._....... lo s.. 1:4 Septic Tank—Liquid capacity Z,?;?q--gallons Length.. K'... Width.-!'�"4"". Diameter---------------- Depth____.. W Disposal Trench—No..................... Width¢. ............. Total Length---............ .. Total leaching area....................sq. ft. x Seepage Pit No-------/........... Diameter.....Z.-.----.--. Depth below inlet-_•-3 ..... Total leaching area._!o7 0!sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `" Percolation Test Results Per by.-_GADlc/�ir�....�s:...� �........... Date.�'�...�3-•-------.--. 0_4 Test Pit No. 1... ...minutes per inch Depth of Test Pit...Z......:'...... Depth to ground water------'------------- (i, Test Pit No. 2__L_g-..minutes per inch Depth of Test Pit.../44F........ Depth to ground water........................ 9 ...•......................................................................................................................................................... 0 Description of Soil........ ��_ a--•!.�/oo '�v�—�'� G---------• 48`-/�v �!!D Th -........5'! ------------------ --------------- W -•---------•----------------••----•------•...-•---••------------•-••••••-•--••--•-•----•-••-•-•-••••----•--•----••••••---•--•---------•-•-••---•••-•-•--•-••-----••••--••-••-----•-•--••._...•••-••_-•-- UNature 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 iiT1.1] of t 1e State Sanitary Code— The-undersigned further agrees not to place the system in operation until a Certificate of Compliance has been i s ed by 4thboard of h lth. Signed-• .... .... . •••-----•- --..................................... � Zit Application Approved BY ... �� = l Date"--- Date Application Disapproved for the following reasons:--------------•--------------•------•----•---------------------•------------•----------------------------_••••-- -------•--•-----------------------•------------------------•--•-••---•---••------............--------•---••-•-------•-••••---•--•••-------••-•••--••--•---•-------•-•-••--•••••--••-------•-•-••••-•••-- �� Date ,- PermitNo......................................................... Issued_....................................................... Date S co No..................!.2• Z Fxs�72�:-:15 ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............Tt.Vi✓----.....OF.....4?9.? .11/.5%/a. ' ................ Appliration for Dispoiittl Works Tonstrur#ion ami# Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 0��...�a :�.......�/�'''�_...-----•--...-----•--------•------------- --------------------------G°T.'�_-�_-��__-___-_-_-__--------------__----------------- Location Address or Lot No. cJ J'!✓ .../ ! -5 �?'L` .__...-........................••------- 1• _..................... •--...-----------------------•-•---••----•---- G'S owner Address W ._�_- .��.tiET>V�! � Sofir VM3T G��Zn1S LEA. .............................................. •e of Building............. .installer... SizedrLo 4 = Sq. feet V YP gr ., Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures ............................ W Design Flow.............. ...___-.....................gallons per person per day. Total daily flow.......... - �'..____-__._...... s. WSeptic Tank—Liquid'capacitylG'.�___gallons Length._!.. .:..._ Width._!!?� .�.. Diameter................ Depth_•_.._�.__.�-- x Disposal Trench—No. .................... Width..._....._._..._.. Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------------------- Diameter-----o�:........ Depth below inlet-_3_-�'�_� .... Total leaching area_.!t 7�sq. ft. Z Other Distribution box ( ) Dosing tank ( ) '-' Percolation Test Results Performed by---------------------------------------- n-_.