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Home My WebLink About0030 BERKSHIRE TRAIL - Health 30 Berkshire Trail W. Barnstable F/R A = 109 014001 ,.. ... .emu.. ... - .:w��..-.. u 3' r 3 v - 3. 5 TOWN OF BARNSTABLEc LOCH;ij7N SEWAGE #c2Cdoa- I�6 VE,LAGE We 51 ANASIO� ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. �.CL'-�\i S�e� '-(d.$ SEPTIC TANK CAPACITY %ek r LEACHING FACILITY: (type) Cc�l ee3c�� Cv`r� (size)/a 1'/ux 35 3 NO.OF BEDROOMS 4 BUILDER OR OWNER �AC-Qo r�AC PERMIT DATE: COMPLIANCE DATE: �- Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Rear 4Sa 63 { f No. t... � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pprtcation for Mtoponl *p5tem Con6tructiou Vermtt Application for a Permit to Construct( )Repair(►/SUpgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1 1 Owner's Name,Address and Tel No. Assessor's Map/Parcel W I'43 PRE aT�tloLt� Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Hag s5-OA9 0,rA H,9. oa 5- Type of Building: Dwelling No.of Bedrooms q Lot Size sq.ft. Garbage Grinder(N9 Other Type of Building Woon Fr.401 c No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow yV /O gallons per day. Calculated daily flow gallons. Plan Date U4m 1'1- o`t 00a Number of sheets / Revision Date Title i Size of Septic Tank Q0# &exjJ r Type of S.A.S. Cu /Tcc 330 HAMtSc'e5 It it Description of Soil 0 -S c /0 4M S -3`/ z JoArn,.s6nd iz/4z Q04 C044Pse -5-AAA .A /sS /c<, (,C/ Nature of Repairs or Alterations(Answer when applicable) e S- C v17e_c 3 3®r,-114 M felil /4-,//i A7g-ge trcc-bl A S ice Am Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss d by this'Board of e lth. Signed Date �1A2G� S-od Application Approved by Date .3 -2S-c14 Application Disapproved for the following reasons Permit No. ;god a- IRZ Date Issued 3:ZS-!' a 1 No. w d(� .. F .... ..,'1.� ::.t'�. Fee 5V 71 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: � Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 0(pprication for Mi000af *raem Conttruction Permit Application for a Permit to Construct( )Repair( 1<`f Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. � Owner's Name,,Address and Tel.No. Assessor's Map/Parcel 1�..) •�t- sa /ty-rig,: qyt- 5�� v4i6oZ Installer's?Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1J�vcC �IACG.1�.iT<< JOh.. 'Oi. 1t 6- f ,9Ab)10 / Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder(NO) Other . Type of Building Waa Q F,,Ad►r' No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date 7-A.--r, i ?- z2 CVd Number of sheets / Revision Date Title r ' Size of Septic Tank T�(lJ 1-7,4e Type of S.A.S. C� l is c 33o rha jt ti�P s Description of Soil 'S IcsArll S 3`� = foa;l�, S/l/J// e� 4/ ef' ja1Qr r.7nli?SC' _,i4il/1 !v %f! / Y 0/.irz2,4 � Nature of Repairs or Alterations(Answer when applicable) A D i) .5- C,1ir 3 3 O r qAm 128J s o rl r Tc Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Health, Signed Date fiA&C!/-_�5-OA Application Approved by Date 3 u-v 2 Application Disapproved for the following reasons Permit No. ,200?- Q 4 Date Issued S THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( Upgraded Abandoned( )by at 30 e jl- k%r f.1 le a t( l 'i c-I t T", C has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. a dated d 2 Installer-13, ,Cc. Designer 7o N,(r The issuance of this permit shall not be construed as a guarantee that the syst ill function as d-si tied. Date �"'� U0� Inspector tl a�^-1'� 41,1-� No. ��d�—Id6 ----------------------Fee �. b THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS • Iigpozar *p6tem Conttruyyction Permit Permission is hereby granted to Construct( )Repair( <Upgrade( )/Abandon( ) t System located at 30 _&rk L r'_�,"12 and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. C Date: 3' 7 3' 0 Approved by AjJ_ • • L y f 1 TOWN OF BARNSTABLE fc- LOCATION 3o 1�er1Z3�1�2e``. `�2A�� SEWAGE #r'CQ QA �d6 VII LAGEI.0 es i 1�AhnsTA?s LC ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY l.