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HomeMy WebLinkAbout0107 CAPES TRAIL - Health 107-Capes Trail W. Barnstable,---- P A 088',013 4 pill RECEIVED t COMMONWEALTH OF MASSACHUSETTS $Ep $ 2003 EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIR&N OF BARNSTABLE DEPARTMENT OF ENVIRONMENTAL PROTEC--I&N— DEPT. A t TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address:. [�� oz�-nu4 :z�- NIAP PARCEL, ' Owners Name: �O� , Owners Address: — ---y- 44 4- caig Date of Inspection: {� Name of Inspector• (please print). " . t Company Nam Mailing Address: •U ' ck�D6,1f Telephone Number: 5O$ • `7"7/• Q CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a.DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: —./Passes Conditionally Passes e ds F rther Evaluation by the Local Approving Authority �Fa is Inspector's Signature: T Date: 3 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Y Notes and Comments �e., —7tQ �'C.�v�� � �1�• ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will.perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 3 of]'1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: a Owner: Date of Inspection: `�C✓ ©3 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b) that the system is not functioning in a manner which.will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier,if any)determines that the system is functioning in a.manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private.water supply well. _ The system has a septic tank and SAS and the SAS is less than 100.feet but 50 feet or more from a private water supply well"..Method used to determine distance "This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria.and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A•copy of the analysis must be.attached to this form. 3. Other: 3 Page 4 of l l OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: J Owner: Date of Inspection: D. 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 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 I of a public well. Any portion of a cesspool or privy is within 50.feet of a private water supply well. Any portion of cesspool or privy is less than 1.00 feet but greater than 50 feet from a private water supply well-with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria and volatile organic.compounds indicates that the well is free from pollution from that facility and th.epresence 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.] (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a.large system the system must serve a facility with a-design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1.1 OFFICIAL INSPECTION FORM.—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM CHECKLIST Property Address: /o Owner:( Date of Inspection: . Check if the following have been done. You must indicate"yes"or,"no"as to each of the following: _ 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? _LZ—_ 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) IZ _ Was the facility.or dwelling inspected for signs of sewage back up? L/""_ Was the site inspected for signs of breakout? v — 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? Was.the facility owner(and occupants if.different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Ye no Existing information.For example, a plan.at the Board of Health. Determined in the field(if any of the failure criteria related to tart C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of I I OFFICIAL-INSPECTION-FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C - SYSTEM INFORMATION Property Address: Owner:( - hbi Date of Inspection: 5`O FLOW CONDITIONS RESIDENTIAL Number of bedrooms(.design):��: Number of bedrooms(actual): DESIGN flow based on 310,CMR 15.203 (for example: 11:0 gpd x#of bedrooms): Number of current residents: _ Does residence have.a garbage grinder(yes or no):/-(,—)O Is laundry on a separate sewage system (yes or no):6)Df if yes separate inspection required] Laundry system inspected(yes or no);420 Seasonal use: (yes or no): Water meter readings, if available(last 2 years usage(gpd)): l� l Sump pump(yes or no): Last date of occupancy: ` 0�z COMMERCIAL/INDUSTRIAL/;U- Type of establishment:. Design flow.(based on 310 CMR.15.203): gpd Basis of design-flow(§eats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system (yes or no):_ Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records ` Source of information: q Was system pumped as part of the frispection.