Loading...
HomeMy WebLinkAbout0040 VILLAGE LANE - Health 40 VILLAGE LANE,• Lot #2 r West Barnstable A = 155 - 006/007 3 i li No. 4214 1/3 BLU ESSELTE 1 o% (a a a o 0 JOB NO. B16-02 Budlong.dwg N/F FB 31-60 `NARii'ipM ® O WELL PALEY L 6 �i O , am. v o o N 78 29'43� 1,4, }. L/ / 0 187.82' N/F 1. 63' cpop LEX V o 52.6' ^� 19 ry T: �; c'�✓� 6.9 OSMUN N/F 3B COLBY SEPTIC LOCATION o) co FROM AS AS-BUILT 0 0 0 �cO' co 2 NOTES 1 LOT2 1. LOCUS IS A.M. 155, PARCEL 007-002. 2. LOCUS IS IN FLOOD ZONE X (<0.2% RISK) ON 43, 816±S.F. FIRM DATED JULY 16, 2014. 3. OFFSETS SHOWN ARE TO THE CORNERBOARDS. LOT COVERAGE `s06 ;5>. EXISTING HOUSE 1227±S.F. us EXISTING PORCH 214±S.F: EXIST. CHIM, BULK 45±S.F. N/F F PROPOSED GARAGE 432±S.F. i C O LB Y TOTAL 1918±S.F. LOT COVERAGE=1918±S.F./43816±S.F.=04.4% Y I CERTIFY THAT THE LOCATIONS SHOWN ON THIS PLAN WERE MEASURED IN THE FIELD ON 2/29/16. PLOT PLANE FOR XjN OF.iyq& JOYCE BUDLONG RCNaLD LOT 2, 40 VILLAGE LANE, W. BARNSTABLE. MA JAM1,ES m• CADILLAC FEBRUARY 29, 2016 SCALE: 1*=50' T35779 RONALD J. CADILLAC, PLS, RS, P.C. PROFESSIONAL LAND SURVEYOR & REGISTERED SANITARIAN P.O. BOX 258 WEST YARMOUTH, MA 02673 (508� 775-9700 ©2016 BY R.J. CADILLAC i Commonwealth of Massachusetts /675- DD - boZ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name t��atim West Barnstable AAA 02668 11/18/2015 every page. CityRown state Zip Code Date of Inspection Inspection results must be submitted on this fonn. Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Impoft"I"When A. General Information filling out forms on the computer, use only the tab 1. Inspector key to move your cursor-do not Paul Martin use the return Name of Inspector key. Cape Cod Septic Services �y Company Name 350 Main St Company Address W.Yarmouth MA 02673 CitylTown State Zip Code 508-775-2825 S15016 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. 1 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 11/19/2015 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. Title 5 Orr Form:Subsurface Sewage D System•Page 1 of 17 t5iru 3H3 � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information d for West Barnstable MA 02668 11/1.8/2015 required for every page, Cityrrown state Zip Code Date of tnspecfion B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 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 in working condition. 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 exfiitration 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•N13 Trde 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name irtformation dfo is r every required for West Barnstable MA 02668 11/18/2015 page. CityfTown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt.): ❑ 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•3l13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 3 of 17 ` fl Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments fi 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information is West Barnstable MA 02668 11/18/2015 required for every page- Citylrown State Zip Code Date of Inspection B. Certification (cost.) 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 dogged SAS or cesspool ❑ 0 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 %day flow t5iru•3113 Title 5 OftW trspecban Fam:Sutrn=zbm Sewage D4osal System.Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name mdor every is required for West Barnstable MA 02668 11/18/2015 page. Cityrrown 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 agent 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 11 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 Tide 5 Official Ufspeebon Forth:Subswrme Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name adon is requir for or every West Barnstable MA 02668 11/18/2015 equir page- Cityrrown 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110x3=110xPd t5ins•3/13 Tide 5 Official Inspection Form:Subs+xface Sewage Disposal System•Page 6 of 17 Commonweatth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information is required for every West Barnstable MA 02668 11/18/2015 page. Cityrrown State Zip Code Date of inspection D. System Information Description: Number of current residents: Unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(include laundry system inspection information in this report) El Yes ® No Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): N/A Well Detail Sump pump? ❑ Yes ® No Last date of occupancy: Current Date Commercial/industrial.Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Galion per day(gpd) Basis of design flow(seats/personstsq_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 Tide 5 Ofiaal lrgpedion Form:Subsurface Sewage Dispo System•Page 7 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information West Barnstable MA 02668 11/18/2015 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (corn.) Last date of occupancy/use: Date Other(describe below): General hiformation Pumping Records: Source of information: No Records 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 ❑ Pry ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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 TiUe 5 Olfiaal hispection forth:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ' 40 Village Ln. Property Address Carol Aiken Owner Owner's Name require for is West Barnstable MA 02668 11/18/2015 required for every page. city/town State Zip Code Date of inspection D. System Information (cunt.) Approximate age of all components, date installed(if known)and source of information: 1996 Per BOH records. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade. 24"feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: +1 p'feet Comments(on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer camera and was found to be clean, properly pitched with no sign of root intrusion. I III Septic Tank(locate on site plan): Depth below grade: 14"feet Material of construction: ®concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: year Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: t500Gal H-10 Sludge depth: t5ins-3/13 Title 5 Olridal Irspection Fomc Sttsuafaw Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's game information is required for every West Bamstable AAA 02668 11/18/2015 r page. City/Town state Zip Code Date of Inspection D. System Information (corn.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 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 How were dimensions determined? Estimated Comments(on pumping recommendations, inlet and outlet tee or baffle condition, sbiwt oral integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 1500Gal H-10 tank in good condition. PVC tees in place and clean. Tank at normal operating level. Covers 14" below grade. Recommend service of tank. Grease Trap(locate on site plan): Depth below grade: 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 Forth:Subsurtace Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts uTitle 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information is required for every West Barnstable MA 02668 11/18/2015 page. Cigflrown State Zip Code Date of Inspection D. System Information (cunt.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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: 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 64M•3113 Title 5 Offiaf Inspection form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village!n. Property Address Carol Aiken Owner Owner's Name inforrnarequired for West Barnstable MA 02668 11/18/2015 required for every page. Cityrrown State Zip Code Date of inspection D. System information (cunt.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" 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.): H-10 DB-3 with 1 line in and 3 lines out in good condition. Box is clean and solid with some solids carryover. No sign of overloading or hydraulic failure. Cover 10"below grade. 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.): *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-3113 Title 5 Official Nspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owners Name requiris e required for every West Bamstable MA 02668 11/18/2015 page. CityfTown State zip code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number. ® leaching chambers number. 3 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Typetname of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 3-500 Gal chambers with stone. No more than 8-10"of effluent in chambers at time of inspection. No sign of overloading or hydraulic failure.Covers 15"below grade. Cesspools(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 ❑ No t5ins•3113 Title 5 official Mpection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information is required for every West Barnstable MA 02668 11/18/2015 rrown C' page. �Y State Zip Code Date of Inspection D. System Information (corn.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate 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.): t5ins•3113 Title 5 f)EricW ktspec iw Fomr.Stbsuuface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name required fo is West Barnstable MA 02668 11/18/2015 required for every page. Cityrrown State Zip Code Date of inspection De System Information (cunt.) 