HomeMy WebLinkAbout0025 BURNING TREE LANE - Health 25 Burning Tree lane
West`Barnstable
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EGO-TECH
ENVIRONMENTAL
THIS FORM IS A FACSIMILE OF THE STANDARD SEPTIC INSPECTION FORM ISSUED BY THE MASSACHUSETTS DEPARTMENT OF
ENVIRONMENTAL PROTECTION (revised 6/15/2000)
TITLE 5
OFFICIAL INSPECTION FORM _NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION RECEIVE®
Property Address: 25 Burning Tree Lane
West Barnstable
Owner's Name: John Bates APR 2 9 2002
Owner's Address: 25 Burning Tree Lane
West Barnstable TOWN OF BAR.NSTABLE
HEALTH DEPT.
Date of Inspection: April 23, 2002
Name of Inspector:(Please Print) David D_ Coughanowr, R.S.
Company Name: Eco-Tech Environmental
Mailing Address: 43 Triangle Circle '
Sandwich, MA 02563 MAP i .••�
Telephone Number: (508) 364-0894 PARCH
CERTIFICATION STATEMENT: L OT
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:
X Passes
Conditionally Passes
Needs Further Evaluation By the Local.Approving Authority
Fails
Inspector's Signature �ON C S Date: k P f o l 23, 2Cb Z
The System Inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or
DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000
gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the
DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving
authority
NOTES AND COMMENTS
Inspector's Note=_> A septic system is deemed to pass this Real Estate Transfer Inspection if it does not trigger
any of the failure criteria listed below. The septic system has been evaluated according to the conditions observed
on the day it was inspected. No estimate or guarantee of system longevity is made or implied by a passing
W determination.
""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 1
Page 2 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
INSPECTION SUMMARY: Check A, B, C, D or E/ALWAYS complete all of section D:
A] System Passes:
X I have not found any information which indicates that any of the failure criteria described in 310 CMR
5.303 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, or 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 breakout or high static water level in the distribution box is due to
broken or
obstructed pipe(s) or due to a broken, settled or uneven distribution box. The 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 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
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: 25 Bring Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
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
s failing to protect public health, safety and 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 by 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: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
D) System Failure Criteria applicable to all systems:
You must indicate either "yes" or "no" to each of the following for all inspections:
I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.
The basis for this determination is identified below. The Board of Health should be contacted to determine what
will be necessary to correct the failure.
yes no
X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool.
X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or
clogged SAS or cesspool.
X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or
cesspool.
X Liquid depth in cesspool is less than 6" below invert or available.volume is less than 1/2 day flow.
_X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number
of times pumped
X Any portion of the SAS, cesspool or privy is below high groundwater elevation.
-X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface
water supply.
X_ Any portion of a cesspool or privy is within a Zone 1 of a public well
X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well
X 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 by 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 Systems:
To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000
gpd
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)
x 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: 2525 B�Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
Check if the following have been done* You must indicate either "Yes" or "No" as to each of the following*
Yes No
X Pumping information was provided by the owner, occupant or Board of Health.
X Were any of the system components pumped out in the last two weeks?
X Has the system received normal flows in the previous two week person?
Have large volumes of water been introduced to the system recently or as part of this inspection?
X Were as built plans of the system obtained and examined? (If they were not available as N/A)
X Was the facility or dwelling inspected for signs of sewage back-up?
X _ Was the site inspected for signs of breakout?
X Were all system components, excluding the SAS. located on site?
X Were the septic tank manholes uncovered, opened, and the interior of the septic tank inspected for
the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of
scum.?
X Was he facility owner(and occupants, if different from owner) provided with information on the proper
maintenance of subsurface disposal systems?
The size and location of the Soil Absorption System(SAS)on the site has been determined based on:
X — Existing information. For example, Plan at the Board of Health.
