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HomeMy WebLinkAbout0046 BURNING TREE LANE - Health 46 BURNING TREE LANE WEST BARNSTABLI , A = 136 027 - a 0 a 9 a r COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS M d DEPARTMENT OF ENVIRONMENTAL PROTECTION OW / V SJO TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSJJRFACE SEWAGE DISPOSAL SYSTEM FORM ,pR PART A CERTIFICATION Property Address- 27 urning Tree Lane est Barnstable MA Owner's Name: Fred Mamuya&Hillary Kassler { Owner's Address: Same Date of Inspection: April 10,2006 Job#06-88 ?;S Name of Inspector: PATRICK M.O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 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: _X_ Passes Conditionally Passes �o' Needs Further Evaluation by e Local App oving Authority : ' P HIC ••;F � s = :R,_ ' ELF r CO Inspector's Signature: Date: 4/10/06 '., �;•. Q.•Q'k ��i /T�RTI,F\Fr• Q �� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of HeNhi joi 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:Flowdifussors have no standing water or sidewall stains.Tank is not in need of pumping at this time,recommend replacing original heavy duty cover with a"special ring&cover"for maintenance and inspection.Also recommend an effluent filter in outlet tee. ****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. 4 Page 2 of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional ,> p onal Pass section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the.Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: 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_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 ground water elevation. _X An portion of cess ool.or privy is within 10_ Y P p p vy 0 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 at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.) _No_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large 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) yes no the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 Check if the following have been done.You must indicate"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 previous two weeks? _X_ _ Has the system received normal flows in the previous two week period? _X_ 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 note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ 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? _X_ _ 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: Yes no _X_ _ Existing information.For example,a 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)] Page 6 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 5 Number of bedrooms(actual): 5 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 550 Number of current residents: 4 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):No Water meter readings,if available(last 2 years usage(gpd)): N/A Well Water Sump pump(yes or no): No Last date of occupancy: Currently Occupied COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: Tank pumped two years ago. Source of information: 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/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: 2000 Were sewage odors detected when arriving at the site(yes or no): No 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: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 BUILDING SEWER: XX (locate on site plan) Depth below grade: 1' Materials of construction:_cast iron _X_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: XX (locate on site plan) Depth below grade: 6" Material of construction:_H20_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: 10.5' long x 5.8'wide—1500 gal. Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle:31" Scum thickness: trace Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: STICK WITH HINGE FLAP. 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 are intact and clear,liquid level at bottom of outlet invert Tank is not in need of pumping at this time,recommend pumpine every three years GREASE TRAP: No (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.): Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 TIGHT or HOLDING TANK: No (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: XX (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: 0" 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.): Equalizers are Properly adjusted,observed a trace of solids and no high stains. PUMP CHAMBER: No (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.): Page 9 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number: _X_leaching chambers,number: Five Flowdifussors. 