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HomeMy WebLinkAbout0013 HEATHERLY ROAD - Health 13 Heatherly Road, Marstons Mills Y A= 124 - 035 V Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street Boston Ma. 02108 .John Seed D.E.P. 'Title V Septic Inspector IF P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508) 564-6813 Governor ARGEO PAUL CELLUCCI U.Governor i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r PART A 4 e t CERTIFICATION Min Property Address: 12 Heatherly Rd.Marstons Mills 02648 Address of Owner: Date of Inspection: 2/3/98 (if different) py� Name of Inspector: John Graci Lazarescu F E B 5 1998 I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: ,BLF CERTIFICATION STATEMENT _ �j` I certify that I have personally inspected the sewage disposal system at this address and that the information reported below,is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the unction and proper func maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria defined In Tttle V _ Conditionall P ses code 310 CMR 16.303.My findings are of how the system is performing at the time of the inspection.My inspection does Needs Fur er valuation By the Local Approving Authority not Imply any warranty or guarantee of the longevity of the Fails septic system and any of Its components useful life. Inspector's Signature: Date: 2J31g8 The System Inspector shall su mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this _ inspections. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B,C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B]_SYSTEM CONDITIONALLY PASSES:. One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. Indicate yes,no, or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of — CoMpiiance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04127197) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 12 Heatherly Rd.Marstons Mills 02648 Owner: Lazarescu Date of Inspection:213198 _ Sewage backup or.breakout or hiah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced _The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed C] FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must Indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage.in facility or system component due to an 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 cesspool. SAS is in hydraulic failure. (revised 0427W) c SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 12 Heatherly Rd.Marstons Mills 02648 Owner: Lazarescu Date of Inspection:213198 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or a mapped Zone II of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (re via ed 04117)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 12 Heatherly Rd.Marston Mills 02049 Owner: Lazarescu Date of Inspection:2I9199 :You must indicate either"Yes"or"No"as to each of the following: Check if the following have been done _X_ _ Pumping information was requested of the owner, occupant,and Board of Health. east two ks and the and the em has een x — None of the have been pumped for at flow rates during t h at per od.eLarge volumes of water have lnot been Introduced duced Into the system recently b receiving rural rrecentlyor as part of his inspection. _ x As built plans have been obtained and examined. Note if they are not available with N/A. x _ The facility or dwelling was inspected for signs of sewage back-up. x The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. x _ All system components,excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected .— for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x _ Existing information. Ex. Plan at B.O.H. Determined in the field(if any failure criteria related to Part C is at issue, approximation of distance is "— — unacceptable)115.302(3)(b)j (revised 0427)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 12 Heatherly Rd.Marston Mills 02048 Owner: Lazarescu Date of Inspection:213199 FLOW CONDITIONS RESIDENTIAL: d./bedroom for S.A.S. Design flow: 330 g'p' Number of bedrooms: 3 Number of current residents: 4 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yea last two 2 year usage d Water meter readings,if avaiIable:(as O y g (gp )' rda Sump Pump(yes or no): No Last date of occupancy: We COMMERCIAL/INDUSTRIAL Type of establishment: ora Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: nra Last date of occupancy: nis OTHER:(Describe) rds Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: r0a System pumped as part of inspection:(yes or no)No If yes,volume pumped:0 gallons Reason for pumping: nia TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no) ( if yes, attach previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 1970 Sewage odors detected when arriving at the site: (yes or no) No (rsvlaed 04127l97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 12 Heatherly Rd.Marstons Mills 02648 Owner: Lazarescu Date of inspection:213198 SEPTIC TANK: x (locate on site plan) Depth below grade: 6' Material of construction:x concreate_metal_FRP_Polyethylene_other(explain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: Le'5^H5'7"w4'10" Sludge depth:2" Distance from.top of sludge to bottom of outlet tee or baffle: 25" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 15" How dimensions were determined: measured Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound and functloning properly.Recommend pumping everyone to two years. GREASE TRAP: (locate on site plan) Depth below grade: rya Material of construction: _concrete_metal . FRP_Polyethylene_other(explain) Dimensions: rva Scum thickness:rya Distance from top of scum to top of outlet tee or baffle:rya Distance from bottom of scum to bottom of outlet tee or baffle: Na Date of last pumping;v_ Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Na BUILDING SEWER: (Locate on site plan) Depth below grade: 5B" Material of construction: cast iron x 40 PVC_other(explain) Distance from private water supply well or suction iine!00+fromwell Diameter. a" Qi1mments: (conditions of joints,venting,evidence of leakage, etc.) (revlsed 04127147) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 72 Heatherly Rd.Marstans Mills 02648 Owner: Lazarescu Date of Inspection:213199 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal_FRP_Polyethylene_other(explain) Dimensions: nra Capacity: We gallons Design flow: rda gallons/day Alarm level:_nra Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) rda DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: We Comments: (note if level and distribution is equal, evidence of solids carryover,evidence of leakage into or out of box etc.) We PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no)No Alarms in working order(yes or no)_v.. Comments: (note condition of pump chamber,condition of pumps and appurtenances, etc.) rda (revised 0427)971 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 12 Heatherly Rd.Marston Mills 02648 Owner: Lazarescu Date of Inspection:V3198 SOIL ABSORPTION SYSTEM (SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: n1a Type: leaching pits,number: two:1000 gallon pits leaching chambers,number:nla leaching galleries,number: nla leaching trenches, number,length: rda leaching fields,number, dimensions:nla overflow cesspool, number:nia Alternate system: rda Name of Technology:_wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.) Leach pits are strucruraliy sound and functloning properly.New pit had 2s'of water In It, CESSPOOLS: (locate on site plan) Number and configuration: rVa Depth-top of liquid to inlet invert: nla Depth of solids layer: nla Depth of scum layer: nla Dimensions of cesspool: nla Materials of construction: nla Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) rda Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) nfa PRIVY: (locate on site plan) Materials of construction: rda Dimensions: nla Depth of solids: nfa Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) Na (rsvlssd 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 12 Heatherly Rd.Marstons Mills 02648 Lazarescu 213198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) It fly 0 ?aye ! o! 10 (rovloed 0412719T) • ti • G SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(contlnued) 12 Heatherly Rd.Marstons Mills 02648 Lazarescu 213199 Depth of groundwater 12, Please indicate all the methods used to determine High Groundwater Elevation: Obtained from design plans on record. Observation of Site(Abutting property,observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts (revised0427197) page 10 of 10 J3 / ✓ o 7 �' TOWN OF BARNSTABLE4 LOCATI0 ����3, 2 4.4,Je- SEWAGE# VILLAGE ✓j'I!L" ASSESSOR'S MAP & LOT Av)V0 INSTALLER'S NAME & PHONE NO. rn2�fJ7��.r G�ks� ���= ► SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) 4,0>e-<6 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: �v�c3�9� DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes �No� i r�o�f 0 os' s - No.--�- � Q - 4 /FE:B....�--5�......�................ THE COMMONWEALTH OF MASSACHUSETTS BOARD O� HEALTH APPROVED ®arnstable Conservation Department TOWN OF BARNSTABLE k�, Appliration for Di�ipoml Works Toutitrnrtin .g ruti oaro Application is hereby made for a Permit to Construct ( ) or Repair 0-� an Individual Sewage Disposal System • ---- ---- ---- -------------------------------•------------------------.....-----.....--- Location- ..--.... - �JLI .. ....... Owner ess Installer Address Q Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms..............---_..................Expansion Attic ( ) Garbage Grinder ( ) 04 Other—Type of Building ---------------------------- No. of persons.-___--__--_.___---_-----._. Showers ( ) — Cafeteria ( ) a Other fixtures ------------------------------------------------------------------------------------------------------- - -- •------...----._._._..._.....---•- Design Flow..................... g< P P P Y Y ` ` V gallons. W �........_gallons per person per day. Total daily flow............................................ WSeptic Tank—Liquid capacity./MO-gal Ions Length_.............. Width---------------. Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length-----_.............. Total leaching area....................sq. ft. 3 Seepage Pit No....... p g q.. ... lliameter.._.....�Q._._. Depth below inlet___..__.._.____. Total leaching area..................s ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY-------- -----------------------------.----------------------------------- Date........................................ ,.a Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... Lz, Test Pit No. 2................minutes per inch Depth of Test Pit-_.___-_--______-._- Depth to ground water........................ ----------------------------------------------------- .............................................................. ............ O Description of Soil...................0.. .5,.7.----- :._ 7.c:�le�cShcK- �.__'.�� � ..... x x -------------------------------- -----------------------------------------------------•-•--------------------------------------...---- ---• -----------• U Nature of Repairs or Alterations—Answer when applicable._.._. A ....../'L .__ J_.J/..........y ...... 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 as een 'ssu, board f health. _ Signed ..... _........ - Date -� ... --------------------------------- - -- - ------------- ------- ApplicationApproved By .............. ._...... ................................................................. -------- V V Dace Application Disapproved for the following reasons: ...................................................... .. .. ..................................... ........................ ................................................. . ...................../x... ... .....................--- . . .. ... ................. ........................................ �s Due Permit No. ...........p....3.... ............/V.... . .......................... Issued Dare .......�v�' ..�•--w.`I e..r�`.�.'���..--•r..r,.Y r.a v r....,-_...v-�-:of .,:-�;.w:.,Y._-.raJ:.,.'a-....Y:r' .: �._ -..:. - - -� t.. _� .- �. . � .. �..� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ~ TOWN OF BARNSTABLE Appliratiun for Difipuual lVurku TouBtrurtiod r rmit Application is hereby made for a Permit to Construct ( ) or Repair (X) an Individual Sewage Disposal System at: _ � Location-Address — or Lot � No' / .. .. .G._....,.4 .. �`/ `tD � f.................... a , Owner�2G (-U/`7 c ;C ess ------------------- ----------------------G------------------------------------------------- -------------=------------------------------------------------------------------------------------ Installer Address U'• Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.............. _----------------------Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures _______________________________ _ _d ------•-=--•-•-----••-••••----.-------•------- W Design Flow...................... ..........gallons per person per day. Total daily flow..._..._.:---------------------------------gallons. 9 Septic Tank—Liquid capacity,bO4)-gallons Length---------------- Width................ Diameter----............ Depth................ Disposal Trench--No. .................... Width..................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No------- Diameter--------O----- Depth below inlet................ Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water..................... Prq Test Pit No. 2................minutes per inch Depth of Test Pit.........q-__-•--- Depth to ground water........................ a --------•---------------- --••---•--•---........_......----..................----••......---•......................................................... 