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HomeMy WebLinkAbout0045 COMMODORE LANE - Health �45 Commo'dore Lane, y , P , 012411,3 �",Mars tons?mills 4 1� � 1N i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °,M •'°r 45 Commodore Ln a Property Address Bank Owned (Contact David Holt C Today Real Estate 1-800-966-2448) Owner Owner's Name / information is Marstons Mllls ✓ MA 02648 3-25-16 required for every page. City/Town State Zip Code Date of Inspection ice+ Inspection results must be submitted on this form. Inspection forms may not be altered in way. Please see completeness checklist at the end of the form. A. General Information Si 1. Inspector:, Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S 13971 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. 3-25-16. 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 Disp I System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner.,z Owner's Name information is require`W-Dor every Marstons Mills MA 02648 3-25-16 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/ahvays 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: 0 System is in good working order with no sign of failure. 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection .Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 3-25-16 page. City/Town 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 Boaed 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 , Commonwealth of Massachusetts R. Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments , M 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mllls MA 02648 3-25-16 page. City/Town 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 ` El ® 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 '/Z day flow t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons MIIIs MA 02648 3-25-16 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 I Area—IWPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to an question in Section y y y q 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons MIS MA 02648 3-25-16 page. City/Town 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: * r ' 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 i` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s° 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mllls MA 02648 3-25-16 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 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 ears usage Well 9 ( Y 9 (9pd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate Commercial/Industrial Flow Conditions: Type of Establishment: 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 3-25-16 page. City/Town 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: N/A 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/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 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 s 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Marstons Mllls MA 02648 3-25-16 required for every ' 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: 1990's Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well'or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 12"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: 1000 gal Sludge depth: 12" t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form:Not for Voluntary Assessments 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is Marstons Mills MA 02648 3-25-16 required for every - 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 20" ' Scum thickness 1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 15" How were dimensions determined? Tape 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 is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet r Material of construction: e ❑ 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 - Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mllls MA 02648 3-25-16 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.): 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 t5ins-3/13 Tide 5 Official 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 45 Commodore Ln Property Address Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is. Marstons Mills + MA 02648 3725-16 required for every ' 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 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.): Good condition with water at working level and no sign of back-up from pits. r 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•3/13 Title 5 Official Inspection Form: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 45 Commodore Lin Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mills MA 02648 3-25-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number. 