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Home My WebLink About0120 BUTTON WOOD LANE - Health 120 Buttonwood Lane Y West Barnstable s A= 217-008 a No. 4210 1/3 BLU ESSELTE r 10% � O ® 0 0 }TOWN OF BARNSTABLE LOCATION'',{a(dG(N� SEWAGE# VILLAGE ASSESSOR'S MAP&PARCEL 2/7�tF INSTALLERS NAME&PHONE NO. +H OM 6qb f 46 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) (size) NO.OF BEDROOMS OWNER _ PERMIT DATE: c - 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)P_ Feet FURNISHED BY �/ FOtc) 5 ol7o 7 rtfo 301 v I r e� --4/5,0 /AkSP Pd14- _ So No. t0 — / Fee 100 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZippYi ratio n far Migozar bpgtem CCon!6trurtion Permit y�^� Application for a Permit to Construct( j"Repair( )Up rade( )Abandon( ) ❑Complete System ❑Individual Components Y(�' Location Address or Lot No. ej4W k&V6�. Owner's Name,Address an4 Tel.No. Assessor's Map/Parcel / Installer's Name,Address, d Tel Np. � a � �� Designer's Name,Address and Tel.IYo.C"Jo Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building A16744-e- No.of Persons Showers( ) Cafeteria( ) Other Fixtures/ Design Flow !66 gallons per day. Calculated daily flow -33 C) gallons. Plan Date 4NIOG Number of sheets / Revision Date /y/11 Title Size of Septic Tank / y Type of S.A.S. � /� /� Description of Soil! f Nature of Repairs or Alterations(Answer when applicable) ,5 0. . Date last inspected: Agreement: The undersigned agr to ensure e co s d mai enance of the afore described on-site sewage disposal system in accordance with the provisions f ' e 5 vi nm 1 Code and not to place the system in operation until a C rtifi- cate of Compliance has be by t ' th. Sig ed Date Application Approved b Date ✓ Application Disapproved for the following reasons Permit No.sDC�G —X7 Date Issued � •' �� a; Fee /00► THE CO ONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION = TOWN OF BARNSTABLE., MASSACHUSETTS ZIPPrication for Di5po.5ar *pgtem, Contruction permit Application for a Permit to Construct( )Repair( )Up grade( )Abandon( ) ElComplete System ❑Individual Components C Location Address or Lot No. Owner's Name,Address p4 Tel.No. t Assessor's Map/Parcel Installer's Name,Address,a9d Tel.Nam, Designer's Name,Address and Tel. d. �• �-p �Oi�SULTf� v�9 (v (�Kl-t)�' 1/l�0�j-�lj -7 `7 Type of Building: Dwelling No.of Bedrooms -3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building /=k� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow a33-. gallons. Plan Date tD Number of sheets_ 9 Revision Date Title Size of Septic Tank soe, e Type of S.A.S. 1! (.5.5 44 •fIV r° ��- Description of Soil Nature of Repairs or Alterations(Answer when(a�p/licable) I X0 "7 Date last inspected: Agreement: The undersigned agrees to ensure e co str 'on d mai enance of the afore described on-site sewage disposal system in accordance with the provisions fT't e 5 t Envir nm n 1 Code and not to place the system in operation un 1 a Certifi- cate of Compliance has be iss �by t 's -.. 4f_ ealth. �� ;Sig}�ed r Date y Application Approved:bNa Date �S Application Disapproved for the following reasons Permit No. 6 —"Jg � Date Issued �V�t�THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded'( ) Abandoned( �by ' at has been constructe4 in ac ordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ( fo"137dated .� Installer Designer. The issuance of this permits all hot b/e construed as a guarantee that(te system 11 function as designed. Date Z�/ n InspeNor�_ No. (�C�CS�' f� ! ------------------------ Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE., MASSACHUSETTS Mfi5pozat *vztem Couotruction Permit Permission is hereby granted to Construcjt(� )Repair O pgrade( )Abandon( ) System located at and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to ti comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be/completed within three years of the date o this perm . Date: (� _Approved by A �a �; .TM2 - • . :!: � � -- fJ �I �' '1�/ r� 1 � -/ V �� -_ y ? FROM FAX NO. May. 08 2006 10:18AM P2 Matj 07 06 07:26p 508 833-217? p. 1 - t Town of Barnstable E` Regulatory Services m� Thomas F.Geiler,IRtrertor Public)Health Division ay - Thomas McXean,Director 200 Main Street,�Tjyannis,i'r1A 02C&A Office-.508-862.4644 ItGY.: $08-190-Eri3�� Installer&DeS111ner Certiflcat:ion Form. Dare: Designer: ,_' installer: �o� ; (bC� Address: f On WZ.S issu.cd a pemi t to install w.