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HomeMy WebLinkAbout0018 HIGHPOINT ROAD - Health 18 Highpoint Road --- Marstons Mills� `P A = 028 040 A UVCOMMONWEALTH OF MASSACHUSETTS _ WIN 0i !B RF 5 TABLE EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS Mao DEPARTMENT OF ENVIRONMENTAL PROTEC ION�� DIVISION TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 18 Nig_hpoint Road Marston Mills. MA 02648 *� Owner's Name: Mary Colella C� Owner's Address: Date of Inspection: April 5, 2005 Name of Inspector:(Please Print) James M. Ford Company Name: James M.Ford Mailing Address: P.O.Box 49 Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage"disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: April9, 2005 The system inspector shall subra 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. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 HiQhpoint Road Marstons Mills. MA Owner: Mary Colella Date of Inspection: April 5. 2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined",please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 Highpoint Road Marston Mills. MA Owner: Mary Colella Date of Inspection: April 5. 2005 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 18 Highpoint Road Marstons Mills. MA Owner: Mary Colella Date of Inspection: April 5, 2005 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow ✓ 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a.design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No _ the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II.of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 18 HiXhpoint Road Marston Mills. MA Owner: Mary Colella Date of Inspection: April 5. 2005 Check if the following have been done: You must indicate"yes"or"no"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ _ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components,excluding the SAS,located on site? ✓ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the So il 1 Absorption System(SAS)on the site has been determined based on: Yes No ✓ 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(3)(b)]. .. C 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 18 Highpoint Road Marstons Mills, MA Owner: Mary Colella Date of Inspection: April 5, 2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): Unavailable Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after inspection for maintenance Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: _gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (if yes,attach previous inspection records,if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed on 2112193-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. SYSTEM INFORMATION(continued) Property Address: 18 HiQhpoint Road Marstons Mills. MA Owner: Mary Colella Date of Inspection: April 5, 2005 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC _other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 15" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 pal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 10" Distance from top of scum to top of outlet tee or baffle: 5" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How were dimensions determined: Measuring stick Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Cement tees were present. The liquid level was even with the outlet invert There did not appear to be any signs of leakage The tank was pumped after the inspection for maintenance. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Hi Qhpoint Road Marston Mills. MA Owner: Mary Colella Date of Inspection: April 5, 2005 TIGHT or HOLDING TANK: None (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of r leakage into or out of box,etc.): The D-box was level. No solids were present. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 V Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Highpoint Road Marston Mills, MA Owner: Mary Colella Date of Inspection: April 5. 