(000 Seri e)Lka-� LEACHING FACILITY: (type) CS-) (size)/a+�/uY-35 3 r, NO.OF BEDROOMS ff�� BUILDER OR OWNF PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet iFurnished by ReC4r 0 - 20V 63 ` COMMONWEALTH OF MASSACHUfAI&ED pI EXECUTIVE OFFICE OF ENVIRONMENTAL A Fi t� ON DEPARTMENT OF ENVIRONMENTAL PROTECTION I o`) TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 30 Berkshire Trail West Barnstable, MA 02668 Owner's Name: Tim McCorkle Owner's Address.: Same RECEIVED Date of Inspection: November 17,2001. NOV 2 8 2001 Name of Inspector: (Please Print) James M. Ford TOWN OF BARNSTABLE Company Name: James M..Ford ;HEALTH DEP.T. . - Mailing Address::. P.O. Box 49. r 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 Con ' ionally Passes Nees rther Evaluation by the Local Approving Authority ✓ Fail e� Inspector's Signature: Date: November 21, 2001 The system inspector shall sub rcopyf 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.. f Notes and Comments ****This report.only describes conditions at the time of-inspection and under the conditions of use at that time. This jnspection 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 1 Page 2 of 1 I (OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS � 0SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 30 Berkshire Trail West Barnstable. MA._.. Owner: Tim McCorkle _ _ ....__._ .. .. Date of Inspection: November 17. 2001 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 CNM 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-tobroken-or-obstructed pipe(s). The system will - - ass•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: 30 Berkshire Trail West Barnstable AM Owner: Tim McCorkle Date of Inspection: November 17, 2001 C. Further Evaluation is Required by the Board of Health: i 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 10-0 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 l of 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) ; 1- . - . Property Address: 30 Berkshire Trail West Barnstable. MA _..... '..._t..._ ._._.._ ;.,. Owner: Tim McCorkle Date of Inspection: November 17. 2001 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 '/z 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's 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:] Yes (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 11 of a public water supply well If you have answered`yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM _. PART B CHECKLIST Property Address: 30 Berkshire Trail West Barnstable. MA __..........- Owner: Tim McCorkle Date of Inspection: November 17, 2001 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 dwellmg;inspected for signs of sewage,back up?; e ✓ Was the site inspected.for signs of break out Were all system components,excluding the SASjocated 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: x: 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)]. 5 Page 6 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM.INFORMATION Property Address: 30 Berkshire Trail West Barnstable. MA Owner: Tim McCorkle Date of Inspection: November 17. 2001 - - FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 4 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: 6 Does residence have a garbage grinder(yes or no): n/a Is laundry on a separate sewage system (yes or no): No [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)): Private well Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIA ANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): Qpd . 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 approximately 3 weeks ago-per owner Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: Qallons--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) technology. Attach a co of the current operation and maintenance contract(to be Innovative/Alternative t P- gY PY 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 inform`ation:' Nov. 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 -T PART C ' ' SYSTEM INFORMATION (continued) Property Address: 30 Berkshire Trail West Barnstable. f - Owner: Tim McCorkle Date of Inspection: November 17, 2001 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: 4' 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 gal. t Sludge depth: 0" :. , Distance from top of sludge to bottom of"outlet-tee or baffle:"-" 32"--- '-"` Scum thickness: I" Distance from top of scum to top of outlet tee or baffle: 10" Distance from bottom of scum to bottom of outlet tee or baffle: 12" 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.): Tees were present The liquid level was even with the outlet invert. There were no signs of leakage. The tank was pumped approximately 3 weeks ago Recommend installing risers. I 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, iquid`levels as related to outlet invert,,evidence of leakage,etc.): 7 t t Page 8 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) J J.2 �. Property Address: 30 Berkshire Trail West Barnstable. MA---- Owner: Tim McCorkle Date of Inspection: November 17, 2001 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). r e Depth of liquid level,above outlet invert:- --= 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.): I was unable to locate the D-box Approximately 4 'below grade 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 s Page 9 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY,ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM SYSTEM INFORMATI"ON (continued) .. 