HomeMy WebLinkAbout0328 PARKER ROAD - Health 328 Parker Road
W. Barnstable F/R
-- - - a A = 176 011
f
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01)
No. Fee-
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zpplicat ion-for Well Congtruct ion permit
Application is hereby made for a permit to Construct (f); Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
Owner Address
45 tcr�_W Q� ��'�—_ ____ oo x �-�' 3-C�rlr s _j _oZ#►53
Installer — D ler Address
Type of Building
Dwelling---- _-----------
Other - Type of Building -------- No. of Persons--- _.------._ —__ _-__-_
Type of Well H "-SC 4 6 Svc-- Ca acit tot yy\
Purpose of Well P Y--- ---—---
Agreement: ,`�P�G.cew�i^�" ��� s�►""� lucc -v.
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 un it a Certificate .of Compliance has been issued by the Board of Health.
Signed — ----- —__— -3 20�----
ate
Application Approved
Gate
Application Disapproved for the following reasons:
date
Permit No. 2®1 !7�� -— Issued-- � y �-1 _-------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( )
by �2 S Y- r.'22A 6) A y w'
Installer
2 t
at— -—� -- P0.� 2c ( v t�____-----------------------____-------------------------------------
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. ----------------Dated------ ---------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE --- _ Inspector _—_____—_- ------____--
` 1'Z
41
o y - � o.V1
�Z �- (� Fee-----��-----------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Zipplicat ion,forWell Cootruction Permit
Application is hereby made for a permit to Construct (1(), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
_P�.� _ _��L s 61�_IAA a_u_p
Owner — Address ,�
Installer — DAler Address
Type of Building
Dwelling
Other - Type of Building------------ No. of Persons------- —___
Type of Well �C��(�P��=-- Capacity ----
Purpose of Well
Agreement: Rp P�Tr u rNt�i
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 rHealth.
Signe 2.01 i----
/� ate
Application Approved By
----
date
1- Application Disapproved for the following reasons:
date
Permit No. (&) 2 0I - ��� Issued-- Z 1 Z O —_-
date
'BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed'( ), Altered ( ), or Repaired ( )
y nA
-------------------------- --_____--__.__-----
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. ---------------_Dated------ -------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE --- __ Inspector—___—_—______-- —_-- ------ s
BOARD OF HEALTH
TOWN OF BARNSTABLE
3001 ContructionPerrnit
�r NO. 20 i l_0 �t ` qc °v -
Fee-
Permission is hereby granted SlInOINN WQJLla-M�co=—_:
to Construct ( �, Alter ( ), or Repair ( ) a_n Individual Well at:
No. —— o_dc Q cRA._ �QC ^-� -"b ----- -- ------------------------------------
street
as shown on the application for a Well Construction Permit
No. W 2-011 0 0 ------ Dated- � 0. — -- - ---
_�- _ --------------..---_.--
DATE 2- I �----Board Health of
FIRS f :t = 44.9` SYSTEM PROFILE
ACCESS COVER T® WITHIN 6` OF FIN. GRADE (NOT TO SCALE)
ACCESS COVER (WATERTIGHT) TO
42.5' MINIMUM .73 OF COVER OVER PRECAST -� WITHIN 6-OF FIN. GRAPE
2% SLOPE REOUIREO OVER SYSTEt
41.4• RUN PIPE LEVEL
- I PROPOSED 1500 / FOR FIRST Z' Z` DOUBLE WASHED PEASTON
40.SO'/ GALLON SEPTIC
TANK (H- 10 )
u.rvlc
MIN 39.0' 8.83'
(�x SLOPE) 000
7 0 C7 O C3 O
�--6' -CRUSHED STONE OR MECHANICAL 38.68 0 CJ C7 C7 CD p
COARPA,CTION. (15.221 (2)) CJ 0 CD C) C] C] C7
. DEPTH 0'FLOW 4�
`EE SLZEr. ( 1 R SLOPE) ( R SLOPE) 2 0 C) C3 0 C7 m
INLET DEPTH = 10" 3/4" TO 1 1/2" DOUBLE WAS
OUTLE' DEPTH'= 14" -
FOUNDATION- 20' SEPTIC TANK
118' D' BOX
17 L'
� F
CONFIRM INVERT PRIOR TOT INSTALLING
ANY PORTION OF SEPTIC SYSTEM I
I .
02
U:
I � TEST E �^
Y / CUE C AROUND
/ BEA PLUM BUSH 1
BENCHMARK
NAIL AT CL END'PAVEMENT
- / ELEV. 41.62'
0OL
... HORSE '
HORSE CORRAL
CORRAL c
o\
CESWOOL\
fy-y�IV�
LOT AREA / "
50.439 Sft vk,
`\ \ .
1�. O
CESSPOOL O s V
R OWNER
BARN
LARGE TREE i�DECK
DGSTMC
DWELLING
\ t?T 6\ N 6,d' \ FFw44.9' \/
- - �'1 INV OUT
1 ._ ELEVn41.4'2
It WELL
�n OWNER
AON
I /
SOLAiEO WETLAND
!/��-5
i
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
Irla
2� 0//
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
*,v,*Xk-e
C ERTIFICATION
Property Address: 3�e e Owner's Name• e
Owner's Address•
Date of Inspection:
Name of Inspector:(please print) Glr
Company Name: 0
Mailing Address: O p
Telephone Number
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 the inspection.The inspection was performed based on my
training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP
approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:
✓ Passes
Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
4 v C)
Inspector's Signature: /- Date: 44 G
Gs C—'
The system inspector shall submit a copy of this inspection report to the Approving Authority(>3�ard of Health or,
DEP)within 30 days of completing this inspection.If the system is a shared system or has a de flow of.1�,000
gpd or greater,the inspector and the system owner shall submit the report to the appropriate re ' office eithe
DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable, d the app-ovine
authority.
o
Notes and Comments CT,
****This report only describes conditions at the time of inspection and under the conditions of use at that
time.This inspection does not address how the system will perform in the future under the same or different
conditions of use.
Title 5 Inspection Form 6/15/2000 page 1
" Page 2 of 11
` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
Q CERTIFICATION(continued)
Property Address:
Owner: O S r ✓-
Date of Inspection:
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A. Syst asses:.
I have not found any information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 CMIt 15.304 exist.Any failure criteria not evaluated are indicated below.
Comments:
B../ System Conditionally Passes:
/I/ One or more system components as described in the"Conditional Pass"section need to be replaced
repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass.
Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please
explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally
unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the
existing tank is replaced with a complying septic tank as approved by the Board of Health.
