HomeMy WebLinkAbout0050 SUN HILL ROAD - Health 50 SUNHH,L RD.,
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CERTIFICATE OF ANALYSIS Page: 1
Barnstable County Health Laboratory
Report Prepared For: Report Dated: 7/23/2010
David Gilliland Order No.: G1058605
50 Sunhill Rd.
West Barnstable, MA 02668
Laboratory ID#:� 1058605-01 Description: Water-Surface Water
Sample ti: Sampling Location: The Jordan River Collected: 2/16/2010
Collected by: D.G. Received: 7/21/2010
Test Parameters
ITEM RESULT UNITS RL MCL Method#. Tested
E.coli <2 CFU/100mL 2 0 EPA I)U3.1
Attached please find the laboratory certified parameter list. Approved
(Lab ector)
C
C-
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is /
required for every West Barnstable V/ Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
SL
,.
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When A. General Information
filling out forms
on the computer, V
use only the tab 1. Inspector:
key to move your
cursor-do not Matthew Gilfoy
use the return Name of Inspector
key.
B&B Excavation _
rQ Company Name
374 Route 130
Company Address
Sandwich Ma 02563
City/Town State Zip Code
(508)477-0653 SI 13640
Telephone Number License Number
B. Certification
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 ❑ Fails
❑ Needs Further Evaluation by the Local Approving Authority
5-11-16
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority (Board
of Health or DEP)within 30 days of completing this inspection. If the system 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 DEP. The original should be sent to the system owner
and copies sent to the buyer, if applicable, and the approving authority.
****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.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17
/
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°» 50 Sunhill Road _
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Inspection Summary: Check A,B,C,D or E/always complete all of Section D
A) System Passes:
® I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
System was found to be in working order at time of inspection.
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.
Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17
Commonwealth of Massachusetts
w Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every west Barnstable Ma 02668 5-11-16
page. Cityrrown State Zip Code Date of Inspection
B. Certification (cont.)
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
B) System Conditionally Passes (cont.):
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below).
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
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 public health, safety or the environment.
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
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Sunhiil Road
Property Address
David Gilliland
Owner Owner's Name
information is
required for every West Barnstable Ma 02668 5-11-16
page. CitylTown State Zip Code Date of Inspection
B. Certification (cont.)
2. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must
be attached to this form.
3. Other:
D) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
❑ ® Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
❑ ® 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 1/day flow
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17
i -
c Commonwealth of Massachusetts
M Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�wM 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
B. Certification (cont.)
Yes No
❑ ® Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or
tributary to a surface water supply.
❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well.
❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered. A copy of the analysis
and chain of custody must be attached to this form.]
❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd-
10,000gpd.
❑ ® 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.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section D.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection
Area—IWPA) or a mapped Zone II of a public water supply well
If you have answered "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.
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
'M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. CityrFown State Zip Code Date of Inspection
C. Checklist
Check if the following have been done. You must indicate"yes" or"no" as to each of the following:
Yes No
® ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ ® Were any of the system components pumped out in the previous two weeks?
® ❑ Has the system received normal flows in the previous two week period?
❑ ® Have large volumes of water been introduced to the system recently or as part of
this inspection?
® ❑ Were as built plans of the system obtained and examined? (If they were not
available note as N/A)
❑ ® Was the facility or dwelling inspected for signs of sewage back up?
® ❑ Was the site inspected for signs of break out?
® ❑ Were all system components, excluding the SAS, located on site?
® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank
inspected for the condition of the baffles or tees, material of construction,
dimensions, depth of liquid, depth of sludge and depth of scum?
❑ ® Was the facility owner(and occupants if different from owner) provided with
information on the proper maintenance of subsurface sewage disposal systems?
The size and location of the Soil Absorption System (SAS) on the site has
been determined based on:
® ❑ Existing 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(5)]
D. System Information
Residential Flow Conditions:
Number of bedrooms (design): 4 Number of bedrooms (Actual) 4
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440
i5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is
required for every West Barnstable Ma 02668 5-11-16
page. CityrFown State Zip Code Date of Inspection
D. System Information
Description:
Number of current residents: 2
Does residence have a garbage grinder? ❑ Yes ® No
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No
information in this report.)