1j t f .... Property Address: 30 Berkshire Trail West Barnstable. MA - "- - Owner: Tim McCorkle Date of Inspection: November 17, 2001 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: 6'x 6'with 2'stone-per design plans 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 4'ofwater on the bottom. The scum line was up to'lhe cover, above the inlet pipe. 'The"pit'was'in hydraulic failure. The cover was 3'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.): F 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 e Page 10 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ", .SYSTEM INFORMATION (continued) Property Address: 30 Berkshire Trail West Barnstable. MA Owner: Tim McCorkle Date of Inspection: November 17. 2001 - SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks r benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. � ` B 3 ,,q37 3 f33- a9 10 r Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEDISPOSAL SYSTEM INSPECTION FORM - . PART C. SYSTEMINFORMATION (continued) A Property Address: 30 Berkshire Trail West Barnstable, MA Owner: Tim McCorkle Date of Inspection: November 17, 2001 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 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: Checked with local excavators,installers-(attach documentation) ✓ Accessed USGS database-explain: topographic and water contours maps You must describe'how you established the high ground water elevation: The bottom of the leach pit to grade was approximately 10'• Using the Barnstable topographic map and the Cape Cod Commission water.contours map, the maps were showing approximately 100'+/-to ground water at this site. This report has been prepared and the system inspected and failed 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 f ti. �AU'� P� � �,o �� 1•�,�� ev�e� /// anc��n iavvctvucim ✓. Borrower/Client ' Prop orty Addreee City County. state Zi Code Lender 'Ndt ra srA LE: . t, e .. DP . ►yy D A . w 3 N rx 3 IC I (n � a a A A ..G G CP r o r .0 3 D TOWN OF BARNSTABLE LOCATION � ,� /��o SEWAGE # e° --o VILLAGE ASSESSOR'S MAP & LOT —0&_0 _JNSTALLER'S NAME & PHONE NO. >7 EPTIC TANK CAPACITY LEACHING FACILITY:(type) Z> (size) r O. OF BEDROOMS 0�k, RIVATE.WELL R PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No "' :, �Uli S � aC'cz.�Qsr�.e. ,, � _� y ., �� . � u� � i b .. � o �� CC o �. r�r� \\�\ / � i cR s� ._ \ • J No..... FEs..J .D....._ THE COMMONWEALTH OF MASSACHUSETTS _ BOARD OF HEALTH 1 Z WN..................OF......��S( ................................................ Apli iration for Diopoottl Works Tontrurtion Vern fit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ---..... 6 -•—'66U15-I QZ•-•TQA) -=- -------------------------------------------------------------------------•----.................... Location-Address/ l �y6 or Lot No. / 6�.L.-.c2...--------•---•-^...... p1�---` •••-O �....l fRl�tt..�.f..::.L!:i..s...... Owner Address w - .�,ra:Z1................................. ................................................................................................... ,-a •------ -------••---------- Installer Address !-�4-Type of Building Size Lot.. ,+C1 -�......Sq. feet Dwelling—No. of Bedrooms......__________________________________Expansion Attic ( ) Garbage Grinder ( ) 04 Other—T e of Building *No. of persons............................ Showers — Cafeteria a' Other fixtures ..............••......-••••••--• . •- W Design Flow.............5S........................gallons per person per day. Total daily flow.......... ..........................gallons. WSeptic Tank—Liquid capacityj.QW...gallons Length.&7.._.. Width..t�4..... Diameter................ Depth..`lxl T x Disposal Trench—No. ----_---------_- Width.................... Total Length _....... �.__..... Total leaching area....................sq. ft. 3 Seepage Pit No.........I........... Diameter......1.Q.......... Depth below inlet..... .......... Total leaching area...S41......sq/ft.ev/0 Z Other Distribution box ( ) Dosing tank ( Percolation Test Results Performed b .....-t-NOrr!)�._.. C'LF,L� Date... �} �� aY + . ...... ------ ) r ........................... Test Pit No. 1..