*A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance
indicating that the tank is less than 20 years old is available.
ND explain:
Observation of sewage backup or break out or high static water level in the distribution box due to broken or
obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with
approval of Board of Health):
broken pipe(s)are replaced
obstruction is removed
distribution box is leveled or replaced
ND explain:
The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will
pass inspection if(with approval of the Board of Health):
broken pipe(s)are replaced
obstruction is removed
ND explain:
Titles Q T.,c..A�rin„ 17f—4/1 C/)nAA 2
f
Page 3 of 11
t
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 3m
Owner: O SS r
Date of Inspection: / 6 O
C.,(Further Evaluation is Required by the Board of Health:
y� Conditions exist which require further evaluation by the Board of Health in order to determine if the s stem
is failing to protect public health,safety or the environment. y
1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303 1 b that the
system is not functioning in a manner which will protect public health,safety and the environment:
— Cesspool or privy is within 50 feet of a surface water
Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
2. System
y m will fail unless the Board of Health(and Public Water Supplier,if any)determines that the
system is functioning in a manner that protects the public health,safety and environment:
_ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a
surface water supply or tributary to a surface water supply.
— The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply.
— The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a
private water supply well**.Method used to determine distance
"This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and
the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other
failure criteria are triggered.A copy of the analysis must be attached to this form.
3. Other:
Tula C incnantinn Pnrm 411 ciinnn 3
s
d
Page 4 of 11
t OFFICI.AL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: Gfr r Q
r �Owner:
Date of Inspection:
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
✓— ckup 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
ogged SAS or cesspool
Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
esspool
id depth in cesspool is less than 6"below invert or available volume is less than Y2day flow
✓Re uired pumping in more than 4 times in the last year NOT due to clogged or obstructed p pe(s).Number
q
times pumped
�y portion of the SAS,cesspool or privy is below high ground water elevation.
Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
�y portion of a cesspool or privy is within a Zone 1 of a public well.
_ _ y portion of a cesspool or privy is within 50 feet of a private water supply well.
Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water
supply well with no acceptable water quality analysis. [This system passes if the well water analysis,
performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds
indicates that the well is free from pollution from that facility and the presence of ammonia
nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria
are triggered.A copy of the analysis must be attached to this form.]
(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as
described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of
Health to determine what will be necessary to correct the failure.
E. Large Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd.
You must indicate either"yes"or"no"to each of the following:
(The following criteria apply to large systems in addition to the criteria above)
es
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
one II of a public water supply well
If you have a ered"yes"to any question in Section E the system is considered a significant threat,or answered
yes"in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304.The system owner should contact the appropriate regional office of the Department.
Titles G incnuntinn 97^r rn;ilnnn 4
Page 5 of 11
f
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address: �,e
Owner:
Date of Inspection:
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
✓_ _ Pumping information was provided by the owner,occupant,or Board of Health
c/W/ere any of the system components pumped out in the previous two weeks?
✓ — Has the system received normal flows in the previous
p two week period?
_ Have large volumes of water been introduced to the system recently or as art of this inspection?
P .
Were as built plans of the system obtained and examined?(If they were not available note as N/A)
Was the facility or dwelling inspected for signs of sewage back up ?
Was the site inspected for signs of break out?
r— Were all system components,excluding the SAS,located on site?
v_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected f or the of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum condition
Was the facility owner(and occupants if different from owner)provided with information on maintenance of subsurface sewage disposal systems? the proper
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
Yes no
xisting information.For example,a plan at the Board of Health.
_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable)[310 CMR 15.302(3)(b)]
Title G Tncnortinn 1~nrm Ail snnnn 5
I . - '
Page 6 of 11
OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
P'O.-4n-
YSTEM INFORMATION
Property Address: /'�J-
I�t/2S le
Owner: i P
Date of Inspection: C
O CONDITIONS
RESIDENTIAL
Number of bedrooms(design): --? Number of bedrooms(actual):
x, DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Number of current residents: �--
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yetor no):�[if yes separate inspection required]
Laundry system inspected(yes r no):�(_/ •
Seasonal use:(yes or no):,L
Water meter readings,if availablellast 2 years usage(gpd)):
Sump Pump(yes or no):�e
Last date of occupancy: t--'-L4/ix w
COMMERCIALANDUSTRIAL
t Type of establishment:
d
t Design flow(based on 310 CMR 15.204. apd
Basis of design flow(seats/persons/sgft,etc.):
Grease trap present(yes or no):_
Industrial waste holding tank present(yes or no):
Non-sanitary waste discharged to the Title 5 system(yes or no):—
Water meter readings,if available:
Last date of occupancy/use:
OTHER(describe):
4
GENE ORMATION
Pumping Records
4 Source of information: �4� S � /(iv �
Was system pumped as part of the ins n no):
If yes,volume pumped:_gallons--How was quantity
q ty pumped determined.
Reason for pumping:
` TYP F SYSTEM
_Septic tank,distribution box,soil absorption system
—Single cesspool
_Overflow cesspool
_Privy
—Shared system(yes or no)(if yes,attach previous inspection records,if any)
_Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be
obtained from system owner)
Tight tank _Attach a copy of the DEP approval
—Other(describe):
Approximate age of all components,date installed(if known)�nd so}uce of information:
Were sewage odors detected when arriving at the site(yes or no):
T41. ►nenurtinn Fnrm Aii cnnnn 6
t
• Page 7 of 11
z
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FOR
M
PART C
SYSTEM INFORMATION(continued)
Property Address: afr`j„�✓
Owner• /' "/�� f.p ��•�s 1�a �c•� /lij O� L
Date of Inspection: /.- b 0
BUILDING SEWER(locate on
site plan)
/
Depth below grade: /)c,
Materials of construction: e-t iron _`$p PVC_other(explain):
Distance from private water supply well or suction line:
Comments(on condition of joints,venting,evidence of leakage,etc.):
SEPTIC TANK:_(locate on site plan)
Depth below grade:
Material of construction:_�-t�oncrete_metal fiberglass_polyethylene
_other(explain)
if tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of
certificate) '
Dimensions: �o X /O
Sludge depth: 1,
Distance from top of sludge to bottom of outlet tee or baffle: o?