�r--- �' __•_•----- Date_ .._� ------------------- Test / 8 W Pit No. 1._G.` ___.minutes per inch Depth of Test Pit__�1 ¢".... Depth to ground water-__"""_____________ fs, Test Pit No. 2._L!!�....minutes per inch Depth of Test Pit../4�"..... Depth to ground water.__'.............. a ••••••-•-•••----------------•••••••••-••---••••-••-••••••-..........-•-••---••-...-•---------•-••---...------------••---••-•••----••••. -- O Description of Soil....... ••=--, "---I !aa1�_laA�-_---` .SwB- Scs G -f44" /7G�, �, -- -•--•---------- ! . ....-----------------------------•-----.................... W UNature 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 T IT i 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................•-- l -------- _.,._....,_._ Dat Application Approved By..................... ---_:�:�._G!:..G:Y.��1. .0...-- ......--•-7"------ -�-------------- Date Application Disapproved for the following reasons:.......................................................................................... ..................._ ...............•---...__...--------------------------------...------------•--....._......................._..........._..._.._........------•-•--...----------------------•----•••--•••...-•-•_..._•--•-- -� Date �.�`� .. "Z `.,.> Z .... Issued Permit No................ ----------•----------•-------- --------------•-------------------- ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..............PJ�.........OF........... r..... .............. Tnrtif irab of faompliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (1/f or Repaired ( } by---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Installen- 1 t/ �� ` C at............................ ... •-----. ._�.. .................. --Idk----•----.---• -----------------`----�-----.----•-......J-............:rn.. ....... ---------- has been installed in accordance with the provisions of of The State Sanitary Code a describbed in the application for Disposal Works Construction Permit N o............ � Z••--= 2••--• dated-------- J! 7..�> ---•-- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUA ANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE..............5-,�..x_.1.�..-�� .....------.....:.-----...-------- Inspector-- --. THE COMMONWEALTH OF MASSACHUSETTS -�-- BOARD OF HEALTH I C _ . 0 1A Al .....OF......... / /V.S7 i 'G r..................... S FEE.... ... %Vaoa1 Vorkg Tono#r ion "permit Permission is hereby granted.............................................................................................................................................. to Construct (VI or Repair ( ) an Individual Sewage D � System � --•••--.. - � / .�3at No.........L-.C> .......... 7------------- --I� Street as shown on the application for Disposal Works Construction Permit NC-.k'_'_'_:'zDated..... .r�........... G r��.� •----•--••--•----•---•---• •---......-•-----•----------=------•--••------- -',------------------- Board of Health DATE................................................................................ FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS i Department of Environmental,Management/Division of Water Resources i WATER WELL COMPLETION REPORT WELL LOCATION Address J n 4 17 (—)/,/ —rO!