Laundry system inspected? ❑ Yes ® No
Seasonal use? ❑ Yes ® No
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
"*WELL WATER"
Sump pump? ❑ Yes ® No
Last date of occupancy: CurrentDate
Commercial/industrial Flow Conditions:
Type of Establishment: NA
Design flow(based on 310 CMR 15.203): Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available: —
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17
Commonwealth of Massachusetts
v Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Last date of occupancy/use: Date
Other(describe below):
General Information
Pumping Records:
Source of information: Owner- Last pumped 8-2015
Was system pumped as part of the inspection? ❑ Yes ® No
If yes, volume pumped:
gallons
How was quantity pumped determined?
Reason for pumping:
Type of System:
® Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract (to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
❑ Other(describe):
t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Approximate age of all components, date installed (if known) and source of information:
1998
Were sewage odors detected when arriving at the site? ❑ Yes ® No
Building Sewer(locate on site plan):
Depth below grade: 1'8"
feet
Material of construction:
❑ cast iron ® 40 PVC ❑ other(explain):
Distance from private water supply well or suction line: '150' per plan
feet
Comments (on condition of joints, venting, evidence of leakage, etc.):
Septic Tank (locate on site plan):
Depth below grade: 8 -
feet
Material of construction:
®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No
Dimensions: 1500gallons
Sludge depth: 1
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
�M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Septic Tank(cont.)
Distance from top of sludge to bottom of outlet tee or baffle 35"
Scum thickness 011
Distance from top of scum to top of outlet tee or baffle NS
Distance from bottom of scum to bottom of outlet tee or baffle NS
How were dimensions determined? Measured
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
Tank was in working order at time of inspection with liquid level equal to outlet invert. Tank is not in
need of pumping at this time but should be pumped every two years for maintenance.
Grease Trap (locate on site plan):
Depth below grade: NA
feet
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Scum thickness
Distance from top of scum to top of outlet tee or baffle
Distance from bottom of scum to bottom of outlet tee or baffle
Date of last pumping: Date
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
°w 50 Sunhiill Road
M
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc:):
II
i
Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan):
Depth below grade: NA
Material of construction:
❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain):
Dimensions:
Capacity:
gallons
Design Flow:
gallons per day
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments (condition of alarm and float switches, etc.):
Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Distribution Box (if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert 0
11
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
D-box is in working order at time of inspection with liquid level equal to outlet invert. D-box did not
show signs of back up or carry over.
I
Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Narne
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Type:
❑ leaching pits number:
® leaching chambers number: (5) chambers
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow_cesspool number:
❑ innovative/alternative system
Type/name of technology:
i
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching was in working order at time of inspection with no sign of hydraulic failure. D-box has no
sign of high water staining and the area around leaching chambers were probed and found to no be
saturated.
Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration NA
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17
P 9
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every west Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.)-.
Privy (locate on site plan):
Materials of construction: NA
Dimensions
Depth of solids
Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
i
I
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
^M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building. Check one of the boxes below:
® hand-sketch in the area below
❑ drawing attached separately
RIGHT SIDE OF.DWELLING
Ala 24` " 8y{ - 0'
A2-36' 2-25'
A3-50' 83-41'
0 .........
1500 gallon tank
(5) Leaching Chambers
t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17
I
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
wM 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every west Barnstable Ma 02668 5-11-16
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
Site Exam:
® Check Slope
® Surface water
® Check cellar
® Shallow wells
Estimated depth to high ground water: No Gw @ 192"
feet
Please indicate all methods used to determine the high ground water elevation:
® Obtained from system design plans on record
If checked, date of design plan reviewed: 4-28-98Date
❑ Observed site(abutting property/observation hole within 150 feet of SAS)
❑ Checked with local Board of Health -explain:
❑ Checked with local excavators, installers- (attach documentation)
❑ Accessed USGS database-explain:
.You must describe how you established the high ground water elevation:
Plan on file with BOH.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17
r
Commonwealth of Massachusetts
W Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
^M 50 Sunhill Road
Property Address
David Gilliland
Owner Owner's Name
information is required for every West Barnstable Ma 02668 5-11-16
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
® Inspection Summary: A, B, C, D, or E checked
® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed
® System Information— Estimated depth to high groundwater
® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file
t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17
Bottle Number: 775401 Date: 05/27/98
BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT
O SUPERIOR COURT HOUSE
BARNSTABLE,MASSACHUSETTS 02630
'7A 55 PHONE:362-2511 _
Client: MACHERAS, MICHAEL Collector: CHARLOTTE STIEFEL LAB337
Mailing P 0 BOX 714 Affiliation: COUNTY STAFF
Address : HYANNISPORT, MA. 02647
Type of Supply: W
Telephone: Well Depth: 50 FT
Sample Location: SUNHILL RD-LOT 5 Date of Collection: 05/11/98
Town: WEST BARNSTABLE Date of Analysis : 05/11/98
PARAMETER SAMPLE RESULT RECOMMENDED LIMITS
Total Coliform Bacteria ABSENT 0
pH 6 .9
Conductivity (micromhos/cm) 124 500
Iron (ppm) < 0 . 1 0 . 3
Nitrate-Nitrogen (ppm) < 0 . 1 10.0
Sodium (ppm) 14 20 . 0
Copper (ppm) < 0 .1 1 . 3
BASED ON THE ANALYSES PERFORMED, THE FOLLOWING ADVISORIES ARE GIVEN:'
* Water sample meets the recommended limits for drinking water
of all above tested parameter`s .