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 Mns•3/13 Title 5 Offiaal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusefts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Vidlage Ln. Property Address Carol Aiken Owner Owner's Name equired for every tron r West Barnstable MA 02668 11/18/2015 require page. Citylrown State Zip Code Date of Inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. +10feet Please indic ate all methods used to determine the high ground water elevation. ® Obtained from system design plans on record If checked, date of design plan reviewed: 1996 Date ® 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: Hand auger near leaching to 10'with no water encountered. Max bottom of leaching is 5'. Minimum of 5'separation. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3113 Title 5 Official Inspection Form:Subarbw Sewage Disposal System-Page 16 of 17 CommonweaM of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 40 Village Ln. Property Address Carol Aiken Owner Owner's Name information is required for every West Barnstable MA 02668 11/18/2015 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 Me t5ins•3113 Title 5 Official Mspectian Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 IUiWty UV UAKlMJIAULt TION#' V�#taQP j acre+. 1 SEWAGE 0 WrALURSNAMEdoPIIOWENO. LQ(TA N cW%las "770- 6OW SErnc TANK CAPACtTY LEAC M FACHMY:(type) NO.OF BEDROOMS BUUJ)M OR OWNER t C PHRMffDATE: 101-zq.h&_COMP[IANCE DAM /21/219�e Separatio nce Between the: Maxims Adjusted CuamdwaterTahk and Bottom of Leaching Facility NtutO_ Feet Private ware Supply Well and beaching Facility (If any welts exist an site or 200 im of kacbiag factl'ty) 2 tb Feet Fdge of wedaod and Leaching Facility(II any wetlands exist within Sou fat of lewhng faeifity) n/ate Feet Fumished by 7 Pc C� i =1 1 h ://vvww.town.barnstable.maus/assess' di la . .ma —155007002&se 11/16/20 5 ttP ulg/Hl� sP Y�P PPS 9 TOWN OF B,{A'RNSTABLE _ LOCATION SEWAGE # Z < . VILLAGE A,IeI r�� ASSESSOR'S MAP & LOT.i INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO.OF BEDROOMS I BUILDER OR OWNERS PERMUDATE: VC COMPLIANCE DATE: f-?—, Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility � `�e Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) /U Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leac -ng facility) Feet Furnished by `I •4 n�� 1 er f_ ti s TOWN OF BARNSTABLE Q ,,JPoll LOCATION � SEWAGE # S 7 '� j . VILLAGE �A ' !! ASSESSOR'S MAP & LOT 1% -006-00 INSTALLER'S NAME&PHONE NO. LaCLA NZ C 1-sA I03S 77 SEPTIC TANK CAPACITY I 1 LEACHING FACILITY: (type) (size) :;7 ICS NO.OF BEDROOMS {� BUILDER OR OWNER !y c C1Ci1��� �U� i&1 PERMITDATE: Z COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility knti e Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) 1 O Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) &IDA CG Feet Furnished by So6T)(vtsfm— t� kS 1�0 ,0 '1 -�'^a 7t o I i 00(O/C?(:!:) NO. . t.. Fee THE COMMONWEALTH OF MASSACHUSETTS 1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS v1 01ppricatiou for Oigpogal *pgtem Congtruction Permit Application is hereby made for a Permit to Construct(P()or Repair( )an On-site Sewage Disposal System at: Location Address or Lot No. LOT /V8/ /L1.��G� �. wner's Name,Address and Tel.No. 57X,,i!�C? /i/O, *0 94114 ►/1✓—Ir- ,La Assessor's Map/Parcel � Ile g'17 �9�� e^O,-A1 Installer's Name,Address,and Tel.No. 1 Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms J Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow�l�, �8® � gallons per day. Calculated daily flow gallons. Plan Date // ~ !Ve Number of sheets / Revision Date Title AYX /ll4kAMC L 0 6 d4 " Description o� g ®f� r 23 SS s 92" r /#a- 7,o- l2rC- S 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 En ironmental�ode and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo th Sign Date Application Approved by ZILDate Application Disapproved for the following reason Permit No. Date Issued Fee i t THE COMMONWEALTH,0F MASSACMUSETTS PUBLIC HEALTH DIVISION -TOWN,OF BARNSTABLES MASSACHUSETTS 2pplication for Miooal *'p" tem Cangtruction Permit Application is hereby made for a Permit to Construct(Po)or 12 pau )an On-sit Sewage Disposal System at: Location Address or Lot.No. L or /Vd,Z L/LG L-40V Owner's Name,Address and'Tel.No. '\ SJ%ZFC 7 ND• -00 dc/♦ /�a• = /✓/G,�'!/LAS "/NG CO ' Assessor's Map/Parcel /r� , d 37 �76 eOV. 1 v vi C/ll S IV Installer's Name,Address,and Tell.No. Designer's Name,Address and Tel.No. �33_ �(9s-- 3- �� /Ic, •:� oX S'f g yv� F�I�MGtl7� o2s7¢ Type of Building: 2 Dwelling No.of Bedrooms .7 Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i Design Flow ��� -�8�r gallons per day. Calculated.daily flow gallons. Plan Date Number of sheets / Revision Date Title T� S"G?�/�F OX i Description of Soil 2 a 4 Loll 1,4 Z" C 64- 7.o v e5�9D Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ' E 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 E ironmental Coe an not to place the system in operation until a Certifi-s "cate of Compliance has been issued by this Bo f Heal , 'i Signed,/. Date �G ?