HomeMy WebLinkAbout0009 BOXWOOD DRIVE - Health 9 Boxwood Drive
West Barnstable
A= 216—016
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Massachusetts Department of Environmental Protection
Bureau of Resource Protection
WELL DRILLER
Please specify work performed: Address at well location:
New Well . Street Number: Street Name:
9 BOXWOOD DE=RUNE +
Please specify well type: Building Lot#: Assessor's Map#:
Domestic —�
Assessor's Lot#: ZIP Code:
Number Of Wells: 1 102668
City/rown:
Well Location BARNSTABLE
In public right-of-way: GPS
G Yes Q No North: West:
41.69450 70.34763
Subdivision/Property/Description:
Mailing Address:
click here if same as well location address!.
Property Owner: Street Number: Street Name:
OWENS 19 BOXWOOD DE=RUNE
City/Town: State:
Engineering Firm: BARNSTABLE MASSACHUSETTS
ZIP Code:
02668
Board of health permit obtained:
Required
Permit Number: Date Issued:
2011007 5/18/2011 1
W
Page 1 of 1
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Massachusetts Department of Environmental Protection
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Username: -TDESMOND3
Transaction ID: 398083
Document: WELL DRILLER
Size of File: 68.35K
Status of Transaction: Submitted
Date and Time Created:.V30/2011:10:37:57 AM
Note: This file onlyyincludes forms that were part of your,
transaction as of the date and time indicated above. If you need
a more current copy of your transaction, return to eDEP and
select to "Download a Copy" from the Current Submittals page.
aIA
Massachusetts Department of Environmental Protection
# Bureau of Resource Protection—Well Driller Program
_ Well Completion Reports(General)
Well Driller - General Well Form
DRILLING METHOD
Overburden Bedrock
AugerChoose Bedrock WELL LOG OVERBURDEN LITHOLOGY
From Drop in Extra fast or slow Loss or addition of
To(ft) Code ` Color Comment
(ft), drill stem drill rate fluid '
C20 Medium Sand Brown _ Yew 0 Fast r Slow Loss 0 Addition
Fine To Coarse Sand Brown 20 40 _ G Fast G Slow G Loss r Addition
40 60 Fine To Coarse Sand Brown Ye r Fast r Slow r Loss r Addition
80 Silty Sand Brown �Ye r Fast Slow Loss C AddiUon
80 94 Fine To Coarse Sand Brown r Ye Q Fast GJ Slow T Loss (7 Addition.
K] C " 0 [ � �
WELL LOG BEDROCK LITHOLOGY
Visible. Extra
)From Drop in Extra fast or slow Loss or addition of
;(n) To(ft) Code'. Comment Rust Large
drill stem drill rate fluid -
1'i Staining Chips
( Choose Code Ye (4 C Fast � Slow 0 Loss Addition (�1 Yes r Yes;
L r
ADDITIONAL WELL INFORMATION
Developed Yes O No Disinfected %Yes C No
Total Well Depth 194 Depth to Bedrock
Fracture
Surface Seal Type None Enhancement �''Yes r No
------,
CASING r Is Casing above ground? From: 1 To: 0
;From To Type Thickness - Diameter Driveshoe
_..
0 91 Polyvinyl Chloride Schedule 40 4 r Yes
SCREEN No Screen
'From To Type _ _a Slot Size Diameter
((91�� F9—41 ISt-inless Steel Well Point 0.015 4
WATER-BEARING ZONES DRY WELL:
(From,- - "To Yield (gpm)
61 194
PERMANENT PUMP(IF AVAILABLE)
---Choose Pump ---Choose Horsepower--
Pump Description Horsepower
Description---
Page 1 of 2
Massachusetts Department of Environmental Protection
`. Bureau of Resource Protection—Well Driller Program
Well Completion Reports(General)
Pump Intake Depth(ft) Nominal Pump Capacity(gpm)
ANNULAR SEAL 1 FILTER PACK
.....