Scum thickness: LQ1S a *
Distance from top of scum to top of outlet tee or baffle: G
Distance from bottom of scum to bottopp,of outlet tee or ba e: Z
How were dimensions determined: /�v/ A c/
Comments(on pumping recommendations,inlet and outlet teeflor baffle condition,structural integrity,liquid levels
as lated to outlet invert,evide ce of leakage,etc):
ePs ✓1 �- o� c
GREASE TRAP: (locate on site plan)
Depth below grade:—
Material of construction:_concrete_metal fiberglass_polyethylene_other
(explain):
Dimensions:
Scum thickness:
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottom of outlet tee or baffle:
Date of last pumping:
Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels
as related to outlet invert,evidence of leakage,etc.):
T41. S Incnartinn G'nrm ail aiInnn 7
1
C
S
' Page 8 of 11
t OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
??�� SYSTEM INFORMATION(continued)
Property Address: v�� a#-.
49
Owner: �/ r
�` �/
Date of Inspection
TIGHT or HOLDING TANK tank must be pumped at time of inspection)(locate on site plan)
Depth below grade
Material of construction: concrete metal fiberglass__polyethylene other(explain):
Dimensions:
Capacity: allons
Design Flow: gallons/day
Alarm present(yes or no):
Alarm level: Alarm in working order(yes or no):
Date of last pumping:
Comments(condition of alarm and float switches,etc.):
DISTRIBUTION BOX: � if( present,must be opened)(locate on site plan)
n !,
Depth of liquid level above outlet invert:(� �Q/-/" A /
Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of
leakage * or out of box,etc.): /
PUMP CHAMBER: locate on site plan)
Pumps in working order(yes or no):
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Ttlo G ►ncnnntinn Rnrm/ll ciinnn III
i
Page 9 of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
2 Q SYSTEM INFORMATION(continued)
Property Address: Ja O pa; ,j er— jqd
Owner: QKf " O�6 ty
Date of Inspection:.
SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required)
If SAS not located explain why:
Type /7 /
leaching pits,number: ��
leaching chambers,number:
leaching galleries,number: V S 0 n
leaching trenches,number,length: f--
leaching fields,number,dimensions: 3 D /O X A
overflow cesspool,number:
innovative/alternative system Type/name of technology:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,
etc.): ae)dr 7/C s
911,
CESSPOOLS:/V(cesspool must be pumped as part of inspection)(locate on site plan)
Number and configuration:
Depth—top of liquid to inlet invert:
Depth of solids layer:
Depth of scum layer:
Dimensions of cesspool:
Materials of construction:
Indication of groundwater inflow(yes or no):
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
PRIVY:4210cate on site plan)
Materials of construction:
Dimensions:
Depth of solids:
Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):
Tifln S inenonfinn Fnrm 4/1 c/7nnn 9
" Page 10 of 11
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 3d
Owner: OS /ems
Date of Inspection: flIx C, 0�'
SKETCH OF SEWAGE DISPOSAL SYSTEM
Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or
benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building.
B
143
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Title Q Incnantinn iz^r �/I G/innn 10 !!�
Page I I of I 1
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 57 tAlas 4- 0"4f�'
�2
i /�f} pol 6 �
Owner: O L
Date of Inspection: / Or'
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
i
Estimated depth to ground water feet ✓ lei h e4_ /4A e Ole/
Please indicate(check)all methods used to determine the high ground water elevation:
Obtained from system design plans on record-If checked,date of design plan reviewed:
Observed site(abutting property/observation hole within 150 feet of SAS)
Checked with local Board of Health-explain:
Checked with local excavators,installers-(attach documentation)
Accessed USGS database-explain:
You must des 'be h w you established the high gro nd water elevation: /
o O� 3 S 2 xOw i.� c'
o
741A C inenonhinn Fnrm 4/1 Cnnnn 11
FIRST FL = 44.9' SYSTEM PROFILE
ACCESS COVER TO WITHIN 6`OF FIN. GRADE (NOT TO SCALE)
ACCESS COVER (WATERTIGHT) TO
42.$' MINIMUM .75' OF COVER OVER PRECAST F WITHIN 6"OF FIN. GRADE
7.l 2% SLOPE REOUIRED OVER SYSTEA
\ 41.4'• RUN PIPE LEVEL 2' DOUBLE WASHED PEASTON
PROPOSED 1500 /—FOR FIRST 2'
40.50' GALLON SEPTIC 40.25'
:. TANK (H- 10 )
MIN' e.�1c 3 38.83'
(?x SLOPE) a a 0 00
�6' CRUSHED STONE OR MECHANICAL 38.68' C E.7 CD 0 Q CD 0
COMPACTION. (15.221 [21) 0 0 C7 0 0 0 O DEPTH 0= FLOW 4' 2' 0 000 o C3 a' TEE SIZE.3: ( 1 R SLOPE) (L X SLOPE)
INLET:DEPTH = 10" 3/4" TO 1 1/2" DOUBLE WAS
OUTLE• DEPTH 14"
FOUNDATION— 20' — SEPTIC TANK 118'
D' BOX 17' L
F
4
CONFIRM INVERT PRIOR TO INSTALLING
ANV- PORTION OF SEPTIC SYSTEM
t7 ob
6
e
U% a
p0
TEST E
I \
/ CLEA C AROUND/ 1
BEA PLUM BUSH
BENCHMARK
NAIL AT GL END PAVEMENT
/ ELEV.41.62 OOL
MORSE 1
MORSE CORRAL `
N
CORRAL / O\ �
CESSPOOL /
/ 0 AREA 5 / \0.439 SFt
OPOOL
/ R OWNER
\ BARN
a2\
ru
I 1
/ yAG
LARGE TREE� /DECK �Vpo'
E7fISTINC
\ 'a DWELLING
\\ e} FF-44.9'
i2i•00'1 I N INV OUT /
r I ELEV.41.4't
I WELL PER
fn OWNER
O5, P
"oo",� NFL
.' IsoLarEo WETLAND
429
THE FOLLOWING
IS/ARE THE BEST
IMAGES FROM POOR
QUALITY ORIGINAL(S)
I N ,
DATA:
TEST HOLE LOGS
ENGINEER: ARNE H. OJALA, PE �Z,
42.5' WITNESS: S. WHITE (BOH) s }
DATE: 2/6/03 �.
3' MAX. PERC. RATE _ < 5 MIN/INCH
39.5' CLASS I SOILS. P# 10426
Q 1
04
ELEV.
L43�5 x .
ED 36.68' �� �A
STONE LS
�
B —____—
�� Nk ,'NO SCALE
�IINC LS
ITY 36„ 10YR 5/8 /►40.25' ZCEL 11
'"'h
5.08'
C a
FS
31.6' 2.5Y 6/6
�y
A:u
138" 31.75'
NO WATER ENCOUNTERED
NOTES:
EPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED
1. DATUM IS ASSUMED
SE A 330 FLOW: 3 BEDROOMS ( 110 GPD) = 330 GPD
SEA GPD DESIGN FLOW 2. MUNICIPAL WATER IS NOT AVAILABLE
3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT.