2-1000 gal ❑ leaching chambers number ❑ leaching galleries number ❑ leaching trenches number, length: ❑ leaching fields number;dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): Both pits were empty at inspection with stain line in pit"G" at 18" off bottom of pit. 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons Mllls MA 02648 3-25-16 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: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons MIS MA 02648 3-25-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) I - 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 C � kc - ��& l A -1- /0316'. U � 7, t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 - i Commonwealth of Massachusetts ; Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary,Assessments - M s 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons MIS MA 02648 3-25-16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑- Check cellar ❑ Shallow wells 20' Estimated depth to high ground water: 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: 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: USGS and town maps show groundwater at greater than 20'. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 45 Commodore Ln Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Marstons MISS MA 02648 3-25-16 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 f CI I t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 I Town of Barnstable Health Inspector Ft Tp� Office Hours o Regulatory Services 8:30—9:30 Thomas F.Geiler,Director 1:00—2:00 * &MWSTABM '""SS. 1639n. Public Health Division �0 Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 AMNESTY PROGRAM APPLICANT — SEPTIC QUESTIONNAIRE 1. General Information: / V 'A 2S-R R 5 M (L(f Size of Property: G f21; Address: 45 �AAUODOR—& LANE Map Parcel Name: Nct4 Phone#: (,!jL) "Z 3 9 3 2a. How many bedrooms exist at your property now? 2b. Are you planning to add any bedrooms? I V 6 If yes, how many? 2c. How many bedrooms total are proposed at this property(including the amnesty unit)? 2d. Please include a copy of the floor plans for the entire property- showing the existing rooms in the home plus the proposed amnesty apartment and/or addition. Please label each room clearly on the plans. 3. Is the dwelling connected to public sewer? YES or ONO If the dwelling is connected to public sewer,skip qu6stions#4 through'#9below: 4. Location of dwelling is INSID or OUTSIDE a Zone of Contribution to public supply wells? w $Js the dwelling connected to an ONSITE WELL or to PUBLIC WATER?-X m GIs a disp sal works construction permit on file? YES or NO X: _ ea- yes, many bedrooms were approved according to this permit? Bedrooms. m _co t 7>—Were an > - ilding permits obtained for construction of additional bedrooms? OYES or NO Q .� oGIs there n engineered septic system plan on file at the Health Division? YES or NO 9. Has the septic system been inspected by a DEP certified inspector within the last two years? YES or NO -------------------------------------------------------------------------------------------------------------------- FOR OFFICE USE ONLY i The Public Health Division has no objection to bedrooms at this property. Special Conditions: 2.o�� t52Con ' S14C4 LW nvO b - rtsmvkiD-) Signed: Da 4- Q,/health/wpfiles/amnestyapp McKean, Thomas From: McKean, Thomas Sent: Thursday, June 10, 2004 4:36 PM To: Mcauliffe, Paulette; Weil, Ruth Subject: 45 Commodore Lane I called Nancy Burke back this afternoon and discussed the two options (#1 Providing a completed septic inspection report or#2 converting one of the very small second floor bedrooms into a "non-bedroom" by removing the door to the room and eliminating privacy to that room). She chose option#2 and agreed to remove the door to the very small room on the second floor. She will convert that "bedroom" into a computer room without p.-ivacy; thus the dwelling will contain three bedrooms. P.S. —Paulette, I will FAX you the approval form now. i r McKean, Thomas From: McKean, Thomas Sent: Thursday, May 20, 2004 5:23 PM To: Mcauliffe, Paulette; Perry, Tom Subject: RE: Nancy Burke/45 Commodore researched the Health Division file on this. In 1987, a three bedroom home was constructed. In 1995, the septic system apparently failed, a"repair" permit was obtained, and a 1,000 gallon leach pit was installed. However, the applicant claims, on the septic questionnaire for amnesty, that the home contains four(4) bedrooms, not three. The property is within a GP district and is limited to three bedrooms, unless the fourth bedroom was constructed before 1987. My question is: when