Water
,From To Material 1 Weight Material 2 Weight(gal) Batches Method Of Placement
[Choose Material Choose Material I_ I Choose One WELL TEST DATA
Time Pumping Time To
Recovery(ft
,Date Method Yield(gpm) .Pumped Level (ft Recover BGS)
(HHWM) BGS) (HH:MM)
5/24/2011 Constant Rate Pump 15 1:00 63 0:01 61
WATER LEVEL
Date Measured Static Depth BGS (ft) Flowing Rate(gpm)
F5/24/20117 115
COMMENTS
WELL DRILLERS STATEMENT
This well was drilled or altered under my direct supervision,according to the applicable rules and regulations,and this report is complete a
knowledge.
Driller iTHOMAS E DESMOND 1111 Registration# 764 Monitoring[M] C Supervising Drill
Firm DESMOND WELL DRILLII Rig Permit# 1023 Date Job Compl
NOTE:Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
Page 2 of 2
w '1
CERTIFICATE OF ANALYSIS
} ,a+lwFi T
Pager 1
�m Barnstable County Health Laboratory (M-MA009)
Report Prepared For: Report Dated:6117/2011
Sally Desmond
Desmond Well Drilling Order No.: G1162608
P O Box 2783
Orleans, MA 02653
Laboratory ID#: 1162608-01 Description: Water-Drinking Water
Sample#: Sample Location: 9 Boxwood Dr West Barnstabel MA Collected 6/15/2011
Collected by: Customer Received 6/15/2011
Routine
ITEM RESULT UNITS RL MCL METHOD# ANALYST TESTED NOTE
Nitrate as Nitrogen 2.2 mg/L 0.10 10 EPA 300.0 LAP. 6/15/2011
COpper ND mg/L 0.10 1.3 EPA 200.8 LAP 6/16/2011
Iron ND mg/L 0.10 0.3 EPA 200.8 LAP 6/16/2011
pH 6.4 PH AT 25C NA 6.5-8.5 SM 4500-H-13 LAP 6/15/2011
Sodium 29 mg/L 1.0 20 EPA 200.8 LAP 6/16/2011
Total Coliform Absent P/A 0 0 SM9223 BSS 6/15/2011
Conductance 190 umohs/cm 2.0 EPA 120.1 DCB 6/15/2011
Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a
physician.
Attached please find the laboratory certified parameter list. Approved B
(L anager)
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605
OF pA
CERTIFICATE OF ANALYSIS
Barnstable County Health Laboratory (M-MA009)
ysrncxrs'.`� "
Recipient: Sally Desmond Matrix: Water-Drinking Water
Desmond Well Drilling Sampled: 06/15/2011 12:00
P O Box 2783 Received: 06/15/2011 9:04
Orleans, MA 02653 Collection Address: 9 Boxwood Dr West Barnstabel MA
Order#: G1162608 Sample Location:
Description: Re Kit
Lab ID: 1162608-01 Date Analyzed: 6/15/2011 @ 16:14
Sample#: Analyst: yn
Method: EPA 524.2 Dilution Factor: 1
Comment: Sodium level is above the maxium contaminant level. Those on a low sodium diet may wish to consult a physician.
EPA 524.2- Volatile Organics by GC/MS
Result MCL MDL Result MCL MDL
Parameter-- ug/L ug/L ug/L Parameter ug/L ug/L ug/L
Dichlorodifluoromethane ND 0.50 cis-1,2-Dichloroethene ND 70 0.50
Chloromethane ND 0.50 cis-1,3-Dichloropropene ND 0.50
Vinyl chloride ND 2.0 0.50 Dibromochloromethane ND 0.50
Bromomethane ND 0.50 Dibromomethane ND 0.50
1,1,1,2-Tetrachloroethane ND 0.50 Ethylbenzene ND 700 0.50
1,1,1-Trichloroethane ND 200 0.50 Hexachlorobutadiene ND 0.50
1,1,2,2-Tetrachloroethane ND 0.50 Isopropylbenzene ND 0.50
1,1,2-Trichloroethane ND 5.0 0.50 Methylene chloride ND 5.0 0.50
1,1-Dichloroethane ND 0.50 Methyl-tert-butyl ether ND 0.50
1,1-Dichloroethene ND 7.0 0.50 Naphthalene ND 0.50
1,1-Dichloropropene ND 0.50 n-Butylbenzene ND 0.50
1,2,3-Trichlorobenzene ND 0.50 n-Propylbenzene ND 0.50
1,2,3-Trichloropropane ND 0.50 p-Isopropyltoluene ND 0.50
1,2,4-Tdchlorobenzene ND 70 0.50 sec-Butylbenzene ND 0.50
1,2,4-Trimethylbenzene ND 0.50 Styrene ND 100 0.50
1,2-Dibromo-3-chloropropane ND 0.50 tert-Butylbenzene ND 0.50
1,2-Dibromoethane(EDB) ND 0.50 Tetrachloroethene ND 5.0 0.50
1,2-Dichlorobenzene ND 600 0.50 Toluene ND 1000 0.5o
1,2-Dichloroethane ND 5.0 0.50 Total xylenes ND 10000 j 0.50
1,2-Dichloropropane ND 0.50 trans-1,2-Dichloroethene ND 100 0.50
-_ .,3,5-Trimethytbenzene_ __. ND _. 0.50 _ . trans-1,3-Dichloropropene ND 0.50.. ._..