•taa � I a sept+o s'me=at 1 " a 1 ) 1 � IigecI on a design drawn by (ems) dated _ b� — - certify that the Septic System referenced above ;uvz t,nstalled,�si., se+b.st-maccording tc ly according the deei 'w1kich may itacinde.nuin�or approved ��e.c such 3atcZal relocationaccor cif the distribution bax and/or septic tank. Y comfy that the septic system referenced above was ;wga.txl with major edges (i' P�t eater than 10' lateral relocation ofe cr1S or aoy vetcbaj re7ocatiariz.or isizy coaapani o f tl,r septi-rs sy.tew)brat in aeoordAnce�vitb State&Local i Regruatious_ 1'Iau rcrisioa or wr filAl as-heti1t by de,Sigu to f'a11�nv_ �,�OF (rxasta cr'sianarare}� o� DaviU �9y B. `1 1� MASON m, C9 P.r'3 '1�1F3.tL'rf:D ••"� (f+itX, r s ITl - PLEASE RETL11ZN TQPLJfSJL.IC x •1 331° ` 1 CO1V[PT IVOP1 . .;S --- �— -'E+R'I'fF�CATE � t�! I,., �: E17 , IT?31 1L, A0TH •THIS�'d�f21d�j�5 �.�$,�� .R ,�z�,c;�.v�i�A,.�.`$�r'z�� .�.��T�x��l.�, Pt��c��:,��• �x�I�r�r. Q:7rle�ithJ3ep4clileai��er C�nii)c;rhUn Faun • 1 Rpr 25 06 04: 14p 509--633-2177 p. 2 LNotice: This Form Is To Be Used For the Repair Of Failed Septic Systems Only PERCOLATTON TEST AlvD S011 LVALUATION FXEMPTION FORM f.creby certify that the plan signed by-me dated. l�/V ,colleenung the- property located at i'7 �� i�i1 > l ,�' _ �:c�tUwt �11 of the following criteria-. .r Two soil evaluations eaca:gated for detailed.examination.(nio :xetcl aau4;crii�v)ancl two percolation tests shall bnt conducted. 1?ais.Railed systety, is connected to a.residential dwellini a ai-Ily. �Here are GO c.,nlmercial or buSiij!m uses associa ed with the 6velling. The,soil is classified as CL.^i.SS I and the n,rcolation rate is less than. 4r equal to 5 nunutrM- mrinch. There is no increase in flow andfor change in:sse proposed 1%There are no variances reque fed or needed. f 'The bottom o:j%e proposed Imchie;;taUiIity wII?he located r.ct inns Char.five Ree-above the :1>axitnum HdjustYci g,daudv,atcr iiHC CIO",atiOTI. �(�ll�ityl gl'OlIIICjiJatCr`?i?I[;?IF?ii�tli` Frirnptor inethod when-applicable] lylcase complete the follovt7ng: A) TOY of Ground S-o.face Elevation (tt;arng t"IS znfczroatiotk) '730+ B) G,'. Elevation/S/0 +adjw;taleud "Or ta:gl:Ci.';"t' G , /6,- - DIFFERENCE BETWE-EN A and 3:3 SIGNLIJ"� NOTICE Bast-d upon the above in.formatiorp,'A r air pe1jait will be,issued for bedrooms rra.xiinum- hIo additi:jual bedk:0u;w-1 sue«uUkorized in the future w'tt t h kr�u esr&ceeecl..el►1k:5ysteeri pians. tj tScpL:,�prrce�:eir p.do�: Rpr 25 06 04: 13p _.._. .-.--..__._..-....._..,_.. �...�__�._,,..2. 500-833-2177 p. 1 J fir' __-___ —• -. � _..__. _ • N 1 1 rCENTER 802.60' RAILROaON. A. ?654' �� /j ` 5.32 IP FNJ � L-OT 1 G V DNiLGo IP FND OH ' SHED r-ND 133.78) o� PONU r _ DH FND .. WETLAND �� _ er 1 1 �`� �.•!,` x lFw _` ` I IP SET IN STNS v Vl �a\ A �CB FND IP FND �\ `f ��• BROKEN p O In FND `!9`� �',C8 FND N 3� ,+ . \ c, t:p S p�m PoK p C6 FND A' l�f - 267.40' gTx SET NOTE: POND AND WET'-AND LOCATION TAKEN Qq� ty. FROM PLAN BOOK 232/59. I � �1 Of M PETER °�y CERTIRED PLOT PLA. sw.l` — — E No. 29719 4 PREPARED FOR. GREGOR%' L T�`�''L k•^`1N� 5510�� LOCATION: Zo t3urtc�t>/ann L:v. ;GIN: �.v, S.cl?.r7sTAF-, C NA. ldyo suavt��Q SCALE: t ZOO GATE: APR. Z, i'19b DEED 800K: CTf. A;Sk'S. .Hr;P: 2(7 PARCCL: 6 L C -t ,• PLAN BOOK: Z3Z/59 LC P-AN: FILE. ZO?-Z PRGEESS!GNAL LAND SURVEYOR I HEREBY CERTIFY THAT THE Pw'F-CLIn C- SOULE LAND SURVEYING ;110WN ABOVE IS LOCATED ON ;HE GRO Ir;O AS INDICATED, 103 vESPER PON4 DRIVE 6REWSTER. AAA. 02571 (506) 255-4728 _ BORTOLOTTI CONSTRUCTION, INC. r. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop n;Q 32%1ZP6CX)0 n zlL Date of Inspec��/ PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. NONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO /THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED. NOTE IF THEY ARE NOT AVAILABLE WITH N/A. HE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. ALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. HE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. ✓'THE SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. 6—THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION RESIDENTIAL FLOW CONDITIONS No of Bedrooms 1,2 No of Current Residents _Garbage Grinder yt�5 Laundry Connected to System Q Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER READINGS,IF AVAILABLE: Pumping Records and Sourc of Information: GALLONS SYSTEM PUMPED AS PART OF INSPECTION? IF YES,VOLUME PUMPED GALS Reason for Pumping: TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system (if yes, attach previous inspection records, if any) Other(explain) Appr imate age of all components. Date installed,if known. Source of information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? CS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC TANK: De 6 below _ /O 53 if / J Dimensionsib, ` ♦ X / X� Material of construction: & Ooncrete Metal FRP Other} C O Sludge Depth G Distance from top sludge to bottom of outlet tee or baffle Scum Thickness Distance from Top of Scum top of outlet tee or baffle Distance from bottom of Scum to bottom of outlet tee or baffle Comments: Q WPC 573 Q 1 16 0z ,s 3� s«17) 62,6117r► DISTRIBUTION BOX: DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: d d� PUMP CHAMBER: Pumps in working order? Comments: SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: / TYPE:A O A)i'? G'ec T Comments: CESSPOOLS: Number and configuration Depth—top of liquid to inlet invert Depth of solids laver Depth of scum layer Dimension of cesspool j Materials of construction Indication of groundwater inflow(cesspool must be pumped) Comments: PRIVY: Materials of construction Dimensions Depth of solids Comments: SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST TWO PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' r� � f 0 yl' DEPTH TO GROUNDWATER: Z O DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: e / /h SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA V/V (IndicateY—yes N—no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? . I Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? 1 A/ ,— Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? f Required pumping 4 times or more in the last year? Number of times pumped I�! Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiftration? T tank failure imminent? Al Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? i Within 100 feet of a surface water supply or tributary to a surface water supply? i Within a Zone I of a public well? Within 50 feet of a private water supply well? �Y Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools &privies only, not the SAS)? Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. j I i II PART D — CERTIFICATION !I INSPECTOR: ROBERT J. BORTOLOTTI ADDRESS: 765 WAKEBY ROAD, MARSTONS MILLS 1 I'COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508) 771-9399 CERTIFICATION STATEMENT II I CERTIFY THAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION j REPORTED IS TRUE,ACCURATE AND COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE I IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. �I CHECK ONE: II I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC j HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED ARE AS j! STATED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. I I� 1 HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS i FORM. jl I II INSPECTOR'S SIGNATURE: �i DATE: j ORIGINAL TO SYSTEM OWNER,COPIES:BUYER(if applicable),APPROVING AUTHORITY I -1hux 41-aa TOWN OF BARNSTABLE LOCATION 14 ) a SEWAGE # VILLAGE , r4fYc l �i, ASSESSOR'S MAP 6t LOTT�/ -�(J� INSTALLER'S NAME & PHONE NO. Cy� � � SEPTIC TANK CAPACITY 670 0 i. LEACHING FACILITY:(type) ; . Imo, (size) X -NO. OF BEDROOMS ) PRIVATE WELL OR TIER t O%UILDER OR OWNER DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: � � - VARIANCE GRANTED: No _r t . 