� S,/ Application Approved by Date Application Disapproved for the following reason E Permit No. Date Issued ——————————————-——— — —————————————— r. THE COMMONWEALTH OF MASSACHUSETTS I BARNSTABLE, MASSACHUSETTS 3 k i 4 Certificate of Compliance if y� THIS IS CERUEY—that the Onnsi� ewage Disposal System installed('� )or repaired/replaced( )on by - Installerf�' .­r/ at es`s�-r constructed in accordance with the pro i 'on 'title 5 and the for Disposal System Construc 'on Perna No. 'Win dated Date 1 -. c7'� Inspectors E f THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYS- TEM WILL FUNCTION SATISFACTORY. �. _ No. Fee a• THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS - M.f6po5 f bpgtem Con %ruction Permit 4 Permission is hereby granted to to construct repair( )an On-site Sewage ystem located at No.# 7, r Street . A d f and as described in the above Application for Disposal System Construction Permit. o No. Rate The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or speciallconditi ns. 4 All construction must be om 1 ted Ithin three years of the date below. �o Date: � Approved by � , Board of 14iffii 4 S ENVIkOTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich,MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508)888-6446 CLIENT: Nickulas Bldg. Co. LOCATION: Lot 2 ADDRESS: P.O. Box 507 Village Lane W. Barnstable, MA 02668 W. Barnstable, MA SAMPLE DATE: 10-7-96 COLLECTED BY: Desmond Wells DATE RECEIVED: 10-7-96 TIME: 4:30PM LAB I.D. #: E10-160 JOB TYPE: New Well SAMPLE I.D. #: E10-160 WELL SPECS. : 4" 53'/ 10, RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 6.57 Conductance umhos/cm 500 144 Sodium mg/L 28.0 7.7 Nitrate-N/ Nitrite-N mg/L 10.0 LT 0.01 Iron mg/L 0.3 LT 0.05 Manganese mg/L 0.05 0.004 Volatile Organics See attached report. EPA #524.2 None detected. COMMENTS: Yes WATER IS SUITABLE FOR DRINKIN URPOS FOR PARAMETERS TESTED. xxx Date 22 Ro ald J. Saari Laborato Director IT = Less Than LAPUCK LABORATORIES,INC. ENVIRONMENTAL TESTING WASTE WATER DISCHARGE 50 Hunt Street TESTING Watertown, MA 02172 FOOD ANALYSIS 617 923-0300 FAX(617)923-0301 CHEMICAL ANALYSISFORENSIC TESTING REPORT LAB NO. 56525-2 October 18, 1996 Mr. Ron Saari . ENVIROTECH LABORATORIES, INC. Sample Received: 10/09/96 449 Route 130 Client I.D.: Desmond Well Drilling Sandwich, MA 02563 Sample I.D.: Lot#2 Village Lane Test Results: Volatile Organics-ppb(ug/L) Method#524.2 Benzene ND 1,2-Dichloropropane ND Bromobenzene ND 1,3-Dichloropropane ND Bromochloromethane ND 2,2-Dichloropropane ND Bromodichloromethane ND 1,1-Dichloropropene ND Bromoform ND Cis-1,3-Dichloropropene ND Bromomethane ND Trans-1,3-Dichloropropene ND N-Butyl Benzene ND Ethylbenzene ND Sec-Butyl Benzene ND Hexachlorobutadiene ND Tert-Butyl Benzene ND Isopropylbenzene ND Carbon Tetrachloride ND P-Isopropyltoluene ND Chlorobenzene ND Methyl Chloride ND Chloroethane ND Naphthalene ND Chloroform ND N-Propylbenzene ND Chloromethane ND Styrene ND 2-Chlorotoluene ND 1,1,1,2-Tetrachloroethane ND 4-Chlorotoluene ND 1,1,2,2-Tetrachloroethane ND 1,2-Dibromo-3-Chloropropane ND Tetrachloroethene ND Dibromomethane ND Toluene ND 1,2-Dichlorobenzene ND 1,2,3-Trichlorobenzene ND 1,3-Dichlorobenzene. ND 1,2,4-Trichlorobenzene ND 1,4-Dichlorobenzenc ND 1,1,1:'richloroethane ND Dibromochloromethane ND 1,1,2-Trichloroethane ND 1,2-Dibromoethane (EDB) ND Trichlorofluoromethane ND Dichlorodifluoromethane ND Trichloroethane ND 1,1-Dichloroethane ND 1,2,3-Trichloropropane ND 1,2-Dichloroethane(EDC) ND 1,2,4-Trimethylbenzene ND 1,1-Dichloroethelene ND 1,3,5-Trimethylbenzene ND Cis-1,2-Dichloroethylene ND Vinyl Chloride ND Trans-1,2-Dichloroethylene ND Total Xylene ND N.D. =Not Detected Analysis Date: 10/16/96 Method Detection Limit =0.5 ug/L Recoveries of Surrogate, -% 1,2-Dichlorobenzene-d4 90 P-Bromofluorobenzene 80 Testing Conalting Services for over 30 Years . . . J me Fontenarosa, Lab Manager This report is rendered upon the condition that it is not to be reproduced wholly or in part for advert sing or other purposes over our signature or in connection with our name without special permission in writing.Total liability is limited to the invoiced amount.The results listed refer only to tested samples and/or applicable parameters. AsBuilt Page 1 of 1 I U W N Ur i1AKNs1AbLt: /ATION *40 V;t ta � tR 2 G C. Ln* SEWAGE# (0 �� 7 .A ' T VILLAGE V�QSF- �arn Rh(t2 ASSESSOR'S MAP&LOT 11,b-006-00" INSTALLER'S NAME&PHONE NO. (TA N i G�Ia5 '17 0- 6080 SEPTIC TANK CAPACITY LEACHING FACELrl-Y: (type) S:"161�5 —(size) (31 NO.OFBEDROOMS 3 ,,4` //'� BUILDER OR OWNER N t C.15a5t 2( 6 11Aq C0. PERMITDATE: 10 2 COMPLIANCE DATE: f 21I I S/ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility konP_ Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) '� i Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) 4Inne Feet Furnished by 7 �y ti http://issgl2/intranet/propdata/prebuilt.aspx?mappar=155007002&seq=1 8/17/2015 0 C96 /S�� - No.]U_n___S4 Fee-- -- - BOARD OF HEALTH TOWN OF BARNSTABLE 0[pplication for Vell Cootructionpermit Application is hereby made for�_� ermit to Construct Alter ( ), or Repair ( an individual Well at: �--------------Ll�! ��1"_?