f3� 17AI W
Thomas F. Bourne, Laboratory Director
a s
RECEIPT Ng 10370
'hAS* EnAronme tal Health Seri c e/s
From:
f
For.(specify se Ice 9-
Amount:
Signed: �r -
Date:
BARNSTABLE COUNTY HEALTH AND
ENVIRONMENTAL DEPARTMENT Telephone
Superior Court House 362.2511
Barnstable,Mess.02630 Ext.337
Barnstable County Health and Environmental Laboratory
Superior Court House, Route 6A
. P.O. Box 427
Barnstable, MA 02630
(508) 362-2511 ext. 337
Volatile Organic Analysis Analytical Method: 502 .2
Collection Date: 05/11/98 Date Received: 05/11/98 Analysis Date: 05/22/98
Client: MICHAEL MACHERAS
Mailing P.O. BOX 714 Sample Location: LOT 5
Address: HYANNISPORT, MA 02647 SUNHILL ROAD
W. BARNSTABLE
Sample ID: LOT 5 Laboratory ID: 775402
Sample Description: PRIVATE WELL
Compound Amount MCL Reporting
Detected (ug/L) (ug/L) Limit (ug/L)
Benzene BRL 5.0 0.5
Bromobenzene BRL 0.5
Bromochloromethane BRL 0.5
Bromodichloromethane BRL 0.5
Bromof orm BRL 0.5
Bromomethane BRL 0.5
n-Butylbenzene BRL 0.5
sec-Butylbenzene BRL 0.5
tert-Butylbenzene BRL 0.5
Carbon tetrachloride BRL 5.0 0.5
Chlorobenzene BRL 100 0.5
Chloroethane BRL 0.5
Chloroform 9.4 0.5
Chloromethane BRL 0.5
2-Chlorotoluene BRL 0.5
4-Chlorotoluene BRL 0.5
Dibromochloromethane BRL 0.5
1,2-Dibromo-3-chloropropane BRL 0.5
1,2-Dibromoethane BRL 0.5
Dibromomethane BRL 0.5
1,2-Dichlorobenzene BRL 600 0.5
1,3-Dichlorobenzene BRL 0.5
1,4-Dichlorobenzene BRL 5.0 0.5
Dichlorodifluoromethane BRL 0.5
1, 1-Dichloroethane BRL 0.5
1,2-Dichloroethane BRL 5.0 0.5
1, 1-Dichloroethene BRL 7.0 0.5
cis-1,2-Dichloroethene BRL 70 0.5
trans-1,2-Dichloroethene BRL 100 0.5
1,2-Dichloropropane BRL 5.0 0.5
1, 3-Dichloropropane BRL 0.5
2,2-Dichloropropane BRL 0.5
1, 1-Dichloropropene BRL 0.5
cis-1,3-Dichloropropene BRL 0.5
trans-1, 3-Dichloropropene BRL 0.5
Ethylbenzene BRL 700 0.5
Hexachlorobutadiene BRL 0.5
BRL: Below Reporting Limit MCL: Maximum Contaminant Level
L 1
page 2
Sample ID: LOT 5 Laboratory ID: 775402
Compound Amount MCL Reporting
Detected (ug/L) (ug/L) Limit (ug/L)
Isopropylbenzene BRL 0.5
4-Isopropyltoluene BRL 0.5
Methylene chloride BRL 5.0 0.5
Naphthalene BRL 0.5
Propylbenzene BRL 0.5
Styrene BRL 100 0.5
1, 1, 1,2-Tetrachloroethane BRL 0.5
1, 1,2,2-Tetrachloroethane BRL 0.5
Tetrachloroethene BRL 5.0 0.5
Toluene BRL 1000 0.5
1,2, 3-Trichloroberzene BRL 0.5
1,2,4-Trichlorobenzene BRL 70 0.5
1, 1, 1-Trichloroethane BRL 200 0.5
1, 1,2-Trichloroethane BRL 5. 0 0.5
Trichloroethene BRL 5. 0 0.5
Trichlorofluoromethane BRL 0.5
1,2, 3-Trichloropropane BRL 0.5
1,2,4-Trimethylbenzene BRL 0.5
1,3,5-Trimethylbenzene BRL 0.5
Vinyl chloride BRL 2 . 0 0.5
Total Xylenes BRL 10000 0.5
BRL: Below Reporting Limit MCL: Maximum Contaminant Level
S1'2'��g
Thomas F. Bourne, Laboratory Director
TOWN OF BARNSTABLE � !/
LOCATION t�i Sc��j, �Ll_ /<�. __ SEWAGE #
VILLAGE—Wed - �A,SSESSOR'S MAP & LOT - D
INSTALLER'S NAME&PHONE NO. ROW A77®-IlZ/--
SEPTIC TANK CAPACITY �• ®�
LEACHING FACII,TTY: (type) (size) d—�`tt /QS�S
NO.OF BEDROOMS
BUILDER OR OWNER �, JL&4 a eheArt&
PERMIT DATE: /0/r q9 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