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.): Interior of Flowdifussors have no standing water or sidewall stains. CESSPOOLS: No (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): PRIVY: No (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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet. Locate where public water supply enters the building. ell more than 100' from SAS 6 2 38 2 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 27 Burning Tree Lane,West Barnstable Owner: Fred Mamuya&Hillary Kassler Date of Inspection: April 10,2006 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 15 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: _X_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: You must describe how you established the high ground water elevation: Low area with no surface water on opposite side of property is considerably lower than SAS. c R.�. 09HEARN, SURVEYOR SANITARIAN & LAND SURVEYOR SWAN RIVER PLAZA UNIT 2 P.O. BOX 237 35 ROUTE 134 SOUTH DENNIS, MA 02660 (508) 394-1265 FAX (508) 398.4057 April 26 , 2000 Health Department ' Town of Barnstable Barnstable, Ma. R: Lot 12 Burning Tree La . West.. Barnstable, Ma. Health Agent, I inspected the sanitary system at the above referenced project on several occasions and I beleive it has been installed substantially in accordance with the approved plans. The installer has two inlets instead of one, but after reviewing the layout, it is my opinion this does no harm to the system, it improves flow into the septic tank. During the excavation for the soil absorption system, a small area of clay was found. The excavator removed it and for 5 feet around, per code, and clean sand was used for backfill . To summaries, I beleive the system has been installed per the approved, plans . 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MR.rNIG IASDIAAE NSCAATm SDRSIm A xSIN1ID ITT a0R NOT " (iE 0",B00t PAR%B) BIOR To flNROE SaAWiMo i0 1N[a CCIX D1SR EUuxAR 01A1P•aRRlw w RALL -- ------- -----1--- a RrONRNASARORAT2.r4— BOTTOM Deexc rc rc 3SSxt Rc—mo 4 u o x T,BS R.9 ARE ORAIIBE CDM'TA ONr-AREAS NRECO R'LRE rs NO RMON UNXR aAK N NRAS 1erR A TNE rs INE K.. aUS NM J/"1 M%'r RY R PR OnSONN0. ,DCtARS erw 9m lOfI.RONS • 4 REC ROOM FOR (Bwew noon p) )559LC DSSN:C OM L mOER"...u—I A�w1�iA1t1¢±NRm �TrT rwRRc w Q* WINDOW SEAT - IOCATa1,5•ARu RDA.PARORENS. • n P 1.srr SNR 1r-�1m r p wutwAA ROn 1rNE eY mm E A+) rR e' SF " ^ � Q srtn Ta wAtt As atamm. waDw TO RPRr Au Arts.us,alAu A lAew,As P[a oAv[R Owl➢ER TO SUP0.T ALL YAiWALt,OETAAi a VbOR STORAGE AS REOmCD RRO -R. rACTORY-MAT STAR TO a NSTAIED flaw TO �g p M ] Dmwu ea RNL�aD Fg R9) IaSFR•TtS'A RRAD•BH' m TY,aI EXERCISE M R ©TowTt�,aErnRw.N.s ACORN 10 PRONa NN00„S NU @N MY. � � �.� _ r.r - ewnER ro vROHDE:ra sTRucTURE rNo smNc I x UTILITY ,; MNR-A—� s ,; p Yd' pcwPDraBTew. I[¢nwR> e'. e-D ep AcrerY wrtN9w N rA1D xm oNaR. ' L O p Rw.10 rRAVC SOTII 01YA RR M1U91 NR1 eolTw ' ST P 'QWN rp N�I P�f"N,�f;'`z1 •call A aAN Na x%.mPNin slaoc T � ®ooaa wPruco n1wT lawro Assaur. IT HALL WINE CELLAR r�I °R o Ieuewnwi : UTILITY STOR4 fcw rt nDw) e � 1 .� v BrB roRR�c w-\ I I (uiE+i> a II . I GE I I ACORN STRUCTURES, INC. ACORN® 01*]0 N STREET,,]Tt59-9 SU k WILFRED MAMUYA & HILARY KASSLER WEST BARNSTABLE, MA. LOWER LEVEL PLAN 1/1'4-D• 2/19/99 1/]B/B9 BB /1 BBBB 7/IO/9 BB 1/2/99 80 0/05/99 BB r-r r mr - F GAMBREL CAPE #2567 s 2 'r L — 1 TOWN OF BA.RNSTABLE LOCATION Lit —_ SEWAGE # VILLAGEOar-,2&ut� ASSESSOR'S MAP & LOT G INSTALLER'S NAME&PHONE NO. - i SEPTIC TANK CAPACITY ��dQ 9.