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HomeMy WebLinkAbout0056 BURSLEY PATH - Health .K 4of 3 2A Bursley Path,West Barnstable 1 A=110-025.005 I d f t i { s t i } 1 No. 4210 1/3 BW � D o L d � � ESSELTE i 0%° Commonwealth of Massachusetts Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path r Property Address a Rachael Mccullough -r Owner Owner's Name information is Marstons Mills Ma. 02668 Jul required for every y 25, 2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Thomas Roux key to move your Name of Inspector cursor-do not use the return Company Name key. 89 Mayflower Lane Co � Company Address East Wareham Ma. 02538 City/Town State Zip Code BAR 774-678-9066 S14531 Telephone Number License Number B. Certification I certify that:l am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000);l have personally inspected the sewage disposal system at theproperty address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes i 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Tj v 17- 1 )z Inspector's Signature Date 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 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 form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every Y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"ConditionalPass"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. Check the box for"yes", "no"or"not determined" (Y, N, ND)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. ❑ Y ❑N ❑ ND(Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every Y ' page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will.pass with Board of Health approval if pumps/alarms are repaired. ❑ 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 ❑ Y ON ❑ ND (Explain below): ❑ obstruction is removed ❑ Y El ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): ❑ 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 ❑Y ON ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND(Explain below): 3) 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56,Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every Y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. 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 fecal coliform bacteria indicates absent 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. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25 2020 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent 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 and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® 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. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every y page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Wasthe 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Y Marstons Mills Ma. 02668 Jul 25 2020 required for every , page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 5 Number of bedrooms (actual): No house DESIGN flowbased on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 586 gpd Description: There is currently no house on the property. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail Sump pump? ❑ Yes ® No Last date of occupancy: N/A Date t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for,Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: New system Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form fn i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'u- 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every y page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 25 years, application for Disposal Construction permit dated March 1995. Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.1 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10,feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every Y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.1' feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 10.51 x 5.67'W x 5.67'H Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle 32" Scum thickness 0" 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 16" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The septic tank was full of rain water at the time of inspection. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address . Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25 2020 required for every y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet 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: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(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 per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every y page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(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.): D-Box is new. Never been used. t5insp.doc•rev.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name required fo is Marstons Mills Ma. 02668 July 25, 2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Both pits were clean and dry, since the system has never been used. Type: ® leaching pits number: 2 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25 2020 required for every Y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Both pits were clean and dry, since the system has never been used. 12. Cesspools (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 ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 1' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every Y page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25, 2020 required for every _ y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view 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. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately r t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 :;' Rr'x'iza�:'y,hh f+11'At•`1• k,'d$ 4::�x a c r e,. }, x,_. I - _ - _"�""*'""'•"� y '�3, "x Y>- n :; a.i.:IX.�Y r"}'r$�i:� x k�4A_:. R •: '•-'.. F -, ...✓ ' � -��` 4 :, p� IdA 1.dET OAJ [sss13 .K SEN:C'FI 'MkRK r TEST W9LE RESULTS ' x -d $j . •. _ 1. �r k '' !.-�r: >r �a'�+ ,:',dt;" '��',�...�,;,I�,,•d ;�yj .;._ w ,r '�` DATE: � `ED Y DEL hlcst1T 4. G � - -HIGH OROUNO-WATER ADJUST MENT-. it ' `•�+ ,# �� Y.'1 s t' OBSERVED WATER DEPTH *'., "'• j �; t "eri Efdv en l2Y., £'.,(43 .a 62.4 v h f 1�?GIATIC)N Mppq j Y8 � � U�3 ' INDEX WELL TEST HOLEli ,4 ! TEST HOLE2 WATER RANGE ZONE R r S' r `., " ""e *... 'I;wpC 5,"" 'a+i- •, tt..n .. RENT WELL DEPTH —� L'.r .tea,... a •m�pikVJE a :,Fk)It fix`' 'WATER ADJUSTMENT MATED DEPTH TO WATER ' .r , ,y� ESTIMATED'MAX, WATER.ELEV. _ ae L� a t s 'DiS`T' ; `k 'L•sT r t':r cta„s Lt1 S77 t. RMd"+T.w.�n ' d S •3 R. lr$ rWH44 48`r.J,�" :06..Y'a'.I'.. , lZ MaGROUNO WATER ,_-GROUND WATER' £HCQUNTERED ENCOtiNTERED �^;;J .✓.J' �r " 4a+` F .FC rs9C�.Ki C7 4 , _ .,; - .�! F•°• IL l(NN04."E8 AND COVER TORE BUILT T0: - I "'+y .- .Y'Jlf!S's'C"'i'.�..1 '..j'y+,� #, 'Y.:OTAUT gIgTHIN_12" OF FINISHED ORAOE .,. v + ^'}'.?�, �„•.' &"` �� r "$ "'-n.� ,.'{k' FINE IA1K 8'/• SLOPE, t ELEA"DIA ,,.DIA. PIPE ^rE e' FIh3 2 1 _ M " AYE 11 0i PI MIN:PITCH jLfYE �PITEASYONf * FTDIDIA: INVERT aox G7.ld . 3$v a m �iASNeTi sT4N.F. .y; .g zi°�#•. a rFya.y" r { n'('; " f47*'.D,Y l�Is' "„ f �;i INVERT IN .D"� ALL AROUND # 'r. $ - si•r< „ { .35 x PLA C'E' ON' •. Of sty} I 1_ - '•. r^i iY ,� qk^5 r. w ''t". w " R'+,'¢Li 1,., •b. (10'M F i R'M S A S B 9!9' .:..--r. ,,' � `F �'''_ � -,:' � ,+�.;,�� �� � �`r�•r„A,f„ -"'-,- '�.' s>: iA _ `�_. _ ��R n�cEUE'"".i`2ci'M1�I`L` `_ ........ 1^�.,� � -•*�' r Y. rrr r l mr' PROFILE- OF r5,z SAN-1,TA:RY DISPOSAL SYSTEM I :..,� ,;; a'�,tr' ,rha�1L"d#2;'Yt' Ad' '« '--"' t' ,"r• ' ,pAArMS < ✓" 'y,i.: (NOT TO 'SCALE 1 DES ©ATA CONSTRUCTION OF SEPTIC,SYSTEM SHALL CONFORM TO w ATAvzsai L'wl5 4C?' } THE COMM. 'OF MASS, ENVIRONMENTAL CODE, TITLE 5 BEDROOMS AND THE TOWN 80AR OF HEALTH REGULATIONS. DESIGN FLOW - SSO GAL; DAY' ., • �+. + " 6XAP�, ° �. 2) THE'DESIGN IS TO BE 'STRICTLY ',FOLLOWED, CRAIS R. LEACH RATE f. ¢ MIN.rINCN: y 1jdsuy �•ara• SHORT-IB TO BE CONTACTED PRIOR TO ANY CHANGES. PRbP'D. SOT, AREA"�6lYaz� lao- s I I }�' lY11tt ROP A 57t,Gi3 T y. I#$J @L IG1GFsCS °� P '0 SIDE AREA 3)`SEPTIC :TANK;.015T(PI'B'llT10N B''OX AND TEACH-. TOTALAREAn T ING UNIT TO "BE OF REI-NFORCED CONCRETE, MIN:. CONCRETE.5,TRENGTH 3;OOOP8.1, P'RO AttS� LEA�•�PpING CAPACITY MIN; _STEEL STRENGTH 2O.000 PS 1. REQUIRE L£�`pGMG CAPACITYtfC"I MIN. DESION LOADINO: r0. REQUIRED SEPTIC TANK '- �� 6All 4) DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM Pacnaate "' i6eae� 1 UNL-ESS' H2O DESIGN LOADING IS USED 1 r ; II � 5) ALL PI'PES'AND FITTINGS TO. BE WATERTIGHT WEALTH AGENT APPROVAL :OA a PLAN SGAL E ' &fir AND TO BE CAST IRON OR.APPROVED. P•VC.' ^"'CAUTION; CONTRACTOR TO.CONTACT DIG-SAFE 72HOILRS PRIOR TO EXCAVATION I� -� p ;t' � I E PL N SHOWING PROPOSED CONSTRU TION ZOMNG' DATA LEGEND LOCATION:'Ao7'34 SUP.,5L.P i�g I•j { a FOR: p,Q7";tecJe' �:R rv!i t f�/�/ DATE' !