X 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)]
j 5
e
Page 6 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design): n/a Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): n/a-no design plan on file at BOH
Number of current residents_
Does the residence have a garbage grinder(yes or no): no
Is laundry on a separate sewage system(yes or no): no If yes, separate inspection requiredl
Laundry system inspected (yes or no): n/a
Seasonal use(yes or no): in
Water meter readings, if available (last two year's usage (gpd):n/a-well in use:
Sump Pump(yes or no): no
Last date of occupancy: current
COAMERCIALIMUSTRIALe
Type of establishment:
Design flow(based on 310 CMR 15.203):: gpd
Basis of design flow(seats/persons/sqft/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: System not pined in recent past(Owner)
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:
X 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/Alternate 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)
APPROXEl UTE AGE of all components, date installed(if known)and source of information:
Age: Original system 25 years. Overflow leach nit: 13 years Certificates of Compliance on file at BOH
Were sewage odors detected when arriving at the site: (yes or no)_w
6
Page 7 of I I
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
BUILDING SEWER_(Locate on site plan)
Depth below grade: 15 in
Material of construction:--X—cast iron 40 PVC_other(explain)
Distance from private water supply well or suction line 20+
Comments: (on condition of joints, venting, evidence of leakage, etc.)
Sewer is vented through roof and appears structurally sound with no evidence of leakage or backup into dwelling
SEPTIC TANK: (locate on site plan)
Depth below grade: 3"
Material of construction: X concrete metal fiberglass polyethylene
other(explain)
If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(yes or no): (attach a copy of
certificate)
Dimensions: 9.5 ft x 5 ft x 5 ft(1000 galloil
Sludge depth: 4 in
Distance from top of sludge to bottom of outlet tee or baffle: 30 in
Scum thickness: l in
Distance from top of scum to top of outlet tee or baffle: 9 in
Distance from bottom of scum to bottom of outlet tee or baffle: 14 in
How dimensions were determined: Probe to ton of tank
Comments: (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet invert, evidence of leakage, etc.):
Pumping not required at this time. Liquid level at outlet invert. Tank and tees appear structurally
sound and functioning as intended. No evidence of leakage in or out.
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: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
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 inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX: X (if present must be opened) (locate on site plan)
Depth of liquid level above outlet invert: at outlet invert
Comments:(note if box is level and distribution to outlets is equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.)
D-box appears structurally sound with no evidence of leakage in or out, Effluent level at outlet invert,
No solids in tank_
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
Page 9 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan; excavation not required)
If SAS not located, explain why:
Type:
leaching pits, number 2
beaching chambers, number
beaching galleries, number
beaching trenches, number, length
beaching fields, number, dimensions
overflow cesspool, number
-- innovative/alternate system Type/name of Technology
Comments: (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.)
Soils above leach pits appeared unsaturated No evidence of surface ponding, breakout, lush vegetation, or
other evidence of hydraulic failure was observed.
CESSPOOLS: none (cesspool must be pumped at time of inspection) locate on 1( p p p p ) ( o site
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
Page 10 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 23, 2002
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' (Locate where public water supply enters the building)
LOCATIONS
LEACH A B C
O PIT 1 25 ft 16 f t
2 37 f t 25 ft
3 36 ft 47 ft
2 0 D-Box 4 44 ft 32 ft
LEACH
PIT SEPTIC °
O TANK o C
B
3 BEDROOM
DWELLING
n # 25 WATER LINE
—� WELL
BURNING TREE LANE NOT To SCALE
10
Page 11 of 11
OFFICIAL INSPECTION FORM_NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 25 Burning Tree Lane
West Barnstable
Owner: John Bates
Date of Inspection: April 2323, 2002
SITE EXAM
Slope
Surface water
Check Cellar
Shallow wells
Estimated Depth to ground water: 20+ feet
Please indicate(check) all methods used to determine 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 local excavators, installers-attach documentation)
__X_ Accessed USGS database
You must describe how you established the high ground water elevation.