2005 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -6'x 6'(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.): The pit had 3'of liquid on the bottom. The scum line was at the same level There did not appear to be any signs of failure The bottom to grade was 10'. The cover was 20"below grade CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: None (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.): 9 r1 Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Hi ghnoint Road Marstons Mills. MA Owner: Mary Colella Date of Inspection: April 5. 2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. O we✓I� >1 Qack B i C 3 O A a l 30 18 a 3-7 /s� 3 y7 a a y 99 -7 y 10 Jy 1 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 18 Highpoint Road Marston Mills. MA Owner: Mary Colella Date of Inspection: April 5, 2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40+/- feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours snaps Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using Barnstable topographic and water contours maps, the maps were showing approxitnately 40'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees,either expressed,written or implied,relating to the system, the inspection and/or this report. 11 p I ' TOWNL,OF BARNSTABLE �-- OCAT10N I O N1 )n1'+T R�. SEWAGE # �a"�33 /ILLAGE. /h Wl ills ASSESSOR'S MAP & LOT Oaf" Oy0 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) �X G, 1"n ;T (size) /WD .6 NO.OF BEDROOMS / -- BUILDER OR OWNER M/Jr`-t COIC114 PERMPTDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) l / / Feet Furnished by Tit Spti� �. FB/C �! SIOJ O well y aA(,k O A L3 / 30 1� ' a 37 8� 3 C/ a s y 99 -7y OW F BARNSTABLE ' LOCATION 1 `1 / ��Li ��17 SEWAGE # VILLAGE /V�, /V/i//S ASSESSOR'S MAP & LOT S " INSTALLER'S NAME & PHONE NO. A Iry "'SEPTIC TANK CAPACITY /000 S ,LEACHING FACILITY:(type) 10490 / (size) X /0 NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �/G S4 G,s-?-e- Cal S ,;.,DATE PERMIT ISSUED: /1- rd•2 - f DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes ` No Ci J � s J► \ g THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH u--.`.. ...............OF........�.ar r s... a. ..l" ...... Appliration for Digvogal Warks Tonstrnrtiun ramit Application is hereby made for a Permit to Construct (w) or Repair ( ) an Individual Sewage Disposal System at: ............... or Lot Z . .... Pt - - ..... Location- dress No. ---.._..... 1 ...... ., 1.e..., tea.. .c----- -........................ ....-••---..........----•---------•-••---- -'---....----•-------------........----------- W Owne........... Address --•-----•................................ .'.._....-'---•................_........-" _......... Installer A Address /f�— Z Type of Building Size Lot......a.%_y7__.-._Sq-feet �-- Dwelling_—No. of Bedrooms.......................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) A4 Other fixtures ..._....._.. W Design Flow...................45-.5 ..............gallons per person per day. Total daily flow................. ...C7............gallons. WSeptic Tank—Liquid capacity/.oQogallons Length__.P=..Ir..NWidth_/1-_/./_.Q_'rDiameter---------------- Depth.5-._'_7" x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No-------/........... Diameter_.la.'.=_ _". Depth below inlet...A....O".. Total leaching area..2..G_.Z..sq. ft. z Other Distribution box (K ) Dosing tank ( ) P 7 9/ G a Percolation Test Results Performed bye.Ya-4,tt...9!1"..r._¢f51.o.c.,................ Date....Z&V_l_9..Z......... Test Pit No. 1----z•.......minutes per inch Depth of Test Depth to ground water....e!�1 _-__. (3� Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O1:4 3 ---------------- -v;rP.4.as.1............5,.�. s _►_.L...-•------•---••--'•-----------'-----•------........---•- Description of "-------------.... .,� .............. -------------- --------------•-•--------•--................. x ..........................--•----------•-•------•--------•----•-- ------- ....0........�/�-.mow__�r- ,�k.c_a_v'�...................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... --'-••--'•-------------••--•'••• •••-•---•••-----•'••-•---••••-•--••.....--••-'--•-••-•"------••.•---••-'--•••.....----•------•---•'"-••--.•---.--............_........-'•-'---'•---•-•....---•.------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of THTI1i� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issu by e board of health. Signed. ............................... .... .........................