4�� ASSESSORS NO: Z/ C� PARCEL NO. r7� Fxs....�s.5.............. THE COMMON TH OF MA HUSETTS BOAR® OF HEALTH ...........................................O OF.....15�iv.STABI�-•-------------------------------- l � Appliration for Biopoaal Works Tonitrurtion JIrrutit Application is hereby made for a Permit to Construct (✓S or Repair ( ) an Individual Sewage Disposal System at: �T'S`�� St,7'�n/iMoaD L � wr A197ZI1e�ST)9gL� ---•---•---....--•-•----------------•------•--------•---•----------------•----•-------••--•.------ ----......---------•----•-----....-----•-•--•----•-----•--------•---------------•....------------• Location-Address or Lot No. _... LS� r Owner Address MA7?,S�NS Mi�G s Instalier Address Type of Building Size Lot_�y_73C._...Sq. feet -t Dwelling—No. of Bedrooms.............3....._......_.....___-__--Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures __________________________________ W Design Flow................ ............_..._..gallons per person per day. Total daily flow__._........._3............................................gallons. G: Septic Tank—Liquid capacity Z 4!'P.gallons Length.A JL"... Width.I�"__. Diameter................ Depth__-►`__�'&--". Disposal Trench—N?o_ ____________________ Width.............._..... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No.._.........____.. Diameter.....�'` _�___ Depth below inlet.....3:-`^�... Total leaching area_�a7.q_.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by........ .................................................. _ ...... r 41 1.4 Test Pit No. 1---G.4----minutes per inch Depth of Test Pit-__146�.. Depth to ground water....................... Gi, Test Pit No. 2...L..--'`_--..minutes per inch Depth of Test Pit....I6��---- Depth to ground water_--_- a -•-•-------•---------------------------------------•----....----------..............---_----- O Description of Soil.........!?."�-/B'� (.oA+ti a S'✓3:sad G /8'=78"ti�Sgivo '746'•-60 ---------- ------------------ --- - --- - - - V -•----•-•-----------•---....-•-------••-------------------------••------------------•-----•------ ------------- W .....C---—i56L�?�Z•----P-/--5---0------O a --Wtav-ALo!d'7_. sc,�sol------36"7zl.��e�'8 0�'r1dD S/devA l ' ---•-------- V Nature of Repairs or Alterations—Answer when applicable__------_P_�� s' -72`=/Bo U vv -------------- ------------------------•••--------•-•-•----••...._..--------------•----•------------------------••-•------•-----------------•-----•--•-•------.....-••---••-----•••-•-•-•••----•-•-•-•••-----••-------. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iT I:". p 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been is u by th board heal Signed-- ---................................. Date Application Approved By....... r---� �.t -----••-------------•--------.-------- Date Application Disapproved for the following reasons----------------•-------•------------•----------------------------------------------------------------........... •---------•-----------------•---------------•------•-----------...-------------------------•-------------•------•--------------•------------•----•-----•---•----------------------••--•---•-----•----•-- e Date PermitNo.....--d/-... --------------------- Issued_------------------------------------------------------- Date • 1 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------- ---Tv /_ 1/..........0F....i�i /zi•!/5_Tf113G " , ppliratinn for Dispasal Vorka Cnnnitrnrtiun ramit Application is hereby made for a Permit to Construct (✓) or Repair ( ) an Individual Sewage Disposal System at: ..............................................? Location-Address or Lot ATo. Owner �- ---..._..--- Address --..... .L..t.G��2----------------•----•--••---.......... --•-M.......zSTz.n!��......Mi......I........................................ Installer Address d Type of Building Size Lot' T.7,3 .......Sq. feet Dwelling—No. of Bedrooms......