1,3-Dichlorobenzene ND 0.50 Trichloroethene ND 5.0 0.50
1,3-Dichloropropane ND 0.50 Trichlorofluoromethane ND 0.50
1,4-Dichlorobenzene ND 5.0 0.50
2,2-Dichloropropane ND 0.50
2-Chlorotoluene ND 0.50
4-Chlorotoluene ND 0.50
Benzene ND 5.0 0.50
Bromobenzene ND 0.50
Bromochloromethane ND 0.50
Bromodichloromethane ND 0.50
Bromoform ND 0.50
Carbon tetrachloride ND 5.0 0.50
Chlorobenzene ND 100 0.50
Chloroethane ND 0.50
Chloroform 9.2 80 0.50
f
Attached please find the laboratory certified parameter list. Approved By:
(Lab Director) .
ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level
Superior Court House, PO. Box 427, Barnstable, MA 02630 Ph: 508-375-6605 Page 1 of 1
No.----------------- '� Fee--------------------
BOARD OF HEALTH
TOWN OF BARNVTA'BLE
Application for Well Con0tructionPermit
Application is hereby made for a permit to Cons uct (`--T, Alter ( ), or Repair ( )an individual Well at:
olg
Location — Address Assessors Map and Parcel
Owner Address
Cp�'lS��
Installer — Driller Address
Type of Building ���
Dwelling -- --- - - _ —-- —
Other - Type of Building-----------_----_ No. of Persons-----------------_—__—____._____
Type of Well— Capacity
Purpose of Well- -7-577--�' ____—___--___
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 unt' Certi 'cate C pliance has been issued by the Board of Health.
Sigd —/ ---_--__-_ __--- ____--
Application Approved BY - — ___---_--___—_-- ---__-_--
date
Application Disapproved for the following reasons:
date
PermitNo. — ^_-_ Issued---- ------__-------_---______--____--
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of (Compliance
THIS IS�-CE TIFY, Th t the I dividual Well Constructed (+I'Altered ( ), or Repaired ( )
Cmr_ _------ -- --- — — -- —--___-- ------- —--
installer
at /Z-
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-- ----- — --
J
.�Jrav
No ------ Fee -
U47s � # BOARD OF HEALTH _ °
TOWRI OF BARN' LE
f
ZippCicationlorlVerr (Lon0ruct ion Permit
Application is hereby madea permit � struSt � Alter or Repair individual Well at:
� � —�
Location — Address Assessors Map and Parcel
Owner Address-----------------
------------------------ -------- -----------------------------------------------------------------------
Installer — Driller Address
Type of Building �Gf �n
Dwelling ----- ----— -----
Other - Type of Building---__—__—______ No. of Persons--- _.----------_—__—_—_____.
�c� _ /O G ir7
Type of Well --- -- Capacity-- - - - - --------------
Purpose of Wel 'G'`� �`____--_----.
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 .6f Compliance has been issued by the Board of Health.
IG �(.