Barnstable GIS department data shows groundwater to be at elevation 0 while leach pit is at elevation 2
Frimnter groundwater adiuc men =2 1 f (Index well SDW-252 Zone A,Elevation — 48.0)
11
000,
TOWN OF BARNSTABLE
LOCATION `�-`S1i "��-c SEWAGE # 'L13.
VILLAGE &jOy5 Jk G-�?- ASSESSOR'S MAP 6z'LOT f�J(� `C}a 8
INSTALLER'S NAME & PHONE NO. � t , , —,L UjL�
SEPTIC TANK CAPACITY Iv
LEACHING FACILITY:(type) (size) ;mG'�
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER
BUILDER OR OWNER � _ of
DATE PERMIT ISSUED:
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No eo
-� -, �< ,
C�----
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THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HEALTH
.... . .�� . j... . ---...OF... ...: .:.. ....07A .�'� -----------......................-.--.....
Appliratiou for Elispoii al Worka Tomitrnrtiun ramit
Application is hereby made for a Permit to Construct ( ) or Repair <) an Individual Sewage Disposal
System. t
�- � ...t..fZ_iD�.u ....:�. .E. ... ,4: ..............
Locatiorp-Address �J-
r Lot No.
.L e' - -------------•--------------•--------•. -----------•------. q9 ......................................................
..
W •- �_ Owner,.
Address'ptt•�/_ � 4..
Installer Address
Q Type of Building Size Lot............................Sq. feet
U. Dwelling—No. of Bedrooms.............................. .. .Expansion Attic ( ) Garbage Grinder ( )
'4 Other—T e of Building No. of persons________________________ Showers — Cafeteria
Q' Other fixtures ..............................................................
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter................ Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date----------------------------------------
Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water____--__-__-_-__---_-__
�14 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
P4 •-•-----•--------•-----•••-•-------------------•--•--•---------•-•-----•--------------------•---•---.........................................................
0 Description of Soil------------------------------------•-----------------------------------------------------------------......._..--------------------------------......................
x
W ...-----•-•--------•----------------------------- -------------------•--------------------•----------------. g� 4
U Nature of Repairs or Al ratio —Answer when applicable -_____-_- .
..•-
.....................................................................................................................................--------••......................•----•------•---•-------------••---•-•-------....---•-•----•---•-•-.
Agree ent:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of iI1IL� 5 of the State Sanitary Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has be A�sed th oard o health.
�Signed---- -- . .......... ......................................... •---- - rms%......
e
Application Approved By.................................................................................................. --------
ate
Application Disapproved for the following reasons:.............................
---------------•-----•----------------------------------------------------•--------------------------.....------------------------------------...--------------------------------------------------------
Date
PermitNo. _ .............................. Issued.......................................................
Date
i-
N - ....._....... Fps..............................
THE COMMONWEALTH OF MASSACHUSETTS
BOA OE HEALTH
A.V41 iration for Disp.aiittl Works Tontitrudintt Vantit
Application is hereby made for a Permit to Construct ( ) or Repair , ) an Individual Sewage Disposal
System_g.t:
L cation ddress r Lot No.
---- .......... .t. . ... ------•.......-•-------•---•-----.......... ......................^�'�..�.�......................................................
Owner° `d ress
Installer Address
PQ
VType of Building Size Lot____•----•------_---------Sq. feet
Dwelling No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( )
a' Other fixtures ..................................
ell
W Design Flow............................................gallons per person per day. Total daily flow............................................gallons.
W Septic Tank—Liquid capacity------------gallons Length................ Width................ Diameter________•-_-_- Depth................
x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date............................-...........
Test Pit No. 1________________minutes per inch Depth of Test Pit.................... Depth to ground water___________-_-----.____-
rZ4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................
9 -•-•--•--•-•--------•--------•------•-••-•••--•-•--••-•-•------•-••-•-•-•-•-•-•----•-•--------------........._...............................................