_ - - - -- - - - --r-� -- - /,:;�j hon — Address Assessors Map an Parcel --------------- Y_i_ — >.' -----------------��} 61x — - --�-------- -!!�J-1 = ✓/� _ Owner C //1 Add ss J z t Yet ✓/' C�� r_--j---------—--------------- -------------------- — ----------------- ---------------------------------- Installer Driller Address Type of Building Dwelling------------ % w Other - Type of Building ------------------ No. of Persons.---------------------- -------------- Type of Well---------------------/------------------------------------------- Capacity-------------------------------------------- ---------------------------- Purposeof Well----------------------------------------------- - ------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Certificate Compliance ha b issued by the Board of Health. r SignedE -_ - C or date Application Approved By � � "� — C -'^ ��-------------- date - J J te Application Disapproved for the following reasons:----------------------------------------------- ------------------------------ -------------------------- ------ ------------------------------------------------------------------------------------------------- �) ----------- date Permit No.y"— -�- Issued - - = Q '�6---------------- ate---------------- ----- -- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed�Altered ( ), or Repaired ( ) bY--------- �'`.'=--------- 1`, ''�-d'� ---------------------------------------------------------------------------------------- Installer 77 at ----------------------------G___------ „r 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.VV 1-"-6'1______Dated--- -------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- ---- — - ----- - -- Inspector------------------------------------------------------------------------- t No. -- -�---� Fee BOARD OF HEALTH TOWN OF BARNSTABLE Zipplitat ion ffbrVell Construction Permit Application is hereby made for a permit to Construct Alter ( ), or Repair ( an individual Well at: ZV_-` -- -- - -- -ice Lo tion — Address Assessors Map an Parcel ��-- � -- -------------- ---- - - Owner Add ss - 'e -----� ------------------------fir ms-Q- - ------------------------- Installer — Driller Address Type of Building � Dwelling -�!'" �"'-- ------ rOther - Type of Buildin --'------------ No. of Persons------------------------------------------------------ Type of Well—— ---—- - = -— — -- Capacity --------------------- - ----- Purposeof Well------------------------------------------------------ 1 Agreem`ent: 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 Complia ce ha b issued by the Board of Health. r Signed - � % - ---------— - � g date �y j Application Approved By -7 w ' J J date Application Disapproved for the following reasons:------—------------------------------------------------------------------- ——---------- _ r date Permit No. Issued------�--=3-��-------��------------—-------------------- date i �_._�.._�_�.�...f_..'=�—��.�.�.� �.�...�.�...s_._'-....,�.,,ram•,... ._.- _._. .., ._- .. -.- +...�_+�.`.+d.�...coei...�r....�....Nrp+:a►rv..�+rS��...r.sesgrr+.eR-aa -.m�wc$MM.+�.... .rr..�..��r��..r.- ....._.. _ _... .Y�+...�`,,,�••k---. ..tt BOARD OF HEALTH % TOWN OF BARNSTABLE C ertif irate ®f compliance THIS IS TO CERTIFY, That the Individual Well Constructed),r), Altered ( ), or Repaired ( ) ! D ' by—--------- Installer at ///� 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.V?A&--15_1------Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL I SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------——---- — - ---- — - Inspector--------------------------------------------— - --—-------- ENVIROTECH LABORATORIES, INC.- MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich, MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508) 888-6446 CLIENT: Nickulas Bldg. Co. LOCATION: Lot 2 ADDRESS: P.O. Box 507 Village Lane W. Barnstable, MA 02668 W. Barnstable, MA SAMPLE DATE: 10-7-96 COLLECTED BY: Desmond Wells DATE RECEIVED: 10-7-96 TIME: 4:30PM LAB I.D. #: E10-160 JOB TYPE: New Well SAMPLE I.D. #: E10-160 WELL SPECS. : 4" 53'/ 10' RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 6.57 Conductance umhos/cm 500 144 Sodium mg/L 28.0 7.7 Nitrate-N/ Nitrite-N mg/L 10.0 LT 0.01 Iron mg/L 0.3 LT 0.05 Manganese mg/L 0.05 0.004 Volatile Organics See attached report. EPA #524.2 None detected. COMMENTS: Yes WATER IS SUITABLE FOR DRINKIN URPOS FOR PARAMETERS TESTED. xxx Date 2 Ro ald J. Saari Laborato Director IT = Less Than - LAPUCK- -- LABORATORIES,INC. ENVIRONMENTAL TESTING SO Hunt Street