_....3............................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ...........................• No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures ... W Design Flow............... ` ....................gallons per person per day. Total daily flow............. 3 .....................gallons. WSeptic Tank—Liquid capacity/_,;a ira..gallons Length_�+��_".._.. Width�`-6____... Diameter................ Depth-�.:8_".. x Disposal Trench—NTo..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No--------/-._--_____- Diameter....`4......... Depth below inlet.... : '__._.. Total leaching area:3oZ.�....sq. ft. Z Other Distribution box ( ) Dosing tank ( ) `-' Percolation Test Results Performed b /�'-_.� 2. e"3 �/6.! ___________, - 1/ Z 3 W Y ...... = = Date. ... Test Pit No. 1.. -__..minutes per inch Depth of Test Pit..lti�.".... Depth to ground water....'.^........,_.. Lz. Test Pit No. 2..4._!�_....minutes per inch Depth of Test Pit...l44........ Depth to ground water........................... a ....•................................................................-•----------......----••--••-•......................................................... 0 Description of Soil------.G' f?.,'...eo'p-"I ..av� ._5pi_4 ...... ."_ ."O �s `'.......................................' ..... ala W x ...--•-----•------------•--......•••--------•••-•--••---------------•••-••-••-------•------•-•----------••-•-•---------------•-•--•----------......-••-•-••-•----...................................... U Nature of Repairs or Alterations—Answer when applicable----------------_-------------_---------------------------------------------------------------- -------------------------••• --•----•-----••••--•-•--•-•--••------•--••--•-•---••-------••-•-.-------•----••-•----•-------------•---•------•---••---••---•••-----••-•-•--•-•---•-•......------------•... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of T 'I'l-E j of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ................................ Application Approved BYE --`•...�: -� •----------------------- ------------ Date Ell, Date Application Disapproved for the following reasons--------------------------------------------------------•------•--•---------------------------------------.....-- ----•-••••-•-•----••---•------•--....-•--•••------------•-----•••-•••--------••--------••-•----•.....-----•--------•-----•--•---••----•-----•-•---•-•--•••----------••--•------•--•-------------------- Date PermitNo.... ---------•------------ Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. ........OF...... `....................................... QW if irate of fauntpliFanrr THIS IS TO CERTIFY, That the I d�v- ual ewp �is�System constructed (/}" or Repaired ( } by . -•.�� _ ....- • :. - �---------�..................................................................... O Installer at. /i t't•f 1i' is 2,�!.1X`r: ......3 cc. (=t has been installed in accordance with the provisions of T i T IE j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No._ 4'._._:__ / .,l._____-_•_- dated-.---------------------------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT YHE SYSTEM WIL CTI N SATISFACTORY. DATE z� -------------•-••----------•--•----- Inspector.................. // THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH Gov,r�............._OF._............................................................ G .......... .. •....................... �- NO.•,1.. .....?f--f• FEE.. - ?--...::.... Disposal Worbi 0-51anstr ivi rrntit Permission is hereby granted.....fL-L . Construct Joo) or Repair ( ) an Individual Sewage Disposal System at \o.- a .............U./------k. c:c._:r.f.�_" '' ------------------------•-------------•- Street, as shown on the appplicati n for Disposal Works Construction Permit No.._....... Dated...............................::.::...... ........... . .. Board of Health DATE.....................