� � I z 0 LEACHING FACILITY: (type) '"— (1 A 1wi bN rS (size) ;600 ol- NO. OF BEDROOMS C r BUILDER OR OWNE PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by a 9 -9 2-5 -4 - sn 9� z s R No. Fee BOARD OF HEALTH TOWN OF BARNSTABLE 2pprication ff or Yell Cow5truction Permit Application is hereby made for a permit to Construct( A r( ), or Repair( ) an individual well at: --:z blI / v Aq1-2-e- /3 - d.2-7 /� Locatio -Address ``Assessors Map and Parcel 96 27 7 R4� /��t FbK�A-T 02001 INSe0 UeL/41A& wner Address eeSffloa, INO1l/ e �ill�i� Rau -GAL--Oi-leanr Ida_ DZ(v53 Installer-Driller Address Type of Building Dwelling 1/ Other-Type of Building No. of Persons Type of Well T� �Ym�� / ISG- CC 1�9� Capacity Purpose of Well Agreement: The undersigned agrees to install the afore described 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 Certificat of C ance has been issued by the Board of Health. Signed Vat Application Approved By , /e/S Application Disapproved for the following reasons: / Date Permit NO. Issued ate --------------------------------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed Altered( ), or Repaired( ) by D 9MO I Z) t<-Y U-- LL/ /V Installer t /1 ,� at 7(o U NS `Q Z�Q , l%�-A-I v`'z� l�T �" q( S' -(�Z.�f has been installed in accordance with the provisions of the Town of Barnsta eW H - /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 SATISFACTORILY. Date Inspector `t No.eL� Fee v BOARD OF HEALTH " TOWN OF BARNSTABLE 01ppYtcatton for Vern Congtructton permit A�pp/lication is hereby made for a permit to Cons/truc)t( '), Alter( ), or Repair( ) an individual well at: Location,'Address `Assessors Map and Parrcel `j [� K(i Hl 1�e h _rr*eA_r �UU/ IN se k l�r�L/Sl��re%4 , 7 Owner i Address hakekPd. OkPoiit Installer-Driller O Address f Type of Building rJ Dwelling / Other Type of Building r No. of Persons Type of Well M01))Q)-PY t7 )a d kt,- Capacity Y �r Purpose of Well Agreement: The undersigned agrees to install the afore described 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 /!!,ld(�A�ii..>� f:�� le,ley. �..a 1 Date Application Approved By ��� J /�.. ��� �/p/ J Y V' Y V v }fir Y r�/ v v / I Date` Application Disapproved for the following reasons: h Date Permit No. Issued Date y ABOARD OF HEALTH TO WN WN F BA RNSTABLE ARN T S AB L!E Certificate of Compliance THIS IS TO CERTIFY,that the individual well Constructed(.e) Altered( ), or Repaired( by P)i t WE,L.(..•. 1 )ltC. t L L j /V Installer has been installed in accordance with the provisions of the Town of Barnstable Board Jof Health n`h: rivate Well Protectio Regulation as described in the application for Well Construction Permit No. ���N�/mated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORILY. Date Inspector --------------------------------------------------------------------------------------------------- r. BOARD OF HEALTH TOWN OF BARNSTABLE Very Con5tructton Permit No. r� Fee Mw, Permission is hereby granted to [ ) ,, > hj 0 l 4 z U)Fit_.L Installer to Construct( ), Alter( ), or Repair( an individual well at: No. ETA i-IL Street as shown on the aplicat7lio, for°a Well Construction Permit No Dated,,,,Date �` �// Approved By 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION �� I 27.07: continued 3. it contains more than 3000 mg/1 Total Dissolved Solids and it is not reasonably expected to be used as a source of public drinking water. (2) Registration. The following Class V injection wells are exempt from the registration requirements of 310 CMR 27.08: (a) on-site subsurface`sewage disposal systems used solely for the disposal of sanitary sewage and regulated under 310 CMR 15.000: The State Environmental Code, Title 5: Standard Requirements for the Siting, Construction, Inspection, Upgrade and Expansion of On-site Sewage Treatment and Disposal Systems and for the Transport and Disposal of Septage; (b) Class V injection wells permitted under 314 CMR 5.00: Ground Water Discharge Permit Program; and (c) Class.V injection wells on properties that are only used for one single-family residential unit, and that are only used for one or more of the following types o isc es: 1 stormwater runoff, 2. water purification backwas wastewater from the recovery of geothermal energ�for heating, or water us or cooling, -- - 4. groundwater infiltration; and 5. swimming pool drainage. 