WASTE WATER DISCHARGE TESTING Watertown, MA 02172 (617)90300 FOOD ANALYSIS 23- FAX( 23- 923-0301 CHEMICAL ANALYSIS FORENSIC TESTING REPORT LAB NO. 56525-2 October 18, 1996 Mr. Ron Saari ENVIROTECH LABORATORIES, INC. Sample Received: 10/09/96 449 Route 130 Client I.D.: Desmond Well Drilling Sandwich, MA 02563 Sample I.D.: Lot#2 Village Lane Test Results: Volatile Organics-ppb(ug/L) Method#524.2 Benzene ND 1,2-Dichloropropane ND _ Bromobenzene ND 1,3-Dichloropropane ND Bromochloromethane ND 2,2-Dichloropropane ND Bromodichloromethane ND 1,1-Dichloropropene ND Bromoform ND Cis-1,3-Dichloropropene ND Bromomethane ND Trans-1,3-Dichloropropene ND N-Butyl Benzene ND Ethylbenzene ND Sec-Butyl Benzene ND Hexachlorobutadiene ND Tert-Butyl Benzene ND Isopropylbenzene ND Carbon Tetrachloride ND P-Isopropyltoluene ND Chlorobenzene ND Methyl Chloride ND Chloroethane ND Naphthalene ND Chloroform ND N-Propylbenzene ND Chloromethane ND Styrene ND 2-Chlorotoluene ND 1,1,1,2-Tetrachloroethane ND 4-Chlorotoluene ND 1,1,2,2-Tetrachloroethane ND 1,2-Dibromo-3-Chloropropane ND Tetrachloroethene ND Dibromomethane ND Toluene ND 1,2-Dichlorobenzene ND 1,2,3-Trichlorobenzene ND 1,3-Dichlorobenzene ND 1,2,4-Trichlorobenzene ND 1,4-Dichlorobenzene ND 1,1,1-Trichloroethane ND Dibromochloromethane ND 1,1,2-Trichloroethane ND- 1,2-Dibromoethane (EDB). ND Trichlorofluoromethane ND Dichlorodifluoromethane ND Trichloroethane ND 1,1-Dichloroethane ND 1,2,3-Trichloropropane ND 1,2-Dichloroethane(EDC) ND 1,2,4-Trimethylbenzene ND 1,1-Dichloroethelene ND 1,3,5-Trimethylbenzene ND Cis-1,2-Dichloroethylene ND Vinyl Chloride ND Trans7l,2-Dichloroethylene ND Total Xvlenel : ND N.D. =Not Detected Analysis Date: 10/16/96 Method Detection Limit =0.5 ug/L __. Recoveries of Surro ate-% 1,2-Dichlorobenzene-d4 90 P-Bromofluorobenzene 80 Testing I&ECouxult-ing Services or over 30 Years . . . /.r Fontenarosa, Lab Manager This report is rendered upon the condition that it is not to be reproduced wholly or in part for adveurposes over our _signature or in connection with our name without special permission in writing.Total liability is limited to the:invoiced amount.The results listed refer only to tested samples and/or applicable parameters. `- ENVIROTECH-LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508)888-6446 CLIENT: Nickulas Bldg. Co. LOCATION: Lot 3 ADDRESS: P.O. Box 507 Village Lane W. Barnstable, MA 02668 W. Barnstable, MA SAMPLE DATE: 10-8-96 COLLECTED BY: Desmond Wells DATE RECEIVED: 10-8-96 TIME: 12:00PM LAB I.D. #: E10-159 JOB TYPE: New Well SAMPLE I.D. #: E10-159 WELL SPECS. : 4" 59'/ 12- 'w. RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 6.56 Conductance umhos/cm 500 159 Sodium mg/L 28.0 8.6 Nitrate-N/ Nitrite-N mg/L 10.0 0.03 Iron mg/L 0.3 0.10 Manganese mg/L 0.05 0.029 Volatile Organics See attached report. EPA #524.2 None detected. COMMENTS: - Yes WATER IS SUITABLE FOR DRINKING PURPOSEP FOR PARAMETERS TESTED. XXx Date L�,J-- 9 116 Rdnald J. Saari Laborato y Director LT = Less Than LAPUCK LABORATORIES,INC. ENVIRONMENTAL TESTING 50 Hunt Street WASTE WATER DISCHARGE TESTING Watertown, MA 02172 (617)923-0300 FOOD ANALYSIS— CHEMICAL ANALYSIS FAX(6-.7)923-0301 FORENSIC TESTING REPORT LAB NO. 5652`-1 October 18, 1996 Mr. Ron Saari ENVIROTECH LABORATORIES, INC. Sample Received: 10/09/96 449 Route 130 Client I.D.: Desmond Well Drilling Sandwich, MA 025631 Sample I.D.: Lot#3 Village Lane Test Results: Volatile Organics-ppb(ug/L) Method#524.2 Benzene ND 1,2-Dichloropropane ND Bromobenzene ND 1,3-Dichloropropane ND Bromochloromethane ND 2,2-Dichloropropane ND Bromodichloromethane ND 1,1-Dichloropropene ND Bromoform ND Cis-1,3-Dichloropropene ND Bromomethane ND Trans-1,3-Dichloropropene ND N-Butyl Benzene ND Ethylbenzene- ND Sec-Butyl Benzene ND Hexachlorobutadiene ND Tert-Butyl Benzene ND Isopropylbeniene ND Carbon Tetrachloride ND P-Isopropyltoluene ND Chlorobenzene ND Methyl Chloride ND Chloroethane ND Naphthalene ND Chloroform ND N-Propylbenzene ND Chloromethane ND Styrene ND 2-Chlorotoluene ND 1,1,1,2-Tetrachloroethane ND 4-Chlorotoluene ND 1,1,2,2-Tetrachloroethane ND 1,2-Dibromo-3-Chloropropane ND Tetrachloroethene ND Dibromomethane ND Toluene ND 1,2-Dichlorobenzene ND 1,2,3-Trichlorobenzene ND 1,3-Dichlorobenzene ND 1,2,4-Trichlorobenzene ND 1,4-Dichlorobenzene ND 1,1,1-Trichloroethane ND Dibromochloromethane ND - 1,1,2-Trich loroethane ND 1,2-Dibromoethane (EDB) ND Trichloroflubromethane ND Dichlorodifluoromethane ND Trichloroethane ND 1,1-Dichloroethane ND 1,2,3-Trichloropropane ND 1,2-Dichloroethane(EDC) ND 1,2,4-Trimethylbenzene ND 1,1-Dichloroethelene ND 1,3,5-Trimethylbenzene ND Cis-1,2-Dichloroethylene ND Vinyl Chloride ND Trans-1.2-Dichloroethylene ND Total Xylefie ND N.D. =Not Detected Analysis Date: 10/16/96 Method Detection Limit =0.5 ug/L Recoveries