- ` r _ Date Application Approved B i '. . ................. r.. Date Application Disapproved for the following reasons:................................................................................................................ -------••-••-•--•-•-•--'...............•-'--'-••••••'•-•-•-'--••..._....._.•--•---•-'•-------------••-'••---'•'---'-'••--•------••--•-----------•'•-----------•-•-•------------------------------------ Date Permit No...,,� r..- . vim............. Issued----- �... = . Date No.. `.......1(;.`..tea FEB.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH f ApplirFation fear'. Diiliuiiaal Works Tonntrnrtion thrmit Application is hereby made for a Permit to Construct (, ) or Repair ( ) an Individual Sewage Disposal System at: ......... .--•--........ . . ...' .• •r=` •-' -==:'l.j. -'=................. '=:" :. '............................... "- Location-Address or No. 1._._ ...... ..................... ...: ........ .._.l.. !.._....I.................. ..........._........................•...... ...........................................___ Owner Address W Installer Address .m Type of Building Size Lot-----e:_._`j__f......5 feet Dwelling No. of Bedrooms..............:..:..........................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Q' Other fixtures --------------------------------------------------••--. W Design Flow..................: - .......................... per person per day. Total daily flow..................^.......f_e............gallons. WSeptic Tank—Liquid capacity'........:..gallons Length.."-`:. �..`_'Widthe _:`Diameter________________ Depth.......... . x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......./........... Diameter./!...`.=._5.....:. Depth below inlet............ '":__. Total leaching area.........:..:....sq. ft. Z Other Distribution box (,r Dosing tank ( ) T 7 r t Percolation Test Results Performed by r r,.._ ...--`..::. ................................ Date.--. ---------- Test Pit No. 1..... .........minutes per inch Depth of Test Pit../... .`... Depth to ground water....... _ ........... fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water..__-______---------____ R4i / i......................... .........:`.................................t......1---......................................................... Description of Soil....�.._...... x Lta ______________________________ _ ..._........_.___��•�...._.. ._.....e_�t___ C_._____---_✓ :_t_!_s_,:.r? �." e- <�� . ........................ __ ......_.__...................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ..--•••--•-•----------•---••--•-••-••--•---••-••-•••-•••••••-•-•--••-•-•••••-•-----••••--•••....-•-----•-•••-••••-•••-------...--•--•----------•••-----•-••--....••••-•--------------------••-..._..---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 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 health. Signed..................................................................................... ................................ "...•� Date _ Application Approved By-' .....r l. � ''' "� ---• •••-••.......'� ..•-•-•-•-----......•-••-••.....••.... .......... ------- Date Application Disapproved for the following reasons:..........7...........................................................................Dat.•.............. ...----•-•-••--••••-•••..............•-•------•---•-••-•---•--•••••••-----•---•-•----•--••-••-••----••••••••••••--•----••--•-•••••••--------•------•-•-•------------------•--•••--------••-•---...••---- _ D e Permit No...,.... Issued `� r � ------------------------•----• ••----•--....... .............. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH � ..........................................OF.... f9'�I.!.. T%.. .J.......J.. �":...... Tertifirtttr of f ompliFanre THIS IS, TO-CERTIFY, T at the vidual Sewage Disposal System constructed (�or Repaired ( ) by ...................................................+ -��-�-" / � � Installed .....------ 7 • x at. ....... .....-.4..._`��;,1��!-1...............�1. . �- has been installed in accordance with the provisions of "_'I`IE' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No,.