EPTIC TANK: 330 GPD (2 ) = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H-
SE A 1000 GALLON SEPTIC TANK (EXIST) 5. PIPE JOINTS TO BE MADE WATERTIGHT.
ACHING 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
SIDES: 2(30 + 9.83) 2 (.74) = 118 ENVIRONMENTAL CODE TITLE V.
7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
)TTOM: - 30 x 9.83 (.74) = 218 USED FOR LOT LINE STAKING.
8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
)TAL: 454 S.F. 336 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WIl
;E (2) 500 GAL. LEACHING CHAMBERS (ACME OR INSPECTION BY BOARD OF HEALTH AND PERMISSION ❑BTE
)UAL) WITH 2.5' AT SIDES, 4' A7 ENDS, AND 5' FROM BOARD OF HEALTH.
TWEEN UNITS 10. CESSPOOLS TO BE PUMPED AND FILLED WITH CLEAN SAND C
LEG EN REMOVED AS NECESSARY.
100.0 PROPOSED SPOT ELEVATION
1 COX0 EXISTING SPOT ELEVATION TITLE S SITE PLAN
,00 PROPOSED CONTOUR OF 328 PARKER ROAD
— 100— EXISTING CONTOUR IN THE TOWN OF:
(WEST) BARNSTABLE
PREPARED FOR: BORTOLOTTI CONSTRUCTION/BRITTON
BOARD OF HEALTH
APPROVED DATE
MA 30 0 30 60 90
SCALE: 1" = 30' DATE: FEBRUARY 10, 2003
wI sae-781-454I
(m,Sae 781-9eea
down cape engineering, inc. 1n OF 4" r+`°,H a, "44
CIVIL ENGINEERS �� ARNE H. 9G a� ARNE
o�ALA ti✓
o a
LAND SURVEYORS CIVIL ° H
No.3m92 .26348 c
939 main St. yarmouth, ma 02675 Tt IEa JPa4 a1 Q
NAL N p(
H. JALA, P.E., P.L.S. DATE
'v —
,�: F.as: CERTIFICATE OF ANALYSIS
Page: 1
Y Barnstable County Health Laboratory (M-MA009)
M
,�'.`f Report Prepared For: Report Dated:3/30/2011
Sally Desmond
Desmond Well Drilling Order No.: G1161395
P O Box 2783
Orleans, MA 02653
Laboratory ID#: 1161395-01 Description: Water-Drinking Water
Sample#: Sample Location: 328 Parker Rd. W.Barnstable, MA Collected 3/25/2011
Collected by: Customer -._ Received 3/25/2011
Roudhe
ffEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE
Nitrate as Nitrogen 0.72 mg/L 0.10 10 EPA 300.0 LAP 3/25/2011
Copper ND mg/L 0.10 1.3 SM 3111E LAP 3/30/2011
Iron ND mg/L 0.10 0.3 SM 3111E LAP 3/30/2011
pH 6.2 PH AT 25C NA 6.5-8.5 SM 4500-H-B LAP 3/25/2011
Sodium 20 mg/L 1.0 20 SM 3111B LAP 3/30/2011
Total Coliform 0 CFU/100mL 0 0 MF-SM9222B BSS 3/25/2011
Conductance 180 umohs/cm 2.0 EPA 120.1 DCB 3/25/2011
Sodium level is at the maximum contaminant level. Those on a low sodium diet may wish to consult a physician.
Attached please find the laboratory certified parameter list. Approved By
(Lab i ector)
� tom.
:c. --:
.. t
t UZI
co r•a M
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
y
pF HA`• l
p r` CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory (M-MA009)
ysrlCf 1.5�.,
Recipient: Sally Desmond Matrix: Water-Drinking Water i
Desmond Well Drilling Sampled: 03/25/2011 11:45
P 0 Box 2783 Received: 03/25/2011 9:04 1
Orleans, MA 02653 Collection Address: 328 Parker Rd.W.Bamstable, MA
Order#: G1161395 Sample Location:
Description: Re Kit
Lab I0: 1161395-01 Date Analyzed: 3/25/2011 @ 13:53
Sample#: Analyst: yn
Method: EPA 524.2_ _ Dilution Factor: _ 1
Comment: Sodium level is at the maximum contaminant level. Those on a low sodium diet may wish to consult a physician.
i
EPA 524,2 - Volatile Organics by GC/MS
Result MCL MDL Result MCL MDL
Parameter ug/L ug/L ug/L Parameter ug/L ug/L ug/L
Dichlorodifluoromethane ND 1.10_ cis-1,2-Dichloroethene _ _ND_ 70 0.50
Chloromethane ND 0.50 cis-1,3-Dichloropropene ND o.50
Vinyl chloride ND 2.0 0.50 Dibromochloromethane ND 0.50
Bromomethane ND 0.50 Dibromomethane _ ND _ --1- 0.50 1
-.1 {
1,1,1,2-Tetrachloroethane ND 0.50 Ethylbenzene ND 700 0.5o I
1,1,1-Trichloroethane ND 200 0.50 Hexachlorobutadiene ND ' 0.50
11,1,2,2-Tetrachloroethane ND 0.50 IIssopropylbenzene ND 0.50
11,1,2-Tdchloroethane ND 5.0 0.50 (Methylene chloride ND , 5.0 0.50
1,1-Dich1croethane ND o.50 Methyl-tert-butyl ether ND 0.50
L1,1-Dichloroethene ND 7.0 0.50 Naphthalene_ ND 0.50
- --------------- -- ------
1,1-Dichloropropene ND ! 0.50 n-Butylbenzene ND 0.50
11,2,3-Trichlorobenzene ' ND ( j 0.50 n-Propylbenzene ND 0.50
11,2,31 Trichloropropane _- 1 ND _ j _ I 0_50 p-Isopropyltoluene - _ ND 0.50
1,2,4-Trichlorobenzene ND 70 0.50 sec-Butylbenzene 1 ND i 0.5o
1,2,4-Trimethylbenzene ND 0.50 Styrene 1 ND i 100 j 0.50
1,2-Dibromo-3-chloropropane ND 0.50 tert-Butylbenzene + ND 0.50
1,2=DibromoetHane-(EDB) ND 1 6.50 ;Tetrachloroethene ND j 5.0 0.50
1,2-Dichlorobenzene ND 600 0.50 Toluene ND 1000 I 0.50 i
1,2-Dichlor,oethane ND 5.0 0.50 Total xylenes _ ND 110000 1 0.50
11,2-Dichloropropane ND 0.50 trans-1,2-Dichloroethene ND j 100 I- 0.50 1
1,3,5-Trimethylbenzene ND 0.50 trans-1,3-Dichloropropene ND o.50
11,3-Dichlorobenzene _ ND 0. jTrichloroethene _ ND 5.0 I 0.50 j
11,3 Drchloroopropane - i ND 0.50 richlorofluoromethane _ ND 0�50
�1,4-Dichlorobenzene ; ND j 5.0 0.50 j
12,2-Dichloropropane ------- --- �_- -ND _...:Li- 0.50
j2-Chlorotoluene 1 ND j I 0.50
4-Chlorotoluene ND ( 0.50
Benzene ND 5.0 0.50
Bromobenzene ND 0.50
Bromochloromethane ND 0.50
Bromodichloromethane ND j 0.50
Bromoform ND 0.50
Carbon tetrachloride f ND i 5.0 i 0.50 I
!Chlorobenzene ND 100 0.50
____1------- --- - - _.. '-- -- -
!Chloroethane ND _,._.._ 0.50_..... !