0 Description of Soil...................0--`3`:.-•-•...... �.:_SU—S 1 -1 .................................................� ��................. x .- W .................-..................................................................................---------------------------........................................................_............. UNature of Repairs or Alterations—Answer when applicable.._...- _D ......./GC?D-- /�.. ........................ ;>.................. 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 by the board f health. Signed .....(. -.................... ----------- � � ` .......... ...... Da... . .. y Application Approved By .............. a=� a .. ._............................ ........._ J - ... ate Application Disapproved for the following reasons: . ..... ................................................//'\ ...... ....... ... .......................................... ................... ..... .........................................------.----................. ............. -........................ ooLTace Permit No. ...........L..3 i. ....................... Issued ........ ------------------------------- -� _ Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Cfertiftrate of C ralaltttnre THIS IS TO CERTIFY, That the Individual Sewage Disposal System constricted ( ) or Repaired by .............................- ��G�G-3`0.r 1...�T7.........( ��>37rXT-_.�D-(>1.............................................................. Installer .._............. at ...................... .................................. cs 'T/%' ...... ...-f..!!�............. ............. -- has been installed in accordance with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. ...-Y, .3...-.__te&....- dated ............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE---------------'.�.....�-. -n ................._....---..-----....----....-- Inspector .... ...� ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS -3 BOARD OF HEALTH N �...... FEs. TOWN OF BARNSTABLE � .'.�. . ............ Dispoxial Works Twintrurti>orn "permit Permission is hereby granted_______________f Q�.�__.�.... �__---- ----- .....!��� to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at No. - r'` �� �..C:.`�.._....-G I...1..................l�l!�:. .....C..--.----------..........-- Street as shown on the application for Disposal Works Construction Permit N �/ff� Dated........................................... ............................ < C� ....................• ................ _Board of Health DATE----•--•-----�-—�-�.3--T-/•--�-�- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS - T,"b THE COMMONWEALTH OF MASSACHUSETTS / 3 BOAR® OF HEALTH .s ............ Appliration -for Miipagal Works Cnonstrurti n Vrruift Application is hereby made for a Permit to Construct (� or Repair ( ) an Individual Sewage Disposal Syst Q Location- dress r of No. ......--•--.... -....�=© :--=�-- • - -• ------------------------- . . owne t P ------Address. In er Address UType of Buildi Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms--.-..---- ___________________Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building -_________________________ No. of persons---------------------------- Showers ,( ) — Cafeteria ( ) Q' Other fixtures ............... Q ---- W Design Flow------------------------ ,,.,_��._,,_�111ons per person per day. Total daily flow _- --__-.--.--...gallons: W Septic Tank i_Liquid capaci-ty --i/ ,gallons Length_............. Width.____..__. _.. Diameter---------------- Depth___._.--_.----. Disposal Trench— o. .................... Wid h--._--.--- --^taL fit _._ _ Total leaching area.-_-- _._..-.--_--._sq. ft. Seepage Pit No______ ___________ Diameter... _Q. _ inlet_ .___. .._.�._ Total leafgping area...__.._.._._____sq. it. z Other Distribution box ( ) Dosing tank ( ) D/�. �� ?y" -7'Y, Percolation Test Results Performed by-------------------------------------------------------------------------- Date------------------------------••------.. Test Pit No. 1................minutes per inch Depth of "Pest Pit---_................ Depth to ground water..-.----.-.--.-.__.----- f4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--.--.-..-_-------_----- O -------;------- -.-----••---- I - i Soil ----- i �- VI•-------------•---------------------------------------•----------•-----------•-•-----••--•-------------•---------------•-•---- ----------------------------------------------------------------------- W VNature 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 Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. ---- fined---` ----------- -- ---------•--------••--------•--•-----................... ................................A Application Approved B ( � � � �`� -�� -••-•-•--•------- -----' Dat r PP PP Y--------.