0 Description of Soil....................................................................---•-------------------------------------------•-----------------------------------•-••--•------••-
x
V ...........................................----------------------------•------•------------------•----------------------------------------------•----------------------------------------------•---•-
---------------- ---- -- -------------------------------------------------------------------------------
V Mature of Repairs or Al ratio Answer when applicable_ ..............................I.......... .� '�......
��✓
------------------------------••---------•---------------•------•----••--•--•-•-•-----•-----•-•-•----_---------•---------------------
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 be n 'ss ed bAth .oard o .li;th.
Signed••-• ••. ---------•... ..•. •---•-••--.. ---•--•.
Application Approved BY --
ate
Application Disapproved for the following reasons---------------------------••--------------------------•-----------............................................
---•-•-------••-•-•••--•---•--•-•-••----•••-••--•••-••--•••-•-•-----•----•-----•---•--••------------••--•-•----••---•••-••---••-•----...---•-------------------•-------••-••----•---------••-•-•--------
�/ Date
PermitNo. T ------------------------------ Issued-----------------------------------------------•-•-----
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOA OF HEALTH
1,.: .!. ► :J...............:OF }, :,�.5 �'. ,......................................
Trr ifiratr tit Toutpliattrr
THIS IS TO CER Th t e Individual Sewage Disposal System constructed ( ) or Repaired )
by ' LI tllr-
at----•-. t..�1��t io �-�'V �/,, 09 .('�^f9G��
.................. -----------•---
has been installed in•accordance with the provisions of I' " ; 5 of The State Sanitary Code as described in the
application for Disposal Works Construction Permit No. -----•-----•• dated---------- -----------------------•------------
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE.................... --_�: �� .................................... Inspector............. .....................................................
THE COMMONWEALTH OF MASSACHUSETTS
�—, BQARI���F HEALTH
....... ..u)'oo..............OF... ......... �,9I&- Z:............................
N ��".V .;;� FEE. ..............
Roplas �r ��tt��tirrtt rr�ti�
Permission is hereby granted......----..... .-----•-----------------------•-----...----------------------•---......---•--.
to Construct / r Repai(C.- ) an Individual Sewage D's ou S stem
at No..t��'-'`.........ap ��/ � .. 1�..---•--... 1.treet --------------------
Street
as shown on the application for Disposal Works Construction Permit No.___L 33 ated.. ���'%------------------
•---------- =-T----- -------------------------------
Board of Health
DATE---------.. -��---
FORM 1255 HOBBS & WARREN. INC., PUBLISHERS
�a
BOUSFIEI,'�.SAMTARY SERVICE
17 Burbank Street
Sandwich.;Massachusetts
O 563
Name��! o r�s Sewer Permit No.
4# ZS
Location: _��- � ���.a n.n Zi e e la r. e
zoo,—:7- ���is�f 6 g-- I S-07
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Builder's Name and Address �'o6e.�i o ,e���e-J,
Date Permit Iesueds .? -.2- 7
Date Compliance issued:
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THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
.. OF.........A. ............................................
, pphratiun -fur Riipouttl Workii Tonotrurtiun Vantit
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at: / !�
wT_ .....:8v_.2n�.....c_T � >�---L ..i�- ,/ -
------....--••----•••-•------•-•--
131 v� /�/ �LJ�tjon-Address or Lot No.
W p� � C—0/w � Address
Installer Address Q7
Q Type of Building. -� ____-____Sq. feet Size Lot....... ......
Dwelling zNo. of Bedrooms--._-,_-____-__----..----------------------------------Expansion Attic ( ) Garbage Grinder ( )
Other—Type of Building ---------------------------- No. of persons....Z------------------ Showers Cafeteria
Q' Other fixtures ------------------------------- --
W Design Flow..-__..2 o..........................gallons per person per day. Total daily flow.....220 gallons.
WSeptic Tank ' Liquid capacityro00 gallons Length---------------- Width_........._... Diameter-----.---------- Depth----------------
x Disposal Trench—No..................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft.