27.08: Registration (1) The owner and operator of an existing, proposed, or closed Class IV or Class V well that meets any of the following criteria shall jointly submit an electronic registration application to the Department using the Department's electronic filing system(unless the Department indicates that an alternative filing format is acceptable at the time of filing, or unless the Department grants a hardship exemption that allows for paper submission on a form available from the Department) in accordance with the following: (a) Unless exempt pursuant to 310 CMR 27.07, the owner and operator of a Class V well in existence as of September 13, 2002, shall jointly submit a registration application to the Department for each such well by January 1, 2003; (b) Unless exempt pursuant to 310 CMR 27.07, the owner and operator of a Class V injection well first put into use after September 13, 2002, shall jointly submit a registration application to the Department prior to commencing any injection; (c) The owner and operator of a registered Class IV or Class V injection well shall jointly submit a registration application to the Department prior to any conversion of the injection well's class or type of injection; (d) Unless exempt pursuant to 310 CMR 27.07, the owner or operator or Massachusetts Licensed Site Professional (LSP) of record of a property with an existing Class IV or Class V aquifer remediation well authorized by 310 CMR 27.05(1) shall submit the information required by 310 CMR 27.08(2) on a form provided by the Department by the following deadlines: 1. by April 1, 2017, for a well in existence as of October 1, 2016; or 2. within 30 days after commencing any injection for a well first put into use after October 1, 2016; and (e) The owner and operator of a Class V injection well that has become an inactive well or has gone through a closure process for which a Department-issued UIC registration number ENVIROTECHLABORATORIES,INC. •' MA CERT.NO.:M-MA 063 449 Me. 130 Sandwich, MA 02963 508(888-6460) 1-800 339-6460 FAX(908)888-6446 CLIENT. Harborside Construction LOCATION: Lot 12 ADDRESS: c/o L. Wile 46 Buming Tree Lane Bamstable, MA COLLECTED BY. L. Wile SAMPLE DATE. 8-12-99 SAMPLE TIME. N/A WATER SAMPLE TYPE. New Well DATE RECEIVED: 8-12-99 LAB I.D. #: 998248 WELL SPECS.: 1007 4" PVC RESULTS OF ANALYSIS: Parameters Units Recommended Results Method Date Analyzed Limits Coliform bacteria /100ml 0 0 9222 B 8/12/99 ph pH units 6.5-8.5 6.40 4500 H+ 8/12/99 Conductance umhos/cm 500 90 120.1 8/12/99 Nitrate-N mg/L 10.0 0.20 300.0 8/12/99 Sodium mg/L 28.0 7.8 200.7 8/12/99 Iron mg/L 0.3 0.25 200.7 8/12/99 Manganese mg/L 0.05 0.150 200.7 8/12/99 Potassium mg/L 20.0 0.9 200.7 8/12/99 C.^_lcium mg/L N/A 7.2 200.7 8/12/99 Magnesium mg/L N/A 1.9 200.7 8/12/99 Hardness(as CaCO3) mg/L 500 25.8 200.7 8/12/99 Alkalinity mg/L 200 22.2 2320 B 8/12/99 Sulfate mg/L 250 8.2 300.0 8/12/99 Chloride mg/L 250 9.3 300.0 8/12/99 Color APC units 15.0 < 5.0 2120 B 8/12/99 Turbidity NTU 5.0 4.6 2130 B 8/12/99 Volatile Organics ug/L See Report ND EPA 524.2 8/16/99 ND= None Detected. COMMENTS: pH is below recommended limit and may have corrosive characteristics. Manganese is not a health hazard, but may cause aesthetic problems. WATER MEETS EPA STANDARDS AND IS SUITABLE FOR DRINKING PURPOSES FOR PARAMETERS TESTED. � Date 41 ald J. SagA Laboratory i ctor <=less than >=greater than TNTC=too numerous to count c � I Groundwater Analytical,Inc. GROUNDWATER ANALYTICAL Main 1 Street 228 Main Street Buzzards Bay,MA 02532 Telephone(508)759-4441 FAX(508)759-4475 August 17, 1999 Mr. Ron Saari Envirotech Laboratories 449 Route 130 Sandwich, MA 02563 Project: Harborside/46 Burning Tree LAID: 28360 Sampled: 08-12-99 Dear Ron: Enclosed is the Volatile Organics Analysis performed for the above referenced project. This project was processed for Rush turnaround. This letter authorizes the release of the analytical results, and should be considered a part of this report. This report contains a project narrative indicating project changes and non-conformances, a brief description of the Quality Assurance/Quality Control procedures employed by our iaboratory, and a statement of our state certifications. I attest under the pains and penalties of perjury that, based upon my inquiry of those individuals immediately responsible for obtaining the information, the material contained in this report is, to the best of my knowledge and belief,accurate and complete. Should you have any questions concerning this report, please do not hesitate to contact me. Sincerely, Jonathan R. Sanford President J RS/awc Enclosures ------ GROUNDWATER ANALYTICAL EPA Method 524.2 Volatile O Y Organics b GUMS g Field ID: 998248 Laboratory ID: 28360-01 Project: Harborside/46 Burning Tree QC Batch ID: VM1-1565-W Client: Envirotech, Inc. Sampled: 08-12-99 Container: 40mL Glass Vial Received: 0E-12-99 Preservation: HCI/Cool Analyzed: 08-16.99 