Chloroform ND 1 80 0.50
Attached please find-the laboratory certified parameter list. _ _ Approved By:
(Lab Director)
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6606 Page 1 of 1
I
Massachusetts Department of Environmental Protection
BLreau of Resource Protection
'WELL DRILLER
Please specify work performed: Address at well location:
ew Well Street Number: Street Name:
328 PARKER ROAD
Please specify well type: Building Lot#: Assessor's Map#:
Domestic 176
Assessor's Lot#: ZIP Code:
Number Of Wells: ill 02668
City/Town:
Well Location BARNSTABLE
In public right-of-way: GPS
• Yes No' North: West:
41.69540 70.36595
S ubdivision/Property/Descript;on:
Mailing Address:
• click here if same as well location address.
Property Owner: Street Number: Street Name:
FOBERT DEPIN_ i328 PARKER ROAD
City/Town: State:
Engineering Firm: IBARNSTABLE MASSACHUSETTS
ZIP Code:
02668
Board of health permit obtained:
• Yes Not Required
Permit Number: Date Issued:
W2011004 3/21/2011
i
?� o
Page 1 of 1
Massachusetts Department of..Environmental Protection
-' Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
Auger II Choose Bedrock--
WELL LOG OVERBURDEN LITHOLOGY
From Drop in Extra fast or slow Loss or addition of
To(ft) Code Color Comment
(ft) drill stem drill rate fluid
Clay Light Gray Yes. Fast Slow Loss • Addition
6i
20 25 UahtGay Yes' Fast Slow; Loss Additioni
25 32 Fine To Coarse Sand Brown Yes Fast Slow: Loss Addition'
III _
WELL LOG BEDROCK LITHOLOGY ry _
Visible Extra
From To(ft) Code Comment Drop in Extra fast or slow Loss or addition of
Rust Large
(ft) drill stem drill rate fluid
Staining Chips
Choose Code Yes Fast Slow! loss Addition; Yes Yes
- � _ :
ADDITIONAL WELL INFORMATION
Developed •—-•-— - Yes No' Disinfected Yes No
Total Well Depth 32 Depth to Bedrock
Fracture
Surface Seal Type None Enhancement Yes No
CASING Is Casing above ground?' From: (1 To: 0
I...._ — .. - -
From To Type R Thickness Diameter Driveshoe
F 28—� , Polyvinyl Chloride y Schedule 40 C • Yes',
SCREEN No Screen',
From To Type Slot Size Diameter
Stainless Steel Well Point 0.012
WATER-BEARING ZONES DRY WELL
From To Yield(gpm)
32 l 15 --
PERMANENT PUMP(IF AVAILABLE)
2 Wire Constant Speed
Pump Description Horsepower ------,
Submersible ti2
Pump Intake Depth(ft) 12T ^� Nominal Pump Capacity(gpm) 110
Page 1 of 2
Massachusetts Department of Environmental Protection
Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
t
1
ANNULAR SEAL/FILTER PACK
Water
From To Material 1 Weight Material 2 Weight(gal) Batches Method Of Placement
Choose One
Choose Material Choose Material
--
WELL TEST DATA
Time Pumping Time To
Recovery(ft
Date Method Yield(gpm) Pumped Level (ft Recover
(HH:MM) BGS) (HH:MM) BGS)
3/25/2011 Constant Rate Pump 15 1:00 1 t 0:01 18
WATER LEVEL
Date Measured Static Depth BGS(ft) Flowing Rate(gpm)
3/2512011 S 15
COMMENTS
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete a
knowledge.
Driller THOMAS E DESMOND III Registration# 1764 Monitoring[M] C Supervising Drill
Firm DESMOND WELL DRILLI Rig Permit# 1023 Date Job Compl
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
f
Page 2 of 2
���pF.1iAp�..>•
CERTIFICATE OF ANALYSIS Page. 1
Barnstable County Health Laboratory
Report Dated: 8/22/2006
Report Prepared For:
Chris Thonus Order No.: G0637822
ERA Martin Surette
965 Route 28
South Yarmouth, MA 02664
Laboratory ID#: 0637822-01 Description: Water-Drinking Water
Sample#: Sampling Location 328 Parker.Rd.,West.Barnstable,MA- Collected: 8/21/2006
Collected by: C.Thonus Received: 8/21/2006
Routine
ITEM RESULT UNITS RL MCL Method# Tested
LAB: Inorganics
Nitrate as Nitrogen 0.35 mg/L 0.10 10 EPA 300.0 8/21/2006
LAB: Metals
Copper 0.22 mg/L 0.10 1.3 SM 3111B 8/22/2006
Iron BRL mg/L 0.10 0.3 SM 3111B 8/22/2006
Sodium 12 mg/L 1.0 20 SM 3111B 8/22/2006
LAB: Microbiology
Total Coliform Absent P/A 0 0 309 8/21/2006
LAB: Physical Chemistry
Conductance 100 umohs/cm 2.0 EPA 120.1 8/21/2006
pH 6.3 pH-units 0 EPA 150.1 8/21/2006
&ter-sample meets the recommended limits for drinking water of all the-above.testedparameters7
Approved By-
(
Lab i ctor, ;
1 � r
RL = Reporing Limit
MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
TOWN OF BARNSTABLE l�
LCCATION 32 y 201,4w-- 42 SEWAGE #
VILLAC-E k/- A,yLla�l, ASSESSOR'S MAP & LOT i Ao- 0 0
INSTALLER'S NAME&PHONE NO. /Z,��o�d�4/ ���5�`r✓t7iliy S/24'S$l�
SEPTIC TANK CAPACITY /J`ai) r?.,!