•-----------•---------•------••-•---•-----._.. FORM 1255 HOBBS & WARREN. INC., PUBLISHERS '`c Department of Environmental Management/Division of Water Resources *� WATER WELL COMPLETION REPORT WELL LOCATION Address 6 /3 a fh"I I Do n j �i9-✓1 � City/Town + 01 rf- V S'c 13L7— G.S.Quadrangle Map Grid Location fry Owner H /Y A.-W Address Gam' .S A!/s ® fan WELL USE CONSOLIDATED WELL Domestic, Public ❑ Industrial❑ Type of Water-bearing Rock Other Water-bearing Zones Method Drilled 1) From To 2) From-To- Date Drilled 3) From To - 4) From To > , CASING r# Depth to Bedrock Length +a Diameter oC Type UNCONSOLIDATED WELL STATIC WATER LEVEL Water-bearing Materials Feet below land surface "%& f r Sand: fine❑ medium❑ coarse( Date measured s-"-/ F- 19 7 Gravel: fine❑ medium❑' coarse❑ Screen: GRAVEL PACK WELL g , ,�to_2 Slot#/d length from w�L_ Yes ❑ Notq Split Screen (or 2nd screen) WATER QUALITY TESTS MADE Slot# length from to Chemical ❑ Biological CK Depth To Bedrock PUMP TEST i Drawdown feet after pumping .days hours at GPM. How measured Recovery feet after hours. LOG of FORMATIONS COMMENTS: (On well or water) Materials From To ° l � z. , DRILLER m L/ Firm �7ftiI1 ° fn O sya Address dap% ` Cl2S f0 0 4,7City i Registration No. Operator's Signature t Log' Plumber: �' �� Bottle # E659 Gr;,..._e; <,May 21' 1987 °f B`'Rti BARNSTABLE COUNTY HEALTH AND ENVIRONMENTAL DEPARTMEN f SUPERIOR COURT HOUSE____, C BARNSTABLE, MASSACHUSETTS 02630 V AS6 DRINKING WATER LABORATORY ANALYSIS = PHONE: 362:2511 1:1uf. Ext. 337 Cl ient: 3°a : ..: . : Jeff Hoffmann-;", ,;.• ,,Collector: ,; D. Chappel l Mailing Address • 10 Ocean Street- ,,:,,. ;. Affi 1 iati„on:,.% f, - —well driller f= >> r Hyannis . MA 02601 ; Time, &, Date of-,4j 11:J-J' Collection , 5/18/8Z 4.00 Telephone: Type of Supply: we11 Sample Location Lot 16 Buttonwood ( aria Well Depth: 671 W. Barnstable- MA Date of Analysis: 5/19/67 10•45 a m PARAMETER SAMPLE RESULT., RECOMMENDED LIMITS:. Total Col iform Bacteria/100 ml 0 pH _ 5, Conductivity (micromhos/cm 500.0 . Iron (Rpm) �- .= f, . •,: r .„, :� .,•_ ;0.3 Nitrate-Nitrogen ( m 10.0 Sodium ( m) 14 ,. 20.0 I . X Water sample meets the recommended limits for drinking of all above tested parameters. LI . Based only on results of the parameters tested for this sample, the water is suitable for drinking but may present, the problems checked below:, A. Water- sample has higher than average levels of,Nitrate..: Future monitoring is recommended (2-3 times per year) to establish any upward trends. B. The low pH of the water may shorten the useful life of the house's plumbing. C. Water. may present aesthetic problems (taste, odor, staining) due to :. .. f r> E _ � �, °",i�C_ �1 � .. . :t °t .r`. _ - .,err .+3 a. ., j;• � •>`, D. Water sample has - , , • � 1 ; , p s high levelskof' sodium.s Persons 4on low sodium*diets -should _ 9 consult their doctor. III. Due to one or more of the reasons checked below, this water sample is unfit for-- human consumption,, ,, A; ;, High Bacteria., B. �,., High Nitrates z ;. _ �:•, �:, r 8: . � r = , ,; a. �: The Bar nstable Qunjy H.nlf{ nr,.Lnyironm.ental REMARKS: 1 t:_ r; : r �.s. f Department shall not endorse any statements, interpretations or conclusions made by anyone else concerning these results without written consent. CC: Barnstable Boardof Health CC: Clifford Well Drilling 1171g Laboratory Director _ 1 � �T�� L,q-fi •SA��T. / cf Z Sf1Ecz.TS LOCATION . WEsT, ,�? ivs7- BGE" ... ... SCALE . .�:!oo:. . . DATE PLAN REFERENCE , ,BEING �oT �� , A/ S/�aGvv ON. ss �N of E D[�GMA $G� \ \ v KE. ELLEY y No. 26100 $� Rom\ c Fs, 9FCISTER�� a� L �\ snA/ rzzj CA T 'Z zg, N •3g2.00, \\`\`��\\ of-uP,- \ r�E i Z SHErS TOP OF FOUNDATION T 6 CONCRETE COVER jl1 CONCRETE COVERS 7.54 ! 4 CAST IRONr OR SCHEDULE 48' MAX. 4"SCHEDULE 40 PV.C.(ONLY4VERT ' P.V.C. PIPE PIPE- MIN. LEACH ` PITCH 1/4"PER. PITCH 1/4"PER.FT. PIT PRECAST c o J o INVERT a LEACHING ` a EL..z3:Sa.. INVERT IN PIT OR SEPTIC TANK DIST. w EQUIV. INVERT 3BOX ELGAL. INVERT a Iww o. 3/4"TO I I/2' ELr... 7 22,.Lo wo �' WASHED EL.:::..... e. w ;'r: STONE /o T 6'DIA. PROR LE OF GROUND WATER TABLE SEWAGE DISPOSAL SYSTEM ^'�r�_/N 7 Tf/E Gtr74GN A'flt7q A•ND NO SCALE 10'BEyo.10 Tn B6 R40fovED 4WD QEA�4G&-p 1,V;7M SOIL LOG WITNESSED BY : DATE TuyE/7,107 TI ME.!O:00 4-7 �TF7ZTzy , DuNN/NG BOARD OF HEALTH TEST HOLE I TEST HOLE 2 ENGINEER ELEV. . .30.,.04. . . ELEV. . 