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
t
�� + I
Q�/�
S° �Fl
S u+���s
I
No. 7y— 3 J Fee
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V
Yes
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS
ZIPPYication for Ziopogar *potem Congtruction Vermit
Application for a Permit to Constrict XRepair( )Upgrade( )Abandon( ) SComplete System El Individual Components
Location Address or Lot.No. 10,7- � 3- �1, Own�e�r'js Name,Address and Tel.No.
Assessor's Map/Parcel 1176 ,-jpt
C.Po ".IV1S 0 1/7
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
G `'y19QGff L.PftS
Type of Building: f
welling No.of Bedrooms � Lot Size A 0� sq.ft. Garbage Grinder( )
Ot er Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow gallons per day. Calculated daily flow gallons.
Plan Date il—Z k Number of sheets Revision Date
Title
Size of Septic Tank 00 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 o0site sewage disposal system
in accordance with the provisions of Title 5 of the Environmental Co nd not t ce the in operation until a Certifi-
cate of Compliance has been issued by this Bo of Health.
Signed Date
Application Approved by Date S77"—;L„&- 2�'
Application Disapproved for the9ollowQ reasons
Permit No. Date Issued / Z—Z 6—79$r
_7z No. Fee 100
:?:_L THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:Yl I �Yes
PUBLIC HEALTH DIVISION r TOWN OFPARNSTABLE., MASSACHUSETTS _
01pplication for �Dioonl *rgfem Con.5truction Permit
Application for a Permit to Construct Repair Upgrade Abandon El Complete System El Individual Components
Location Address or Lot No. /*/- Owner's Name,Address d Tel.No. C)
1.A ' W /
Assessor's Map/Parcel 1176 S 1:�"_/0�0 7 , 1JN an
Awf,(
U, 0-4- dA=9641;. / & 5e6 PeIV,- 11,MVA�45 /,'W 07
Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No.
A
Type of Building:
Dwelling 0�wein No.of Bedrooms Lot Size A i�93 a4'*'s'q3-ft. Garbage Grinder
t
Ot er Type of Building No. of Persons Showers Cafeteria(
Other Fixtures
Design Flow yJ gallons per day. Calculated daily flow gallons.
Plan Date Z/-2,5_7 Number of sheets Revision Date
Title
Size of Septic i Tank pe of S.A.S.
Description of Soil
Nature of Re
pairs or Alterations(Answer when applicable)
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described Zitesew,'age disposal system
in accordance with the provisions of Title 5 of the Environmental -gnd not t41ce the p � .
Collie n operation until a Certifi-
cate of Compliance has been issued by this Board of Health. i Y-7—
Signed 01 Date
Application Approved by �3 P-A'L Date -
Application Disapproved for thego-Ilowiq reasons
Permit No.- Sl97 9 Date Issued', Z Z�
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE, MASSACHUSETTS
(Certificate of comptiance
THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed(,X)Repaired )'Upgraded
Abandoned by
at
1�4 94 A kil pt�-P j:Aj&r has been constructed in accordance
&,--
with the provisions of Title 5 and the for Disposal System Construction Permit No. dated
Installer Designer
The issuance of this permit shall not be construed as a guarantee that the system will funcjon as designed.