Matrix: Aqueous Dilution Factor: 1 Page: 1 of 2 75-71-8 Dichlorodifluorom_ethane BRL - ug/L 0.5 74-87-3 Chloromethane _ BRL ug/L 0.5 75-01-4 Vinyl Chloride _ BRL ug/L 0.5 �74-83�-9 Bromomethane _ BRL ug/L 0.5 7� 5-00-3 Chloroethane _ BRL ug/L 0.5 75 69-4 Trichlorofluoromethane BRL ug/L 0.5 75-354 1,1-Dichloroethene BRL ug/L 0.5 75-09-2 Methylene Chloride _BRL ug/L 0.5 156-60-5 trans-1,2-Dichloroethene BRL ug/L 0.5 1634-04-4 Methyl tent-butyl Ether(MTBE) -_BRL ug/L 0.5 ��: -3 1,1-Dichloroethane BRL ug/L 0.5 590.20-7 2,2-Dichloropropane BRL ug/L 0.5 156-59-2 05-1,2-Dichloroethene BRL ug/L 0.5 74-97-5 Bromochloromethane _ BRL ug/L 0.5 67-66-3 Chloroform _ _ BRL ug/L 0.5 71-55-6 1,1,1-Trichloroethane BRL ug/L 0.5 56-23-5 Carbon Tetrachloride BRL ug/L 0.5 563-58-6 1,1-Dichloropropene �_� _ BRL ug/L 0.5 71-43-2 Benzene BRL ug/L 0.5 107-06-2 1,2-Dichloroethane BRL ug/L 0.5 79-01-6 Trichloroethene BRL ug/L 0.5 78-87-5 1,2-Dichloropropane BRL ug/L 0.5 74-95-3 Dibromomethane BRL ug/L 0.5 75-274 Bromodichloromethane BRL ug/L 0.5 10061-01-5 cis-1,3-Dichloropropene BRL ug/L 0.5 108-88-3 Toluene BRL ug/L 0.5 10061-02-6 trans-1,3-Dichloropropene BRL ug/L 0.5 79-00-5 1,i,2-Trichloroethane BRL ug/L 0.5 127-184 Tetrachloroethene _ BRL ug/L 0.5 142-28-9 1,3-Dichloropropane BRL ug/L 0.5 124-48-1 Dibromochloromethane BRL ug/L 0.5 106-93-4 1,2-Dibromoethane BRL ug/L 0.5 108-90-7 Chlorobenzene BRL ug/L 0.5 630-20-6 1,1,1,2-Tetrachloroethane BRL ug/L 0.5 100-41-4 Eth (benzene BRL ug/L 0.5 108-38-3/106-42-3 meta-X lene and ara-Xylene _BRL _ ug/L 0.5 9547-6 ortho-Xylene BRL ug/L 0.5 100-42-5 Styrene BRL ug/L 0.5 75-25-2 Bromoform BRL ug/L 0.5 98-82-8 Isopropylbenzene BRL _ ug/L 0.5 108-86-1 Bromobenzene BRL ug/L 0.5 79-34-5 1;1 2,2-Tetrachloroethane BRL ug/L 0.5 Groundwater Analytical, Inc., P.O. Box 1200,228_Main Street, Buzzards Bay;MA02532 civV 1ttV 16-1 44/5:A 3/ b GROUNDWATER ANALYTICAL EPA Method 524.2 (Continued) Volatile Organics by GC/MS Field ID: 998248 Laboratory ID: 28360-01 Project: Harborside/46 Burning Tree QC Batch ID: VM1-1565-W Client: Envirotech,Inc. Sampled: 08-12-99 Container: 40ml-Glass Vial Received: 08-12-99 Preservation: HCI/Cool Analyzed: 08-16-99 Matrix: Aqueous Dilution Factor: 1 Page: 2 of 2 96-18-4 1,2,3-Trichloro r ane BRL ug/L 0.5 103-65-1 n-Propylbenzene BRL _ _ ug/L 0.5 9549-8. 2-Chlorotoluene -- -- _ BRL _ ug/L 1 0.5 108-67-8 1,3,5-Trimeth lbenzene _ BRL ug/L 0.5 106-43-4 4-Chlorotoluene BRL ug/L 0.5 98-06-6 tert-Butylbenzene —— — _ BRL ug/L 0.5 95-63-6 1,2,4-Trimethylbenzene BRL ug/L 0.5 135-98-8 sec-Butyl benzene _ BRL ug/L 0.5 541-73-1 1,3-Dichlorobenzene BRL ug/L 0.5 99-87-6 4-Isopropyltoluene_ BRL ug/L 0.5 10(r46-7 1,4-Dichlorobenzene BRL ug/L 0.5 95-50-1 1,2-Dichlorobenzene BRL ug/L 0.5 104 51-8 n-Sutylbenzene BRL ug/L 0.5 96-12-8 1,2-Dibromo-3 chloropropane _BRL ug/L 0.5 120-82-1 1,2,4-Trichlorobenzene _ BRL _ ug/L 0.5 87-68-3 Hexachlorobutadiene _ BRL ug/L 0.5 91-20-3 Naphthalene BRL ug/L 0.5 87-61-6 1,2,3-Trichlorobenzene BRL ug/L 0.5 1,2-Dichlorobenzene-d4 95 % — 70-130% 4-Bromofluorobenzene 96 % _ 70-130% Method Reference: Methods for the Determination of Organic Compounds in Drinking Water,Supplement III, US EPA, EPA-600/R-95/131 (1995). Method Revision 4.0. Analyte list as derived from 40 C.F.R. 141.40 and 40 C.F.R. 141.61,and additional analyte MTBE. Report Notations: BRI- Indicates concentration,if any,is below reporting limit for analyte. Reporting limit is the lowest concentration that can be reliably quantified under routine laboratory operating conditions. Reporting limits are adjusted for sample dilution and sample size. F - 532 Groundwater Analytical, Inc., P.O. Box 1Z00, 228 Main Street, Buzzards Bay,MA-02 No. _ ' Fee a> L V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: • ' Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS' URpplication for 3Dt5 o5al stern Congtruction Permit lication for a Permit to Construct Repair( )Upgrade( )Abandon( ) O Complete System ❑Individual Components ation Address or Lot No. /Z. lie WA-0G 7tAEjW Owner's Name,Address and Tel.N , tom- K•tsst.E-e Assessor's Map/Parcel 1,34/Z 7 17 w�nt�dw� R � �7 fid S Z Installer's Name,A dress,and Tel.No. Designer's Name,Address and Tel.No. CST t• 39 -/Z Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow S s 4, gallons per day. Calculated daily flow s� gallons. Plan Date S /s• G Number of sheets Revision Date 611 7, 9 Title /CDT /Z dgAVIA40 7;e2EE d1V Size of Septic Tank /S'0 D Type of S.A.S. . S dtt�1L - Description of Soil S'i1AI� 4.4-" �deF/?