Signed
',� �at�
E Application Approved By
date
Application Disapproved for the following reasons:
I,
t`
— -- -------------------- --- ----
date
Permit No. — -- -- Issued----- -— dare--- ----------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate Of (tomphance
• t,
THIS ISTO-CERTIFY, Th t 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
-- ------------------------------------- ----------------------------------------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
Ivell Con0ruct ion permit
No. -----f Fee--`---=�-
T�e�Cif , ✓—
Permission is hereby granted
to Construct (—)—, Alter ( ), or Repair ( ) an Individual Well at:
No. ----�- 36-) GU &✓L ------- -- --- - -----------------------------------
Street
as shown on the application for a Well Construction Permit
No.- ——--- Dated.------/� \S
Board of Health
DATE
i
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Execi,abre Office of Erw1ronmerffai Affairs .John eptiepti
D.E.P. Title V Septic It>spector i
Department of P.O. Bo 2119
Environmental Protection Te ,� f'02' 6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION F R� *
PART A 'r
CERTIFICATION 1 :
'0 °F
Property Address: 9 Boxwood Dr.W. Barnstable Address of Owner:
Date of Inspection:3112197 (If different)
Name of Inspector:John Gracl spencer
Company Name,Address and Telephone Number: 6 8
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
X Passes This Inspection Is based on criteria defined in Title V
CondittnI,1, Passes code 310 CMR 15.303.My findings are of how the system is
Needse valuation B the Local Approving Authority performing at the time of the Inspection.My Inspection does
Y PP 9 tY not Imply any warranty or guarantee of the longevity of the
Fails septic system and any of its components useful life.
114ti
Inspector's Signature: Date: 3113197
The System Inspector shall su copy of this inspection report to the Approving Authority within.thiriy(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.
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, 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 11115195)
One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 9 Telephone(617)292-5500
1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 9 Boxwood Dr.W.Barnstable
Owner: Spencer
Date of Inspection:3112197
Sewage backup or breakout or high static water level observed in the distribution box is due to a broken,
settled or uneven distribution box. The system will pass inspection if(with approval of the Board of,Health):
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 water
supply 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 is less than 100 feet but 50 feet or more from a private
water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is
free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm.
3) OTHER
D] SYSTEM FAILS:
Y
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.
_ 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 I IM5195)
2
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 9 Boxwood Dr.W.Barnstable
Owner: spencer
Date of Inspection:3112197
D] SYSTEM FAILS(continued)
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:
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:
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.
(revised 11115195)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECLIST
Property Address: 9 Boxwood Dr.W.Barnstable
Owner: Spencer
Date of Inspection:3112197
Check if the following have been done:
X Pumping information was requested of the owner,occupant, and Board of Health.
X None of the system components have been pumped for at least two weeks and the and the system has been receiving normal
flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this
inspection.
n►aAs 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.
X 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 existing information or
approximated by non-intrusive methods.
x The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11115195)
4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 9 Boxwood Dr.W.Barnstable
Owner: Spencer
Date of Inspection:3112197
FLOW CONDITIONS
RESIDENTIAL:
Design flow: 330 gallons
Number of bedrooms: 3
Number of current residents: 2
Garbage grinder(yes or no): No
Laundry connected to system(yes or no): Yes
Seasonal use(yes or no): No
Water meter readings,if available: n1a
Last date of occupancy: n►a
COMMERCIAL/INDUSTRIAL:
Type of establishment: nla
Design flow:o 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: n1a
Last date of occupancy: n1a
OTHER: (Describe) n1a
Last date of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and source of information:
System has not been pumped In the last two years.
System pumped as part of inspection:(yes or no)No
If yes,volume pumped: o , gallons
Reason for pumping: n1a
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)
X Other(explain) nla
APPROXIMATE AGE of all components,date installed(if known)and source information:
lose
Sewage odors detected when arriving at the site: (yes or no) No
(revised 11115195)
5 '
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Boxwood Dr.W.Barnstable
Owner: Spencer
Date of Inspection:3112197
SEPTIC TANK: x
(locate on site plan)
Depth below grade: 1'
Material of construction:x concreate_metal_FRP_other(explain)
Dimensions: L 8'6'H 5'7"W 4'10-
Sludge depth:1'
Distance from top of sludge to bottom of outlet tee or baffle: 26'
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•
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.Recommend pumping system every two years for maintenance.