Dater Inspector
Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION - BARNSTABLE,, MASSACHUSETTS
Mi!0001 *p5tem Cott5triuction Permit
Permission is hereby granted to Construct Repair Upgrade Abandon
System located at L'If S",
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 t.
Date: Approved by'
J
TOWN OF BMWTABLE
LOCATION
v� �U/�11'l> SEWAGE # 7
;,, y � �- ASSESSOR'S MAP & LOT - o
VILLAGE— ���A,v /.ace,-�-�.
INSTALLER'S NAME&PHONE NO. •�•`„S„ ' ,�"
SEPTIC TANK CAPACITY
LEACHING FACILITY: (type)
� ��� (size)
NO.OF BEDROOMS
BUILDER OR OWNER
PERMITDATE: /Q/— � COMPLIANCE DATE:
Separation Distance Between the: Feet
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility
Private Water Supply Well and Leaching Facility (If any wells exist Feet
on site or within 200 feet of leaching facility)
exist
Edge of Wetland and Leaching Facility (If any Feet
within 300 feet of leaching facility)
Furnished by
L
/r
Lk
Ll 16
�i
178.77► LOT 4
n
n D AI0..C F jzd
N
LOT 4
!_o1 5
ci
N 45, 0 70 5 F +� •s
� s.
os 0%
50SUN HILL ROAD
o
a
31.4'i CONCRETE Vi
FOUN 104.46'
TF=sz.4 XclK
b W ~
LOT fi `�°` ` N/F
� INDIAN SPIRITUAL
AND CULTURAL
Ia. co
LOT 6
JOB # 89-091C
'R TIFIED PL 0 T PLANro
,TION SUN HILL RD. W. BARNSTABLE, MA
PREPARED FOR:
.E : '1" = 50' DATE : JUNE 10, 1998
:RENCE LOT 5 PB 420 PC 92
MICHAEL MACHERAS
EBY CERTIFY THAT THE STRUCTURE tH OF
y ON THIS PLAN IS LOCATED ON THE 3 `
VD.AS SHOWN HEREON. =off ARNE s�
off 50e—M-4541
fax WS 342—MM NO
No.-�-- "- a1_ Fee----------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
ZippCication-*rVerr Conotructionpentnit
Application is hereby made for a permit to Construct (k), Alter ( ), or Repair ( )an individual Well at:
Lo--r# --- ►e ----------------------------------------------------
-- -- -- -
Location — Address Assessors Map and Parcel
N� _C-hcLe-1--------vla_C�I'0 �------------__ -Q_-- L------"a -`L---- _ r�can�s�ra rt_ M A
Owner Address Ba(.-I
---------R-------------------
6taller — Driller � �`�h Address a 09 �(03
Type of Building c�
Dwelling - ---------------------------------
Other - Type of Building ------ No. of Persons----------------------------------------------------
Typeof Well—— --- —y -- --------------------------------------- Capacity ---------------— ---- -
Purpose of Well-------------�D____-1—n-K-L-n ----------
--------
Agreement:
The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Cer ' 'cate .of Compliance has been issued by the Board of Health.
Signed
date
Application Approved By - ------- ------- ——- —- -— ---- --------------
date
Application Disapproved for the following reasons:----------------------------------------------------------------------------------------------
date
PermitNo. ------------------------------- Issued-------------------------------------—- - - ------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate ®f Compliance
THIS IS TO CERTIFY, That the Individual Well Constructed PC), Altered ( ), or Repaired ( )
by -----------�a----M P—ck�,--------------------------------------------
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-------------------------------------------------------------------------=--
�i
rr
No.- - - =J -_ Fee------------------------
BOARDOF HEALTH
r
TOW-N OF BARNSTABLE
f
Wit ati�Veil Con -tru t x t _
Application is hereby made for a permit•to Construct (9), Alter ( ), or Repair ( )an individual Well at:
Location — Address `'Assessors Map and Parcel
- ---------- `t --N ���r�;__�_��c_-t_ M A .
Owner Address
-- - -------------------
&-rstaller — Driller w_ 4ddressH A O :�-••�
Type of Building -]
Dwelling �- 4 s? �� -------------------------
Other - Type of Building -- - ----- -- No. of Persons---------- ----------------------------------------
Type of Well— y Capacity - - - - - --
t Purpose of X
Agreement:
- The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The
IE Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to
place the well in operation until a Certificate of Compliance has been issued by the Board of Health.