Seepage Pit No..t2Kg____-___ Diameter____________________ Depth below inlet.................... Total leach'pig area..___._.__._______sq. tt.
z Other Distribution box ( ) Dosing to ( ) �` f� � �'- ✓7
'- Percolation Test Resulo Performed b ............. Date._:/Q....S".:-.7-7__--.....
Test Pit No. 1. -__--minutes per inch Depth of Te. Pit____________________ Depth to ground water----------------........
(z, Test Pit No. 2----------------minutes per inch Depth of Test Pit..---__--._.--_--___ Depth to ground water--.--.-..-_-----..-_....
------ --- ----- -- -----
---------
O Description of Soil . �....'. ... ... �----••--• �
x
V ---------- ---�- ' -,' - - -
f--------------------------------------------------
W
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
V Nature of Repairs or Alterations—Answer when applicable-----------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------•---
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary Code—The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issued by the oard of health.
ned--- -- --- . ---•-- --- - .
Date
Application Approved BY ��' . -------- - ••• -------------------
Date
Application Disapproved for the following reasons----------------------•----..-----.-----------.-.--.---.-.---------------.----------------------------------
.........................•--••----........-•--------------•--•------------------•------------•--------- ---------
7 Date
PermitNo......................................................... Issued---- / --Z�.�...................
Date
No. Figs A ...................
L THE COMMONWEALTH OF MASSACHUSETTS, ,
BOARD OF HEALTH
Appliratiou -for Uhipaiial WorkB Tomitrurtion Prrutit
Application is hereby made for a Permit to Construct ( ) or Repair ( } an .Individual Sewage' Disposal
System at
.................... -------------- ....... - --------
i rLion-Address or Lot No.
,o7 Address
---•-•-•-•••----- -•-
Installer Address
d Type of Building Size Lot_.- ------------------Sq. feet
Dwellings No. of Bedrooms---- Attic ( ) Garbage Grinder ( )
Other—Type of Building G-, YP g ---------------•-•-_------._ No. of persons.... .................... Showers (, ) — Cafeteria ( )
Q' Other fixtures ------------------------------------------------------
W Design Flow_..._-__Z 2..52................/_.__. __._gallons per person per day. Total daily flow--_._'._��_.._...._______-__.--------.gallons.
A4 Septic Tank Liquid capacituF�' '__gallons Length-----------_--- Width_......-------- Diameter-..--........... Depth.._.----_.-----
xDisposal Trench—No- _________________c__ Width_-____--_;__--_-_-_ Total Length-------------------- Total leaching area.-------------------sq. ft.
Seepage Pit No. ........ Diameter................ Depth below inlet.._._._ Total leach'ng area------------------sq. it.
z Other Distribution box ( ) Dosing t ( `7- e- . `�
Percolation Test Resul Performed by. / -#_______________________ Date___,M.`_jS':'_s? tom_____-_..
Test Pit No. i _______minutes per ind Dept of T :t Pit____________________ Depth to ground water_.._____..__...__..___.
!14 Test Pit'No. 2................minutes per inch Depth of Test Pit.------__._____-___.--Depth to ground water---------------_---:__.
«.«
O r. Description of Soil -" '*r' __ , 1►� .,, , ' ." .' :�a
W
7..........
V Nature of Repairs or Alterations—Answer when applicable--------------------------------------------------------------------.---------------------------
-------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Agreement
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of Article XI of the State Sanitary.Code— The undersigned further agrees not to place the system in
operation until a Certificate of Compliance has b issued by the_board of health.