L.EACHING FACILITY: (type) sob /s 14'�_(size)
NO. OF BEDROOMS
BUILDER O �W�NER /� o
PERMIT DATE:_922 /o COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility (If any wells exist f-d Feet
on site or within 200 feet of leaching facility)
Edge of Wetland and Leaching Facility(If any wetlands exist
within 300 feet of leaching facility) Feet
Furnished by 2) c:Wy C/r
139� vaN.
. . r
is•7
i O
2
No.� -7 Fee
s ✓
THE COMMONWEALTH OF MASSACHIETTS Entered in computer:
' Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS
01pprication for 33i5pogar *pgtem Congtruction Permit
Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) ElComplete System 2/dividual Components
Location Address or Lot No. Owner's Nqme,Address and Tel.No.
Assessor's Map/Parcel
Installer's XVXVA�Ll
ddress,and Tel.No. Designer's Name,Address and Tel.No.
Type of Building: p
Dwelling No.of Bedrooms 3 Lot Size ✓ / sq.ft. Garbage Grinder(,,(Ila
Other Type of Building L° G No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow ��� gallons.
Plan Date Numbe of sheets Revision Date
Title le- I 91all e Tip'' Q/p e /
Size of Septic Tank AAA Type of S.A.S.
Description of Soil
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has been issued b this Bo of H alth. _. .
Signed Date
Application Approved by Date
Application Disapproved for the ollowing reasons ft
Permit No. 9-0d?—07 7 Date Issued 2 a d
U iU d � r-"�E
� No. - Fee �
� a ,
T THE COMMONWEALTH OFMASSACH .ETTS' Entered in computer:.
Yes
PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS
;[pprication for Migozar *pgtem Construction Permit
Application for a Permit to Construct( )Repair( )Upgrade(/Abandon( ) O Complete System 19 Individual Components
Location Address or Lot No. ? j p Owner's Name,Address and Tel.No.-
Assessor's Map/Parcel
Installer's Name,Address and Tel.No. Designer's Name,Address and Tel.No.
-7 71 3
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( �
Other Type of Building(E'S� P•1l P No.of Persons Showers( ) Cafeteria )
Other Fixtures
Design Flow /0 gallons per day. Calculated daily flow gallons.
Plan Date _ 1119 D Number of sheets Revision Date
Title / ��/!
Size of Septic Tank e pO Type of S.A.S. Z — OA I r4gwoll
Description of Soil X.3"Z
Nature of Repairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi-
cate of Compliance has.been issued by this Boar-d of H alth.
g
Y�
St ned �7 Date X/Zy/1D 3
Application Approved by J v/t^� 12 - Date 2 yY6
Application Disapproved for theYfollowing reasons
Permit No. acid 3 0?'7 Date Issued .2 d Yid 2
1 11
———————————————————.— - —— ————————
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTI, that the On-site Sewage Disposal System Constructed( ) Repaired ( )Upgraded(A)
Abandoned( )by l ��� 6_
at 3i 7 �/)'/�_- �'� / Gf/, �fllt7 S�`4 has been construcZ
d in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No.a OQ—0 7 7 dated d
Installer Designer
The issuance of this p rmit shall not be construed as a guarantee that the syste WW
a esigdied.
Date /V �3 Inspector
------------------------------------�—j► --
No.
2V0 3 - 0- FeeJ(i r
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS
Migpoga[ *pgtem Construction Permit
Permission is hereby granted to Construct( )Repair( )Up ade(✓)Abando
System located at 3 Z f'D'r,�f'/� ✓ r ��'����1'�/
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:Constructio must be completed within three years of the date of th(i' � I
Date:_ a I a Y 0 Approved by `F
TOWN OF BARNSTABLE
LOCATION 3r�g dvixr��� �� SEWAGE # L���
VILLAGE kl ASSESSOR'S MAP & LOT l�01[#
INSTALLER'S NAME&PHONE NO. -
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)
�`
saf !« � )(size)
NO. OF BEDROOMS
BUILDER O R ^ o
PERMITDATE: -2 1y COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
✓�7't Feet
Private Water Supply Well and Leaching Facility (If any wells exist
on site or within 200 f t of leaching facility) Feet
Edge of Wetland and Leac ' ty(if any well Feet
within 300 feet of leachin acili v
Furnished by 3u I
i39`
/5.7 .
1�9,
No.AY-Z.-
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................OF...... . ..........................
Appliration for Bispoiial Works Tontitrurtion Prrutit
Application is hereby made for a Permit to Construct or Repair Individual Sewage Disposal
System at:
.......e-4 !A/................. .................................................................................................
-
Lo -Addss or 11 No.
.A. . ........W
... ........ . ..... ..........................................
..... ..... ... ..............................................
0 �Zress
...........!��.....IOv4a,�2tW.M4....... .........sev.. ...................................................................................................
Installer Address
Pq
Type of Building,.,- Size Lot............................Sq. feet
U
Dwelling No. of Bedrooms............................................Expansion Attic Garbage Grinder
04 Other—Type of Building ............................ No. of persons............................ Showers Cafeteria
PL4Other fixtures ...................................................................................................................................................
Design Flow...........................................gallons per person per day.. Total daily flow............................................gallons.
1:4 Septic 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. f t.
Z Other Distribution box ( ) Dosing tank ( )
Percolation Test Results Performed by.......................................................................... Date........................................
Test Pit No. I................minutes per inch Depth of Test Pit_.----.-.___________ Depth to ground water_.-.-..---_.-_.-_.__..-.
r3, Test Pit No. 2................minutes per inch Depth of Test Pit_.--.-._.._________. Depth to ground water.---_--__.____-__-__----
P4 V................57-
0 Description of Soil........ z��....
W
U .........................................................................................................................................................................................................
W
�4 -------------------------------------------------------------------------------------------------------------
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 TITLE U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of, Compliance has bee i�-....�/
db the bard ()j health. OP
Si
Date
ApplicationApprove y....... . .... ... ..................................................................... .......................................
Date
,win, reason,
Application Disapproved, th lowing reasons:................................................................................................................
.........................................................................................................................................................................................................
Date
PermitNo........................................................ Issued.......................................................
Date
---------------;---------------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
f t ,� OF ...........................
Aplifiration for Diopoiitt1 Work.5 Cron.6trurtion ramit
Application is hereby made for a Permit to Construct ( ) or Repair (� ,7an Individual Sewage Disposal
System,at: a
1ptF "
f1 a L)�ldion A,dd ess r or Lot No.