� xonE _Prt»s "�*' AF - d10 'ti�A TEST HOLE LOCATION °°' REFERENCE SOT 34 AS SHOWN ON REVISIONS RttlU1RED AREA,. �, 43 4� 40 Zt,E'470 EXISTING SPOT 'ELEVATION 1T.6 ` -'� ,.r I.}AP?fir PAR.-! -LRN 19=v•4io Pisllas S.fi REQUIRED FRONTi1GE1— fso l41411 EXISTING CONTOUR --16— CLIENT'S ADLIAESS:176 °Sc7u:h1 sr. Hgwwiyr' 00+ 0t��� I RE4ULRE0 FRONT SETBACK. �E "�' PROPOSED CONTOUR "--�"— - IF THIS PLAN;DOES NOT BEAR A RED STAMP BY CRAIG R. SHORT, ' �+ 'i WATER SERVICE LINE r---W ;,�i"0r+ THEN IT IS NOT A VALID COPY d I ASSUME NO RESPONSIBILITLY y ACQUIRED SIDE- 9ETBA.CK t_ FIOR ITS 'CONTENT OR USE. raf !A.@fi GAS SERVICE 'LINE —0 REQUIRED REAR` SETBACK. N t ELECTRIC 8 TELEPHONE LINES —E eT—Z CAR A I G R. 0 H O R T, p E.- P.ROFFW&IbNAL CIVIL - ENGINEER .--- - rTfF7 Ia4'TOkY LANE,DENNIS,MASS. ,,02438 FilENO,:} ' # fGO} {i ]INSPECTOR 'APPROVAL DATE. _ I � tao4e) aes=�aaG s�e�T u..^�.w--., ..�w.A..i,.nEa„"...a--a..:,aZw#.-wry.aipnvk;•s+^"1u,.-.a..-..v„ubti.,�.•SOwio I Commonwealth of Massachusetts !� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is required for every Marstons Mills Ma. 02668 July 25, 2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: below 12' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 3/6/95 Date ❑ 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: From the design plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments L- 56 Bursley Path Property Address Rachael Mccullough Owner Owner's Name information is Marstons Mills Ma. 02668 Jul 25 2020 required for every y page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TQWT.OF BARNSTABLE J/C/ WCATI , L3 d 3 ON � SEWAGE # S- YII,LAGE_ I✓• L�✓J.-n s ,y���. ASSESSOR'S MAP&LOT LC� `',INSTALLER'S NAME&PHONE NO SEPTIC TANK CAPACITY Lb 6A1� I:EACI ?r FACILITY: (tYPe) S 42 J (size) w / . 1:NO.OF BEDROOMS -5' h BUILDER OR OWNE A �i'/ e,? PERMITDATE: 3 OW -COMPLIANCE DATE:_ >:Separation Distance Between the: k Maximum Adjusted Groundwater Table and Bottom of Leaching Facility I Feet Private Water Supply Well and Leaching Fa P Y Facility P an wel ls 8 exist :'on site or within Y ithin 20 0 fe et of le aching fac ility) cihty) Fat Edge of Wetland and Leaching Facility(If any wetlands exist :;within 300 feet of leaching facility) Feet lshed by t� ' i 1 7�_ t t of Ala ' �� �0 S � Town of Barnstable Department of Health,Safety,and Environmental Services Public Health Division Date� 7 367 Main Street,Ilyannis MA 02601 3 RAMMAarl, Time Fee Pd. Date Scheduled Jc— 3'� Soil Suitability Assessment for Sewage Disposal Witnessed By: Performed By:_ O��%✓ LOCATION/& GENERAL INFORMATION (//�SLC— / ��/ Owner's Name J`'/9�tl6 Location Address 7� � }/ Address B" ?5"l -51?""G✓/�/'/ OZSCo j 25-Z En ' a ilW OOY4e At C Assessor's Map/Parcel: /•�9'� III ���' Engineer's Name ` NEW CONSTRUCTION Y REPAIR Telephone Land Use ]®�SiyT_— )� Slopes("�o) 2t� Surface Stones Distances from: Open Water Body_W tt Possible Wet OS� Area2%�� tt Drinking Water Well Drainage Way R Property Line — It Other tt SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) PA go �� 37 a s4i sl= r-z -, - �o, 3o Sl o' /3S Depth to Bedrock Parent material(geologic) $ � w/ Depth to Groundwater: Standing Water in I tole: /��� Weeping from Pit Face IV449 Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: in. Depth to soil mottles: in. Depth Observed standing in obs.hole: in. Groundwater Adjustment n• Dgpth_to weeping from side of obs.hole: Index Well N_ Reading Date:_ Index Well level" Adj.factor Adj.Groundwater Level_ PERCOLATION TEST note ' S=9 TIMc /a Observation �f i% 2— Time at 9" I lolc N �G 110 Time at 6" Depth of Perc Start Pre-soak Time @ �fJ r ` 6� /9'n Time(9"-6") End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed !/ Site Failed: Additional Testing Needed(YIN) original: Public Health Division Observation Hole Data To Be Completed on Back---� Copy: Applicant DEEP OBSERVATION HOLE LOG Dole # 1 L Dcpth Born Soil I lorizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. % T l Ay 11 (¢-" a .-47v® ja y DEEP OBSERVATION HOLE LOG Hole# T- Z Depth from Soil Ilorizon I Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Do 0deres. % DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other (USDA) Munsell Mottling (Structure,Stones,Doulderes. i ) g Surface(in.) ( ) ( o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Doulderes. % Flood Ipsurarce Rate Map. Above 500 year flood boundary No_ Yes Within 500 year boundary No_ Yes Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required train' g,exp se nd experience described in 310 CMR 15,017. Signature Date TOWN OF BARNSTABLE j 4QCATION. 