was a fourth bedroom constructed? Sent: Thursday, May 20, 2004 2:12 PM To: McKean,Thomas Subject: RE: Nancy Burke/ 45 Commodore Thanks Tom. I don't know why the form is difficult for people to fill out. You did a great job at simplifying it! I'll call her. PT -----Original Message----- From: McKean,Thomas Sent: Thursday, May 20,2004 1:28 PM To: Mcauliffe,Paulette Subject: Nancy Burke/45 Commodore Yesterday, I received an incomplete septic questionnaire form from Nancy Burke. It will take some time to review the incomplete form and to research the information in order to complete the form. Our next staff meting is Tuesday June 1s'. Please call her to let her know that it does take some time to review these. Her phone number is(508)420-3683 • r f : Barnstable Assessing Search Results Page 1 of 2 kt IS Home: Departments:Assessors Division: Property Assessment Search Results Owner: BURKE, PHYLLIS E Property ketch Legend Map/Parcel/Parcel Extension 028 /113/ Mailing Address H BURKE, PHYLLIS E �� _ NINO BURKE, NANCY&MAIER, M 45 COMMODORE LANE MARSTONS MILLS, MA.02648 2004 Assessed Values: Appraised Value Assessed Value Building Value: $ 154,000 $ 154,000 Extra Features: $2,900 $2,900 Outbuildings: $0 $0 Land Value: $ 160,500 $ 160,500 Interactive Property Map: ap requires Plug in: Totals:$317,400 $317,400 1 have visited the maps before Show Me The Man ` April 2001 photos available � ''-._ Sales History: Owner: Sale Date Book/Page: Sale Price: BURKE, PHYLLIS E 5/15/1995 9661/282 $ 100 BURKE, ROBERT W&PHYLLIS E 1/15/1988 6104/014 $ 120,900 BURKE, ROBERT W*M792 11793/204 $0 BURKE, ROBER W-DC 10800/319 $0 2004 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $2,098.01 Town Fire District Rates Other Rates 6.61 Barnstable 2.01 Land Bank 3%of Town Tax C.O.M.M. FD Tax $349.14 C.O.M.M. 1.10 Cotuit 1.52 Land Bank Tax $62.94 Hyannis 2.03 West Barnstable 1.36 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 5/21/2004 W TOWN OF BARNSTABLE LOCATION SEWAGE # VILLAGE,/ 24t/JA/Z3 f ,S' ASSESSOR'S MAP Q LOT6,;f- a p. INSTALLER'S NAME 6t PHONE NO/ �7-0/ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) tl� NO. OF BEDROOMS—PRIVATE WELL PUBLIC WATER BUILDER �OWNER//`71 DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: `b'/��' VARIANCE GRANTED: Yes =No At - do I q.a - �q - s / 1060 Jal J�Wk ��l a► J P�Z 8 113 - .........+.. Fxa THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Uivjipooal Workii Towitrnrtion rumit Application is hereby made for a Permit to Corist uct ( ) or Repair X) an Individual Sewage Disposal System at: Lo o. ..-1 • ...'-.. ..0-ati n...\ddress----••�� X ✓N/�®iQ®f./Q,�+--•--- r� t.N�.X:.�_.v!:[.�!:J..v�............. ............................ Owner -� �r / � / y A[�ddress J7 CU/J.. i/�L.lv! /.nJ 7V W� �f�.. ✓I� (U-S . sta ----}}-.-�-------•---•----- � Installer Addrfss Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms.___2_:7A.._.__________________Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fix t e .------._ W ____Design Flow................__--- ___________________gallons per person per day. Total daily flow-.--__--____--i! a ................gallons. WSeptic Tank—Liquid capacitv_fOQp---gallons Length________________ Width---------------- Diameter.--------------- Depth___•-___'_-_---- x Disposal Trench— No. .................... Width-------------------- Total Length-------------------- Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter------ Q--------- Depth below inlet._6............. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date..................................... 1 Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ t� ...............................•---••---•--•--.....-•-•--•-•---•----•-•-•---•--••--•---------------.......................................................... 0 Description of Soil........................................................................................................................................................................ x U ---•-••-•-••••--•-•------•••-----•---••-•••••--•••••••••-------••--•-•••---•-----•-••••••-••••-----•--•-••-•.........--••••-----••--•---•-••--•-•••••-•-••-•-•-•---••••-••..........-•-•-•----'•......-- w [ UNature of Re airs or Alterations—Answer when applicable._..__.' .b__... --------- _. ........�...�............... ......` ......_ nJ�... .0_ V ti .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliant has been issu by the board of health. Signed ...... . ... . . .. . . .. a ............. ..3`f 3��_ p.... .. - ---------------Date--_------:..-_.. Application.Approved By .................. ... .. .. .. .... .... ... 