��1....minutes per inch Depth of Test Pit... BO!�..... Depth to ground water..IVOt�....._.. Lz. Test Pit No. 2... .:Z....minutesper inch Depth of Test Pit..18.12......... Depth to ground water.Nol..'s .... 94 O Description of Soil......I......!a" !Y SU. __......._ v_� s� CL AYv.... �fJ 0 m.. _. ............................. x 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:ITL; 5 of the State Sanitary Code— The and-si ned further agrees not to place the system in operation until a Certificate of Compliance has bee issued t5y t f health. Signed --.... ........ : ............ ----------------------------------- ................................ .�^�� Date q Application Approved BY -C J -----------------------------------•- 1 't Date Application Disapproved for the following reasons:............................................................................................................ ...............•----••-----...._.__._........_......--------.._...>-••x---.......--•------------.....---...-•-----------•---------•---•-•---•------•-----•--•----•---......-•---.... Q ..........._-- Date PermitNo........./_.1--------- 1_..11----------------- Issued........................................................ Date 6 - _ r..,,+:,.-.--.`+�..�i�.:.-!•.,.i^-�-.�`."`""''�,1"., ^—-r wa..ya.._^;;.,t;.y�-.,.��„�;.y,y;C-,�.�.f�`�e �cY�..r:''"�s�+'''� _ �`` f, :;,v. r . THE COMMONWEALTH'OF MASSACHUSETTS _- CHt. BOARD OF HEALTH !...ToW. N.... ....OF......�� .�L�-------f.......... :.... Ap' pliration for Disposal Works Tonstrurtion j1rrntit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual`Sewage Disposal System at: ................... ................... Location Address or Lot No. Owner Address a _ • �! -.--.... .._ '��------....-•••----•••--•--•--•-• .......••-•-••-•................•••-.•••... Installer Address �q Type of Building Size Lot..`1i_--t,��k-�-�-......Sq. feet Dwelling—No.. of Bedrooms......3..................................Expansion Attic ( ) Garbage Grinder ( ) a`4 Other—T e of Building ............... No. of ersons....................._.._.__ Showers YP g ------------- P ( ) — Cafeteria ( ) QOther fixtures ----------------•-------------------•-••----•---------.-••••-•--••--•--•-•-•••-•--•--... ---•••••••••••.........•••--•-•••-•--•••-••--......--•-•---•• ` W Design Flow............. .........................gallons per person per day. Total daily flow........7P..........................gallons. WSeptic-Tank—Liquid capacitylV...gallons Length. Y&..... Width...t.1 Z..... Diameter................ Depth_j. x Disposal Trench—No- -------------------- Width._._............... Total Length..........-'_....... Total leaching area._...•.........qq.t. SeepZ _-_ , Other a Pit hon --I ( .. Diameter--•Dosing tank�th below inlet.._..�.......-. Total leaching area•-••••49......s . ft.6 16 Percolation Test Results Performed by....�'N.�M)s.....m...GLE� °�► 1•-q 1 .a i�...................... Date---o.. . .........._..- Test Pit No. l...1�1....minutes per inch Depth of Test Pit...MO.!....... Depth to ground water..&ON?......... LL, Test Pit No. 2... Z_....minutes per inch Depth of Test Pit..!$U.._..._.. Depth to ground water.Not' '........ ;� ... ......................................................... O Description of Soil--••--t....-•®r- 1.....Dp---- ................V1 ..--- ff v..� Q.__.GL /�Yy mW-- vf�.._.. --•--------------•--•---•-•--------------- ...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 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 i/\ ssueed by thjef boa�d of health. Signed.. .........................................!l ..................................... ...._..... :................_. _. Date Application Approved B ►- _�. 1_. t ,:. .- -. .....................�m,. t✓ Application Disapproved for the following reasons---------........................................ .:.....•............== ....----•---•--------------....------...nace.....`... --------------------------------------------------- ---------------- / h.... j ^ - Permit No......... ....----..s. .!)----------------- f Issued_.---------------•------------ -----•-•--Date �_/ ..._.. Date THE COMMONWEALTH OF MASSACHUSETTS r { °. BOARD .OF HEALTH " /.. YW4�i ......OF...............(. 1.............................. Tertif irtttr of Tontplinurr THIS IS TO CERTIFY, That the Individual Sewage Disposal ystem, constructed ( or Repaired-(�)� ..... �� vr� �.._. •-•-......••.... �`6----- ----•...---.•....-�. ................. --------... ----.