(yes or no If yes,volume pumped: LAZO- gallons--How was quantity pumped determined? Reason Tor.pumping: TYPE OF SYSTEM ­Z9'eptic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool :Privy —Shared system.(yes*or no)(if yes,attach previous inspection records, if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy'of the DEP,approval _Other(describe): A pr xin) to age of all components, date installed(if known)and source of information: Were:sewage odors detected when arriving at the site(yes or no 6 - Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:/0 2 am,,a zgg Owner: Date of Inspection: %S ©3 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain):- Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: 1/(locate on site plan) Depth below grade: Cp Material of construction:_✓concrete_metal_fiberglass_polyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance (yes or no):_(attach a copy of certificate) , Dimensions: [ 9 �( Sludge depth: 5e a M Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness: Z Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: A� &�, 0- XZ4-� Comments (on pumping recommen tiifilet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc. . / t GREASE TRAZAQ locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 7 Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 0 / 1 Owner: � Date of Inspection: y 7 Q TIGHT or HOLDING TANK-/&6 (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions:: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) _ h Depth of liquid level above outlet invert: J2 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of kale into,or out f box, e .): PUMP CHAMBER �(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no):. Comments (note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM. PART C SYSTEM INFORMATION(continued) Property Address: 0,6,oa Owner: Date of Inspection: SOIL ABSORPTION SYSTEM (SAS):. (locate on site plan,excavation not required) If SAS not located explain why: Type —Zleaching.pits,number:L leaching chambers, number: leaching galleries, number: leaching trenches,number, length: leaching fields,number, dimensions: overflow cesspool, number: innovative/alternative system Type/name of technology: Comments(note condition of soil, ,signs of hydraulic failure, level of ponding, dam soil; condition of vegetation, etc. 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.): 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.): 9 Page 10 of I I OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: OA- Owner: 1( Date of Inspection: SOS SKETCH OF SEWAGE DISPOSAL.SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. CV LID 9V 10 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water C Z feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record -If checked,date of design.plan reviewed: 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: s, s 11 Permit Number: Date: //�� Completed by: 1s�`C�� HIGH GROUND-WATER LEVEL COMPUTATION Site Location: ���/� ,� " 5jC��rlcULot No. Owner:_ _ ,,eez-e ns Address: Contractor: x9f&L �CM517, Address: Notes STEP 1 Measure depth to water table ft. .............................. ...... to nearest 1/10 .......................................:.... .Date morth/day/year STEP 2 Using Water-Level Range Zone and.'Index Wel1'Map locate site and determine: i OAppropriate index well.............................. �� OWater-level range zone ..................... STEP 3 Using monthly report."Current Water Resources Conditions" determine current depth to water level•for index well 1 I ` month/year STEP 4 Using .Table of Water-level Adjustments for index well (STEP 2A), current depth to Water level for index.well (STEP 3)., 'and water-level zone (STEP 213) determine water-level adjustment............................. �►�. STEP 5 . Estimate depth to hi.gh'water by subtracting the water- level adjustment (STEP 4) from"measured'de'pth to water level at site (STEP 1) .................. Figure 11--Reproducible computati011 jorm. i5 i i I i I No. ,�Gqo 3 7 lJ ���! J Fee C � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 3pprication for �Biopooal bpgtem Cow6tructiou Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon(/) ❑Complete System MlI dividual Components Location Address or Lot No. �— � / Owner' Name,Address and Tel.No, g Assessor's Map/Parcel �� � /.