�E �;Tl FiNE 4,r Zo 3 y u Nature of Repairs or Alterations(Answer when applicable)". 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 pLed , the nvironme Code and not to place the system in operation until Ce 'fi- cate of Compliance has ued i Sig Date 9 Application Approved by SZA Date 19'1 Application Disapproved fort following reasons Permit No. J , — s IV Date Issued -v � j; gJ� � vj` ' �. � n:. �+'�. ate � .. • 4. THE COMMONWEALTH OF MASSACHUSETTS , Entered in computer: i r^'i ��,,,� t� Yes j PUBLIC HEALTH DIVISION -,TOWN OF BARNSTABLE., MASiA HUSE7TTS . J 01�prtcatton for ;Dtgpogar *pgtem Construction Permit y � Application for a Permit to Construct O'R"epatr( )Upgrade( ' )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /�, �veMiA,G 7eCC IAI owner's Name,Address and Tel.N . Assessor's Map/Parcel 36 1Z7 w N /4 11 )7 .01Y S Z 1; Installer's Name,A dress,and Tel.No. Designer's Name,Address and.'Tel.No. eZO>✓57•% L�E.vTE.CIl/LGE ,Q,J' Q w,19e-A) -ov- qt� Se-sY 4'. �r / 3 y 1b c s Jrr 39 26 (, Type of Building: Dwelling No.of Bedrooms Lot Size S6 Y60 sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons f Showers( ) Cafeteria( ) / Other Fixtures Design Flow _ S�S gallons per day. Calculated d'aily flow SSA gallons. Plan Date-' 96 Number of sheets ) .Revision Date G z/ 7 ' �!9 Title 12 lore.,," 7;eee 4N � '. Size of Septic-tank / O --Type of S.A.S. P.8v&-s r FLoGu ai iFi�t/SE/Z -Description of Soil _15wj Y �a� � .��iP�/I 7D F/A/i`'.- ` S-^4 27 -3 Y 1z •a ) r r r ' , 11 / "14 Nature of Repairs,or Altei%tio sit nswer when applicable),' Date last inspected: - jJ Agreement: The undersig"ned agre',es to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the pro4isio o it e 5 f rivironmenial Code and not to place the system in operation until a Ce ifi- cate of Compliatice has.bia issued ` i of e th.�, I Sig eZl'=� Date ` Application Approved by, TM Date_ � 4 -9'Sz _ Application Disapproved-for,, . ;following reasons Permit No. A'9r1 � S 1 y ? Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSE7S Certtftcate of Compliance .a THIS IS TO`CE'RTIFY, tjhh�t the On-site Sewage Disposal System Constructed( ' )Repaired ( )Upgraded( ) Abandoned( )by � � ?.V;SIX v e-o;7e -1 at /V /L dS has been constructed in accordance with the provisions of Tit�5 and the for Disposal System Construction Permit No. - dated Installer lelvA Y 11WIX.y0/5 Designer e,- The issuance of this pe t shaynot be construed as a guarantee that the sy, t will funct'on a ,d sig Date Inspecl 4 ———=————————————— ——=---_——_—=—_ --————- - No. / Fee [ 8 41 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS MtgPogar *pgtem Conelructton Permit Permission is herebyted to Construct(,' )Repair( )Upgrade( )Abandon( ) System located at 1ranOT' !2- d&,A.vwe1& 77Ke ,,1il l • Gu. e,0h4u eI7 and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to t comply with Title 5 and the following local provisions-or-'special conditions. l Provided:Construction must ,e comploted within three years of the date of this erm it. Date: v - Approved by T TOWN OF BARNSTABLE ' LOCATION SEWAGE # kII.LAGE Le- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. If r - D SEPTIC.TANK CAPACITY /5-00 )q Z o LEACHING FACILITY: (type) ' Anvi��rS (size) ✓z"00 r NO.OF BEDROOMS BUILDER OR OWNERJ j4h P Tor 5, se- AS ICI-4 o PERMIT DATE: COMPLIANCE DATE: ` Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by 14 x ' o A A-F JV ;- �- -Ila , �r � (P TOWN OF BARNSTABLE LOCA'iION `flt'i186 `Trea— 60. SEWAGE# il,5t-c?t!011 `JILLAGE W• aw f ASSESSOR'S MAP&PARCEL IN +RS NAME&PHONE NO. SEPTIC TANK CAPACITY /500 LEACHING FACILITY:(type) AC)°5 (size) NO.OF BEDROOMS 5- OWNER oo VA Jcc.5 5 kr— PERMIT DATE: CO>Vff&t d£E DATE: /010(0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY �s No. ---- a Fee--- -=-- ------ -- --- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rVell Con0ructionpermit Application is hereby made for a permit to Construct ), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel Owner Address ie Se l - ----- - - /".O X4® Z. - -�O-Y�N1°TAI a'Z3G Installer — Driller Address Type of Building Dwelling----x------------------------------------------------------ 30 Other - Type of