� _�._, ". ".2 dated- aa, THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE...................•• " �..�r ....-.../_................... Inspector THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH L ,y,/'" ...........OF..'..:-'.... ../.....�5„p'.... ............................. NO......•---•-•-•-•-•... FEE——... ......r-4 EE——...fc.... :2 Disposal Marks Tpniitrudivn 11anfit Permission is hereby granted........ _r................. to Constrt ct !,�`' or Repair an Individual r-�r-�-----=-------'-�-----------------------------..._.--------------------------••--•--......... x.. . ( ) p ( ) Sewage Disposal System at No., l> ... _ � i 'rs;� ate' !f fi ... l-�s: ------------------------•-•-••-- ---•••-••... Y....•- Street,-�. as shown on the application for Disposal Works Construction PermitoN9�__.��%�'? ated-_,��'._ ......................................... ---- f, ............................................. C� o rd of Health DATE ' t• � FORM 1255 HOSES & WARREN. INC.. PUBLISHERS ENVIROTECH LABORATORIES Mass. Cert. #:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: John McShane LOCATION: 22 Highpoint Road ADDRESSP•0. Box 618 Marstons Mills, MA Cotuit, MA 02635 COLLECTED BY: n_A. qr-annPl 1 SAMPLE DATE:12-1 n—o2 TIME: 12*nnpM DATE RECEIVED:12-10-92 SAMPLE ID:RnI c) 70B #: New well WELL DEPTH: 63' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml (MF Method) 0 0 pH pH units 6.0-8.5 5.54 Conductance umhos/cm 500 85 Sodium mg/L 20.0 10.3 Nitrate-N mg/L 10.0 0.78 Iron mg/L 0.3 0.09 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 Background bacteria EPA 6011602 ug/L 1 Chloroform 2 COMMENT: ^ See attached report. Low pH indicates high corrosive characteristics. yqX O WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. DATE GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: ET 019 Lab ID: 4241-01 Project: McShane/22 High Point Batch ID: VHA-1111-W Client: Envirotech Sampled: 12-10-92 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 12-11-92 Matrix: Aqueous Analyzed: 12-12-92 PARAMETER CONCENTRATION REPORTING LIMIT (u9/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform 2 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m*Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 1 QC SURROGATE COMPOUND ' SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 28 95 % 83 - 117 Fluorobenzene 30 30 99 % 87 - 113 BRL. Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). No: ----- - ------ Fee— - -------------- BOARD OF HEALTH TOWN OF BARNSTABLE Applitat ion-*r lVelt Con6tructionPermit f� Application is hereby made for a permit to Construct ( ✓5, Alter ( ), r epai )an individual Well at: - --��--`--------------------------------------------------------------- Location — Address Assessors Map and Parcel e - - - - --- -- ------------------------------------------------------------------------------------- Owner Address -------------- -`=a,_ 2r _ 6 __�'`'�a Sr/ _-_�__du u- ----- -- ----- Instal er,— Driller Address Type of Building Dwelling--b-ck s-R---------------------------------------------- Other - Type of Building------------------------------------ No. of Persons--------------------------------------------------------- Type of Well_0--------------------- ----- Capacity ----------------- Purpose of Well-- 0P-4e- L=---------------------------------------------- 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 f Co pliance has been issued by the Board of Health. � a -)S� �dd-aa-I-- ----------- � e umSIALL- — — — Application Approved By-- -`( e Application Disapproved for the following re s s:--- -- - - - — --------------------------------------- --- - - -- - -- --- - - -- - - Per date Permit No.