6177 17- Wood 4,s3ry. DESIGN DATA Pic � A NUMBER OF BEDROOMS 3 v 7Z" S patuc TOTAL ESTIMATED FLOW 33o GALLONS/DAY &'Z• l3,00 47• ZA BOTTOM LEACHING AREA �5`3 �. . . SO.FT. /PIT//o9c.P.D. SIDE LEACHING AREA . . .�� '.� . . . SQ.FT./ PIT/2.431:PD• /v". S- p GARBAGE DISPOSAL .!VoN4� (50% AREA INCREASE) - TOTAL LEACHING AREAo7,.B . . SQ.FT PERCOLATION RATE �5. .s�X MIN/INCH LEACHING AREA PER PERCOLATION RATE .:s .. SQ.FT/C.p,D, .!YP .WATER ENCOUNTERED aNE P/7 /Th/ I,4� NUMBER OF LEACHING PITS . . . . /�v 2. ,„�L-.�T, 4F• -57�an/� •O n/ AaG. S/DES. ' APPROVED . . . . . . . . . . . BOARD OF HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DATE . . . . . . . . . AGENT OR INSPECTOR OF o� E® A g RICHR. ,ARD G� T �G /!✓. FAIRBANK ti . . . . 'LO=Y `� No.2�TIaN wooA ��T/6'" e(. 261G0 .® CIVIL piss'0fG151EF�O��v �00 1ST IA/ �3T Bi9i2ni,s�yi�G�. . ,4L L PETITIONER /'T-OWN OF BARNSTABLE LOCATION 4�1 22ZAZV-�JJ"J/rJJ�X// C;IZ6/2 SEWAGE # VILLAGE�.(�Pf�D�cl d"/�S'D`401P. --// ASSESSSOR'S MAP &LOT o1 I -002) -bMT 22M NAME&PHONE NORa4V6 Ll�rhS°�7u�9LIOr� �o�J� . SEPTIC TANK CAPACITY �/n1�b�tY_�ia� LEACHING FACILITY: (type) ?/'-/ (size) 00 s NO.OF BEDROOMS 3 BUILDER O PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: r Maximum Adjusted Groundwater Table and Bottom of Leaching Facility a0 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•3 et o le ching ff-�lity) eAz Feet Furnished byu` ('Ua7j -�- J , c:E-�- srv�- � �� `9� o ,, ,�a� ��' �� ASSESSORS MAP: �5 - TEST HOLE -LOGS PARCEL NOTES: SOIL EVALUATOR FLOOD ZONE Guth WITNESS: 99L, ZtA4u REFERENCE: �,([i1D �-�-� - DATE, ve1 ?,DOG, 1) The installation shall comply with Title V and Town of Barnstable Board of PERCOLATION RATE: MI i 3 t Health Regulations. n1 l �1_ - - ..- h location of utilities sewer inverts and septic � C �� — _�__.___��" . � 2) The installer shell verify the ocat p \V EL• 0t VV \fI►� � components nn-)r to installation and setting base elevations. TH-2 1 tic piping to be 4 inch Sch 40 PVC at 1/8 per foot. The first t Z. TH I 3) Al gravity septic F P $ - , Q� _ _ _ � � - �►w two feet out of the dbox to the leaching. -- y--- 3 _ _ r4cW v�'lH $ - r'`� 4)' This plan is not to be utilized for property.line determination nor any other . b lt� h r stem installation. purpose other than the proposed system i 1g, ,, 10 1pt� b/ 5) All septic components must meet Title V specifications. fir' . la b1 r 6 Parkin shall not be constructed over H10 septic components. Proposed units LOCATION MAP&t.r.S, � are H2O.� . - t7 - JL45rev 7) The property is bounded by property corners and property lines. 8) The property owner shall review design considerations to approve of total tjt 7 designflow and number of bedrooms to be considered for design. Receipt of � +- GJI f MfA S+ptA1� 1 � —�------ -� payment for the plan and installation based on the plan shall be deemed --- 2oP -UL approval of the,.design flow by the owner. 9 The existing leach. it shall be um and filled with material per Title V ....... Q } ) $ P pumped abandonment urocedures. Those within.the proposed SAS.shall be removed soil and replaced with clean washed sand per Title V along with contaminated ep specs. components to be 10 feet fi-om water line. Sewer lines crossing the „; �., 10)System comps g b SEI" T I C SYSTEM DES I GN water line shall be sleeved with 6 inch SCH 40 PVC with ends grouted. -�- -- 11 If a' e grinder exists it is to be removed and is the responsibility of the _ FLOW ESTIMATE owner to ensure such. 12)As shown on the plan, a potential 5 foot excavation may be required around - r �.. .�. - . � JI � �� '.GAL/DAY/BEDROOM GAL/DAY inches below grade and filled with clean v -._. BEDROOMS AT � the SAS and under to approx. 132 washed sand per Title V specs. ; U \ - _ - SEPTIC ,TANK 2 0 ,. M /DAY x 2 DAYS � ...GAL Requested Variances; 1 /t / - - _ 1 / _� / USE � GALLON SEPTIC :TANK \ f - � Title V Sechonl5.2•_1 7 Requires the to of the SAS to be wrtlun 36 inches of \ f _ �._.4--- �.