GREASE TRAP:
(locate on site plan)
Depth below grade: nla
Material of construction: _concrete_metal_FRP_other(explain)
Dimensions: nla
Scum thickness:n1a
Distance from top of scum to top of outlet tee or baffle:n/a
Distance from bottom of scum to bottom of outlet tee or baffle: nla
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
(revised 11115195)
6
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Boxwood Dr.W.Barnstable
Owner: Spencer
Date of Inspection:3112197
TIGHT OR HOLDING TANK:
(locate on site plan)
Depth below grade: Na
Material of con struction:_concrete_metal_FRP_other(explain)
Dimensions: rda
Capacity: n1a gallons
Design flow: n1a gallons/day
Alarm level: Na
Comments:
(condition of inlet tee, condition of alarm and float switches,etc.)
Na
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet invert: n1a
Comments:
(note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.)
Na
PUMP CHAMBER:
(locate on site plan)
Pumps in working order.(yes or no)
Comments:
(note condition of pump chamber,condition of pumps and appurtenances, etc.)
nla
(revised 11115195)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Boxwood Dr.w.Barnstable
Owner: Spencer
Date of Inspection:3112197
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:
nfa
Type:
leaching pits,number: 1.1,090 gallon teach pit
leaching chambers,number:nla
leaching galleries,number: nla
leaching trenches,number,length: nla
leaching fields,number,dimensions:nfa
overflow cesspool,number:nfa
Comments:(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.)
The overflow is structurally sound and functioning properly.It had V of water in It.
CESSPOOLS:
(locate on site plan)
Number and configuration: n1a
Depth-top of liquid to inlet invert: nfa
Depth of solids layer: nfa
Depth of scum layer: nfa
Dimensions of cesspool: nfa
Materials of construction: nfa
Indication of groundwater: nfa
inflow(cesspool must be pumped as part of inspection)
nla
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: nfa Dimensions: nfa
Depth of solids: nla
Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation, etc.)
nfa
(revised 11115195)
8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 9 Boxwood Dr.W.Bamstable
Owner: Spencer
Date of Inspection:3112107
SKETCH OF SEWAGE DISPOSAL SYSTEM:
include ties to at least two permanent references landmarks or benchmarks
locate all wells within 100'
C
�ckk
0
A f
Aga
A0 7L
8A al
DEPTH TO GROUNDWATER
Depth to groundwater:12 feet
method of determination or approximation:
USGS Maps and Charts
(revised 11115195)
9
LOCATION l3 � SEWAGE PERMIT NO.
^.
HOX- WOOD -7iei'/r 8 - 196
VILLAGE
ASSESSORS MAP NO. 02 Its
} , 55 T �R�S'7"� .L �� c-i
ol N S T A L L E R'S, NAME i ADD.RESS
�' ?T N•` O t�t1 ALL. �.I/. I?ENNJSA
BUILDER OR OWNER
ATE PERMIT' ISSUED _ 7
DATE COMPLIANCE ISSUED y� - �
r
RoPoSED
19F oo m
/ 8 l
iP65. � w9TER L init ���O
- go k WOO D DR ✓E
I `
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH
Appliratiun for Biip.as al Work Tuntrurtion rantit
Application is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal
System at: �� I
..... ........... . -------------------•----....T..----- ---•-------------------------..........•.
Location- ddress or Lot No.
�r.13�'lizl .��./ r'�- �� Bax d i% li dre � :�.��4�?' .............
........................... .......
a ner
W
Installer Address
UType of Building Size Lot,/8 -----------Sq. feet
Dwelling—No. of Bedrooms__________ _______________________________Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building AC-.0 :Q...... No. of persons..................... Showers ( ) — Cafeteria ( )
Q' Other fixtures -----•---•--------------------•-•-•---•--------------.---...••••-•---"---••-....--'-------•'-•••••----•--•••-•-••-•-•••••-••-•----•----•--......•...
W Design Flow............. .......................gallons per person pg day. Total daily flow........:33.0....................gallpns.
R; Septic Tank—Liquid capaci� ®.gallons Length.__....-_..... Widths------..... Diameter__- -.___ Depth._
xDisposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......l.......... Diameter... ........ Depth below inlet••.-�---------- Total leaching areapo.5 A.
......sq. ft.