1
Signed � '' �_�{l -'—�==--
date
Application Approved By ------ - - ------- -- -— --- --date ---------------
Application Disapproved for the following reasons:----+ ---------—---------t---.- --------.-,----------------------------------- - -
�r.•axY a sxfi!'r{ �... �''� _ - __"E-"�Ii— .a+Y' - .ate 5^ •-,.+hyua..sy+ --
- .. .'—. ."?-�� � fi ,'1�...t.= �.., a.�K- .� k`.,"*r,`�; �<,�..»c "� �� � ;Rdate-
4 a
t ----------------------------------
q_ ..Permit,.No:�=----- _ � �.�_ Issued----------------------------------------
s. date
s
' BOARD OF HEALTH
TOWN OF BARNSTABLE
Certificate Of Compliance
,THIS IS TO CERTIFY That the:Indiv dual`'Well ConsErueted,(X) Altered ( f),br`Repaired
by �_�_: 1��1�:� --- ram —- --------- ------
t
;Installer" T
- — - 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. -------------------Dated-------------------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY. A -
iDATE- --- --—------ - —---- - --- Inspector---------------------------------------------------------------------------
�. ..rcre::��ae..r.��.aa:yr.�-::rr�,.r.+:�..sw;e+�►.srP�-+r._n.�i.�wrac.yeak+:rse:=.+�a..rai.:i �?r�Pu�ni;M+wgn�rrr�dk .daYMt!R-A+Y►.a _adaiz�c�iio�'-a.iasti_.�7�%+•:e'.t.++aaa�:
I BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell Cootruction Permit
No. - —1 Fee----V---5 ----
- Permission is hereby granted---- ------ =— ----- ---- ------- --- - ----, --- ---- ------ - -- ---
• to-Construct IX),
Alter(:>,,),>or. Repair, ( ) ant Individual Well at
No.,_C.-o _ --5 -_`��n_+�• 1 L _ ca c� Ca c�Cr�k���2 1 - ----- - .
Street '4? r
as shown on the application for a Well Construction Permit
r•.
yNo. - - - ------ ---— --- --------------- - Dated--- - -�--------------------------------------
i - --- ---------- -----
Board of Health
DATE----------
t 3 _
i , �t40
/
V
FORM 11 - SOIL EVALUATOR FORM
Page l of 3
No, eck-091 C-
Date: j2 -U -7&
Commonwealth of Massachusetts
Massachusetts
Soil Suita ,bili Assessment or On-site Swag a Dis osal
p DowN CR�'E.EJ6tNE;E�1Nb Date: IZ- .ZG.-`1(e.
Performed By: '�An11 Et. .4..-......_... .
Witnessed By: . �E�t..........�V N N.1_N.G-_ .. .�c\i..... .............._.. .... _.__..
I.zrT 5 4vru*\Lt, ILO^.brAftess.
Name. M��.!}�.�t_
Lcranion Addres [,,er and
W�isr 5�g �L—F— j /DNA /
ew Construction O'Repair ❑
Office Review
Published Soil Survey Available: No ❑ Yes ❑
Map Year Published ................... Publication Scale ...--_........... Soil M P Unit ...............
Drainage Class ................... Soil Limitations .................. .
............ .......................................
......................................
Surficial Geologic Report Available: No ❑ Yes ❑
Year Published Publication Scale
Geologic Material (Map_Unit) ............................._.._.................................................................
..................
L andform G�. �4�-........'7sM.YM—......�^o. 1T�G,...........................
Flood Insurance Rate Map:
Above 500 year flood boundary No Dyes !'-
Within 500 year flood boundary No ❑Yes ❑
Within 100 year flood boundary No ❑Yes ❑
Wetland Area:
National Wetland Inventory Map (map unit) .. -. .....................