ned-.. r ' •-••-----------------------
Date
Application Approved BY------ ----- -- - ----- -•---- -------
Date
Application Disapproved for the following reasons: . .--- -• -------- -------- --•----------•------------------•---------------•----------
----••---•---•---•--------------•----....---••------••-----------------_._--------------••-•--••------------------------•-------•---------------------------•--•---• ------•-•------•-----•-----------•-
,... Date
Permit No----------------------------------------- Issued
Date
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF EALTH
........ . d!�'`I'i. "1..OF..... . ....... : :.:
Trrtifiralr, f Tgampliaurr
THIS O CER FY at the Indivial e age Disposal System constructed ( Repaired ( )
by ---------
tller w
at *.-�-• ' ----= ----- +9� « , e -------k-•' -`-'+'k. ---'-fa' _ e
has be installed in accordance with the provisions of �is XI of The State Sanitary Code as described in the
application for Disposal Works Construction Permit Ndw, ._.. dated.`"` --_._7_ ________________
THE ISSUANCE OF THIS CERTIRCATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL FUNCTION SATISFACTORY.
DATE............. -- •-------- Inspector....................................................................................
THE COMMONWEALTH`OF MASSACHUSETTS
BOARD OF . EALTH
C............... FEE...fsd!_...............
Uispo,ittl or no .it $trrutit
Permission i er by granted_"""_`__-
to Cons uct ( ) o epal>! ( ) an t ual Sewa Di pos4 Syst
at No... _. .---- •- ��� � 4� ..'� • *"4
Stre � e"i
as shown on the application for Disposal Works Construction BerMit N - Dated -+ •" 7 ___________________
Board of Health4'
DATE -•--- ...--------••-•-
FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS,.,.. - - -
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Fee-- -�-----
No.- --
BOARD OF HEALTH
TOWN OF BARNSTABLE
2pplication forlVer[ Congtruct ion Permit
ALplication is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
f_�, ------------------------------------------- ----------------- -----------------------------
Location — A ess /Qar �-�J�/p_ Assessors Map and Parcel
-John----eha-beS ----1[�1� -�2.t/14A
Owner Address
-------- hC-U-1-----uAdt---Lr_►-lli ------------- s3.38 - �_-� o f �c�a��h-----------------------
Installer — Driller � =
Address
Type of Building
Dwelling-------------------------------------------------------------------
Other - Type of Building ------------- No. of Persons-------------------------------------------------
Typeof Well—-----------------_--------------------------------------------- Capacity--------------------------------------------------------------------------------
Purpose of Well-Ta---aSdA4ZPL4j-----1.OAI-P-t---------
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- L 'tf — --- ------------------------------------
date
Application Approved By-,
date
Application Disapproved for the following reasons:---------------------------------------------------------------------------------------------
----------------------------------------------------------------------------
date
PermitNo. -�`3------------------—---------: Issued------------------ `�-�- - �----------------------------
date
BOARD OF HEALTH
TOWN OF BARNSTABLE
(Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual ell Constructed ( ), Altered ( ), or Repaired ( )
bY------------------------------r-- )n _ ---------------------------------------------------------------------------------
Instal
at— -64-a ---------�4 - — jAr� � L_ :/ -`C�� �, -----------------------------------
has been installed in accordance with the prow -ons of the Town of Barnstable Board of Health Private Well Protection
��` r.
Regulation as described in the application for Well Construction Permit No. Ae!'f __ Dated------------ -----t���
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL
SYSTEM WILL FUNCTION SATISFACTORY.
DATE-----—---------------------------------------------------------------
- Inspector- ---- - —---—-------------------------------------------------
No. ��' '', Fee--�-------------
BOARD OF HEALTH
TOWN OF BARNSTABLE
0[pprication orWell Conf�tructionPermit
Application is hereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at:
Location - Ad ss Assessors Map and Parcel
a nj.M_Q_ �._[�.4-- .'