" Ow er Address
a _ ......se'
Installer Address
d Type of BuildmEoO Size Lot............................Sq. feet
U Dwelling ZNo. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type T e of Building No. of persons............................ Showers
� YP g ------------------------•--- P ( ) — Cafeteria ( )
Otherfixtures ......................................................................................................................................................
W Design 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 ( )
Percolation Test Results Performed by..-------••------••--------------------------•.........--•--•......••----. Date-----•------------
a
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water--_____--____--_---_.__.
G14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
W ._ r __ _
O Description of Soil........^ ..,` r --- .......................•------•-----------------------•-----.----------------•------•--- -----•------------•-
x
V ----•----•---•--•------•--•---------------•---....-•----•-----...----•------------••-------•--•----....---------------.....--------------------•-•----------.........----......--•-----•-•-------------
VW ..................................••••••----------------------•-----------------•••--•-...•-----------•-----......------- --••=
Nature of Repairs or Alterations—Answer when applicable_... _. r''. _ � .......................................................
-•--------------------------•---•--•------------------------------------•-----------•--............----------------------------------------------------------------------------------.......---.........
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 bee issued b the b and o ealth.
S;nJ Date
Application Approve ........ _ ...............
........................................................ -•-------------------------•-----------
{ Date
Application Disapproved f o the owing reason�.;Y---• ----•••---•-•--•------•-•---------•--•--------•--•••••--•---•--•-•--•-----•----•••-•-•---•.................
..........................................•---- ........_.....
Date
Xr
PermitNo......................................................... ]f'slued...------------------..................................
., Date
4t'
THE COMMONWEALTH OF MASSACHUSETTS
i
BOARD OF HEALTH '
............. r. F,r.�"'„ O F. .,r!! `y" t'�; � `f�,1,�,r,'�(i s-6c:,�f.;t:.:,.....,....................
Trrtifiratr of Tomplittnrr
TES; S TO CERTIFY, That the Individual SewagerD}sposal System constructed ( ) or Repaired («
by. ... . �'` g
a_.::_:. � h ...................................................................................
d,9
at................ �' °* --------- ��-_'_____- �'.�.-----lev j ......_.... Ins aller
has„been installed in accordance with the provisions of TITI /5f .d ate Sanitary Code as described in the
tj
application for Disposal Works Construction Permit No......................................... dated_------------.................................
THE ISS ANCE OF THIS CERTIFICATE SHALL NOT BE CONSTR ED AS A GUARANTEE THAT THE
SYSTEM. . 1 .F CTION SATISFACTORY.
DATE.. - = /•............ ... Inspector: _. ._.....
4
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No.---....y�.........._ FEE
..................
Dispo, aMorko MInstrnrtion rrntit
Permission is hereby granted... . ....?.......... a ._x? h� '� '_ :..... .................:..
'-.'./
to Construct ) Repair„ ( ,.) and�vidual Sewa Dispal System }
atNo. �`' '` g----------------- -•--•-- -------------------•-•----------
Street
as shown on the application for Disposal Works Construction Permit No..... - Dated--------------------
r
Board of Health
DATE................................................................................
FORM 1255 A. M. SULKIN, INC., BOSTON
f
ASSES SOPS MAP No, ........�...
No. "- �- --L� PARMNO' Fee
BOARD OF HEALTH
TOWN OF BARNSTABLE
Application-*rlVe1C Con0ructionPermit
Application is hereby made for a.permit to Construct (A), Alter ( ), or Repair ( )an individual Well at:
Location — Address Assessors Map and Parcel
--------- --------------- - -
Owner Address
Installer — Driller Add ss
Type of Building
Dwelling--------------------------------------------------------
Other - Type of Building----------------------------- No. of Persons------------------------------___________
Type of Well —
Purpose of Well - -—�1 _ --- -----—
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 Certificate f Com liance has been issued by the Board of Health.
Signed - -- -—- --- - — -
date'
Application Approved By-yaeel-.,� _ - '
date
Application Disapproved for the following reasons: _________ --- ----_------
-
--- -----------------------------------
�+ date
Permit No. Issued— 11G�-----— -----
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
THIS IS TO CERTIFY That the Individual Well Constructed (k ), Altered ( ), or Repaired ( )
byG ���2_ —G�� ��Ec-
Inst ler
at— f/i42 v` � 4,-t1e5 —4(C------------------------------- ----_----
Nhas 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.h/-!!Lf f!!f Dated -- �
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE------ - Inspector--- ---— -- --- —-------
I
- - - -- -- - -_ - - -_- __ _ _ _ _ _ -_------
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h. 41 -
. .
P - Q
No. —7��-f i Fee
SOARC'OF HEALTH j
TOWN OF':BARNSTABLE
Cicattott or etC Con tructionPermit
Application is hereby made for a permit to Construct QK), Alter (, ), or Repair ( )an individual Well at:
Location''rAddress�——-- ---- —r �; Assessors Map and Parcel '
Owner 1 Address
1
/34----iso---_C
Installer — Driller Add ss
Type of Building
Dwelling -- ==----------- -------------------------
Other Type.of Buildin ----------- No. of Persons.--------------------_____- 1
Type of Well � rA'
YP - - ---- 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'Privaie Well Protection Regulation - The undersigned further agrees not to
place the well in operation until a Certificate .of Com liance has been issued by the Board of Health.
Signed-� . -- --- - — / --
date
Application Approved By 1% '�-✓- - -'— .n ._!¢'' -
date
Application Disapproved for the following reasons:. —------
---
------------ -- ---- ------------------------- ---------------------------
date
Permit No. -! `' " ----- Issued—f -� � -- -- -
date
� e._+1.e!w9asiaa��4efo'laf�i�s4�le�!c7.•1a 9liVea!o.'lmeeS'a5?m!ttiT 3!n.,h9a9c4oP oeaes�aeaMifaeGL seiiiaSiriliptSwagasaoSQl'sNeiiiV.Y4e749i0619iIiSiliQtlr*itieil�ld�ass��iisla.�.'.+.leii?3[i<_`ib+�Yv3'
r
BOARD OF HEALTH
TOWN OF BARNSTABLE
C ertif icate.®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed (t), Altered ( ), or Repaired ( )
byFE�2 Gvc ,GLa
- -------- -- ---------------------------
Inst y
ler
at_ � /11��' �c� �i'ics-- L�—---- — -----
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.RZ! r'_-�Dated_Z l,9 7
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE'CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY. I
DATE---------- --- Inspector-- —.=-- — ----- -- -
�!i'ti4!.i±i!+Ll6+Lfi TbY�ilB.4a!ie.iTefiiaeili40wiri9vTiVilTli+:W_Ys6lsTi�ffibbrii?i!]it�I.s6la4plbS.i4ilii9slieaCiLoviuN.�A�aVs� Ta4'Yeis�S+r^o'li9Yi+%1144L+iNM�:lw!d!iSi9i'�itiSiw:.4y�s�a 4Ll
BOARD OF HEALTH
.TOWIN OF BARNSTABLE
Well Contructioni3ermit
No._ --- --� Fee-
Permission is hereby granted ___--
to.Construct �„ Alter (' ') or Repair ( ) an Individual Well atc
No. -- ?�—= d `t/ / fli(/��' i'f7 -- ---— -- ------------------- •-------
Street.