Wetlands Conservancy Program Map(map unit)
Current Water Resource Conditions(USGS): Month
Range :Above Normal []Normal ❑Below Normal ❑
Other References Reviewed:
DEP AMOVED FORA•:Zi07195
FOWN1 I I - SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot No. L51 r-,
On-site Review
Deep Hole Number;} ,. Dale:.12"2 Time: .. Weather
Location (identify on site plan) IiEE !roCArTioN t6D
Land Use V^-tgrJT Slope (OIL) 5,Var Surface Stones
Vegetation w oo71>E'fl
Landform 1^m-tz-.h-%N>z—
Position on landscape (sketch on the back)
Distances from:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property line 13" feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE -OG-
I✓L-EV. - 70 e "
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Mottling (Structure.Stones.Boulders.Consistency. 9E
Gravel)
o
�h(-oAr•% IY ��
fLG
3�
5t�-T-`72. G'L t.o�n 2 4,01�G )-fftW) VMW t.TRSLC HOTLI-LOO
SAND`f
72- k"M" C.2 i.c�„� zx� 6& fl�M
A10 WRTCN FINND
Perent Material(geologic) Depthto8edrock:
VepthtoGroundwater: StandingV.'elerin the Hole: We eping from Pit Face:
Estimated Seasonal High Ground Water:
DLP ATPRo%Tj)rokV-12/07193
FOP-M II • SOIL EVALUATOR FORM
Page 2 of 3
Location Address or Lot (lo. Lam' s�N H►u- TLo/�1�
On-site Review
Deep Hole Number 71�2 Date:. LG 1G Time: 10 Weather 35'F j S.vN
Location (identify on site plant SSG. 'E� SK-ETzH..:....
Land Use VOrc A^rT- Slope (°io) 5 Surface Stones
Vegetation wooer
Landform
Position on landscape (sketch on the back)
Distances from:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE -OG'
F-Lc-V. - ��1.•3
Depth from Soil Horizon Soil Texture Soil Color Soil Other
Surface (Inches) (USDA) (Munsell) Monling (Structure.Stones,Boulders.Consistency, 9i
Gravel)
p_z,
3 - 3 G T�> S 1, 1�Y�1y/�
c. C z (MIWL¢Ack VhrLv%%%.E
+�- G� �Lo 2.5Y6/G G1 v►J6ulT-Av�tfi� fn�.ovE
2•576/t;
WA
Parent Material(peolopic] DepthtoSediock:
pepthtoGroundwater: Standing Walerin1heHole: Weeping from Ph Face:
Estimated Seasonal High Ground Water: /V,
PLP AFPRDNTP FORM.12M7195
r
' J
FOWNI l l - SOIL EVALUATOR F01ZNI
Page 2 of 3
Location Address or Lot 0o.
On-site Review
Deep Hole Number '}� Date:. Time: -. 10 Weather
Location (identity on site plan)
Land Use Slope (°io) Surface Stones
Vegetation
Landform
Position on landscape (sketch on the back)
Distances from:
Open Water Body feet Drainage way feet
Possible Wet Area feet Property Line feet
Drinking Water Well feet Other
DEEP OBSERVATION HOLE LOG
Depth from Soil Hori2on Soil Terrture Soil Color Soil other
Surface (Inches) (USDA) (Munsell) Monling (Structure.Stones,Boulders,Consistency, 9E
Gravel)
3� 60 " 5 L_ 21;%N&
4,1
t-04 1r?It 10 0(„ cobb lA5 UN5Vi%WZ-
Off•' ILA k'1 LTj t(,.oq 'r 2•ts�`�L 20 Yo COl y1ACj V&10-
IjiH - [`5" Gy sgt,p
^/c Vj t TL- Z 1`ouND
Patent Material(geologic) DepthtoSedrock:
pepthto Ground water• StandingV:aterintheHole: Weeping f►omPrtFace:
Estimated Seasonal High Ground Water:
N T%\5 T"• l 5 'Poll- TLk'F&P-NJ C.E.
ONL-y j /N0 ?Et1-�- PESLFOjtM��
VLP Aymc w roK\t-vlvm
Rix•
WELL-How
IA
s
7r--
Le Ex►ST•
Ptzo�: t>
�L.�
L-0�oN
U ��`go lot-l•yr'
0
'T�13
o �
1
[..oT �•y3 in Ljo
s
�vs'rc.A�'T> 1 /� �/�T'p�.ox►MRT� oNt`f)
1
F'ORAI 12 - PERCOLATION TEST
9
Location Address or Lot No. L. T 15 6uN r+IL1_ r-Lorq-b
COMMONWEALTH OF MASSACHUSETTS
Massachusetts
Percolation Test` '
Date: .::.�2.�2� —'lCo Time: ::..: .::�.b.A::
Observation Hole #
Depth of Perc TAP P61 -c-
Start Pre-soak
End Pre-soak
Time at. 12"
Time at 9"
Time at 6"
Time (9"-6")
Rate Min./Inch
• Minimum of 1 percolation test mlipt he performed in both the primery 8ree AND
reservee area.