Building ----------- No. of Persons--- ---------------------------------______ �N 4 4PL'""e— Typeof Well— ---------------------------------------------- Capacity--------------------—----------------------------- Purpose of Well-- —- __w 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 � i Q. I C---- dateq Application Approved By — —==�---- /_7 date Application Disapproved for the following reasons:-----------------------------------___—__—_—_______ ----------------- -- - -- -------------------------------- ----------------------------- Permit No. �9 — 10 — Issued-- - - /- ---—date te ------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f (Compliance THIS IS TO CERTIFY, That the kdividual Well Co structed X Altered ( ), or Repaired ( ) tt�v� 4_- - - --- ----- �/ Installer 1�p �O.G,AII.UIo _ 7�tEE �(.tl_---------- - at—____ _ has been installed in accordance with the provisions of the Town of Barnstable Board of Health Private Well Protection Regulation as described in the application for Well Construction Permit No. --------------------Dated----- -------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE—--- --- —- -- Inspector-- ------- ---- —------- ( _ NO.——-- ---------- - Fee--------- BOARD OF•HEALTH TOWN , .0F:, :BARNSTAB,LE p Cicanon Dior elY ongtruct on A rmit Application is hereby made for a permit 'to.Construct,W), Alter ( . ), or Repair (' .)an individual Well at:. Location "Address' Assessors Map and Rarcel Owner Address ------ - -- -- ----- Installer — Driller Address (' Type.of Building •A . ( Dwelling �. - - ---- ------ --- --- Other:.- Type of,Building.;---------'------------------ No. of Persons--=-----=------------ Typer... -- -- of Well `g' c- --------- Capacity Purpose of Well a Agreeinerit: 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. t Signed- A - -- ---` !-� --- - --��- 7-- date ..Application Approved By C�- • . . - _date, Application Disapproved for the:follo w ing reasons: --- �y`. � � C� ` c✓' _ date , J Permit No. — ----- Issued—= — -7-1--,3� - ---------- date �c.!1isE;fiPfi<i+lili9isAali#+i'?"'!�F111!d.Si 117`S0.•Ya1w9�Td2ri0T11'!/,�w4i1l11iM.1,16A}QitiQi•.iMdA�3RiQiY.lplYai'/YQY"ffl8SiN0.lQav'FIN,!yi,4ri.w8@SISQBN'.9fi4'BMAKQGI.�Ti9YR�8.Ei9.iofbH6Tvis3Fl ♦We'.R3..6 ._- . " BOARD OF HEALTH' " TO,WN .s OF BARNSTABLE+ Certificate' ®f Com0[iance THIS.,IS TO CERTIFY' That the Individual Well Constructed (Y), Altered.( ..j),(or. Repaired ( `�) by e-- -- a Installer at has been installed in`accordance with the provisions of the Tt m of Barnstable Board of Health.Pnvate Well Protection r;Regu ation.as;Aescribed m'the'applicandn`for 1Ne11'Coristrucfon'Perrriit 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 Well Con0tructionVermit No. ------. Fee- ---- Permission is hereby granted /LL/,o_{z_ - to Construct O, Alter.( J, or Repair ( ) an Individual Well at: Street as shown on the application for a Well Construction Permit No. - Sx - -- Dated-- , - -—=-------------------------- Q - - -- C /J DATE-- Z' �'/1 _- Board of Health - .k _0 I MI. 0 F _ Y a 4 , t r r r:. , - ,m.., ,3 ,, r#r`-,-, _ - ._-« ..'S . ,.' ,.*� ; x• my... 'n�p: e ' , . ". .+. r :tip• ,-.. _,. .° ..-. p .. ,-+ .;. . ,... :._. ,:fit §,.: .,.: .. ,-5 �' 7 <a S I y' =yi: 41. u 1 � I K { y ; i , :. :N•. may,. .- , .. ,. ♦-m PaRw -4 Jim x 4 r' v T 1 SE 3-3033 CEN TER OF � DRAINAGE DITCH PROPOSED 6.4 E.M. i OP OF F S \ LIM1 OF 2 ,2 UTILITIES R EL_ = ��. B. V. W. ' 24.0 - M ~ S. 7 \ I / JA TUM 22- 7 21.5 ti 15 4' PA VED ^5.7 WA TERWA Y \ �\ }, , \ 6 t3 i �r \ , 29,3 C) I� \ V I AtiOFM �_� INVERT 12" 26. �� \ LIMIT Uf �� t s \ LIORR. AL PIPE ._ B. HAND EL - 15.95 -' f{ .� .27��; � � , � I � � - ov � ,� � k � � SQL T .4 -� '� � ,p \ MARSH !4 1� L 0 T 13 f 15.4 rz� � / > �J APPLICANT. J I III �I\ MIN AILFRED VAAfUYA �c HILARY KA,S,SL�'R � 17 zVORTOY ROAD / ^ Nr'IYTOz f,4. 02159 25.2 .