� G � O ^a1 VIA �5 Installer's Name,Add s,and Tel.No. Designer's Name,Address and Tel.No. 9 A Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( � Other Type of Building ydG 2 No.of.Persons Showers( Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank �S�r� Type of S.A.S. Description of Soil Nature of Re airs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance h�ig�ned o of ealth. / le�3 Date Application Approved Date Application Disapproved for the following reasons Permit No. 3 - 3 Date Issued Q y vim. —�1 3 7 0 Fee t THE COMMONWEALTH OF MASSACHUSETTS Entered m computer: ,� (,; „ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS ZIppfication for Mi0pozaf 6potenkon0truction permit Application for a Permif to Construct( )Repair( )Upgrade( )Aband n(//) O Complete System 19'Individual Components Location Address or Lot No.1a 7 �`�//.�- .: Owner's Name,Address and Tel.No. Cam' �s Assessor's Installer's Name,Address,and Tel.No. Designer's Name,Address andTel.No. ` in 4 ll i n0517,-- Type of Building: D Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow / gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) •���� ®� +� (i�l� 1�ac�i r i r- D✓9 �,�c�r✓ r��r-rc�� ,.,r�r�c��T �c���/ ��r.�� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has en`sue s Board of Health. lu igned f Date Application Approved by-I,., Date / 3 Application Disapproved for the following reasons Permit No. r�cC) 3�'y 3 �l Date Issued 9 �� c)J, --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS (Certificate of Compliance THIS IS TO CER , that the On-site Sew age Disposal System Constructed( )Repaired( )Upgraded( ). Abandoned( /by ,fJU/ �,� ) C--� ,5 , at �/Z� ��D� 5 7-V-Z9//S /, ZV1e5Y*',':;4e&as been constructed in accordance with the provisions of Tlile 5 and the for Disposal System Construction Permit No. 2.003-q 3` dated Installer Designer The issuance of this permit shall not be construed as a guarantee that the system rl' etion as eskg' d. Date Inspector No. Fee �—' �3� ---------------— o. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS ligooaf *pztem Con0truction Vermit Permission is hereby granted to Construct( )Repair( ),Upgrade( )Abandon System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the dat of this p ,`t. Date: Ak 3 Approved by i TOWN OF BARNSTABLE LOCATION M Cg��_,T,re 'Z SEWAGE #a�C,'�3 VILLAGE u/- ws 7�3le ASSESSOR'S MAP& LOT, INSTALLER'S NAME&PHONE NO. /�Qi7 �of/T�' CGQv.I l�ncLfw✓ y117 8�2C SEPTIC TANK CAPACTTY �17�YJ L LEACHING FACILTTY: (type) A' (size) G Ale, NO.OF BEDkOOMS BUILDER OP< WNER rzsae�a q PERMTTDATE: CI 1�-s COMPLIANCE DATE:— ` 5 03 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by l i . als 6 la-7 i ,; A 40&;a iFS(��,yar..,wli.w..�_:. .....,,;.,� t �.xd�r1,{wiClyd�`uf.lYJa fl��(a�,�J . rl! .. �r� / .ram"c: yl',' /y/' C�� � %% I w ��d, A�' ( l�'f �� O r�sA � ` , I 3 � �� / vjql i. No.... . _ l THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE ,� r rlir�t i�an for Movai'Fat Works Tonstrnrtion ramit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: CAP_ E S-.TRA I L_...(.BERKS H I RE_,TRAIL) LOT_ 31_.-------•-----...----•-----------------------------------•-• or Lot No. Location-Address ROSS BUILDING -••-- .............................. F- .... ....................Owner Address f •....---•••--^................. ' a ...............................................Installer Address Size Lot_44, 897-•--__-••.Sq, feet r U Type of Building X Garbage Grinder N � Dwelling—No. of Bedrooms___________ _____________ _.__._._..Expansion Attic ( ) g �a RES. Other—Type of Building ____________________________ No. of persons............................ Showers ( ) - Cafeteria ( ) d Other fixtures . --------------------------•-------------------------------------------------•------------•-----•------------•••-•-•••-_--- XXXX 55 ; 3q ��a1 tons. ' WDesign Flow------------------•- ------ allons per person per day. Total daily flow-------•---...---XX------• __-_6' W Septic Tank—Liquid capacit ___ .___...gallons Length__10____._._Width__6__.______._ Diameter__•___________. Depth................ ______________ Total Length___.__..�..__.._..Total leaching area...26.6--------sq. ft. � Disposal Trench—No.. __ _________ Width___ iameter._____1.2____ De th below inlet.................... Total leaching area___._.___..•.__.sq. ft. Seepage Pit No -----1_ ---- P ' Z Other Distribution box ( ) Dosing tank ( ) 10/3/91 '-' Percolation Test Results Performed by_UPPER--CAPE--ENGINEERING Date_______________________________________ NONE aTest Pit No. 1________.2___._minutes per inch Depth of Test Pit--- 18__._____. Depth to ground water____________________ Test Pit No. 2................minutes per inch Depth of.Test Pit.__.____....____._.. Depth to ground water_______________._.