1_e2 f 3 L3 yr c"/t %�i,► SEWAGE _VII.LAGEn1�,y��� ASSESSOR'+S MAP& LOT � � V 1TJSTALLER'S NAME&PHONE NO. �� . SEPTIC TANK CAPACITY .S_Ct2 -------------------- LEAr.�vr; FACILITY: (type) i ti (size) C.1 Alv_ . NO.•.OF BEDROOMS hBUILDER OR OWNS 1.e'l.1/,q f . PERMTTDATE fJ COMPLIANCE DATE• Separation Distance Between the; f i I Maiutnum Adjusted Groundwater Table and Bottom of Leaching Facility Feet. ! Ptivate.Water Supply Well and Leaching Facility (If any wells exist oo site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet :within 300 feet of leaching facility) !�l shed by-� Feet l I . ` . %L ( . -7_�4 .v . 1 l Barnstable County Health and Environmental Laboratory Superior Court House , Route 6A P .O. Box 427 Barnstable, MA 02630 (508) 362-2511 ext. 337 Volatile Organic Analysis Analytical Method: 502 . 2 Collection Date: 03/27/95 Date Received: 03/27/95 Analysis Date: 04/03/05 Client: PATRICK LENIHAN Mailing PATRICK LENIHAN Sample Location: LOT 34 Address : 276A SOUTH STREET BURSLEY PATH HARWICH MA 02645 WEST BARNSTABLE Sample ID: 705002 Laboratory ID: 705002 Sample Description: PRIVATE WELL Compound Amount Detected (ug/L) Detection Limit (ug/L) Benzene BDL 0. 5 Bromobenzene BDL 0 . 5 Bromochloromethane BDL 0. 5 Bromodichloromethane BDL 0 . 5 Bromof orm BDL 0. 5 Bromomethane BDL 0 . 5 n-Butylbenzene BDL 0 . 5 sec-Butylbenzene BDL 0 . 5 tert-Butvlbenzene BDL 0. 5 Carbon tetrachloride BDL 0 . 5 Chlorobenzene BDL 0 . 5 Chloroethane BDL 0 . 5 Chloroform 7 . 5 0. 5 Chloromethane BDL 0 . 5 2-Chlorotoluene BDL 0 . 5 4-Chlorotoluene BDL 0 . 5 Dibromochloromethane BDL 0 . 5 1 , 2-Dibromo-3-chloropropane BDL 0. 5 1 , 2-Dibromoethane BDL 0. 5 Dibromomethane BDL 0 . 5 1 , 2-Dichlorobenzene BDL 0 . 5 1 , 3-Dichlorobenzene BDL 0 . 5 1 , 4-Dichlorobenzene BDL 0 . 5 Dichlorodifluoromethane BDL 0 . 5 1 , 1-Dichloroethane BDL 0. 5 1 , 2-Dichloroethane BDL 0 . 5 1 , 1-Dichloroethene BDL 0 . 5 cis-1 , 2-Dichloroethene BDL 0 . 5 trans-1 , 2-Dichloroethene BDL 0 . 5 1 , 2-Dichloropropane BDL 0 . 5 1 , 3-Dichloropropane BDL 0 . 5 2 , 2-Dichloropropane BDL 0 . 5 1 , 1-Dichloropropene BDL 0 . 5 cis-1 , 3-Dichloropropene BDL 0 . 5 trans-1 , 3-Dichloropropene BDL 0 . 5 Ettylbenzene BDL 0 . 5 Hexachlorobutadiene BDL 0. 5 Isopropylbenzene BDL 0 . 5 4-Isopropyltoluene BDL ' 0. 5 BDL: Below Detection Limit ! - VAR -- ._ ,� - y page 2 Sample ID: 705002 Laboratory ID: 705002 Compound Amount Detected (ug/L) Detection Limit (ug/L) Methylene chloride BDL 0 . 5 Naphthalene BDL 0 . 5 Propylbenzene BDL 0. 5 Styrene BDL 0 . 5 1 , 1 , 1 , 2-Tetrachloroethane BDL 0 . 5 1 , 1 , 2 , 2-Tetrachloroethane BDL 0 . 5 Tetrachloroethene BDL 0 . 5 Toluene BDL 0 . 5 1 , 2, 3-Trichlorobenzene BDL 0 . 5 1 , 2 , 4-Trichlorobenzene BDL 0 . 5 1 ,1 , 1-Trichloroethane BDL 0 . 5 1 , 1 , 2-Trichloroethane BDL 0 . 5 Trichloroethene BDL 0 . 5 Trichlorofluoromethane BDL 0 . 5 1 , 2 , 3-Trichloropropane BDL 0. 5 1 , 2 , 4-Trimethylbenzene BDL 0. 5 1 , 3, 5-Trimethylbenzene BDL 0. 5 Vinvl chloride BDL 0 . 5 Total Xylenes BDL 0. 5 BDL: Below Detection Limit Thomas F. Botrne, Laboratory Director r TOWN OF BARNSTABLE . 1,S-,_ATION, Log f 3 c e-S l t 4 SEWAGE ,a .VILLAGE 84-4.3 Me— ASSESSOR'S MAP & LOT '_INSTALLER'S NAME&PHONE NO. (:� � SEPTIC TANK CAPACITY ��� LE.:C�r: FACILITY: (type) � ,_di f"� ���(size) ;ar w`i �S/v-v- NO.OF BEDROOMS BUILDER OR OWNER �� ��f�C�. en t'h q/I ;PERMTTDATE: � 5/s� COMPLIANCE DATE: '.Separation Distance Between the: -'Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet 0 .coshed by ' C7 46 411 IA:7 ASSESSORS MAP NO, p— ![�� .... PARCEL NO: Q No..;(. THE COMMONWEAL �FMASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE MAR 2 9 1996 Appliratiou for Diti-Viiiial Workri Tomitrurtban ruti ... Application is hereby made for a Permit to Construct (1 ) or Repair ( ) an Ind* Sewage Disposal - System at: Or ....... 3 y'. t _( _...... ., .............................. ........ ...................... �� ----- --...--- own A,.`�dress Installer Address �/ Type of Building Size Lot- ,�_-/ ....Sq. feet Dwelling— No. of Bedrooms______ ___________________________________Expansion Attic ( ) Garbage Grinder A4 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ......... ----------------------------------------------------------------------- W Design Flow..........................._-J.....gallons per person per day. Total ajly flow-------- ...................gallons. WSeptic Tank—Liquid capacity/ gallons LengtlU4___�'P_____ Width_ ---- Diameter.