__ � -•-- - ate Application Disapproved for the following reasons: --•-----------------------------------------------\-= ......................... date PermitNo......................................................... Issued.....................i-..----_--_••-•_......•_••••....-- Date THE COMMONWEALTH OF MASSACHUSETTS'" -BOARD F �AL�H 1 .-- .OF.....IyG.✓..C j �2� . ..T..........,.. .... ~ � Application -for l3h4puiiai Works Totes ndion Vrrmft .�t�pplicatori�`is ereby made'for a . ermit to Construct ( or Repair ( ) an Individual Sewage Disposal S-St , _M... o s .,& ...................Vt5�.01------All--------- ............. --- ----�4, Location- dress i l • - '---�* -------- •- -•--- ---• --^ ----•--------------•----------•----- -'-------------•-------- W i e , Address a '---- -------------------'------------------- ............................................. .........._........'-:..................................-----------------••-•---.........._.--- >A. , In ler Address UType of Buildit Size Lot__________________:_-__-____Sq. feet Dwell ing,'=N .. of Bedrooms--._.___ .........:..............Expansion Attic ( ) Garbage Grinder (' ) Other 7 Typetof Building p ( ) — Cafeteria ( )� ............................ No: of. ersons.___......_._............,_. Showers — Cafeteria Q' Other fixtures .............. ------- -•--------- '. Design Flow_ ______________ _ ��_ ..---- allons per petson per day. Total daily flow......___:.«r►--_ __ gallons. 04 Septic Tank Liquid capacity/ gallons Length---------------- Width.._ _.._. _.. Diameter-_-.-. __ Depth.-. W x Disposal Trench— o____________________, Wid ....�.�..y.j- __ _. L ' Total leaching .....Sq. ft. Seepage Pit No_____ ___________ Diameter... a th .w inlet .... Total le le. iin are......,_--_--_.___-_sq. it. z Other Distribution box ( ) Dosing tank ( ) 0 �- f 7• Percolation Test Results Performed by........ -----•---------•------•-•--------------•--------.•--=--=-•------ Date---------------------.................. Test Pit No. 1----------------minutes per inch Depth of Test Pit.................... Depth to ground water------------------------ f14 Test Pit No. 2........:.......minutes per inch Depth of Test Pit----------.,------- Depth to ground water---------------------- W ±.. . ---- ---------- ------ --------- ----- ---4 .. il D --------- - .... _.__. _._..Description o So ------ ` x w UNature of Repairs or Alterations—Answer when applicable.----------------..._--_--___-_-_._----------.-_-:----___-_-_---_._----_----_-...__-.__---__----- ....-•-----•---------------•...------------------...---••-................----------------•---------------........._.........=---•-------------------...---•--........._............------•--•-----•-- Agreement: '" The undersigned agrees to install 'the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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. gned -•----------------------------•----------------------------------/� � /ate Application Approved By--------- --r----------- 4 / '!� :. .� � Application Disapproved for the following reasons_____________________________ --------•-------._...._..._..... . _...._.______.__.................................... Date - Permit No......................................................... Issued......................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH f� y .-:.........OF............... A ................ C�rrtifirate of f�lamViiatta T IS TO TIFYj That the Individual Sewage Disposal System constructed ("" ) or Repaired ( ) by , r :- ' ,pyf�J� Inst (/Jj,��' � // j:St-- - - •------- ------ - ---- e� `�"j/G., I _`._ — _ .si�a�----- 'E";. ..._..... - has been installed in accordance with the provisions of Article „of The State Sanitary Code as de ribed in the application for Disposal Works Construction Permit No..................:. ................ dated... r} 7��, _............ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ inspector..................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD No. F HEALTH rx7 ..... ........OF.... .. ... ::.... ......::..... !d ,....... FEE arka flan.5trurtilon Urrmit Permission i hereby granted.................a ' _ ...... :. r to Con tr or R an Individ 1 w e o a S' .. Street -y as shown on the application for Disposal Works Construction P rt o... ..,_,_/ ated__ jf._L_���............... ✓"�'/ .............. .............. �,rr+�f - �/7! � Board of ealt DATE.... .. l. Boa y• FORM 1255 HO 13S & WARREN. INC.. PUBLISHERS • V` r �y 1 M1 No.