' �Owner 1�) Address
-------------------
Installer - Driller / - Address
Type of Building
= Dwelling—------ -------------------------- -------------------------
Other - Type of Building --- No. of Persons-----------------------------------------=-
Type of Well— -----______-- - --------— Capacity---------------------------_--_ —_--— --
Purpose of Well-Tn-tea
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 -
---;------� -r--------- ----------------------
date
Application Approved By--- ---��-t-�-'-"�!�-�v�-�.----- -----a--^ - --"--- date
Application Disapproved for the following reasons:-- ----------------------------------------
}
r
• date---_-----
Permit No. -- �=`— �----- ''Issued--f------
date
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BOARD OF HEALTH
TOWN , OF BARNSTABLE
Certificate (Of Compliance
THIS IS TO CERTIFY, That the Individual ell Constructed ( ), Altered ( ), or Repaired( )
by---- -- -- Q4•�'��►�_ o��—� — - - -- -
Insttall `/)
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 Constructionepermit No. P/--1r/-,VDated-k=�� J
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 !
V ell Cootruct ion 3pffmit
No. Fee `"'----�'�----
�--- �_�!_ - '� 'f'-- •� �a[-�-� "-------------
------------
Permission is hereby granted-------- - ----------- -----
to Construct ({�) 40
,Alter ( ), or Repair ( ) an Individual Well at:
No. - tea _ _ s -a✓,s��er�•w_ �. " - !Y' -� - ' �—-
------------------
Street
as shown on the application for a Well Construction Permit
No. Dated
--------------
� � Board of Health
DATE
11-3 7
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ENVIROTECH LABORATORIES =3
Mass. Cert.#:MA063 =-
z_ 449 Route 130 Sandwich,MA 02563 - (508) 888-6460
BE 13
CLIENT: Mr. Bates LOCATION: Same
ADDRESS: 25 Burning
W. Barnstable, MA 02668
COLLECTED BY: Meehan Well SAMPLE DATE: 6/20/91 TIME: 7 PM
DATE RECEIVED: 6/21/91 SAMPLE ID: ET 536 =_
` New Well 70 ft
JOB ": —__ WELL DEPTH:
== RESULTS OF ANALYSIS: x
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0 0
pH pH units -----— 6.()
6.52 =
Conductance umhos-cm 500 141
Sodium mg/L 20.0
20.1
Nitrate N mgi L 10.0 0.18
Iron mg/L -- 0.3 -
<0.05
Manganese mgi L 0.05 =
Hardness mg/L as CaCO 500 -
t- 3
:3
r Sulfate mg/L 250
e Potassium mg/L -- - -- 20.0
-
c:
r
Alkalinity mg%L 200 =
Chloride ma/L 250
ff Turbidity NTU 5.0
c ?
Color APC (units 15.0
A
Background bacteria'
-.COMMENT;
c: -
_-
YES No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS ESTED.
rXX
t, DATE I =
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_ ENVIROTECH LABORATORIES
Mass. Cert.#:MA063 =
z_ 449 Route 130 Sandwich,MA 02563 (508) 888-6460
CLIENT: Devlin LOCATION: _ 56 Kerry Drive _
ADDRESS: _ _ _ Marstons Mills, MA
COLLECTED BY: D--A—. Scannell SAMPLE DATE: 4-23-91 TIME: 4pm =
DATE RECEIVED. 4-23-91 SAMPLE ID: BC731
JOB �: New Well —__ WELL DEPTH: 53'
RESULTS OF ANALYSIS:
Parameter Units Recommended limit Result
Coliform bacteria/100 ml (MF Method) 0
z:k
pH pH units ----— 6.0-8 5
Conductance umhos/cm 500
Sodium mg%L —— 20.0
Nitrate-N mg/L 10.0
4.63.
Iron mg/L — 0.3 -
0.11
Manganese mg%L 0 05 -
Hardness mg/L as CaCO 3 500
e -
Sulfate mg/L 250 '-
_ 7.6
Potassium
mg%L 20.0
Alkalinity mg/L 200 ---
Chloride mg/L 250
Turbidity,,' NTU 5:0 x
Color APC units 15.0
Background.bacteria
COMMENT:
YES ,NoF WATER IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED.
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