--------------- Depth_.6-___...... ` x Disposal Trench—Ao. .................... Width 5.I-_-.---._.-_____ Total Length____. ------ Total leaching area.................... ft. Seepage Pit No.---- -----_-.__ iameter-----Q............. Depth below inlet... Total leaching area..................sq. ft. z Other Distribution box (d e Dosing to ( ) J ~' Percolation Test Results Performed.. ... by ®yti?� _c___ ______ Date__.� !_�3 ..___._____.. Test Pit No. 1....... ...minutes per inch Depth of Test Pit__1_...._.__.____•_ Depth to ground water."4_----- Test Pit No. 2................minutes per--inch Depth of Test Pit-_--_--__..____----. Depth to ground water-- _:___._--__-._---__. P4 •------ -- ------------•----------•-•----•---•-•-•---•---•------•--------------------------•---------•-•--•--------------------------- 0 Description of Soil_.d,—3 r -v v- S4,6 S01-4 ---- -- - - --- ---- - -- - �/ y -- UNature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------•--------__. ------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------•---- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersi ned further agrees not to place the system in operation until a i� �c�f(fpmpiiance een I by >e oar health. Signed --------- Dare Application,Approved By - Ids ' ' Dare Application Disapproved for the following reasons: -------------- ------------ - ------------------------------------------------------------- --------------__--------- -- -----------..._------------------------------- ------------------------------ -------------------------- ---------- �-------------------------- -.._.--------------------------------- Permit No. -.. '`-- � Issued ---'� " - -�„ G /- Dare r ':yam_-_(n+�.�..•r w � �—— -ate_"._--_. - _ /¢ .•,ri i "„"`_.:.+.e �.n� .ram /, /'j^'" a�'t a. /L!'✓ Fas.............................. THE COMMONWEAL �FMASS'ACHUSETTS BOAR® OF HEALTH TOWN OF- BARNSTABLE. — - +` Allphra i>an for Di-wip Sal MorliB Towitriar#ivitt ramit _ Application is hereby made for a Permit to Construct (Xor Repair ( ) an Individual Sewage Disposal System af: +3 _f3UY�(,�� °� ,6 mot/ //cation i\ arcss ............ !/' .67 4'Ml/) J C �{ CJJ_.-•- t e1 Own r ( "?A dress � T` ................ Installer ;+ �r Address Q Type of Buildingr r 'S`iz`e Lot h' feet Dwelling— No. of Bedrooms___-�--•----____________________Expansion Attic ( ) Garbage rin er ( )/1JQ Other—Type of Building ____________________________ No. of persons___-!,__!r`-r_ L��Showers ( )-- Cafeteria ( ) d Other fixtures ..._.�--- ------------------------------------------- �--•---- 1........................................................................ WDesign Flow........................... --------gallons per person per day. Total ally flow------sl � ...................gallons. 94 W Septic Tank—Liquid capacity/s gallons LengtlV _CP dth__._ Wi ._G�___ Diameter._.__._..__ _�a.._. Depth. _l __.__ . x Disposal Trench— . o. _.______ Width__I__________------- Total Length------------- Total leaching area--------------------sq. ft. Seepage Pit No..... ..__.__. iameter-----r_.--------- Depth below inlet____--------- Total leaching area..................sq. ft. Z Other Distribution box (V' Dosing tan)c ( ) Percolation Test Results Performed by QY 7 4;z___________________ __-___-__ Date...��.....!jf....... ............ Test Pit No. 1_________ ______minutes per inch Depth of Test Pit--l.- __..__.___ Depth to ground water_f� ......_..__. Li. Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ --------------------------- ------....-----------------------_................................................................. O Description of Soil__Qry 3 j`01 V- SU:B 50/'X.__ _ cxj - jw--�"--- f�N -----C�}i---_-----!--- �zJ .c� (/ ---- OFC�Dk3 .�! . * - -- - ----- W I �o�..__.. /N - F/�1��:�-iVG? Gv i xzl_' �. Z G�� `S�!L UNature of Repairs or Alterations—Answer when applicable._______ ____ _____ _____________________________•--_-_-___._.__----.-.-______------------__. -•------•-----------------------------••-•--•-•-------------------------•---••-•-•-•----•---------- --------•-•-------------------.