of Surro ate-% 1,2-Dichlorobenzene-d4 90 P-Bromofluorobenzene 80 i Testing &.Couxu ng Services for over 30 Years . . . a- es Fontenarosa, Lab Manager This report is rendered upon the condition that it is not to be reproduced wholly or in part for ad sing or o[her.purposes over our signature or in connection with our name without special permission in writing.Total liability is tmited tothe;invoiced amount.The results listed refer only io.tested samples and/or applicable parameters. Department of Environmental Management/Division of Watery Resources WELL COMPLETION REPORT �/� g�75- WELL LOCATION' GEOGRAPHIC DESCRIPTION Address_" 07, a N S E W of (feet) (circle) City/Town ,Q,9�t'/yS7AdGC ,( U l�� � , C(/• - (road) Well OWnCf - Address .S7! N S E W of (ml in tenths) (circle) Board of Health permit obtained: yes E] no❑ intersect. w/ (road). WELL USE J WELL DATA Domestic Public❑ Industrial ❑ Total well depth ft. tylortitoring❑ Other Depth'to bedrock ft. J. ����, Water-bearing toc0linconsolidated material: Method drilled Date drilled �� " ���/ Description Water-bearing zones: CASING / �} 1) From To Type esr >� 2) From To Length,'5?> ft. Oia(.I.D.) '9 in. 3) From To Length into bedrock ft. Gravel pack well:, dia. Protective well seal: Screen: dia: Grout-_❑ Other Slot w length-from- STATIC WATER LEVEL(all wells) Static water level below land surface ft. Date �` 7 If WELL TEST(production wells) Drawdown /� ft. after pumping hr. min.at gpin How measuredr�rn'Ir.VrRtcovery -4&f-t-eAafte''r-::241fri min. 0 LOG of FORMATIONS COMMENTS Materials Fram To Driller Firm n Address City/Town• Di'Lil,�ti �%/.� Supervising Driller Reg.# - Si nature o tu�isin re istered welt dr!l/er iPlease Print firmly Y Y •HEALTH COP_,. BOA. F ._: .� . BOARD OF HEALTH I TOWN OF BARNSTABLE f MeU con5truct ion Permit No. -J-"-------— — Fee --------- 'i Permission is hereby granted---——-------- ------------------------------------------------------------------------------------------ to Construct (�'), Alter ( ), or Repair ( ) Individual Well at: No. Street as shown on the application for a Well Construction Permit No. - - -- --- ——- - - - Dated — Z-------------------------------------- --------------------------------------------------. .... q 3� erg/ Board of Health DATE---- — = -- -/- �—---------------— - SOIL EVALUATOR&PERCOLATION TEST FORMS ��F1HE T�o� Town of Barnstable Page 1 of 4 ♦ vRA HATABLE•$ Department of Health, Safety, and Environmental Services `b S. 039. ok Public Health Division ArED MA'S 367 Main Street,Hyannis MA 02601 Office: 508-790-6265 FAX: 508-775-3344 Soil Suitability Assessment for Sewage Asp osal A1,5,55ESSORs MAP Na, ids PARCEL NO. yam/ Date: Performed By: t/��%'" //�"7� . Date' kA15F Witnessed By: Location Address Owner's Name All r Loot: ND> f t �,� Address,and 2 sT�T -5e-d (A Jell Assessor's Map/Parcel: , Telephone# > NEW CONSTRUCTION REPAIR Office Review Published Soil Survey Available: No Yes Year Published gl 97 Publication Scale 1_2Sady Soil map unit Drainage Class Ew,O Soil Limitations C—Wb Surficial Geological Report Available: No ✓ Yes Year Published Publication Scale Geologic Material(Map Unit) Landform 6U7PVjZ5N l✓GA% Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No _1x Yes Wetland Area: National Wetland Inventory Map(map unit) /VO Wetlands Conservancy Program Map(map unit) /VD Current Water Resource Conditions(USGS): Month Range: Above Normal Normal Below Normal _ ` Other References Reviewed: ��C ' �G'�C�Z�IUS & 76 S%� /rldN/ lU2C (7'-✓,--Ot'i�OGr.G3lG-� Lr��G.S'�/L���"l �%�� O� /`j'�� DEP APPROVED FORM-12/07/95 r FORM II - SOIL EVALUATOR FORM� Page 2 of Location Address or Lot 140. On-site Review 6 Z Date: Time: //•`/s �� Weather �S JNWY 7S-V Deep Hole Number . �-�-� ......... ..... .. Location (identity on site plan) glope. (..o/a. Surface Stones Nd Land Use We"A!7 Vegetation Landform .... QU . Position on landscape (sketch on the back) Distances from: Drainage way /2© feet Open Water Body 3s0. feet � feet Property Line . ��.. feet Possible Wet Area 39- Other :.::.....::....:.:::.:..:.: .: Drinking Water Well : /�4 feet D 11 EEP OBSERVATION HOLE LOG* or Soil Other Depth from Soil Horizon Soil Texture eP(Munsell) Mottling (Structure,Stones, BoullGravegrs, Consistency, °� Surface(Inches) �A'A 42 joyKA1 120 / ICI To /o w-1313 Y//ICE S�dl B voo/NE SIA40 � 5� ees DepthtoBedrock: —" Parent Material(geologic) Weeping from Pit Face: -- DeRth to Groundwater: Standing Water in the Hole:,,�,�,I� L -r��/U 7- 5�1-� Estimated Seasonal High Ground Water: J�G�� 6:t /3� - 02 T� 2$'$ Za// 7-1 bat 2'- ld,o /Y 19 DEP APPROVED F0101-12/07/95 7 = 32- > f 3,.a J/EAj/v r 2 = /�� ✓ ` To /}b.T- �� //ZO �w � s- L 1.