/ City/Town A), f v�n r n c*YI{'/'e G.S.Quadrangle Map Grid Location Owner Ta yr7 P. I-_C,ot I � Address ���(1r'1r/4/r1/P 1 !i, �. .r r t1.G err In /t- WELL USE CONSOLIDATED WELL IT Domestic 951-Public ❑ Industrial ❑ Type of Water-bearing Rock Other Water-bearing Zones 6 f r f 1) From To Method Drilled ' + — 2) From To Date Drilled / jn 3) From To 4) From To CASING Depth to Bedrock' nn ,i .Length U+ Diameter Type A IC' UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface 10,R Sand: fige❑ medium ED/coarse R/ Date measured Gravel: fine❑ medium❑ coarse❑ Screen: GRAVEL PACK WELL Slot# 10 length ,3 from to Yes d No- Split Screen (or 2nd screen) WATER QUALITY TESTS MADE SlotJV length from to s Chemical Biological ❑ Depth To Bedrock PUMP TEST / t Drawdown feet after pumping days '7 hours at�Q GPM. How measured 001 oeJ,r ryn+- Recovery feet after hours. 1.� LOG of FORMATIONS COMMENTS: (On well or water) Materials From To lbm , DRILLER z. ►P(-I Firm VY.o01"', 11joI lar,1�� YiGr Cr) Addres s P4t-3 X kaa \ Q �an. City � ti E' do t!- Registration No. ! yj� operator's tiignature Please print f rrm y BOARD OF HEALTH COPY zsrx to as sonot ENVIROTECH LABORATORIES = a 66 Lewis Bay Road Hyannis Massachusetts 02601 • (617) 771-7265 CLIENT: Jim Jackson LOCATION:Lot 77 ADDRESS:41 Wayside Lane Old Folk Rd W. Barnstable,MA 02668 W. Barnstable,MA COLLECTED BY: Ed Meehan _ SAMPLE DATE:11/14/86 TIME: 11AM DATE RECEIVED:11/14/86 SAMPLE ID:E514 WELL DEPTH: JOB #: New Well 121 ft. •RESULTS OF ANALYSIS: Parameter units s Recommended, limi t Result Coliform bacteria/100 ml, (MF) 0 0 p70 pH units 6.0-8.5 6.70 Conductance umhos/cm 500 115 Sodium mg/L 20.0- ~ . 16.7 Nitrate-N mg/L 10.0_ .07 Iron mg/L 0.3. .15 Manganese mg/L. - 0.05. .. Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 COMMENT: Water is suitable for drinking purposes for all parameters tested. (� DATE SNE 57- Z o.c Z L. TOP OF FOUNDATION s CONCRETE COVER CONCRETE COVERS 4"CAST IRON 12 12'MAX. �r�rnarr�,7 . OR SCHEDULE 40. 4°SCHEDULE 40 PV.C.(ONLY) P.V.C. PIPE PIPE- MIN. LEACH PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST 0 0INVERT Q LEACHING '0 EL•/d��•��•• INVERT INVERT P . d•; PIT OR o'. SEPTIC TANK EL..!P7•7.-. DIST. EL � ZA3. a �_ EQUIV. INVERT BOX /.44.p.. .. GAL. INVERT 3s o; EL.07.%�lQ.. EL„7,1� INVERT ;•� ww �: :�: 3/4"TOIV2' EI-0k e. b- WASHED STONE • 6'DIA. PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM NO SCALE p_s7�8 SOIL LOG WITNESSED BY : DATE J�?! !3IyB� TIME.{o;.. .. ... D� !/�S. /`9G�Efj BOARD OF HEALTH TEST HOLE I TEST HOLE 2 W�zD. . L!E'?tE/ , ENGINEER ELEV.. /!�: /c4. . ELEV. .i Z,3:7o I c%o7jCb q n� WOOD 104-r/ s�a_So,c 4a,- _so,� DESIGN DATA : 3 I ,ez. /oe,rF, 5'7� NUMBER OF BEDROOMS p6vc WIrIle3 TOTAL ESTIMATED FLOW .330. . . GALLONS/DAY 7z" �7-0 B411 s 70 BOTTOM LEACHING AREA �53: �. . SO.FT. /PIT /Z7 BG,RD• SIDE LEACHING AREA . . . . . . SQ.FT./ PIT/3075,CAP. S,cr,,r r� Ssru:� GARBAGE DISPOSAL (50% AREA INCREASE) 16111 �Z iio,7c TOTAL LEACHING AREA 307, 8 SQ.FT PERCOLATION RATE —Az= �yx✓ ��az• MIN/INCH i44'- ez, y8,yv /68 _S,a•,�b CsZ./09.70 LEACHING AREA PER PERCOLATION RATE 4 r 7 SQ.FT.�G,f?D, .No WATER ENCOUNTERED NUMBER OF LEACHING PITS APPROVED . .. . . . . . . . . . . BOARD OF HEALTH w2 OT S7`pNE Dom/ /�ZG S/7J�s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE. . . . . . AGENT OR INSPECTOR PL`N OF �o ED A D �✓, o` s- �� l07- 77 a E. n ELLEY N �' •DGT� ?DGG �oA� No. 26100TE i W�.�i• ��'1211/ST��3Lc� ®��sS� I STERN�,�� SANifh0.P% I PETITIONER : -71 M c/ 67Isn.v G W ELC, / 1 ,peg 2v,4YD ®..t- I T �6, lei I I / SEYf7C to f Q. �1 /'.eepsen � V /Z.0, 77/ N - 3! 6Z3 \ P2oposE� 'o. 4xI-5777 vG 9s' /oo -517 LOCATION SCALE . .. _Js a ... DATE PLAN REFERENCE s•46w•v 0Al AL_13.e 3a of �rgsy. . . . G:. .9�. . . . . .. ... . . .. . . . . . . . . . .. .. EDWD . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . _LEY . . . . .. ... . . . . . . 0. 26100 . . . . . . . . . . . I CERTIFY THAT 'ISTE�♦���t SHOWN ON THIS PLAN IS LOCATED ON THE GROUND L L��® � AS SHOWN HEREON, DATE 0&7_/770&/,&7Z REGISTERED LAND SURVEYOR