---------•-----------•-----------•----------------------------------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation uA�a i jate�c�f�pmpliance h.as-been isspe. by the 1Soar f health. Signed .. ..: ----------- Application.Approved By ... - -- ----------- = - - ......... -- Application Disapproved for the following reasons- -------------------------`------------------------.._'......_Date----------------- . ......................... . ... ................. ...... ........_............................................ .. ........................................ �t �/ Permit No. 1.... -----o 1 .4 5- ------------ Issued. .....,7Y...:'...... i�.:L-- G �� e------ Date THE COMMONWEALTH OF MASSACHUSETTS . BOARD OF HEALTH TOWN OF BARNSTABLE Certificate of CoxttlaItttnre THIS IS O CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by ... ` .... .... has been installed in accordance with the provisions of TITI. Syf.The State Environmental Code as d scribed in the application for Disposal Works Construction Permit No. ._�2.^' ,�1-.t ._ dated �.�' e THE ISSUANCE OF THIS CERTIFICATE SHALL NO BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------n7 ...r... ..C/_ -------------------------- Inspector 1 -- - ... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Permission is hereby granted•• c-cam.Yk..... ----•-•----••-•--•-----------•.........---••....................... to Constru t or a air ( ) a Individual Sew ge Dispos S s at No.., Gl��i(,�k/..��•7�� -•-� �a� 19>�i�/ ••. St 4e as shown on the application for Disposal Works Construction P o'" 1 ___ Dat d- - Board of Health DATE.---•• -- ------•------------------••--•......••--•- FORM 36508 HOBBS 6 WARREN.INC..PUBLISHERS Bott-le Nuiber: 705001 Date: 05/03/95 BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT ' SUPERIOR COURT HOUSE VBARNSTABLE, MASSACHUSETTS 02630 • �lA SE' • PHONE:362-2511 LAB 337 Client : LENIHAN, PATRICK Collector: THOMAS BOURNE Mailing 276A SOUTH STREET Affiliation: COUNTY LAB Address : HARWICH MA 02645 Type of Supply: W Telephone : 430-0768 Well Depth: Sample Location: BURSLEY PATH Date of Collection: 03/27/95 Town: W BARNSTABLE Date of Analvsis : 03/27/95 -------------------------------------------------------------------------------- ------------------------------------------------------------------------------- PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100mL 0 0 pH 6. 3 Conductivity (micromhos/cm) 70 500 Iron (ppm) < 0 . 1 0 . 3 Nitrate-Nitrogen (ppm) < 0 .1 10 . 0 Sodium (ppm) 10 20.0 Copper (ppm) < 0 . 1 1 . 3 ------------------------------------------------------------------------------- BASED ON THE ANALYSES PERFORMED, THE FOLLOWING ADVISORIES ARE GIVEN: Water sample meets the recommended limits for drinking water of all above tested parameters . Thomas F. Bourne, Laboratory Director No. -- - Y- - � '� Fee---- - -''- BOARD OF HEALTH TOWN OF BARNSTABLE Application_*rVell Conoructionpermit Ap licat'on is hereby made forermit to Constr ct ), Alter ( ), or Repair ( )an individual Well at: Locat' n — Address Assessors Map and Parcel Owner Installer — Driller Address Type of Building Dwelling �------------ Other - Type of Building------------------------------------ No. of Persons----------------------------------------------- 0 �IP/'77 Purpose of Well Type of Well- - -- - - - --- - - 'y Capacity--- -- - - ------------- - ----— --�p ��r 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 ertificate .of Compliance has been issued by. the Board of Health. Signed - date C} Application Approved By-+ date Application Disapproved for the following reasons:----------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- date Permit No. --- V- �`�— -- -- Issued--- -- ------ - - — ------------------- date BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance �� THIS IS TO CERTIFY, That the Individual Well Constructed ( , Altered ( ), or Rewired ( ) Installer frf J �'� �`'�f�/jf- - —-- -- --------- lie 2� has been installed in accordance with the provisions of the Town of Barnstable Board o�f-Health Private Well Protection Regulation as described in the application for Well Construction Permit No. W-7 --'20---Dated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- - —------ - = -- Inspector-j---------------------------------------------------------------------- ^Nod-- � ;�: BOARD OF HEALTH +ti ... TOWN OF, B�kRNSTABL,E , �p�lication,�or:�eCl �Con�trution�ertnit Ap lication is ereby made for ermit to Construct Alter ( ), or Repair ( )an� .individual Well at: Local' n - Address Assessors Map and Parcel or � ,/�[�/ram //�yq _ L �7--�_-___—% i____ — OAzwner Addrvca �,,,:�— __ Installer - Driller s — Address - Type of Building / 1 Dwelling---���--�1 Other - Type of Building000" -------- No. of Persons--------------------------------____________ f ) Capacity-- Purpose -- 0- 6--'-I P-Type ofWell of Well--- me �__�A7�_ WRPy -- - - --- — 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 date Application Approved By J - � "s------ -- -— e7�� - ��' .; / date Application Disapproved for the following reasons:----------------------------------------------____________________—__________ ------------ -- --------- -- — ---—--------- ------ -- - - - -------------------------------- _ date Permit No. --- _ _ � ----- Issued--- - - - --- ----- ----------------- ;date ?fir' BOARD OF HEALTH TOWN OF BARNSTABLE . Y Certificate ®f Compliance THIS IS TO CERTIFY, That the Individual Well Constructed ( , Altered ( ), or Repaired by-- - - �IW_4------------ 'r' ',fib'/ ------ Installer �/ '. at- ---��--�_ ' --k��-ram-- � -�� -------------- 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. �-� - Q___Dated---�--`/q---',,e f THE ISSUANCE OF THIS CERTIFICATE SHALL-NOT BE CONSTRUED AS A GUARANTEE THAT THE WEL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------—- - -- --- - — - - Inspector-,---------------------------------------------------------------- -- BOARD OF HEALTH TOWN OF BARNSTABLE ° Melt Construct ion Permit No. -- CL r Fee ------- s Permission is hereby granted�� P�/"_ � � �il �✓ ` � to Construct ), Alter ( ), or Repair ( ) an Individual Well at: No. - � .t. � ` _ -------------------------------------- street as shown on fthe application for a Well Construction Permit ; No. -----------�" q- — ----- -- - Dated----- "� -^ ��------------------------------------ ----------- ------------------------ -- ------------ -------- -- Board of Health DATE---- -- , - Bott1P Number: 705001 Date: 04/03/95 f `: BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMENT 0 SUPERIOR COURT HOUSE V [iJ BARNSTABLE, MASSACHUSETTS 02630 PHONE: 362-2511 ! LAB 337 Client: LENIHAN, PATRICK Collector: THOMAS BOURNE Mailing 276A SOUTH STREET Affiliation: COUNTY LAB Address : HARWICH MA 02645 Type of Supply: W ! Telephone: 430-0768 Well Depth: Sample Location: BURSLEY PATH Date of Collection: 03/27/95 I Town: W BARNSTABLE Date of Analysis : 03/27/95 (Lot 34) PARAMETER SAMPLE RESULT RECOMMENDED LIMITS Total Coliform Bacteria/100 mL 0 0 pH 6 . 3 Conductivity (micromhos/r_m) 70 500 Iron (ppm) < 0 .1 0 . 3 I Nitrate-Nitrogen (ppm) < 0. 1 10.0 Sodium (ppin) 10 20 . 0 Copper (ppm) < 0. 1 1. 3 BASED ON THE ANALYSES PERFORMED, THE FOLLOWING ADVISORIES ARE GIVEN: * Water sample meets the recommended limits for drinking water of all above tested parameters . Thomas F. Bourne, Laboratory Director f I BENCH MARK : t,!il �� � fr , AJ A,� nAz r ti - . y T E S 1' H 0 L E RESULTS �yl F i DATE ' r._ WITNESSED HIGH GROUNDWATER ADJUSTMENT • - �- OBSERVED WATER DEPTH LOCATION MAP y ' � ,� �, �� ti ��, INDEX WELL TEST HOLE TEST HOLE #2 WATER RANGE ZONE °• ` �' CURRENT WELL DEPTH . x ' WATER ADJUSTMENT ;`: r ESTIMATED DEPTH TO WATER Al ESTIMATED MAX, WATER ELEV. r T o -:? Or 84 GROOND WATER GROUND WATER ENCOUNTERED ENCOUNTERED - ', '' �' - a•- Tq MANHOLES AND COVER TO BE BUI LT TO Z ELEV. TOP OF - -' ►''� w;c WITHIN 12 OF FN1SHED GRADE FOUNDATION .: FINISHED GLADE MIN. 2 % SLOPE str` a ,�\�t c,r A. 4" DIA. -_-- ' 4tDIA. PIPE ,, �"'�,✓ / PIPE — ^'�,�, MIN . PITCH l/• FT, �2' LEVE _ MIN . 2 tLAYER OF MIN. M,.. , . • 1�g-►�2 P E A S T O N E PITCH N. ov N _ .. INVERT ��. ! NVER1 C INVERT, ' © ' SuMP INVERT RT w, WASHED DSTONE w a 1 1�I V E R L_W' __ _w !N BOX r R c.a ._�� INVERT `;® w Y I ®. ALL AROUND 7 A0�E y- ,. a ,.FI RM EBA -- Q T AT LEV, 00 MIN) BOTTOM E — GARBAGE 2 0 M N S s� _ J } PROFILE OF _y- SANITARY DISPOSAL SYSTEM �., ,. ( NOT TO SCALE ) f <. DESIGN D A T A ` ` 5 Tp � _ _ _ • �- 1) CONSTRUCTION OF SEPTIC SYSTEM SHALL CONFORM TO THE COMM. OF MASS, ENVIRONMENTAL CODE, TITLE 5 BEDROOMS AND THE TOWN BOAR' OF HEALTH REGULATIONS . DESIGN FLOW -� fO GAL /DAY 2) THE DESIGN IS TO BE STRICTLY FOLLOWED . CRAI G R . LEACH RATE t_ MIN./INCH SHORT IS TO BE CONTACTED PRIOR TO ANY CHANGES. w'• SF 43_ tom- ''� � � PROP D. BOT AREA � . PROP'D SIDE AREA '%�' ,�i �� �• SF 3) SEPTIC TANK, DISTRIBUTION BOX AND LEACH - �-' ING UNIT TO BE OF REINFCRCED CONCRETE TOTAL AREA = w""'- SF MIN. CONCRETE STRENGTH = 3000PS. I. PR0P4S:ED LEACHING CAPACITY ti GPD REQUIRED MIN. STEEL STRENGTH 20 , 000� P S. I . �: `'_``"� LEACHING CAPACITY GPD MIN. DESIGN LOADING : REQUIRED SEPTI C TANK °5'- �`, - GALLONS 4) DRIVEWAYS NOT TO BE LOCATED OVER SYSTEM UNLESS H2O DESIGN! LOADING IS USED PLAN SCALE—: (11 = J1 . 