Z Other Distribution box ( ) Dos' g tank ( )
Percolation Test Results Performed b .!6d�d a'v �� °! t'8o�, Date.... ` _••-
14 Test Pit No. 1_A.?- _minutes per inch . Depth of Test Pit/� .....__ Depth to ground water........................
/Gi, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
^ / �..r....•---•...;•- ---•--.--- __ ✓ ------................ ..................NEK 'O DescriptionofSoi.. p �-T-� • • -
el
l
..... ..„ ....�A -----•--•--
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 TITL;J 5 of the State Sanitary.Code The undersigned further agrees not to place the system.in
operation until a Certificate of Compliance has be ed by the board of alth.
Signe ...<........ •. % .• ...-- -•-••••-• -74/7MT3....._
Application Approved BY----
---- i-- /, .................................... ..................
ate
Application Disapproved for the following reasons:----"--•-••--••'•-•--'••••••-••--••-••--•------•...-'-•••--••-•---••--'•••-----•---------•-------•••....---
. ......................................•-----•-•-----•-----••-•-••••-••••...•-'-----------•-•-•••-•...:•-'-•--•-•-••-------------•-•.....--••--••-•---••••-•---•-......------ •.......
D
PermitNo--------------------------------------------------------- Issued.................. ..........
Date
Ov
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
was 2 �........ -_
Appliration for Disposal Works Ton3trairtion amit
Application is hereby made for a Permit to Construct ( 7r Repair ( ) an Individual Sewage Disposal
System at:
- ......r UU J�Q�/�/(:�------------ .......................O 7 ./' ....................................•....
Location-Address or Lot No.
...............
W O er Address
..........................A--.-..- ............................. ...... .................•...,.
Installer Address
U Type of Building Size Lot st1/0........ feet
Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
aOther—Type g ----- - - - -•------. No. of persons.......____.___ ( ) Cafeteria ( )Other—T e of Building �/��.� ____.. Showers —
P4 Other fixtures .-•----•---••-•--•-••-••--•••.-•-• •. ... •.
------------------•..
W Design Flow...............S.- .....�v.gallons per person plr�day. Total flow........-��. ...................gallons.
WSeptic Tank—Liquid capaci ...__._.gallons Length.__..__r____.Width..........:..:. Diameter.... Depth
x . Disposal Trench -:No..................... Width........_:::__.... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No......./.......... Diameter...,�.L�-------- Depth below inlet...., .......... Total leaching area _"5/......sq. ft.
Z Other Distribution box ( ) <,r Dos' g tank ( )
'-' Percolation Test Results Performed b t . . a' ' ..!!_?."!� ....... Date..AZ "�'
,.a Test Pit No. l.ir_z minutes per inch Depth of Test Pit./ Depth to ground water------------------------
G% Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
_ --------••- -•------- ,Y ----•-
.....................................................Description of Soil... .. ----- y�
----------------------------------------
W -------------- ,n,ra.,,,,.�.�.�s, - -Af
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 T IT i
p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has bee ed by the board of lth.
----- '... --------- ---- .D _..._
Application Approved By.. .t.- r --•-••---•------------------••---•-- �y,/��! ...._..
/ ----
ate
Application Disapproved for the following reasons-......................................-..........................................................................
.........-•-------------------------------------------------------------------•-------....--•-------...•....-----------...-------------•-----••--•-------------•-••---•----------...- ------------
Date `
PermitNo......................................................... Issued.......................................................
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
................O F......*4t!!6�...�.....`"....:r..t�......................................
C9rdifirFatr of Tontpliatta
THIS IS TO CERT. Y,,'That the Individual Sewage Disposal System constructed ,,/Or Repaired ( )
by---------------------Ct.... ---•-- -• . •--------------•-•-••-•-•--••-..................................................................... ----... _...--•...•--•.....--•-
Installer
has been installed in accordance with the provisions of 'IT r?? of The,State Sanitaryf Code as described in the
application for Disposal Works Construction Permit No._. ........ dal,e&-----------------------------------------------
THE ISSUAN E OF THIS CERTIFICATE SHALL NOT BE CONSTR D.AS A GUARANTEE THAT THE
SYSTEM WI�17
ON S TISFACTORY.
DATE ...........
�.......................•--....... Inspector--- ----;,.......................................................................