-- nsta er at......- �''�? fin !s rc.... U •' lQ has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........41.-..,a_1.�....._... dated-..............._.............................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �' �y DATE. d! _1�+ _.� Inspector Al 4t. .... ----rC %t/.�...... iy------------•-••-- E•a.�A'Ot.i+Isi•m•Y>Rowv.A'v.g'K.t+a.'FY•r x!v..sn 4±ann 4'n wn. �nww.....we.Te..w�.sm4v.of os9----w-.s-----L- ... ...w.-nn.sines w..re.ww w.r..r y,+!P+}N.A a�.m�`!a---- ---C+a+•.-- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH gf ...OF......... ....................................... NO....F.f..-...��C.�! r FEE......1.!r . Disposal Works Tonnot�ttr#' r i Permission is hereb Ygranted------. �.i fi •-_..�. ---- --....... 1/.............................. to Construct (1,4) or Repair ( ) an Individual Sewage Disposal System p Street a as shown on the applicat"on for Di•posal Works Construction Per`F •t No.?�_-5/0____ Da e&.a................................... / Board of Health DATE --T- ----. --- ----------- tNVIROTECHL ABORATORIES Mass.Cert.#MA03 449 Route 13 Sandwich,MA05a . (0)aa8646 / r ` / CLIENT terry Nlckulas 00000ON: Lot 46 Berkshire Trails k _ ADDRESS: W. Barnstable, k* j � M . k COLLECTED BY: L. Wile SAMPLE DATE}0 17-91 TIME: 9:45 DATE RECEIVED: 10-17-91 SAMPLE ID: z&O5 2 E a F E JOB f New Well WELL DEPTH: 99/144` 4 PVC 20 pm k � RESULTS OF ANALYSIS: E \ F Parameter Units Recommended limit Result R . g CoRmm b de a/10 m! (RF Method) 0 0 -� q / PH pH units +y*5 6.83 Conductance umhmZcm 500 72 Sodium mg/E 20.0 8.O N»geN . mg/L 10.0 0.11 Iron mg/E 0.3 E O.0 U Manganese mg/L 0.05 0.02 9 ® Hardness . mgZL as CaCO 500 % _ a 11.4 a E*� Sulfate mgZL . 25 12.9 q Potassium mg/E 20.0 0 § \ k � fAlkalinity mg/L 20 § & / k Chloride mgZL 25 F 13.3 $ 4 } T2&$!y NTU &O 4.9 Color APC units} 15.0 <l.O Background bacteria . 2 COMMENT: k EPA Method 601/602 ug/L *Below Reporting Limit q 2 See attached report k YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TE TED. E. F RX . \ E A DATE k / GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID:. Z-405A Lab ID: 2115-01 Project: Nickulas QC Batch: VGA-865 Client: Envirotech Laboratories Sampled: 10-17-91 Cont/Prsv: 40ml VOA Vial/NaHSO4 Cool Received: 10-18-91 Matrix: Aqueous Analyzed: 10-18-91 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 BRL 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 ci.s-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 Ethylbenzene BRL 1 m+Mpylene * BRL i 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 31 103 % 83 - 117 % Fluorobenzene 30 29 97 % 87 - 113 % BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. 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 ApprtcattonArlVerr Cootruct ton permit Application is hereby made for a permit to Construc ), Alt r ( ), or Repair ( )an individual Well at: - �--1 './_ �--4 __- /r� . 7,---------------------------------------P-------------- Location — Ad ress /' / Assessors Ma and Parcel ------------------------------------- Owner Address - - - --- - - ----------------------------------------—--------------------------------------- ------- I-----nsta------ller — Driller Address Type of Building - Dwelling - C ------------cy-,a___-- Other - Type of Building No. of Persons-------------------------------------------------- Type of Well------------� ----------------------------.--9------------ 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 Hea Private Well Protection Regulation The undersigned further agrees not to place the well in operation until ertificate of Compli h s be sued by the Board of Health. Signe -- - - - -- -------------------------------- date Application Approved By -—----- _—__—_—- --- -- ------ - -------------------- date Application Disapproved for the following reasons:----------------------- ------------------------- ------------------------------------- ----------------------------------------------------------------------------- date r Permit No. ------ Issued-- -- - - ---- - --- ------------------------ date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS TO EIJTIFY hat t ndividual Well Constructed ( ), ltered ( ), or Repaired ( ) by------- ------ -----------—------—--------------7 -- - -------------------------------------------------------------------------- Installer at-- --------------------------------------------------- -- c-W,,6----4--------------- - has been installed in accordance with the provisions of the To