5) ALL PIPES AND FITTINGS TO BE WATERTIGHT S A AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DATE CAUTION - CONTRACTOR TO CONTACT DIG-SAFE 72 HOURS PRIOR TO EXCAVATION I I SITE PLAN SHOWING PROPOSED CONSTRUCTION ZONING DATA LEGEND Y � LOCATION � = � w - ; Z O N E _._. -�,�..� 4— a. FOR :R f� .v ATE �' .� "` D TEST HOLE LOCATION _ ;. �. ` � � REFERENCE • LOT �" AS SHOWN ON REVISIONS • � � ;,,_ 4;` ': _ REQUIRED AREA EXISTING SPOT ELEVATION 17.6 ;{ w � 0AF F7 �_ 1 ► , - .-A ; '• REQUIRED FRONTAGE : EXISTING CONTOUR — — 16 — c REQUIRED FRONT SETBACK : PROPOSED _ CLIENTS ADDRE „ S ' CONTOUR I6 IF THIS PLAN DOES NOT BEAR A RED STAMP BY CRAIG R, SHORT, REQUI R E D SIDE SETBACK WATER SERVICE LINE ----W �' a THEN IT IS NOT A VALID COPY 8► i ASSUME NO RESPONSIBILITLY REQUIRED REAR SETBACK : GAS SERVICE LINE —G SHO'� � �� '`�` ` FOR ITS CONTENT OR USE . ELECTRIC 8 TELEPHONE LINES - E a T— ��` CRAIG R . SHORT , P. E . L ��� PROFESSIONAL C I V I L ENGINEER BUILDING INSPECTOR APPROVAL DATE r24197 14 TORY LANE , DENNIS MASS. 02638 FILE NO. . r.r 30 SHEET I OF BENCH MARK ; s r , TEST HOLE RESULTS 0 giET DATE WlTN E S S E D BY • HIGH GROUND-WATER ADJUSTMENT : r, < , f << ` OBSERVED WATER DEPTH LPCAT ION MAP INDEX WELL TAT HOLE'm' i TEST HOLE �2 , WATER RANGE ZONE ` " ' ------ 4f " ! CURRENT WELL DEPTH WATER ADJUSTMENT 1 ' �` " - " ESTIMATED DEPTH TO WATER ESTIMATED MAX, WATER ELEV. r T -34 ;. 49' a.. r GROUNWATER GROUND WATER w ENC0UAtERED ENCOUNTERED HOSE AND T I _F MAN N D COVER V 0 BE BUILT 70 f� •° r', ,''r r 'e 2 E L E V. T 0 P OF �� FOUNDATION WITHiN I2 OF FINISHED GRADE o FINISHED GRADE MIN. 2 /o SLOPE 4 DIA. --- ---- . PIPE FIR 2� --- ,taa r ..: ___. MAN _. 4 D ! A � g Mt MIN. LAYER OF ✓ A� PIPE MIN . PITCH I/ FT. Z• LEVE i aDe i . I,gaa PEASTONE MIN PITCHi�'..+r.� �¢� �-, � -• t-, I N V E R T ry j GALL �N INVERT � 7 ,�"susHv I I'i V E RT :.® D .I I I ;M^ P T # C TANK � �+ ©• WASHE QST E �2, l0 INVERT_. .,. VE BOX q ONE _.--f D I S T ct A jg INVERT T `' AROUND _r,� ; < _ _ C E ON NV I E M : e k ALL. a F I R M B A S E �10 ) BOTTOM AT IN! N � _ ELEV. GARBAGE ( 0 MIN ) .a tG A R 2 ' x �- PROFILE OF n. ELEV. 4 ; AI SANITARY N I T A R Y DISPOSAL SYSTEM F _ ,� _W �nfVw � ( NOT TO SCALE „VA ` _-- D E S I G N D A T A i 1) CONSTRUCTION OF SEPTIC SYSTEM SHALL CONFORM TO -190• ,��,•-----..,... - THE COMM, OF MASS. ENVIRONMENTAL CODE, TITLE 5 BEDROOMS " ~ AND THE TOWN BOARD► OF HEALTH REGULATIONS . ...._.. . DESIGN. FLOW GAL./bAY R 2) THE DESIGN IS TO BE STRICTLY FOLLOWED . CRAIG R. LEACH RATE = MIN./INCH �►- SHORT I$ TO BE CONTACTED PRIOR TO ANY CHANGES. ] l PROP 0. SOT AREA ` • .�{ S =' . I PROP'L1 SIDE AREA ` r "�' " �,, SF - I 3) SEPTIC TANK; DISTRIBUTION BOX AND LEACH- 3S - - ,, ING UNIT TO BE OF REINFORCED CONCRETE ,,, TOTAL AREA SF MIN. CONCRETE STRENGTH = 39000PS. I. PROP S p I.EACH,iNG CAPACITY :� EPD MIN. STEEL STR N G T H 2O,000 PS. I . REQUIRES LEA°CHI'NG CAPACIT Y� GP0 MIN. DESIGN LOAD ING : ;' REgUIRED SEP7) C TANK = GALLONS q) DRIVEWAYS NOT TO BE LOCATED OVER SYSTEIIr ' ' , . UNLESS H2O DESIGN LOADI-NG IS USED I „ _ ,+ 5) ALL PIPES AND FITTINGS TO BE WATERTIGHT PLAN SCALE ' I ti� AND TO BE OF CAST IRON OR APPROVED P.V.C. HEALTH AGENT APPROVAL DAT CAUTION � CONTRACTOR TO CONTACT DIG — SAFE 72 HOURS PRIOR TO EXCAVATION I . SITE PLAN SNOWING PROPOSED CONSTRUCTION LEGEND . � X��. L 0 CA T 10 N � ZONING DATA ;�:+ n . "L Li Qwi.Cox t FOR : r,. .j : "". aft „ " ? — DATE . ,. .. � y Z0N E ' Pi- - k- - a =E,.",rTTEST HOLE LOCATION .3',$ REFERENCE C w.. ONS REF E LOT AS SHOWN ON RSV 1 S REQUIRED AREA , ..' � , � K! Af' ,+ ... a ,' ' _._. •R _ EXISTING SPOT ELEVATION 17. ° -- REQUIRED FRONTAGE � . EXISTING CONTOUR _ — 16_-._- . _ .' r�° ... 4 > � a ° _ CLIENTS ADDRE .. S -- _ REQUIRED FRONT SETBACK : R PROPOSED CONTOUR 16 M IF THIS PLAN DOES NOT BE A RED STAMP BY CRAIG P. SHORT, fafi THEN IT IS NOT A VALID OPT' I ASSUME NO RESPONSIR1�_!TLY, REQUIRED SIDE SETBACK ' ____ ,� WATER SERVICE LINE W f 1=0R ITS CONTENT- OR USA REQUIRED REAR SETBACK : GAS SERVICE LINE G-=--- -- h. I ELECTRIC 8 TELEPHONE LINES ---E a T � m �4m CRAIG > E . PRO FESSIONAL C IV I L EN 01 N E E R >' BUILDING. INSPECTOR APPROVAL DATE la TORT LANE , DENt�Is , MA3S, 02 +� � FILE N0. ( 308) 388- 6530 SHEET I OF