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
No ..... .b .4
Disposal orkii Toa ruction ......rrnttt•, FEE..-.
:,. ��. --------------•----
Permission is hereby granted.............. --••-• -- -------•--------•--•----•-----•---------------•-------•--•••••.............._.......
to Construct or Re�P 'r ( ) an ividual Seva ge Disposal S tem
Street
as shown on th/app cati for Disposal Works Construction Permit No..................... Dated..........................................
...........................................
---------•-------------------------------
DATE- `� Board of Health
FORM 1255 HOSES & WARREN. INC., PUBLISHERS
4,1 or
Jams ary' i 7,
+ Mri 4,. Richard Bklvll'es� �4s 4 '`� J ar f r• "s .f t µ y � y
Agent• for.,Eli.zabeth Defrx enV�M,► �_ ' � s � * '
'r 9 Schap+ Avenue
-e+st �Ya-mcihth ma*, '-0267 ') f
Re. V'arianc .,for° Rl.izabeth nefraen afl t,�13, `Boxwood .Dr�.ve,
West 8arstable _ r ._
x, w `Dear Mr,, ,zones:
Y'ou. are granted a,variance .to`',install. a'well: l88 feet from are
• .,
e�ti.st ng cesspool en• Lot 13.0. Boxwood Drive, West Ba nstable,
in• l eix:. of the- .required.150 feet with the. folk vain4 conditions
(l),_ The well must, be installed and the grater .tested: for.
v " bacteria and chemi.eals,�and. must meet the standards
" ,l set forth- in 'the "Safe Drinking Act" 'prior to , issuan.co
of a -building germi:t. `
k 2)' +The septic-system l must b
• , ; •- ' e . nstalled in strict accordance
With the regulations'contain6d in Title 5,. .of the 4ta;te'
Environmental.,Code,, , and,.the'Town of Barnstable Health
Regulations,.
f This variance .expires •Feb uat^y .l, 'l,g8 ..
" ;Y
' :Ve tr yvtre:,: n
Teo:. er.t'L.. Childs- Chairman
Attrt an -B hough,n.
H. F.� It J�?: k
BOART3 pF STEAL '
TOWN OF BARNSTABLE,J
� a
,
9 Scholl Avenue
West Yarmouth, MA 02673
December 30 , 1982
Town of Barnstable
Board of Health
Barnstable, MA 02601
Dear Sirs:
I , Richard Jones, acting as agent for Elizabeth Defriend; hereby
submit the following siteplan and request of the Board of Health
a variance from the 150 foot distance between sanitary and well
to 100 feet as shown on proposed site plan.
Sincerely yours,
Richard B. Jones, r.
OD
J . M. MONAHAN, JR. & ASSOCIATES SOC/ }
FT
REGISTERED LAND SURVEYORS & ENGINEERS
6,.51 MAI N STREET - POST OFFICE BOX
m w
DENNISPORT, MASS. 02639
TELEPHONE: (61 7) 394 - 3843 Z
9� �O
December 171 1982
Town of Barnstable
Board of Health
Hyannis, Massachusetts 02601
Re : File #81-35
Gentlemen:
In reference to Lot 13 Boxwood Drive, West Barnstable,
enclosed is a copy of a site plan for said lot showing the
original design as presented to the Board on November 161 1982.
Due to an existing sanitary disposal system being found on the
southerly side of Accorn Road, opposite our Lot 13 , we are unable
to place the proposed well at the southerly end of said lot,
and meet the requirements.
Therefore, we request a variance to place our proposed well
outside of Lot 13 at edge of existing pavement and said well to
be 110 feet + or - from an abuttors existing sanitary leach
field.
ery truly yours,
Joseph M. Monahan, Jr. , RLS
for Richard C. Jones, Jr.