of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. JV,9Z-�-,9----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 lVeir CongtructtonVermtt No. - _1 __l =�_ Fee-a,5 _-- Permission is hereby granted----------LL - ------------------------------------------------------------------ to Construct (>(; Alter-( ), or Repair ( ) an Individual Well at: No. -------------------------- -------- - --z,�---------------- L------------------------- Street as shown on the application for a Well Construction Permit - --- Dated----------------------------------------------------------------- -- ---------------------- -d------------------------------------------- - -- Board of Health DATE--------------1/----- /-- --------------------------- ,*• �"'.. _ --t _... """w"r� P.�-c,,. �5" ..,.:.z.S+c.�F4;� c.,�,..�S.:t•.;,�,,.`.s•;,.":3�•:,��:;.. 4':R.«JSp4.X•«'�wu. .. . ... ,.q-.. a� No.--V,J p�� -- BOARD OF HEALTH TOWN OF BARNSTABLE 0[pplitation, orlVet[Congtructiot Permit Application is hereby made for a permit to Construct (,w/..y), Alter ( . ), or Repair { ')an individual Well'at: --------------- P - ------;------=--- "~ ` Location=Add�� Assessors Ma and Parcel iry--r-"- ---I-a�- =------------------------------------- --- --- --�---=t-------------------- Owner Address - �sr-�"'`-/ —= •�• -------------------- ---,--- ------------------------------------------------- Installer - Driller Address Type of Building • Dwelling 12® - g------------- ---- -- _ Other - Type,of Buildin - `------:' ., , No. of Persons ,---, }--------------=------=-='--.- _____ t ' ' Type of Well--="------ - — -' Q— -- '.,`Capacity- --- - -0. F ` { , { Purpose of Well--------------------- -----------'0"'---------- 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 -t The°undersigned further agrees notJo_'• place the well in operation until Certificate.of,Complianc has beenai sued by the,Boardof Health. - Signe• - - , - w E date' Application Approved By-- a -- date Ja►. 4 „ Application Disapproved for the following reasons:---------'----- --- --____ _:______ - —'`____'-____ — ---- ---- - = —- -- —-- - - --- ------------------------------------— —- - date } Permit No. t! ----- ------- - . Issued- ----------------=----- -- date - +. BOARD'OF HEALTH f x ' 1 ., - ..pp .... ,�.1 ..«f ......;i ...a "•ic aT,.-"4 a..1Rwr. l.'. •-I,.,.,4.•�' _ �._- ..��_.�..�:.;.�:.��;•� .-�,:'f�j. -��T O W`hI� �0�'�'�`B A�F�N S�-T A�"B L E �''`. . . . Certificate �C ®f��Com Yiar�ce .. .f . �_�._ .�. * �.-..._.•..,..-_ �. 2 f ... 00 THIS IS TO CERTIFY., That th ndividual Well Cons acted( ), ltered or Repaired t, ' .;by . !_ -=".7X - `- ' 5---------------- - ---------------- ------------------------------------------------------- }I_ taller,• has been installed in accordance with the provisions.of the Town of Barnstable Board of Health Priva e Well Protection . Regulation as described in the application jfor-Well Construction Permit No. HE ISSUANCE,QF,THIS CERTIFICATE SHALL NOT BE CONSTRUED"AS A GUARANTEE1THAT.,THE WELL , • SYSTEM WILL FUNCTION SAT!SFACT ORY-`'r�s v. _ w'e�K J1i• ar .r5cti tK t,.aw,. .tI}��.y'�:i; DATE--------------------- ------- Inspector------------------------------------------ -------- -------- --------. "" 60:4RD OF HEALTH ;TOWN _OF' BARNSTABLE 4 . -r- - _ -__ --'T__..•�-_ No. - .. -�,` •• Fee-- .r, Permission`,is hereby granted-- .— "ra' ." --�..'h-,-- ------------------- -------------- ---------------- -----=- ------ to Construct ( 'Alter ( ), or Repair ( ) an Individual Well at - , t Y ---- -------- --- t Street as shown on'the application for a Well Construction Permit No.---------------------------------------—------------------- i '— Dated------------------------------------------------------------------------------------ - - - s -v — DATE-------------- ----------------------- . � Board of Health 1 -q ------------------------------- SD/.C.S' TEST RESt/GT.S �"E/T/.9GE SYaTTEM PROF/LE J • D T—/ _ T Z EL. /Z•4 `f F/N a i G,2.9�E MIN. SL.oPE OF 2 4 I Z"Mhl• 9"M/N. 7aPsol� 7dPS011L 3G"MAX. -=V s•T/n/6 ,D/ST, BOX Ada ,q uo PBRFORAT�D' 91 V4• %eMINIMvtit _ t ° °• Sct1.40 PVC __ /N .EL./28.FG SCH• 4rD PVC. fPE 1 MAX/ti1t1/y Z L'bVER ° F �/�. /2 STOI�IE StJBSDIL SvQSO/L I ,G,/QtJ/a LEVEL uNOHP ' . /N✓. /NV. • .r 4 -TUNl31.go to• /g ///V. /NI/ A l3o•y7 MtN, ¢• vV /30•72 /Z9.59 1 9g2 3/4"-�%2" 3w-fy2' fL•l2¢ �.. �L./2o WASNEa W*$-Y ED ' �►� to ::' STONE � � %f/ C L_ G 3 [!/ M E/e` s Zo�rE Z EFFE'C 771go yE AE/'TN w ":`•."• c :r: •. •>..�sr;• r• fq- / pc C D � C - -. 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