0------ Application Disapproved for the following rea.ro s: ---------------------- --------------------------------------------------- ------------------------------------------- -------- ........................ ........................................ ........ ------.---J..................._.. Date Permit No. v. ..... .. Issued , ..... 9...... .................. �Da[ --'—-- '------------------ No..... ................. ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-vipa!ial Wnrkii Tatuitrnrtinn Vrrntit Application is hereby made for a Permit to Corist,uct ( "') or Repair ( ) an Individual Sewage Disposal System at: ----------------------------------------------------------------------- -•--------•--•--------•-•-----•-•-----...---------•-- --•-------........---...._..•-----.....---- G Lo :\ddress , C_�U 4......................................................Owneror Lot No. 'C-& r�3 _Address '� ...................................................�liN sue L..G7"7f ..G� (,✓i4' ,t�l� ✓VI e t_(S , Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms._____ a____y------------------Expansion Attic ( ) -` Garbage Grinder (---r f%J0 Other—Type of Building ............................ No. of persons---------------------------- Showers .( ) — Cafeteria ( ) r � Other fixtures W Design Flow...............5 ...__.._._........_1_gallons per person per day. Total daily flow---------------- �36................gallons. .R: Septic Tank—Liquid capacity.#.4?/gallons _Length---------------- Width________________ Di --- Depth____.__"`. W Disposal Trench— No- ---------------- idth_'_ ---------- Total Length___.__. ......... Total leaching area....................sq. ft. Seepage Pit No-------- ........... Diameter'-/-_�6..._.... Depth below inlet-_�o.�__..._..._. Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY,----"--t---- ------------------------------------------------------------- Date........................................ aTest Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... 44 Test Pit No. 2................minutes per inch Depth;h of Test Pit.................... Depth to ground water........................ ri t r DDescription of Soil..........................................---.....-=...... •----------._.......---------------------------------------------------------•-----•••......-----_---•- x W UNature of Repairs or Alterations—Answer when applicable.---.--_�_6'�-._.._!�-.____../*A ' .t>�....___L���1._ ,2j-t:-.. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued bbyrthe board of health. Signed .... /:.//U/' J�. / �•� 33�........... .........J �f �---�--..,�..;-.. .. ... „W Dace A lication Approved B �J1 ,-`- �-- -1 - ...._......... -' - PP PP Y f = Dace Application Disapproved for the following rearon ............... .. ---------------------------------------. ------------------------ - Permit No. �� -------.. ...... -- Issued ' ... . .......�... ....9 e llac • THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BAR��NSTABLE ILTTPrtifirate of VT oraplianre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) -G -7 t f'7' C.'U ' ��/c j.J by ---------------------------------------------------------------- ---- -----------------..._----------------------.............----------------------------- -------- Inscalic•r at ....._.... ........................_._....._......... .... L-Gc� i<....1.....' `. Uts--------------------------- has been installed in accordance with the provisions of TINA 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No �' ._ - ............ dated ------- _. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATI •FACTORY. DATE -. ..- --/✓ Inspec " �v`�y4 G �� ...._.--------------------------- - -r _.... _- _ __--------- ----- ----- --_--- ,----_,--- `---- -,---r------ --- ------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.�.�------......3 FEE... ......... r Rnpnial Norkii TungtrWinn "rrntit Permission is hereby granted..........................% G cu j j Ce j --�C7 ir'� .................... •••••......... to Construct ( ) or Repair O an Individual Sewage Disposal System at No. 1 --- ��Grvt vr�c_✓�.y ..----C.-*INS .:.....✓V?_:.. ].c5. it Street as shown on the application for Disposal Works Construction Permit No:-�_ _ Dated�l:_�_.a...... . . ............... �o, DATE / 1 -•••----••-•----•-----••--•••••• r Boar f#Health -� FORM 36508 HOBBS 6 WARREN,INC..PUBLISHERS fT Ts TOWN OF BARNSTABLE LOCATION 407 / 9 Cp/9 m C!d o4_ IAI. SEWAGE VILLAGE M A fS%Q A Zjt,;'/ls ASSESSOR'S MAP 6z LOT � INSTALLER'S NAME & PHONE NO. Zr,,L1J �`sCt_)f( jd 4). SEPTIC TANK CAPACITY C� vG v, LEACHING FACILITY:(type), . F 7® (size) 14 ITod NO. OF BEDROOMS .`� PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNERhQk'� DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: c VARIANCE GRANTED: Yes No �_,�.. , � _�, Y `� �� i �� �a �� `��, __ t � � �3 es � _, � t I Fizic THE COMMONWEALTH OF MASSACHUSETTS X BOAR® OF HEALTH ............... /.QGc)AJ.......OF........... .. .N.,.5 .34 JA ,�ppltr�tttl>�tl for Disposal Works C�ottstrAtrttun rrntt# Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: ----- ..................... L o ti Ad ess GL �Owner .... t Address ---------------------------- - / ✓ 1. f C -: .......................... .....------.......----•----------•--. - ----•--•------------•---------•----•---- Installer Address nn UType of Building Size Lot_.__.�.��.-_!�..._Sq. feet �-, Dwelling—No. of Bedrooms___--�7 3................................. Attic (/ Garbage Grinder Other—T e of Building •-------------- No. of ersons....................._.._.._ Showers a YP g --------------------------------•---------P � ) — Cafeteria ( ) dOther fixtures .. ....--------------------------------------------------•- W Design Flow.......................... � •-g P P P Y Y ... - . ..y.............gallons per person per day. Total daily flow.._.__._._�..._....._...___...__.._._.___gallons. WSeptic Tank—Liquid capacity.1M---gallons Length................ Width................ Diameter---------------- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter-------------_...... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.__.. v _ �! ... ._l _._ .._2>' Date_._.._ __ .�� _�� `a i T l._..L - ------------- Test Pit No ...._.minutes per inch Depth of Test Pit.................... Depth to ground water........................ LT, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a - ---------......................................................... O Description of Soil----------------- ----.-•----•--....�e.. L x . ... • ------ ........................................ V Nature of Repairs or Alterations—Answer when applicable.._............................................................................................. --------•--------------------------------------------------•------••----------------.......----...........--•-------------------------------...........------.......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of i T T p 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h.Valth. ' /? Signed. -/ f r Date Application Approved By............. -------- hxn_a._; :.. ----7 Date Application Disapproved for the following reasons:-------•----------------------------------------------••------•----------------•••-•---------------•---....... ••------------------------------------------•---....-------•-•-------------------•-•--•--•••--•-------•--...... .---•..... ---------------------------------------------------D--ate----- + � PermitNo.... .:.....7.4 ........................ �, Issued....................................................... j Date t t• o FimB v THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ----- .......OF... `1 !.f�/�1,. �� 1 .�E-� _ .... Appliratinn for lhap sal Workii Cfnnuitrnrtinn Permit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at ..... ............................r�g ' ` - ! 1 :. . -�d� _ _ �:? ._. 1Z 1.`` ................................... L^(o/cation Ad retss J�'',d9 j)Jy, -�/�s� \+,"� or Lopt,,a No. /t ..... - Y..._..✓6.'p�•--•--.s?:. ... {I/ #'w+ 7_b.... .............................. Owner Address W 1 ✓_'�it,a.��..................... ......... . ............... ----. ..----------•------- Installer Address d Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic Garbage Grinder Ajl„i Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures -------------------------------- . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. 1:4 Septic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................ Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--_---------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed a b j a .............. r... Date........................................ Y---- Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ -----------------------------------•---------------•--...........-•---------.............---•-------......................................................... ODescription of Soil..................................................................................................------------------•--•---------•-------•-------•---------------.----- x U •-•------------•----------------------••------------•--•------•------------•-......------------•----•••-•-----------------------..........----------•-................................................. W -------------------------------------------------------------------------------------•-•-•----....