__.._1^ i 6 f below grade. A r f / ABSgrade. Due to existing tank elevation and plumbing, the SAS s eet o. \ SYSTEM � 0 ORPT I N . - I1 , / } t- � , vest�s to meet the intent of the requirement. LD�•: � proposed equ 3 ID Lo//6)6oavaI U v-4 0 . . t 1 SIDE AREA. s D - -�• BOTTOM AREA c i 37 Z K- ION .�- S PT I C SYSTEM SECT , y m f1� lA Its p A tA41i t►tlk�C t - Ulil�� _ � �W >� } TI ►`I All OFF MPAI • »ti }S00 GAL _ 4b c '• SEPT 1 C TANK ,. �Z,O.� r qQ �c , N OF Owl co c - - W _ 15 "r No 1066 _ a/.;tEP S I TE AND SEWAGE PLAN r +2' Z�� Z 5 2 2 . ( , 2 " I LOCATION lZ� (1J00� �At4c o r v1�t•�' n ---- PREPARED FOR : a Ewe' to ,. ._. .., ,. .. •. ,� r , SCALE: o 'y� DAV I D B . MASON RS DATE: G DBC ENVlRONMEN� AL DESIGNS EAST SANDWICH . MA DATE HEALTH AGENT W 508) 833-2I77 t ASSESSORS MAP. 5 TEST HOLE •LOGS PARCEL: _ _ ------- — NOTES: . O SOIL EVALUATOR FLOOD ZONE: �- 1 �!� _ s WITNESS: . 0 ti REFERENCE: �,>�i0Z- - GATE: Q�1 �e 1) The installation shall comply with Title V and Town of Barnstable Board of R PERCOLATION Health Regulations. RATE? 1 f t � C % ► .-- --- -- . 7 - 2) The installer shall verify the location of utilities, sewer inverts and septic _ / El,• 3ot 1 vyl. ZS, components prior to installation and setting base elevations. — GAG TH- I TH-2 3) All tic piping to be 4 inch Sch 40 PVC at 1/8" per foot. The first Z��Y�P P P g - � two feet out of the dbox to the leaching: IA 4) This plan is not to be utilized for property line determination nor any other b It purpose other than the proposed system installation. _ 5) All septic components must meet Title V specifications. (,tom► �O 6) Parking shall not be constructed over H10 septic components: Proposed units LOCATION MAP(► ,S� �, "`� ( ;, are H2O, IL, -10IWC 5v#v7) The property is bounded by property corners and property lines. 8) The property owner shall review design considerations to approve of total ! 2 �l3 design flow and number of bedrooms to be considered for design. Receipt of /00 'gc- payment for the plan and installation based on the plan shall be deemed ------ _�20P� GZ -- CSi ._ 0 - approve of the design flow by the owner: ! f�0 { ► 9) The existing leach.pit shall be pumped and filled with material per Title V IJI� Z _11113t abandonment procedures. Those within the proposed SAS shall be removed -�� I— -- s ai rii r along with contaminated soil and replaced with clean washed sand per Title V Lspecs- I 10)System components to be 10 feet from water line. Sewer lines crossing the SEPTIC SYSTEM DESIGN water line shall be sleeved with 6 inch SCH 40 PVC with ends grouted. � .- 11) If a garbage minder exists it is to be removed and is the responsibility of the —-- .. �- FLOW ESTIMATE owner to ensure such. -- = 12)As shown on plan, a potential 5 foot excavation may be required around - y "'�- 3 BED90OMS AT �'�D GAL/DAY/BEDROOM - GAL/DAY the SAS and under to approx. 132 inches below grade and filled with clean washed sand per Title V specs. �-- b - SEPTIC TANK 1 t z G,'./DAY x 2 DAYS GAL Requested Variances; GALLON SEPTIC TANK E�(J wT Title V, Sedionl5.�..1(7)Requires the top of the SAS to be within 36 inches of r V , - _ __?-_.l_— � grade, Due to existing tank elevation and plumbing, the SAS is b feet below grade. A /• O��ORPT l ON SYSTEM $r' g P � r —— � ► vent is proposed to meet the intent of the requirement. c \ - S ;Z E AREA. —�• v/cir,-- :,. __ ,-- n - �` B,)TTOM AREA: Jc3 U� 7 _ �.�.. Wkg)6�,avxc U 14 vtf7 _ .�„ Z 6 --- p SEPJ I C SYSTEM SECT ION - 04 IL y { TI ti 36 C , D 1� 1500 SAL ,27 —�_ b ,s / �r rc•,t, J� o . 'yr- '`•* 'n->c �v-.. "i -+, w•^ e'.i ssat...r, :... .:-r w 4 i e 0 ^ y SEPTIC TANK p o . + v°,�,' ' ZOt - �s — LAVID B. NISON 4 9 I OF N t.106 ti� �GITS SITE AND SEWAGE PLAN LOCATION : ,w• t Z E MA 13 PREPARED FOR n c C►A20L A v - - .. C157 $ SCALE: ' 4 ; F•r DAV I D B . MASON RS DATE: Ib OG. DBG ENVIRONMENTAL DESIGNS W DATE HEALTH 'AGENT EAST SANDWICH : MA ( 508) 833- 2l77 I