- ------ --------- Fee-- -- - ---------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rlVell Conotruction Permit Application is her by �de for e t Co tructe( ), Alter ( ), o0ep it ( an�u dividuaI Well at: � � - _- _ _r� t �-- - ---- ® ----_ ----------- -- _ Location Ad s A�sors Map and Parcel 7 -------------S,-Ca T- ----------S j e-------------------- Owner Adre ---------------------- ---------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling ------ Other - Type of Building ------------------- No. of Persons--------------------------------------------- • /r Type of Well— --—- -----c-------- - - Capacity-----------------— — -- — - - --— Purpose of Well---------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not'to place the well in operation until a Certificate .of Compliance has been issued by the B ,ard of Health. 0 Signe ��. t (. _ / .A �5 _ � Application Approved By �� - -— --__— ------------ date Application Disapproved for the following reasons:---------------------------------------------------------------------------- ------------------- - ------ --- ------------------------- ---------- - ------------------ ----------- da—te r Permit No. ---— -- -- Issued--- 1 date --- — ------------ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS ER IFY,, t Individu ,Well Constructed ( ), Altered ( ), or Repaired -- _ ��----- ----------------------------------------_ J 1� Installer a t- !�l-- 1—�( --1/r/—�J—�/—� ----�-� ----- ---------------------------------- has been installed in accordance with the provisions of de Town of Barnstable Boar f Healt rivate Well Protection Regulation as described in the application for Well Construction Permit No -3r Dated--------------—---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------———-- — —— -- Inspector------------------------------------------ --— f � ,,,� Yam,:r� y aT . �.•yx„r, ���,..,�yt/', lnl1Y-,W L'�-_.i i � r •;�.'+l'�. ,r a.� ...�„��,�,�, �.r`-r... �- �, A- ----------- No.- ------ -- ----� Fee--�;,- BOARD OF HEALTH TOWN OF BARNSTABLE App[icationArVe[i Cootructioupermit Application is hereby ade for a e t o Co tructd *AAlter ( ), or Repair ( �a�n it dividual Well at: - i -- - --- lC) P----— - - Location — Addr A lessors Ma and Parcel i 1 -------------- -------------------- Owner Address � } I -------------------------------------- = - -- Installer — Driller Address Type of Building Dwell l Otheln ---r -e of-Buildin ^-���- --- No."�`� �of*Persoris"- ----------------�—*--------- �'�-------- I� ,.,z Type g s Type;—'Of"Well ---------- Capacity Purpose of Well----------If w.� ------------- -- Agreement: h � �.r _ • The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of.Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation-until a Certificate .of Compliance has been issue&by the B .ard of Health. Signe At 7:;. /70 Application Approved By - -- q. date Application Disapproved for the following reasons:-------—----------—----------------------------------------------------------- R date \Permit No. --�'-"-�- —` ----------- Issued --- i - — — ti. date D OF TH TOWN OFAR BAR LN{STABLE !_ t Certificate Of Compliance THIS IS TO CER FYA th Individua`Well Constructed ( ), Altered ( ), or Repaired bY- -- 1� -i--'------------------------------------------- -- - - —- -- - - --- —-- `� Installer at------ — _ - - - has been installed in accordance with the provisions of thfe Town of Barnstable Boa1r4Af Healt rivate Well Protection Regulation as described in the application for Well Construction Perr --- Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. i DATE- --- —- — -- — - - —— -- Inspector--- =----------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Vell Conoructionpermit No. --- -------3 Fee-- - ---- --- Permiss' is herebyranted--- -- ='------ ----�� -- -- - N to Conptruct Al er ( ), or pair ( a. Indivi 1 ell at: No. - - -- - — p -—�""------ 1! ;. ".