----•----------.....----------------------------------------------------------------.....--••...-•-- U Nature of Repairs or Alterations—Answer when applicable................................................................................................ -----------------------------------•-------•----------------------------------------...........•--••----••--------------------•----•------•------------------------------•--------------------......---. Agreement: The undersigned agrees to install the afor edescribed Individual Sewage Disposal System in accordance with the provisions of TTTLZ' }of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Date Application Approved B --•••----•-- _.. ........... ----.-•._ ...�......-' ---- --•---- U 1 -/-cam----Date Application Disapproved for the following reasons-------------•-------------------•-------------------•---•-•----------•-----•--_... ----------•----------...---- .................--...................................................................................................................................................................................... Date Permit No.... .._ .. y Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Trr#ifiratr of Tnntplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ) or Repaired ( } by-----'')....... ......2/ t 45 C :-----------•-•---•-•-•--•-•--•------------•--------------------•-•------------------•-•---•---............---.....-•-•--.....-•---- , - at L O1. - /� r'q(z �[ 7 �' Installer a�� e ,� ...............................---••-• ----- .. 3-- -- 0 has been installed in accordance with the provisions of TIT E 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.......3..7........ ..b�-.-.- dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH // 7 . / No...l :... .< FEE.j t....... J r Dtop sal Norkii Tnnstrnc#inn rmn't Permissions hereby granted..... .............144 .��: : :: •............................ . to Construct O or Repair ( ) an Individual Sewage Disposal System /� p at No...'' `.�..�F....r_�.. �_C,-f'� ���l�` r r�P'-4a..... z:!�!.� ...f:��� �� � =..'....• ....... ......... .... .. ...... Street < as shown on the application for Disposal Works Construction Perrrut--N( 24..... Dated........ 3/-' -----•....... Board of Health .__......___•____... _tV....................................... DATE FORM 1255 HOBBS & WARREN. INC., PUBLISHERS OCp�'1(xON, ja i M`nd��„oP F,# SBWAG L, ASSE5aOR'S MAP&;LnT 5'I'P LBXZ' NAWM& HO RIE'NO- I�Tdc x�at c; ►c� c l UU 0PWILITY o 5DROOM S �p� �CYNLtb��IAI'�IGE E ITDI`rI S���reitiom R�itsarc;]3�tVleeta.SL 20. Iviflximum l�djustcd GiauindWilke�.'1'sbte ka t{aG En►4om of X,c�s1chin I�,�c�lit� �,—;�------� PiIv�Bc: 1t�tc r;du�pl 'VJc;Iiii k,ca��aing acty y wvfls exls ._ kzi�c�s bw8Btd.ac ?cl t"iyff tiN�'1�d�149 Qdld.'ILeAC�liilj o�C1I� •���ai9y WGlland4 exist.:., DM r+i�9:la�tt'��:;g�et t Ieac.I�zag�arilgEYa fc �'UTi1�3�1Cd b�: -. .� 0 �'G" 394 ,Q,G _�171 � - n Log' Number: Bottle # E233 Date: October 30, 1987 BARtisa BARNSTABLE COUNTYr_HEALTH,,ARDi:E.NVIRONMENTAL DEPARTMENT SUPERIOR COURT HOUSE J BARNSTABLE. MASSACHUSETTS 02630 �rAse DRINKING WATER, LABORATORY ANALYSIS PHONE: 362-2511 J. iu C,[1 i11i1 '�ff;;l)(IJ;" 111i IU lotfi')tr:rii fffi _'!R f,1' ,! ,;;r{ r.!„E1ct. 337 ^["'C to IfIH(Y1 '11orl"I '1'Ir:�lll� (v1p ;,!,ior ar Jr 7i{ 32 ff!I( !r coot !,I+r Client Corol-lectoh.' '� Fred Clifford r fr_ *fill 1• L MaiIir5 Address. ox , , „f.,!1,11 ff•i'1'iation ref y1sz2( 'r t. l Well °Driller. i 1. ,;I, •(?, !1,[!I i(t:flfS - MA 02632 ,1 - Centerville', Time & Date" of 1 '• oI 31fif;zi'11`10 j�/87 ti 7' i OOam Telephone: Type of Supply: WelI Sample Location: Lot 17, Commodore Lane Well Depth: 631 --� Marstons Mills, MA Date of Analysis: in.128/87, 11:00am PARAMETER ' `4 SAMPLE'•-RESULT flit'"il Pl RECOMMENDED LIMITS' m !�„ ,,, +J, e1joil 1 I, TIE-) to l')l1;V/ o .'Ifs 3fI r .7tt!I4;??!t, :'! •,/ '1(;,; - Total Coliform Bacteria/100 ml 0 0 VII _ — 5.4 II>•[ !•, tr• „ 1- +' {fl 2r"))%9 ft PAM10MA .(fOlt(ltoF Y..ttE? t)7Vtf12i ih�(1t1r1'1 rl.lrr,'1tn f• ! Conductivity (micromhos�'cm) ` 48" 500'.0' .I1 n) { 1 )73(15-77[)l::Zi;t. 1, 9Vf rI VGfrl Iron (Ppm) 0.1 0.3 Nitrate-Nitrogen ( m) 0.1 10•0 '.. ['!`J'!.`�•1';!1[fi G 77![:1.! ';ilj 3;'i*) :Y[if! '131f3't� To rrlrJ(� �.. itflltCl1fr93fT1'') til '1c!i!;/r r•1j Sodium m) 'S ['� .! > t'120:O IU11.1J de*];M1'I0 b -153sw Jf ;tt)vj 11 ll'.1 lY •`lo J7 ! 1. ,.� 7 ) ) 'iSII[ .. .! ,. •,[ ,!,. - ,,rl{ rio;11/;f{ ,rnf�,q f�. r. 71 -1 lti>'J'f ?.•t)[)r� �. . - •, ., , , .,r Wy,f .slit) At IJ .:Ut.11:...:J1:iU 1,1'JI7111 i:111 r) .!);I .'I li ,')'•, :!