JMM:lem
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. Rei ister Lan Sury
g e ', d , eyOrs & Engineers
'f "yr. �'��`�653 fMa3n.'Street �_ p, '` �� •* •' � � � a ,i '., r ., �� �<.• �,i..,
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( y �x Y"i f""t .` { r r ."'C `S' } �� ,'• ` ^ a + t r"':
'Re: ''Variance on`Lot 13, Bok%g6od Drive,, °Nest4 Barnstable
'? , �{.`c�g �V ,.` �`F f , ' ,P ">i�.�,r. J{s •. .` G � .,+ � ,,,.«..•„i �t r •,d' �• .. • � s �"
Morahan. s � R• t z `g r. w '.
i'' vir,! ,'t I�r ,s�a 'fit•.i �{.t�.K sa, i � r ;_,.• f t° - r 4•,.+ .. X� r as
iThanMyou =for -,meetingr:with -us?concerning the `loeaitign of a `
` �mY.. Oo 4 , S
. ^r` twel1 Sand a septic syr� '�tai, an 3 Lod tI3� •Ba�w �t Drive, `West Barn'
' } 4stable• J Y• , K � ! ; N i,s , e,•r Fti f ..
,
_ '� fi} .x A }� i +w. ,4 y x'` S!^t ,' •i i • •A 5.' +e� m
• �4 3
Itr'�was oY�-i. opinion: that e add t�.r�nal test.=,ho2. .sy ana�. e d 5011'
testir4 -Ohoed` 15e accompli`sY�ed to :see if abetter lcicat on
'could be t3tinC A for. the''wel l or Ythe`p*sept ,c S�7Stelri
yy�,.; � �{,� G � �,h'.,N (� r 3 :�,=- r -r ,;•.1 -..' . r � '.. a,`# � � `, M - ; � ! ray, +
T Y .� '^/' f t�J�.��.�. �k•�Y , +'- ..� � '- .. r ..y iy4 •:",l..t ,.` .P ,.. ,. ,. � -
= r 1 ,Plea a arrange an aPpo ntmentti;with our agents,to'•observei these
�ree�t, oles.
Vt
x 1a3 t1+'"m^'i ht Y('�.r
t S�iyS ,,'� }.}a_i.�o-�, `�' �"' '•s r ` 'M1l '= a '3+i;+ bra .'i..• Ar.NY• a* ��•,s . - , �� _ r • .1.
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s t Ro hrt I,. Chlds,, Chairman,
{ 4 r '�` '..}ei%y I` •� �M':k ,� •,r P .,xy,.�. � ,� � � ,�t. �Y 4 ` 4r^ )„'a f ..P Ym = ,. 1 .A
,Ann 'Ja eY bang
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a
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BOARD dF 4jiA!,
{ TOWN; OFiRNSTABLE t
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''. _- zo '/Lli�✓ 6-0 ors
PROFI LE OF
SANITARY DI SPOSAL SYSTEM DESIGN DATA
NOT TO SCALE
-3 BEDROOMS
CONSTRUCTION OF SANITARY DISPOSAL DESIGN FLOW -3 l GAL .�DAY
SYSTEM SHALL CONFORM TO MASS . LEACH RATE � "' MINJINCH
ENVI RON MENTAL CODE TITLES PROrOSE D LEACH CA PAC IT Y :
AN D THE TOWN OF 4549 Ae /� '�-" �1 •. '�'. Tj
HEALTH REGULATI ONS.
� /"�GC�
� f: f r'.; / s r�/�L G E /• Crj7�U t
GAL DAY
�.N G,.�/� � �I�''.fa r••/ r✓G/1 rt._. !??r;:;�7�?r` ,f.� r'_ /''`� �� �''` d�r.._=��',1��.
Gt. �C
J^"/ e — hfY?'d�F - ,J tr.rs� .�. :. /'^x. /[ w � �:' �'° CaR' yr ` L ✓! 'yr ( / lu E.-,r;�
,r tf
S IT E PLAN SMHOWING PROPOSED CONSTRUCTION
FOR G- / ? - ' `.., r' .D. / AJ APPROVED
SCALE: /` ' 30 DATE - /fie _ —�- l BOARD OF HEALTH
R E F E R E N C E : O •4<:�1 7 /3.
A T E A G E N T
> !" /r:t✓< L>
Alk
136b
J . M. MONAHAN, JR . & ASSOCIATES
REGISTERED LAND SURVEYORS & ENGINEERS ,
651 MAfN STREET DENNISPOR7 MASS. 02639
C21 9198t
7--.�.r .- • .T7r*'
lei
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. �J� �_-y � �-ter,]$ti �� ��•
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/ 9 T
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/
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