as shown on the application for a Well Construction.Permit 1
No.--- — Dated f
�___ _ -----------
I
Board of Health
DATE —
III
' I
W A�-
3
l�er
7
FIRST FL = 44.9'
SYSTEM PROFILE TEST HOLE LOGS
ACCESS COVER TO WITHIN 6" OF FIN. GRADE (NOT TO SCALE)
ACCESS COVER (WATERTIGHT) TO ENGINEER: ARNE H. OJALA, PE
42.5' MINIMUM .75' OF COVER OVER PRECAST WITHIN 6" OF FIN. GRADE S. WHITE BOH
,.- 2% SLOPE REQUIRED OVER SYSTEM '' 42 5' WITNESS: ( )
,* RUN PIPE LEVEL 2" DOUBLE WASHED PEASTONE DATE' 2/6/O3
41.4 _jI pROP05Eb 1500 FOR FIRST 2' 3' MAX. < 5 MIN/INCH �o
PERC. RATE = Locus
GALLON SEPTIC CLASS I SAILS P# 10426
40.25 39.5 eP
4C1.50' TANK (H- 10 )
� AS BAFFLE 000 38.83' O CHURCH ST.
39.0 aaao 0 ED0
MIN � 38,68 O O CI 'O CD ID C7 p 0„ Q ELEV.
7"5,
( 2 % SLOPE) �6" CRUSHED STONE OR MECHANICAL o [� C� l� CJ � C 1 E� El E� A
1 1 2 '
COMPACTION. 5.22 0
( � ]) C70E� C�_
2' 000a a
°DEPTH OF' FLOW = 4' "moo 0 36.68
( 1 � SLOPE) ( 1 % SLOPE) LS
TEE SIZE;: 3/4 TO 1 1/2 DOUBLE WASH=D STONE
INLET EPtH = 10'� g" 1OYR 3/3
OUTLET DEPTH = 14" B LOCATION MAP NO SCALE
LS
LEACHING FCUNDATtON— 20' SEPTIC TANK 118' D' BOX 17' ASSESSORS MAP 176 PARCEL 11
FACILITY 36„ 10YR 5/8
40.25'
* CONFIRM INVERT PRIOR TO INSTALLING 5.08
ANY PORTION OF SEPTIC SYSTEM C
FS
31.6' 2.5Y 6/6
Ig
-- / TEST OLE \� TO WELL
,,. CLEA ING AROUND / � 138" 31.75'
p BEAC PLUM BUSH NO WATER ENCOUNTERED
NOTES:
/ BENCHMARK t SEPTIC DESIGN: (GARBAGE DISPOSER IS NOT ALLOWED ) 1 . DATUM IS ASSUMED
NAIL AT CL END PAVEMENT
/ ELEV = 41.62' E POOL DESIGN FLOW: _ BEDROOMS ( 110 GPD) = 330 GPD 2 MUNICIPAL'WATER IS NOT AVAILABLE
HORSE USE A 330 GPD DESIGN FLOW 3. MiNIMUM PIPE PITCH TO BE 1/8 PER FOOT.
CORRAL
HORSE _SEPTIC TANK: 330 GPD ( 2_) = 660 4. DESIGN LOADING FOR ALL PRECAST UNITS TO BE AASHO H- 10
CORRAL / \ USE A 200 GALLON SEPTIC TANK (EXIST) 5. "PIPE JOINTS TO BE MADE WATERTIGHT. j
0
/ 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH MASS.
cEssPooL
\ LEACHING: ENVIRONMENTAL CODE TITLE V.
2(30 + 9.83) 2 (.74) = 118 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE
LOT AREA \ SIDES: USED FOR LOT LINE STAKING.
50,439 sFf \/ BOTTOM: 30 x 9,83 (.74) = 218 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC.
cE�ssPooL \� 0�9 \� TOTAL: 454 S.F. 336 GPD 9. COMPONENTS NOT TO BE BACKFILLED OR CONCEALED WITHOUT
/ ER OWNER \ � ° is INSPECTION BY BOARD OF HEALTH AND PERMISSION OBTAINED
(ISE (2) 500 GAL. LEACHING CHAMBERS (ACME OR
FROM BOARD OF HEALTH.
<\ / •\ \ BARN _EQUAL) WITH 2.5' AT SIDES, 4' AT ENDS, AND 5' 10. CESSPOOLS TO BE PUMPED AND FILLED WITH CLEAN SAND OR
BETWEEN UNITS REMOVED AS NECESSARY.
LEGEND
PROPOSED SPOT ELEVATION TITLE S SITE PLAN
h
1�COx0 EXISTING SPOT ELEVATION OF
ru
'00 PROPOSED CONTOUR 328 PARKER ROAD
i DECK ���°� �� /�
LARGE TREE ( '0
\
100 EXISTING CONTOUR IN THE TOWN OF.�J DXWELLING °��� � ��
(WEST) BARNSTABLE
121.00' 1 I V- E EV 41.4't ,/ - PREPARED FOR: BORTOLOTTI CONSTRUCTION/BRITTON
a0 , BOARD OF HEALTH
/ O
30 0 30 60 90
WELL PER MA
OWNER APPROVED DATE
68',�• �l to
/'�QP SCALE: 1" = 30' DATE: FEBRUARY 10, 2003
a / \C-
i
off 5W-362-4541
i fox $08 362-9880
down cape engineering, inc. ����JH OF 4f
Ass9 ,N of 4.1,9,J
ARNE y�
� ARNE
CIVIL ENGINEERS o OJALA r^ OJ
LAND SURVEYORS U No sm9z 26348 ISOLATED WETLAND 4e
939 main st. yarmouth, ma 02675 TE °Q NAL P6/0
N ��,f,
'
02--429 H. OJALA, P.E., P.L.S. DATE
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