- 15' , l oV MIN. S .r 4(2 �� �' �' /� j <r A# L_ 0 T 72 BURNING TREE LANE � WES T BA RNS TA BL E, MA41 for Q) 125�7\ ACORN S TRUC TURFS, 0#NC. DA TE: MAR 26 199� j,7 \ o , SCALE: I I N - 20 FT 76 R. J. 0 Hearn, Serve o.r 35 Route 134, Unit 2 South Dennis, Mo. = I i j 28 ' ' oo � REV: 7120199 - SAN S YS TEM � O T 1 E � o c 4 ,Q) o �� REV. 5/I7/99 - NEW HOUSE REV. 8124196 .Q�- 1(5 SHEET I OF 2 LOT 17 � 1 ALL COVERS TO SANITARY UNI TS SHALL BE BROUGHT 4' SCH 40 P VC PIPE - MlN PITCH 10 FT. MIN. TO W4THIN 6 INCHES OF FINISH GRADE 1/8" PER FOOT TOP OF FOUND I " - `7 EL= 28.0 CONCRETE 4 SCH 40 PVC PRECAST z y COVER FIRST 2' TO PIPE - M1N PITCH CLEAN SAND FL' 0WDIFFUSOR v ����� LOCLS BE LEVEL 1/8" PER FOOT -7 M/N. ZX MAX EL =26.5 " GRADE AWN EL 24,5 2" LAYER OF �� �y 1/8'-1/2" DOUBLE WASHED STONE N FLOW LINE _ - SrCORTON CREEK d EL-25,0 10" MIN. ir N ^ EL a 23.5 .: NN EL=23.0 cmCt O O O O G C EL 23.0 Eiji C G FI C7 G C G C3 4" CAST IRON ( ORcd EQUAL ) PIPE - MIN. PITCH 1/4' PER FT 3/4" TO 1 1/2'EL =21.0 - EL = 21.0 Z 0C,/ �`l0AT 1�'1 4P IJIST. DOUBLE WASHED �. OUTLET TEE BOX 44 x 12 STONE 5.8 MIN. 1VOTE., LIQUID DEPTH TEE DEPTH }--_ - 1500 C�iL FLOOD ZONr IS 6!Z N FOR THL' ARLA x BELOW FLOW LINE f Or THa' LOCATION OF THA' STRUCTURA' 4 FT. 14 INCHES S I'VPTIO" - -- BOTTOM OF TEST HOLE OR OBSERVED WATER TABLE EL 15.2 5 FT. 19 INCHES TA1Vf1' ADJUSTED GROUND WATER TABLE ( / / ) EL = 6 FT. 24 INCHES 7 FT. 29 INCHES PROFILE OF 8 FT. 34 INCHES ,5.�'T�14G�' .DI,SPO,S�4L ,SYS'T�'�Ll NOT TO SC14LL' l0lFS Jv CALCULATIONS NUMBER OF BEDROOMS ................................... 5 GARBAGE DISPOSAL UNIT ................. .............. NO #1 DEEP OBSER VA TION HOLE LOG DEEP OBSER VA TION HOLE LOG TOTAL ESTIMATED FLOW DA TE OF TEST W4 " DA 7E OF TEST _WJZ2k ( 110 GAL11$R.110A Y x 5 BR. ) ... .. 550 GAL,IDA Y REWIRED SEPTIC TANK CAPACITY.................... 1100 GAL, WITNESSED BY 1F. Y WITNESSED BY � BERRY PERFORMED DY R. N'lLEaQ1( PERFORMED BY R iNLGOX ACTUAL SIZE OF SEPTIC TANK......... ................ 1500 GAL. EFFLUENT LEACHING RATE ...... .., .._......:., 0.74 GAL/SF , LEACHING AREA PROVIQED ELEY DEPTH FRM SOIL SOIL sox SOIL DIEP7H FRAM SOIL, SOIL SOIL SLYL SURFACE HORIZON 7EX7tm COLOR Ai:iTF2.ING 07II£R tzEV. SLWACE' HOIRRGt�I lEA'TURE COLOR MoT7LlNG o7NER SII�EWALL + BOTTOM 44x fY + �44x 121 x2x 2 752 S.F, 2&7 23.2 LEACHING CAPACITY (_%DE*Akk -t-a99T"0 .; b56 GAL. 213 O - 5' O/A Y LOAM t0YR4/`1 24.7 0 - 6' O/A SANDY LRAM tOM�4/2 752 x 0.74 5' - 34' B LOAMY SAND tOYR6/3 FEW ROCKS 8' - 28' 8 LOAMY SAND t0YR7/!5 FEW ROCKS RESERVE LEACHING CAPACITY............................ 556 GAL. . 22.9 22.9 ' C1 FINE SAND 1OYR7/4 28' - 120` C FW SAND 10YR712 177 112 NOTES' 96' - 120' C2 MED SAND 117 1. ALL WORKMANSHIP AND MATERIALS SHALL COWORM TO D.E.P. TITLE 5 AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS FOR THE NO GWF NO GNU SUBSURFACE qISPOSAL OF SEWAGE. 0 EL s 15.7 f EL - 15.2 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WTHIN 6 INCHES OF FINISH GRADE 3. EXISTING AND FINAL GRADES SHALL REMA/NE ESSEIV77ALLY THE SAME, EXCEPT PERCOLA TION TEST PERCOLA 77ON TEST AS III 7ED 4. NO DETE7RMINA7XW HAS BEEN MADE BY THIS OFFICE AS TO COMPLIANCE DATE .,�,�j,4, DEPTH OF PERC. _7Z' DATE �i/1 DEPTH OF PERC. 72' W7H TOW ZONING REGULATIONS OWNER /ANVCANT SHALL 06TANV SUCH 1w. 11:W RATE MW. PER AVCH c 2 WE 11.•00 RATE MIN. PER INCH < 2 DETERMINA70V FROM THE APPROPRIATE AUTNOII#T)' 5. 7711S PLAN IS VAuD /F /T /S STAMPED AND wavEv:kv REA Inks ova ASSUMES NO RESPONSOLI T Y FOR /NFaRMA710N aW TA^W OW COPIES #3 DEEP OBSERVA 77ON HOLE LOCI W h H DO NOT HAVE ORIGINAL STAMPS AND SOM TtWI ' 6. ALL COMPONENTS OF THE SANITARY SYSTEM S IVA L`BE CAPA&E OF DATA OF TEST WIHSTAAVWG H-10 LOADING UNLESS THEY'ARE UIVER OR WHIN 10 WNESSED BY FEET OF DR1I OR PARKING, H-20 LOADOVG SMALL BE USED UNDER OR PERFORMED BY Wf IHIN 10 FEET OF DRIVES OR PARKING AREAS. 7. CONTRACTOR IS RESPONSIBLE FOR VERIRCATJIJN OF ALL LOCA7701VS AND EL.EVATIOJV LN UDNNG EXIS77NG UTILITIES# PRIOR TO CONSIRM77ON. IF DEPTH FRIOU SON. S171C, sm SIOML ANY DISCREPANCIES ARE FOUND, 7HIIS OFFICE SMALL BE NO7*7ED aEV SIARFACE Ho pow mX7L1PE' COLOR NOTTLOG OTHER ANY Y, • 8 ALL UNSUITABLE MATERIAL SHALL BE REMOVED UNDER AND FOR 5 FT. AROUND L£AO*C FACILITY AND BE REPLACED WTH CLEAN GRANULAR SAND PER:SECIkaM 15.255(3) OF 7HE STATE' ENWR lVWNTAL CODE, TITLE 5. t' Hfz4Riy SSL.M'R 17 AfORTOW RD sAN SrsrEM aAl= PERCOLA TTON TEST iff TO-1Y A. 02159 �/rtjfuv - ,ti9e�► t ezr ` &TE:. c7EP77,r OF PEW. ..an#a 96-606R-00 DAM- 5AS196 n RATE UK Aw �Wf.�,► �*'�tt�x As NOTm Sid' 3-3083 tit > R 01H. sNXT 2 4F 2 OF 1 0 HeamSA W APPRO LUA �OT 12. UTWEZ -~ 30, Rom' Im p aL Box z �. MAP l.IlW PARCSL Jr A" amw FLOW XWk_C _AUVATIOM DAM . ,......, r�F---� .',a.,,..._:ram_s,,'.aaar,[ ae. r:,,,.�ma'k. -. �.,•.«,.,x sr* :aw:aa:a�'a;.=:+.r�ems+,.**s r S .,... .:,.:-, d�'. _ a, _ .... ..._ :.. ... _. - _..