- - T-___---_--__ Street as shown o the application f� Well Construction Permit ' No. -=� — ------ -- — - Dat _ -- y - -- ----------------------- , —A, r --- ------------- Board of Health` DATE=—- — -- /a 0 3S No, Fee---,/ BOARD OF HEALTH TOWN OF BARNSTABLE 01pplication for Melt CongtructionPermit Application is h eby m de for a perm't to Construct Alter ( ), or Repair ( )an individual Well at: -3-------- _�.c--Y _l� _ 7`_C'✓f� -- - ----- --- - --------—- ------- Location — Address Assessors Map and Varcel --1x- ------------ - Owner P Address --------------A rn Installer — Driller Address Type ofj5u4l, ing D w e l ll i�---------------------------------------------------- ,IC Other - Type of Building------------------------ No. of Persons-------------------------- Type of Well--- 100JX o1-9- _ - ------- Capacity------------------- Purpose of Well--` to_ �"-�°-" S _--- 1 Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation until a Cer-' icate .of Co liance ha bee-ut issued by the Board of Health. g date Application Approved B --��`-- -------- — date Application Disapproved for the following reasons: —-------- — ---- — - -- - - ---- ------------- -- - -- ___----------- Issued--- rJ ://_ --------date Permit No. -------- -G �r`-� - date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Comptiance i THIS IS TO CERTIFY, That the Individual Well Constructed ( ), Altered ( ), or Repaired ( ) by--- ------ ------ ------------------- Installer ----------_-------at -- — - --- - -- - has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -------------------Dated------ ------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------- ----- —- -- Inspector---------------------------- - ---- - - - - ---- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- --------- No.- --------- Fee-- `` - -- 'r BOARD OF HEALTH TOWN , OF 'BARNS:TABL'E App[icationArlVe[C Con0ructionver,mit ' Application 'is h reby made fora permit to Construct(. <Alter ( ), or Repair ( )an individual Well at: 1-3 ` Locahori rAddress• -- _--__--Assessors Map and-arcel----- - Owner / Address h. . ., - ------- 1 ----- /,D,Pi//,G- :`33 -2 /3v -= `c-G,� / - ------- Installer Driller Address Type of 5.ualding sfy Td 'Dwellin _----—--------------------------------- ------------- Other - Type of Building --- ----------------- No. of Persons----------------------------- Type of Well__�dc �o l -- ----== ---- Capacity Purpose of Well--- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with,the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation.- The undersigned further agrees not to place the well in operation until a Certificate .of3COpliance ha been issued by the Board of Health. Signed — — -4 date Application Approved B -- --------=-- -�date Application Disapproved for the following reasons:- -PP PP 8 -- —-- — -- ----------------------------------———----- - ---- Xf q date t, \� Permit No.--- ---- Issued---�_'r / ---— ---- t ' : date ------------- BOARD OF HEALTH TOWN OF • BARNSTABLE Certifitate (of Com [iarite f HIS IS'TO'CERTIFY-;That the Individual Well Constructed ( ), Altered{ ) or Repaired Installer .: at— —-- -- — -------—--- ------ ----- — `—------`-- has been installed in accordance with the provisions of the Town of Barnstable Board of.Health Private Well Protection Regulation`as described in the application for,Well Construction Permit,No. ----------------Dated-------- ---------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. -DATE—------ -' — Inspector __-- --------------- d +c°Ca•4a!iesla9�lpliRi9s}i.".E�1R{cT(�asiNilGO®�STOf�tiiTi.f.��alL¢i+_i14GK06@i9��1.T4�-$NiDi!' .Y�PiQi'�GlsTfAAi^S�yli?a9iF114.�C•.j4i4i�i,.A..L,f{.4GTO!;fi!?iSb1V`Xfii¢yr4i!.'nTiiT&Pi�i!.i�eTc��PaM BOARD OF HEALTH , TOWN Of ' BARNSTABLE Vets Con!truct ion Akrnrit i 0. cy , / ��f Z Fee Pei mission is h eby granted 2 to Construct ( Wet lt r ( ), or Repair ( an Individual Well at: ! ."yy No. /3 e Street 1 as shown on the application for a Well Construction Permit No. _ yZ ---- Dated - — —---- - -- - i Board of Health DATE a ENVIROTECH LABORATORIES, INC. MA CERT. NO.:M-MA 063 n 449 Rte. 130 9s Sandwich, MA 02.563 !! 508(888-6460) 1-800-339-6460 FAX(508)888-6446 CLIENT. J Schofield LOCATION: 13 Heatherly Rd ADDRESS: 13 Heatherly Rd Marstons Mills MA 02648 Marstons Mills MA 02648 COLLECTED BY. Meehan Wells SAMPLE DATE: 6-17-99 SAMPLE TIME: N/A WATER SAMPLE TYPE: New Well DATE RECEIVED: 6-17-99 LAB I.D. #. 996477 WELL SPECS.: 30'to Water 47' Deep RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 6117/99 pH pH units 6.5-8.5 5.62 4500 H+ 6/17/99 Conductance umhos/cm 500 213 120.1 6/17/99 Nitrate-N mg/L 10.0 4.18 300.0 6/17/99 Sodium mg/L 28.0 31.4 200.7 6/18/99 Iron mg/L 0.3 0.03 200.7 6/18/99 - Manganese mg/L 0.05 0.207 200.7 6/18/99 COMMENTS: Low pH indicates high corrosive characteristics. Sodium level is not a health hazard. Manganese is not a health hazard, but may cause aesthetic problems. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. Date 07 P&nald J. Sa i Laboratory . ector <=less than >=greater than TNTC=too numerous to count