� //49 q foL M f FORM 11 - SOIL EVALUATOR FORM Page 3 of 4 Location Address or Lot No. ��' � �t /A/l�' Determination.for Seasonal High Water Table Method Used: ❑ Depth observed standing in observation hole..._... inches ❑ Depth weeping from side of observation hole... .. inches y0epth to soil mottles inches round water adjustment feet Index Well Number ............... Reading Date .................. Index well level .- Adjustment factor ..... .... Adjusted ground water level ....................... ......... ..... 0* sew 2s2 � Ia- T /�z� ��. �, & 13. 6- Depth of Naturally Occurring Pervious Material yW I15 TES 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 6 (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 DEP APPROVED FORM-12/07/9S i r• FORM 12 - PERCOLATION TEST Page 4 of 4 Location Address or Lot No. qr� a--�%� �•/ COMMONWEALTH OF MASSACHUSETTS �A/STf9l�Lc=, Massachusetts ]Percolation Test* Date: .. $-�'- Time:, : . //; o ! I Observation Hole Depth of Perc Z 'l jd7tiA Start Pre-soak End Pre-soak Time at 12" Time at 9" Time at 6" ,�Ov�C?l s4 Thu /arCNvT Time (9"-6") Rate Min./Inch Minimum of 1 percolation test must be performed in both the primary area AND reserve ,area. Site Passed L7 Site Failed ❑ ............................................................................................................................. ......._......._ Performed By: Witnessed By: �'�'�� Comments: _........w....w..........-...�.........._.......w._ �.�..... ..__... ,.... DEP APPROVED FORM-12/07/95 .SO/LS EYHL[/AT/ON 2ES(IL Ts job FtJt/wDi9771�N .fit, - 28.So ' "�Wr9G� SYSTEM PiYDr�/GE T--/ T Z 27 3 //V SHwd Y D s9�uoY 9 - esfp cot e CavE�Z 8D.1' 1✓6'' 5'UMP G N Lo,9iy I 3 M9k i vv MAx. 5 M/N, y 8 Zdw, }� 4 -•�- ., N N N s�Nd NE,E' .D/r�ENS/D 2 2,70 s Ec. ' C. SEwE,e � v /Nv IN✓. /D LF/'�G w /VE Y /¢ i2/'.3 55Et.22.7 /ti, 23. //vvr4 � Y• a/5"TONE J 4c/v C' T>0 6• LEfI / C'19 Q o a DFi�T� 771 s o 0 2� 7 a TD 6 BOO 0� Z 7 /4 Z 7i I55E A5<- e 6, �3'�f'T/C 779W51- A117-11 e e .STa►�E STowE ,�irvE /NG,! ET Ts f 1!5-,E' 71-1—LE F/ITE SToNC 3AN0 7.Z L /G. BO TTc�M 6/' 7Z-5T i�0.TT.cSTEO C',20(/�h/ATEi2 s t'OUN13 .2 G �UA7� /✓O T �NC'OGWT�.e�d . .' WA /rEla �c�✓E ' 2'7 y (3)SW 6 GEAGN C11410wBE,e$` 50�[..S' c�'�i/gL UATa,2: ✓, .00 yr.E, • ' � �ERC, 723'T.A'ItYN ,S2 CLASS -Z SO//-,Y. r LQT Ale, 3 ,SFh/ACE 0—S/GN G'ULAT/OA/S 0� SD6-5'A5 v f-ow 47- //o GPD 33o GPD D.7¢ G �r 1�i9Y = S4� s, 'I�AG�i�✓� ,E' �//mod• �' v' . (l E . ,2EC�9.5T QQ G; J/ 2'7- "-V/20 .TTDNE 4.;,- -� 8�, ti V/ L .5/DE.S a /20 ( n - v . ppepes y o c>r a q .a � zoo cor�lM�iV:C�►7�e/✓s w.qY P,egPDSEo a. ti 1&,gA1N/S 6 2G dsE 3 U f N ASsESa�2s /Yl•9i� �i� /5Sf1.C'C, .i 7 ry 'D 3� v T.2 o -5l L oT/t/o. 2 r' F S/TE -9�/D SW, E466 /✓ .L'GA FfliC w /t//o�E't/CA�s BU/G D/N6r G"' cQ ,�h' /�/ f'TZUf'OSE.d 3 ,f3E1,>�DDn'I �p�ZN OF M ,/A� Z1-1—NG -,Vb '-e -46e SYSTEM ASf a 1�( 0L7 �� o .loHN W / LOT. A/o, 2 t/'/ZZ�I6E Z~ + t P. is OF ST,Pf�T Np, p Y/Lt AGE GA�C/E DOYLE,III ti �"� 3589' i v. /�iQ/llc5'TiCr��-E !%A. it No.3 9F ISTER�4 Q. : WILLM1M l9 G y0 U RMAN ✓U Y , /9 9 Np g�E w G?9PNiC 3C.4cE /iy T S U 'cE A[� p So /OD YLE fI SCC/�9 TE'S' 5 I I _ �a/�s ,. �i9L u9 r/diy �EsyL rs i O!� F�G/N.l�fJT70N �"L. = Z8.SO SEWA6E .SYSTF/�! P�Y4�/GE _ 273 � SfJivD Y A �' S�i✓.DY v 2— 28 vMVA, 8 Lo,9/+•s>y T`-^ /Z"/rvNE' ,d/r�IENS/D�✓ 2z,70 --- 3� MfIX, 2",-eV W Oi /'g 18",5-7e 55" 2Z•7 v /wv, /41V GEr /¢"' 23.33 /n/v 13.// /vv 12.y¢ • , a d '•. 23.9•¢ 83,5B � //vV. 3 a_ ., L oisTowc �9CMf S40 G• LF�9cH c//i9MBE�f'S sTo�� ZT 72) 6L ZD .7 0 0 0 o D 7-0 2'7" C1,SE /S4o 5, �F/'T/C T.91V�j'" W1/-7 /irvE �i2U5/1ZD Sf/ND /NLET d�/TGET TEE. /:it,e Ti7Z Z-- • 7,Z s /vC To 3 � _ BO TTcJM O/` TEST AArz�SrEO a e�eAV6, 72!F�e /3Z" 3 ; 4 G�ClJ/41)/t//9 MOT ENCIIGfVT�.eEU r {✓/15/mod STG�NE 2.7 v (3�SW G GEACN C//r9a/B6�'S '. E.t2'i9✓/lTde= Li9Mrd% E ., _ • � - . - •: - /��-�� /C471-1� < 2 /vl�N�iNc H_ �E.PI, /�T��t/N ,j2 CLASS S SO/G S. t l S LOT SLh/A6E be5ICAI CAL ezll-4710A/.; 2y. / 1 OEsi�,v /'L a;r✓ T //0 CPU 3 3,3 e GP.4). Z. USE �3� �P�C 9,57 See G, LEAcs//�G c//NMa 's /v`2 7•�� /I51/�D STDN� /1J£-5 Aiv1� 2'3" S iOrtrE /l T G�N�Os, ti tv� s� o i i � � AGE k=30•oo' \� ., �� 3 Zafa 07TpM= /U X 30 30o s F. GAME SIDES ('20 tG0 ToT�z _.Peovis/av =304 t/Lo - ¢GO -, P� 4 USE /SG+D 6'AL• v' �s'T✓G T•9Nit k/ NO �ArP13. /5,�0 \�4• 7 /, f/'/ fl,�.aL/CANT- N/CAUGAS BUIIZOING eO . 2 CDMM1/N.C.AJ74NS tAlAy L = �� /26 r - � - i "19NIVZS Mho G b s ASSESS�/2S /YlAP _ /��id /5S �i9 CSC. 3 7 GOT 2. 10 d 0 0� l30,�- o r {)///�'•� LOT�i/D. , sYs7Etii 3 / F ciwE , �zc y I �O ZAe S/TE - 1/0 �&W,46E ,oGA V F02 ems. � • ti �//OH/jNG F'/2of'4 SEh 3 ,8E.1,�DDM a e>V,=Z.L/N6 4,Vb -56 46-E SYS7 EM p LO /Vo, 2 GL/A6 Lfl�/E /q JOHN �G � T V! E P. "(N ,STeL�T NO, -¢O ✓/6GAGE Gf�i�✓E /t/ 5'iVSTt/,C�eE � DOYLE,111 �, � 7 No. 33589 wtttlAY ✓UG y /9 9 G 'gEGI�TE.R�� Q L�RMAM � I q'LO Slur��(y� No.ZA71© GTi�Pf1iG 3GtGE1�T 'A -- --- _ �µ E'�► D So /OD �. ,doyl-e5 1915SG'clll rl I