Site Passed Site Failed ❑
..............................................................................................:............................................._.......
Performed By: -b^t t o SA SC— -1>0we,.r tmy- ��/�t tTz-V�E►�
Witnessed By: tl 6.r-svf -D ,N N EM G-
.Comments: xk�:
DFF A"ROVM FORM-12MMS '
FORM I I - SOIL LVALUATOR FORM
Page 3 of 3
Location Address or Lot No. lx�T S S uN 4-}1t.i► � �
Determination for Seasonal High 10 ater Table
Method Used:
❑ Depth observed standing in observation hole..._...... ..... inches
❑ Depth weeping from side of observation hole . . inches
❑ Depth to soil mottles inches
❑ Ground water adjustment ................... feet
Index Well Number ................. Reading Date ............... Index well level
Adjustment factor .................. Adjusted ground water level .. /� ...................
N 0
Depth of Naturally Occurring Pervious Material
Does at least four feet of naturally occurring pervious material exist in all areas
observed throughout the area proposed for the soil absorption system?
If not, what is the depth of naturally occurring pervious material?
Certification
I certify that on NOV +95 (date) I have passed the soil evaluator examination
approved by the Department of Environmental Protection and that the above analysis
was performed by me consistent with the required training, expertise and experience
described in 310 CMR 15.017.
Signature Date IZ ��/'1G
DEP APPROVED MPM•12107/95
SEPTIC ;TANK" 21 D' BOX 61 LEACHING
FACILITY
sow 40
LOT 4
vnuTy
CLUSTER
GRATE ELEVATION = 52.42'
__j
178.77'
z Cv drainage
area I , \ �
LOT 5
� \-~� ^ i ' / Area = 45,070 sq.ft
1.03 Acres
PROP. RET. WALLS
SE
PROP WELL DE
us
EDGE S E I
PAVEMENT 4 X
NO BERM US!
LE/
S.
0
6 104.46' 80*
162 PROP EXIST. WELL TOI
DWELL. USE
29'
TF-
WITF
67.5'
cy tH
20'
RES. THZ N/F
7()- INDIAN SPIRITUAL
AND CULTURAL
TH1 71- 0—
k, 5' REMOVAL OF UNSUITABLE SOIL REQUIRED
AROUND PERIMETER OF SYSTEM, DOWN TO
SANDY LOAM LAYER. REPLACE WITH CLEAN
—7 er cco\4 MED. SAND
LOT 6 -p
AF
TO f: AT�'EL. 67.0' 1J 1J1 1.1 V 1, 111J1' 1 1 31'
ACCESS COVER TO WITHIN 8" OF FIN. GRADE (NOT TO SCaW: .
ACCESS COVER (WATERTIGHT) TO
66:5,' MINIMUM..75' OF COVER. OVER,PRECAST . WITHIN 6" OF FIN. GRADE.
2% SLOPE REQUIRED OVER SYSTEM
a:
' ? a
64.50' RUN PIPE LEVEL 2' DOUBLE WASHED PEASTONE
PRO
1500 FOR FIRST 2'
POSED I
64.26' GALLON..sEP71c: 64.Q.1'
:TANK (H- 10. ).
63.66 63.52
fswww
63.48' ED ED 0 0'0 0 0 .
( 2 R SLOPE) — 1-1D O 0 O 0 C7 �
6" CRUSHED STONE OR MECHANICAL C7 O C� C7 a o a o o
COMPACTION. (15.221 [21)
DEPTH �OF FLOW. = 4 2' O O O O r CJ C7
( 1 x SLOPE) . ( 1' .% SLOPE)
TEE' SIZES: n a
INLET DEPTH 1 Q 3/4 TO 1 1/2". DOUBLE. WASHED STONE
OUTLET. DEPTH
: FOUNDATION .12' SEPTIC TANK 32' D' BOX 6' LEACHING'
FACILITY
DOST. WELL . w
I
_O _ LOT 4
..y
i O. UTILTn J
CLUSTER
_ O. - -
�. GRATE ELEVATION = 52.42'
,
178.77'
J
Z N: drdnage
J area . {A=47;29'
R=41:33
LOT 5.
1 _ \� \'` ^�\ r �r Area 45,070 sq.ft
I BENCHMARK: C. BASIN t �� 1.03 Acres
GRATE EI EVATION 53.3T
ROP. RET. W
r �, 0
\ /f !� PROF! 'WELL *
A=75.00
EDGE
PAVEMENT
NO BERM
� . o/
i
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