� . � ----------- - -- - Issued---------------------------------------- - -- --------------------- date BOARD, OF HEALTH TOWN OF BARNSTABLE Certlftcate ®f Compliance , THIS IS TO CERTIFY, That the Individual Well Constructed (V), Altered ( ), or Repaired ( ) by------------L117_ ?Lr�t�n.cL__[ e l_f �i= 1`= ------ - ---------------------------------------------------------------------------------------------------------- Installer at------- --------- .J--------------/—------------------—-------—-------------------------—----------------------—---------------------------------------------— 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.L-------,- - ----- Fee---�-;-------------- BOARD OF HEALTH TOWN OF BARNSTABLE Zipplication forlVerr Con5tructionPermit Application is hereby made for a permit to Construct ( ✓), Alter ( ), or Repair ( )an individual Well at: _______�� Location- Address Assessors Map and Parcel Owners Address ----------------- /-D `--- ----vl_/n___C�__------ Installer — Driller r Address —— Type of Building Dwelling --------------------- Other - Type of Building------__----------_----------- No. of Type of Well-��-�� ——-_---------------------------------- --------- Capacity --------------- -- -- Purpose of Well---^�4- `rl'-------------------------------------------- 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 Board of Health. Signed 2_ :. �., = -- -t r 1 Z� _ e /date Application Approved By-v� - / / � -� / _ U � date l Application Disapproved for the following re so s:---------------------------------------------------------- -- ---- -- - -- ------ ---- ----------------------------------------------------------------------------------------------------------- date Pri Permit No. -4� J- > - - -- Issued------------------------------------aa------------------- -----__ te a f _ BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO CERTIFY, That the Individual Well Constructed (-'), Altered ( ), or Repaired ( ) / bY- - = "- �' ,// : ' ------------------------------ - Installer at---------a u--------/1= - ....... ------------------------------------------------------------------------------------------------------------------------- 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------------------------------------------------------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE lVell Con!9tructiouPermit No. Fee 1a1��'4 --- Permission is hereby granted-----y - - Jwel=t7�1—____-________----------------------------------------------------------------------- to Construct ( lter ( ), or Repair ( an IInndividual W 11 at:No/L Street( v as shown� on he application for /a Well Construction Permit �� c-1 - =� / Y//a -:�---�------ - ------------ No.--�� � � -�.- --------�--;;y -------------------------------- Date ---- �-�------ ,- - ------------- Board of,,Health v DATE----; -r-��`-//-; --------- --- - b+.SP'1/ . 1'L F�. e. .0.. -. a- 1 V V V :./t.•y A....1.... :ram R ' -0 PRECAST CC1/��"�' :•o::e•:,•e•..•O••'0:•e; -. 0 1p.,,�� I �vv+� R P• p,e.p; ,e•o.�:e:..e:o:::o-:o;'•,o.�,:ir.'p•.:a:.b:•p'•'e::+::. .b,-;o,.o, b;.a.p°.o:e A•,o,b o•.;4•,•0-.�.•e:'.o,c o;:o'e': •. SEPTIC TA/V • INSTALL ON LEVEL BA. to D --- - y3- - �� zz�r / �o• N 1000 GALLON ff PRECAST CONCa;ET �n v► I �• SEPTIC TANK s N \ F PRECAST CONCRETE > LEACHING PIT yo• to I nn y ie. h c S 3 i ' 2 s w Al po� � r ' C15 PLOT PLAN SCALE: 1 3 O " i ENVIROTECH LABORATORIES Mass. Cert. #:MA063 449 Route 130 Sandwich, MA 02563 • (508) 888-6460 CLIENT: John McShane LOCATION: 22 Highpoint Road ADDRESSF•0. Box 618 Marstons Mills, MA Cotuit, MA 02635 COLLECTED BY: 11_A_ Scannell SAMPLE DATE:12-1 n-92 TIME:12 a nnpM DATE RECEIVED:12-1 0-92 SAMPLE ID:Fn19 JOB #: New well WELL DEPTH: 63' RESULTS OF ANALYSIS: Parameter Units Recommended limit Result Coliform bacteria/100 ml. (MF Method) 0 0 pH I pH units 6.0-8.5 5.54 Conductance umhos/cm 500 85 Sodium mg/L 20.0 10.3 Nitrate-N mg/L 10.0 0.78 Iron mg/L 0.3 0.09 Manganese mg/L 0.05 Hardness mg/L as CaCO3 500 Sulfate mg/L 250 Potassium mg/L 20.0 Alkalinity mg/L 200 Chloride mg/L 250 Turbidity NTU 5.0 Color APC units 15.0 -Background bacteria EPA 601/602 * ug/L 1 Chloroform 2 COMMENT: * See attached report. Low pH indicates high corrosive characteristics. X NO WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. DATE GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: ET 019 Lab ID: 4241-01 Project: McShane/22 High Point Batch ID: VHA-1111-W Client: Envirotech Sampled: 12-10-92 Cont/Prsv: 4Oml VOA Vial/NaHSO4 Cool Received: 12-11-92 Matrix: Aqueous Analyzed: 12-12-92 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL 1 Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1, 1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform 2 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropene BRL 1 Bromodichloromethane BRL 1 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1, 1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+p-Xylene * BRL 1 o-Xylene * BRL 1 Bromoform BRL 1 1,1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 28 95 % 83 - 117 % Fluorobenzene 30 30 99 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). ° r TES PROF IL E NOT -TO SCALE ' 'TOP FDN. a o, 5' - FINISH GRADE OVER L . F.ZNISH CRADE FINISH GRADE OVER BhST: BOX 8 n= FINISH G.R�!;JE AVER p.. p.b SEPTIC TANK L F•A C fING PIT ec / \ \ // \ / \ �\ t / \\ ,r\ / ,,\ 12 MAX. I/�� \ / 0. 0. 0 'n' .'o::a ''e•�? a:' e ' t.;e:;.a;:.:a.:d:d::^ '.p•.:!: 'e: e'.f; :^e!'� w7 7,777777, (7F J f� 1 MAX ��� , FRL'r'�'S T C��NC. G,y . ...0.0.;•p -. : .0; . . - �' :. AiJ��F.1 7"t.;ASTO{'Y,� ' T/� /� A /''�('�•7� �l .3" Q OUTLET PIPE LEVEL >� �. TO 12 F.RE'L Gh' GRACE n FQB 2 FT. P,IN. e,p•.'4 _ ..4' .•n��.ro.. . �:i+,4e: A:n:j:n 0,•^o..".O.;o,.Y, - OF77 &40 r ••• .6' /B.U� •.• .n :s J .jar,.:• :. 0•. .. 4'.4 h: 'ea 775� ./ .... ..o ."C:'pp °°:„0 .n� '��. ,p 0 .•D.'. - .; 7 S D Q: 0•.D.o.C. I. OP PVC TEES 77 28 RSMT. FLR. .1000 GALL ,� +� EL o D. S TP.Tr T. � . a INSTALL ON LEVEL BASF �/� _ �a ' ' PRECAST CONCRETE " � ., TO .�-1/ :.e_ .e:,.4..0•,.0.•4. !) _ IfAST7+. O .n A H O REI �" a cRUSd-fD GGM► ' 'TE ° 4:Q;o .a ':e' o:o:: o-:a�,o.o,a. p :e;b Q•'o:,. :.'a' 6. 'o. b o,.O�b.0.4�.o:e p.C e.,•o•.q'..o,b;•o 0 0:o n;.• ;o.. o_.•o b.•o S TONE •., SEPTIC TAN,�C e: •Q .D.o o.n.� INSTALS. ON LEVEL BASE NOTE:• EXC."t VA TE TO E'LE•V. ��.2 'OR a "n'D._c a�'c• e s 4�0wD 4D K t ttJ 7=2 0 LOMER TO RE/'COVE ALL, rmPF-f7V,£OUS MA TERI.AL BENEATH THE_ LEA CHING AREA 2 '-0 f, 2 '_0 SAP `,. RE•PLACE E-XCA VA TED 11A TER.IAL WI TN , . 6• ._0 ,f - •C!_EA IV, CL A Y FREE' S,4 N/J 10 0 t ; EFT VE [?IA TEE' CIO p LE AC I/ G Pj, T Gt.HERB P. NO TES INS TA1_L ON LEVEL BASE ALL' EL,E'VA TION.�' SHOW ARE-'BASED CN ASSUMED 2. ALL PIPES' IN 7Hr.: SYSTEM MUST BE CANT IPON I G'R SCHE�GUL E :�Ci t` VC. .., +� B o -` 3. THE BOARD OF HEALTH "MIST BE NOTIFIED ORS ER VA TION -..r. T s .t rYz N `CONS TRUC "ION IS' COMP ETE PRIOR Di PRETE ENGINEERING - - - '•.ham' - z•-.n Q .r+E/�."'r"`f y,♦ •_ , P E _..A' .,6 C", R f Lz .. �l'Ql -r v 4. ANY CHANGi:Sn 1"..e Tf,'fS' FL AN MUST BE ArPPRO�FD BY THE BOARD &' KEAL TH AND CAPE 6 ISLANDS I�'ITNES.SECl BY.• SURVEYING CO. I'rNC. :. _ . Z � J.DUNNING 6 5. MATEPIALS-•AND INSTALLATION SHALL BE' IN '' 9. Cl, HEAL TH DESIGN A T/ --' a COMPLIANCE h�'I TH �f�� a TA TE SAKI TARP _..BARNS L't7F y 3 C013F - TITLE I/:-- AND LOCAL ' APPL ICAL91_E DATE: �IUL_Y. ..2 4,.1992, RULES ANO r:.REGL iL A d TC,'V5 �( P-7916 1VUA,!13ER OF SEDP/0!�1S 1000 GALLON /i- PRECAST CONCREr �� M.� h 6. l+!QRTH At'RO. ' .d'S FF'S' t FJ'�CORlJ RLANS AI`117 0 �{` a y SEPTIC TANx IS I"�tO T TO L�!r' 'USED FOR SOLAR PURPOSES GA RSA GE D I�S''OSA L IVO f ' TOPSOIL 6 GAL . ti 7. FL(7OG7 H11 ZA1?V 7 t)/" E C (NON-HAZARD _. DA f L }' EL C7>� _r3 SUBSOIL ,0 0 s $. ls'A TEFL SUPPLY N t o a 4 ><� : , w;� �� 30 " SEPT.1"C TA NfC F;EC D. _1000 GAL 3 SEP T.fC TANK l"pG III,CED GA L . a "r V PRECAST CONCRETE 1000 LEACHING PITLEA _ C7PQ yo L EA Gl-�...1 NG ,�F_'l.�L.1.Z`P�',C _,_330 ,o o MEDIUM I L o-r ZZ r SAND S.TCtc1ALL AFPEA - 188 S x/ y • I 188 S. F. X 2. 5 C'/.-5,. F. 470_ Q it \n 1 c7. ,4c ° C'O T TI^^9 Al A ::' 7S_..^�. / „f .. o ro L EGEND. 79 s. F. X_1,..�0 C/,:a. F. L E•A CHING 'RC1 l!I!-'E!7 _ 9 is Pla PTP-POSED ELEVA TIOr'1/ �` 432111 NO GROUNDWA TER T"' /Ny. 1 -----fs'o ---— EX1 T3NG COs'VTQUR N SINGLE FA MIL Y RESIDENCE 6 -Of -Z-1?VA TI.ON PIT DID Ti?1PUT.X CAN 30)< �' _ ,.qgg/'•q w ' r• ,r `.( ,,,r '., `a..,r.;'�.-.M .:-•. . >'r 6 . '`r L - P s.. � EIS f r; L EACr�t mG PIT ✓o >� 2 r asp l �} fP'f f J PEE F013 A/� // MCSHANE CONS TRUC TION. ..CO. :.+ Tf'f'./f Y �f' LOT 22 HIGHPOINT ROAD (RP t PE-SERVE - ,�,of M MA RS TONS MIL L S -- MASS. �. � DAVID E 8o Flipr INVERT EL EVA TION � �CHARLEs SANICKI !�A TE.* /Vo Y, 2aoss CAPE & .Z"SL A AIDS' ENGINEEPING -Sq PLOT PLAN $= �r o SALE AS NO �=; TQP' .��., F A L MOUTH 130110 -- SUI T1- P-lz SCALE: 1 "� 3O `'� �a _ _AN NO. -.. p� L=t , < EC Pi^�. !OT t�' �1 so A':"ASHPE l�`A55.