•, 1; ' I • XX Water sample meets the recommended limits for drinking of all above tested parameters. II . . rat Based onl�y.l on,., resultsl:of the parameters tested for this sample, the water is i,su i taf;l e" for drinking buff'`may''�i�esetit'`the'rprobl`erri�3" ecked"bel ow. flf)+ ',J ,,;r",�[?31lZ fl `.)' 1;11 (3Pf;; Ilfitiff ftA) nirw3didotcgorri9di5rft JZUtz3 /rrtr N. ��a��r`sample` has`higherrythan'iave'rage' 'level'§'iofi'Nitrate?"if'Future'-monitoring''is+ ! :r1. recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. 'fill 0, ,III-n loll -;.r'I !•r ! ..C�•.r •. t l r1,•,. ,r) f t111i C. Water-',may present`°aesthetic problems �tasttr oddr, staining)"due to '11;-) yf;rrr inqq 0.1 io zz73x9 rtI 2fiC)It67�i193114� ,t3V3V/r[(I ;t)'[fi�ff tll{,"1t{ 1: {I?:�')7.� P..0-lulzil fllf+t,)loft flo ftll,i:, ll'.'YT,., r!'ilild D. Water sample has high levels of sodium. Persons on low sodium diets should consult their doctor. I I 1. l�-..-..- Due to lone„or more lof the Oreasons checked'below,) zithis water sample is unfit for human consumption•_ High Bacteria B. High Nitrates ' tl' " ''! +fll tflf!i, r 7 3'r[CI '.' Ia[!Irerl!) lifitt t),t f; , ; n�i•?. f10 39 oft'// !)1go,3q qTh-TFr-,P 'Zr jf ,rrtuiboz ovir;0 fis(f t Jl/i1'! l..['rI YIr{f�!Ir t[iftri E c,'tft)i!')Jl") 2fil1i1r;7j113")f?t)`_) .9tC�62t'rt7F, Zf 7J11;V.' gritntrrtuznr`° li frlrfryr a. tl l '[c!1' lth 1! 1 The Barnstabfe County•Hea and Environmental REMARKS: 6ev :,;r,.,,, , _) . 11 Department shall' not endorse ahy "statements, interpret tions or conclusions made by anyone else con. rning the a results without written consent. CC:Barnstable Board of Health CC: Fred Clifford Well Driller a oratory i ctor 117/85 t Department of Environmental Management/Division of Water Resources WATER WELL COMPLETION REPORT f /I W/1LL LOCATION L- Address o-b 17 Linw- mo doR.f- J-4 r -R- City/Town W03 G.S.Quadrangle Map Grid Location r- / /� `�. Owner 1 _zn 9 r�;At, y� /DO/YlPwl7 C.Or 2 /7 Address, i30& .5 10 C2/1�c t ✓r t• a �. WELL USE CONSOLIDATED WELL Domestic LEK Public ❑ Industrial❑ Type of Water-bearing Rock Other . - Water-bearing Zones Method Drilled rViJ9 e-rr 1) From To 2) From—To- Date Drilled /D- 7- r7 3) From To - 41 From To CASING Depth to Bedrock r, Length 0 Diameter a Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials r Feet below land surface Sand: fine❑ medium❑ coarse N Date measured 16-a7- ] Gravel: fine❑ medium❑ coarse❑ GRAVEL PACK WELL Screen: Slot# ength3—from &6) to 63 Yes ❑ No Split Screen(or 2nd screen) WATER QUALITY TESTS MADE Sloth length from to Chemical ❑ Biological, Depth To Bedrock PUMP TEST Drawdown feet after pumping days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: lOn well or water) Materials From To i O 1 _ c d / t/ DRILLER Firm a Address d (03 City Registration No. Aerators Signatume Please print rrm y • CUSTOMER COPY. 15M.2 84-176471 i i J a A NAN C7 9,26- kl 1-C 1-4-C-7N �a (Zoo m )T Y �{ S� COMMo b o r C/N P . Z MPA I n H D v fie_.__ �1 kj JA Poo 0 AeA e 1t t 9� Pt-T►--I (1o�M I � ED HA l Lo . , �17 LI 5 LC)MfO00 Cs-Jrtoolip p �a ,^� I �e.e- Y�" Q � �o Ida I Vill( � m�o ry% L�✓�A,y�a n LAW �.2+Y10J{ WQI� J C Q u O! qq L1Vlny `•� �nl�J LL 1� �Ccond -fr-f '6?L-Ao ... AN FT. MIN. TOP OF FOUND. SOIL TES T EL _ IO FT. M4I. DATE OF SOIL TEST )ll.�!`tTlst t 98 7 CONCRETE WITNESSED BY 2R NNtJ 4 SCH. 40 P�yC PIPE CLEAN SAND, PERCOLATION RATE MK IN M Mi► COVERS MIN. PITCH 1/8 PER FT. ;, ° F OBSERVATION HOLE I OBSERVATION HOLE 2 12 CONCRETE 2" ELEV. _ 8 4 . Z' ELEV. 4" CAST IR PIPE COVERS LAYER OF FOR EQUALJMIN. 1/8"- I/2" WASHED PITCH 1/4 PER FT. STONE TOP 4 S U I3501 L 46 FLOW LINE 2 M ED I UM T O 61 EL = HI`.0 aI COARSE SAND EL.= 2,0„ EL = 80.5 LEVEL EL,= 30.3 1 17.S" EL. = 60.1 , DiS T. EL _ 71:�. � N� ►� BOX o • o � WW WATER AT I EL.: Cc °�.�o ° WATER AT EL.= 3/4"- 1 1/2�� o to s u (I u .O , d GALLON WASHED STONE °e 4 .4 o � 0 °o DESIGN CALCULATIONS SEPTIC TANK `� ° EL.= PRECAST LEACHING NUMBER OF BEDROOMS BASIN OR EQUIV. ° 6' DIAM. Z GARBAGE DISPOSAL UNIT' N A Z TOTAL ESTIMATED FLOW SEWAGE DISPOSAL SYSTEM PROFILE to'�s �.o MIS c // 0 GAL./SR./DAY x 3 BRA 330 GAL. DAY NOT Ta SCALE REQUIRED SEPTIC TANK CAPACITY 4 9s GAL. _ ACTUAL SIZE OF SEPTIC TANK 4000 GAL.C'efQ,M°k) BOTTOM OF TEST BOLE EL.= LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE ( / EL.= / SIDEWALL AREA �.0* 6AL./S.F- BOTTOM AREA f. 0 GAL./S.F. LEACt*NG CAPACITY (BOTTOM t&DEWILL) S 7* GAL. (Zx3.1I1XS.0 X"XZ.S) t (3./# X x6X/.o) 40 ,gA,+ervST I4 4 V®co/n 4 CO LEGEND: RESERVE LEACHING CAPACITY :SIY9_'T 7.*GAL EXISTING SPOT ELEVATION OOxO 40 EXISTING CONTOUR — -00- FINIAL SPOT ELEVATION NOTES FINAL CONTOUR I. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D:E.Q.£. g2 10 T s/ �'� . SOIL TEST LOCATION TITLE '5 AND THE TOWN OF BH.eA/S7`g&--RULES AND UTILITY POLE TOWN WATER W -=�W REGULATIONS FOR THE 'augWRI DISPOSAL OF SEWAGE. -- \ CATCH BASIN 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO \ c � � )I WITHIN 12 " OF FINISHED GRADE... 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. \ Z44411b 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H- 10 LOADING UNLESS- THEY ARE UNDER. OR \ ° WITHIN 10- FT OF DRIVES OR PARKING AREAS. H-20 LOADING p' v d 1'jraG �► �- ' \ MIN. FRONT SETBACK 30 / SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. -WELL ' Ij MIN. REAR SETBACK ANY MASONARY UNITS USED TO BRING COVERS TO GRADE MIN. SIDE SETBACK /S SHALL BE MORTARED IN PLACE. Q. 6. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH U� o / TAN $ IO° ,LEGNI'/V�'► {fF as j-'t T n DEEDED OR ZONING REGU&ATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINA*N FROM APPROPRIATE AUTHORITY. F LRN' /`rrr y. -` ,,►._ \ 7 YfATICA" /44o ;IZoN-r'Al. CoNTRAL —sE L.E W sucv r APPROVEC�: BOARD OF HEALTH 10"O©K *2o3 COS M o pE So _re VVAY P DATE AGENT fir` k C p j PROJECT LOCI P10( OSE S/ / A hf ID LOTWf-L lab 17 aMMOQE LRnlE 5ARNST'ABLE 4 y• d/ ` �G w APPLICANT Isle r ; ,Lev Eldredge & Wagner Associates Inc. 1. Y 9 9 Et*mn lame Architects Planners Land Sur"yon K� 889 West Main Street v , E 4 7- A :, . :j- _ _ c °cr` Centerville Mo. 02632 F/0A3 o V Ufa. iG�i7 Jo,Iony� �� k LOCATION MAP ''0� � '-� SHEET / OF '� "ft ._.: RAIN. TOP OF IOU ND. SOIL~ TEST EL. _ IO FT MIN. I DACE OF SOIL TEST WITNESSED BY j ERfe-Y CONCRETE u ��r�rr14 OVER5 4 SCH 40 P;yC PIPE CLEAN SAND PERCOLATION RATE < 2 MIN./ INCH MIN PITCH 1/8 PER FT. OBSERVATION HOLE I OBSERVATION HOLE 2 , i CONCRETE 1 2" LAYER F ELEV. _ 14 , 2 ELEV.= �J 4" CAST iR N PIPE 2 -- ... GONERS 1/8''- 1/2' 'WASHED tOR EQUAL MIN. t PITCH I f4 PER FT is "`'� ` STONE 7-o 1 I �tr3�1 1 _ FLOW LINE ? --- } MEDI TO ttfj ' dl U^4 `7C ------,� \teaMIN, ttt EL. c EL LEVEL (D T_EL -7- 9 DIS ;- - �, ►� j T ( 79 ' L =,r+, -_- -- \ • v o 1 w WATEF AT T � EL._ ( t WATER AT 192 EL.= 7. J g vALLON WASHED STONE `� I o a DESIGN CALCULATIONS SEPTIC TANK o EL = -7<. 0 ", '' ,� w PRECAST LEACHING / NUMBER OF' BEDROOMS BASIN OR EQUIV. 4 GARBAGE DISPOSAL UNIT N/A Z ` 6' DIAM. TOTAL ESTIMATED FLOW / f C7 A / R f AY x BR ) .33 0 GAL./DAY SEWAGE DISPOSAL SYSTEM PROFILE I � ` � c GAL, B D 3 REQUIRE( SEPTIC TANK CAPACITY sir 9-1- GAL. NOT TO SCALE + ,� ACTUAL SIZE OF SEPTIC TANK 4000 GAL.�Ie,EO MI") �D BOTTOM OF TEST HOLE EL ~ � f LEACHING AREA REQUIREMENTS OBSERVED WATER TABLE ( I / ? EL z N„fit SIDEWALL AREA � ,f tAL./S.F BOTTOM AREA > 0 GAL,/S.F LEACHING CAPACITY t BOTTOM t SIDEWALL) = 7 GAL r - /V�r ��x3.P ><S. 0 x .n x 2.5) f (3.J4 LEGEND - \ � o{ , T, f t�� '°�'/ ► r RESERVE LEACHING CAPACITY SY I. 7 GAL EXISTING SPOT ELEVATION r k 1 j EXISTING CONTOUR 00 L \ i FINAL SPOT ELEVATION NOTES : FINAL CONTOUR ----- -- -; —�-` -- 3 SOIL TEST LQ{ A' ; f I ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO O.E.O.E. r •� TITLE 5 AND THE TOWN OF dC.VS7:946Z6RULES AND 2 ~ r/ :� UTILITY POLE %� , REGULATFONS FOR THE SUBSURFACE DISPOSAL OF SEWAGE. �~ TOWN WATER - W �`"° W �� 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO . CATCH €3A` 5 k N t2 OF FINISHED GRACE _. �. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIA; LY THE SAW. 4. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE CAPABLE OF WITHSTANDING H- 10 LOADING UNLESS THEY ARE UNDER OR WITHIN 10 FT OF DRIVES OR PARKING AREAS. H-20 LOADING �, �, \ ©; %' r.=. ' ✓ - MIN i R{ NT SE 3A;.; � ,?!� SHALL BE USED UNDER OR WITHIN 10 FT OF DRIVES OR PARKING. WELD .., ! �.i jz i,�-� MIN. REAR SETBACK 5 ANY MASONARY UNITS USED TO BRING COVERS TO GRADE w \ l MIN. SIDE ?ET6ACCK /3" ° SHALL BE MORTARED IN PLACE- 4�4 0 0NuW � ` NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH 1 ,` �' DEEDED OR ZONING REGULATIONS. OWNER /APPLICANT IS TO Y � # f i _. ` " --� r �C? l E/M 1 Al �, OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. {�� -, t � �,,',' , ' � }-`:t p3' ; ,+ ,� �•� '' A, �;�..>1;:_?" � ; � �r , � N 7 KC>� --.5155 � E V" S j f:v,1 SY T I / 4 f ' a A Tv -- u1 � �, ..- r- �1 APPROVEb: BOARD OF HEALTH 2 3 0 f"j f Q rr 1 p i c� i l . 41 ✓ f i r so c 1 1.. ?" cr CJS, +•rC 't o l l W i ri A — M , _ ___. __ ___._ _._ __._ --- -___._ AGENT f v,-41 F /P _ PROJECT LOCATK7N IL N % ` a TV V "� S/ as/, T 'z f , . F 0- ` 1 /L. APPLICANTf l; /2 6 T 1 Le Eldredge t F v , E edge & Wagner Associates Inc. ! -4 Ems Landscape Architects Planners '.and Slwyorl ' - 889 West Main Street Centerville Ma. 02632 ~Harr tip *. \ ` 9 ` MAP '� � SHEET � OF tj o , 771 ,