______ E 0 3° TOP SUBSOIL 3' -12' CONSOLIDATEDFINE$ SAND- ' ..................... O Description of Soil_..... ----•--- ---------•- x WITH FINES 12-14 CONSOLIDATED FINE SAND WITH CORBELLS/...................................... W F W 14' -18' MEDIUM SAND ---------------------•-------------------...--------------------••--••---•-•-••--•-_-• - -- -------•-- --• U Nature of Repairs or Alterations—Answer when applicable____________________________________________________________________________________ ------------------------------------------------- ............................................. Agreement: es to install the aforede The undersigned agrescribed 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 until a Certificate of Compliance s b en issue board of health. l _- Signed 9� Application Approved B --•------------- ?an �Date dfor the win reasons- ------------- ----------------------------------------- ---------- ------------------- ------•-------------•-------APPhcation DisaPProve ----------------Date.._---._---..-.:. Issued ---------------------------------------- Permit No. .--- ��----/� - - Date CtQ% nINC.45INDUSTRY'�ROAD,•MARSTONS MILLS, MA'09508-428-8926 FAX: 508-428-939SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPE ` PART A CERTIFICATION Property Address: "/ Date Of Inspection `7 Insp ctor's ame: O ner's Name and Address: 10 CERTIFICATION STATEMENTI I Certify that I`have:personally Inspected the Sewage Disposal System at this address and that Ihe,informa- tion reported'`below is`true,`accurate and complete as of the time,+,A Inspection. The lnspectioin was perform- ed based on my Training and Experience in the Proper Function and Maintenance of On-Site&1wage Dis- posal Systems.T}ie system: °'Passes, 7 ' Conditionally Passes Needs'Fur Eva a o By the Local Approving Authority Failure Inspector's „r , Inspector's Signature Me: TheSystem Inspector shall submit a copy �f this Inspection Ri;4)ort to the API roving Authority s ith Thirty (30)Days,of completing this Inspection. 1'7the System is a Sk,red System or ias;a Design:Flow c:r 10,000 gpd or greater,the Inspector and the System Umuer shall submit `he Report to the appropriate Reghi;nal OfFe of the Department of Environmental Protection. The Original%hould be sent to the System Owner and copies sent to the Buyer,if applicable and the Approving Authority. INSPE TION SUMMARY A) SYS, k PASSES,,.,,,. I have not found anv Information which i n licates that the System violates any F the fail- ure criteria as defined in 310 CMR 15.303. Any Failure Criteria not evaluated,ire indi- ..,. , { Gated below. B) S Y ST,EM,CONDITIONALLY.PASSES: ..> One or more System Components need to be Replaced.or Repaired. The_System,upon - t $ completion..of the Replacement or Repair,Passes Inspection. , j : OR . Describe bases of determination in all instances. If"not Indicatcyes,.,nor,ort{not determined,(X,N,,. ND) determined",explain why not. The Septic,Tank is,Meta1,Cracked,Structurally Unsound,shows Substantial.Infiltration ov exfii- tration,or Tank Failure is iimminent. The System will Pass Inspection if Existing Septic T..nk ,r.,,is,.Replaced.w.,ith,a conforming Septic Tank as Approved by the Board Of Health. Sewage Backup or Breakout or High Static Water Level observed in the Distribution Box is duce to ken orw obstructed pipes)or due to a broken,settled or uneven Distribution Box. The System will pass Inspection if(With Approval of the Board Of Health):' -1 - , S � t h F s SUBSURFACE SEWAGE DISPOSAL'SYSTEM.INSPECTION.FORM PART A CERTIFICATION(continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four times a year due to broken or obstructed pipe(s). The sy_~stem,will,pass inspection if(with approval of The Board of Health): Broken pipe(s)are replaced Obstruction is removed C)FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by The Board of Health in order to determine if the system is failing to protect the public health,safety and the environment SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE ; "'.PISYSTZWIS'NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE, 'PUBLIC HEALTH'AND'SAFETY AND THE ENVIRONMENT: .Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Feet of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES'THAT THE-SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLICZEALTH-AND SAFETY.AND THE ENVIRONMENT: x The system has septic tank and soil ab a sorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply.- The system has a septic tank and soil absorption system and is'with a Zone I of.a public f water supply well. The system has a septic tank and soil.absorption system and is within 50 Feet of a private water supply well. T The system has a septic tank and soil absorption system and is less than 100 Feet but 50 Feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free.from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less -.e__ _ -. r than 5.ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined tm 310 CMR;15.303. ;The,basis.for.this determination is identified below. The Board of Health should be contacted to;deterimine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS ,,or cessp001; Discharge or ponding of efluent to the surface of the ground or surface waters due to an �. ,r overloaded or clogged SAS or.cesspool Static hquio level in.the distribution box above outlet invert due to an overloaded or clog- > ged,SAS or cesspool . ,; •, �+ ... Liquid depth in cesspool is less than 6"below invest or available volume is less than 1/2 ox Pow. Required pumpin more than 4,times in,lhe last year NOT due to clogged or obstructed pipe(s). Number of times pumped -2- SUBSURFACE-SEWAGE DISPOSAL SYS`fEM INSPECTION FORM PART A CERTIFICATION.(continued) Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 Feet of a surface water supply or tributary to a surface water supply. ' Any,portion of a cesspool or privy is within a.Zone I of a public well. Any portion of a cesspool or privy is within 50 Feet of a private water supply well. Any portion of a cesspool or privy is less than 100 Feet but greater than 50 Feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a_significant threat to:public health and safety and the environment because one or,more of the following conditions exist: The system is within 400 Feet of a surface drinking,water supply, . ..The;system is within 2U0 Feet of a.tributaiy,to a surface drinking water.supply ; The system is located in a nitrogen sensitive area Interim Wellhead Protection:Area (IWPA)or a mapped Zone II of a public water supply well.. The owner or operator of.any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Check-if the following have been done: _/'Pumping information was requested of the owner,occupant,and Board offHealth, a _None of the system components have been pumped for atleast two weeks and the system has'? been receiving normal flow rates during that period. Large volumes of water,have not been introduced into the system recently or as part of this inspection. ✓A;;uilt plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. ne site was inspected for signs of breakout. All system components,excluding the Soil Absorption System,-have been.located on site. GThe.septid tink:manl oles weliuncovered;opened,and the interior of the•septic tank.was-in-. r spected for condition of baffles or tees,material.of construction,;dimensions;,depW of#quid, `` depth ofaltidge;'deptfi of scum: ;r The size,and location of the Soil Absorption System on the site has been determined based on ` existing information or approximated by'non-intrusive methods: -3- t 6 ° SUBSURFACE'SEWAGE'DISPOSAL'SYSTEM INSPECTION FORM PART B CHECKLIST(continued) e facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C. "ry` SYSTEM INFORMATION ' E. dE,, •s.,;.• FLOW CONDITIONS Design Flow:�lons Number of Bedrooms:_ Nun)bqr of Current Residents: Co Garbage Grinder: 4 JYJ_ Laundry Connected To System:.(,0 Pg Seasonal Use: "Water Meter Readings;• vailable: v Last Date°of Occupancy Type of Establishment: Deslgn•Flow;.:. `aallonslday Grease Trap Present"(yes'or no) Industrial-Waste Holding Tank Present: _ - -'Won-Salutary Waste Discharged To The Title V System: - Water Meter Readings,If Available: Last Date of Occupancy: OTHER Describe) Last Date of Occupancy: GENERAL INFORMATION,/ PUMPING RECORDS and source of information- System Pumped as part of inspection: -If yes,volume pumped: gallons Reason for'pumping: u TYOF SYSTEM. 4;"",'Septic!TanktDistribution Box/SoiI Absorption System . Single Cesspool Overflow Cesspool ' Privy Shared System(If yes,attach previous inspection records, if any). Other(explain): AP ROMUTE'AGE of all'components,date installed(if known)`atid source of.information: "- -- Sewage 6166 detecfed'wlien'arrivmg at the`site:` VI ,4 SUBSURFACE.SEWAGE. ,. ,DISPOSAL SYSTEM INSPECTION FORM . . ., GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grade Material of Construction: concrete metal FRP_Other. lain Dimisions: ' Sludge Depth: Scum Thickness: Distance from top of sludge to bottom of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments:(recommendation for,pumping,condition of inlet and outlet tees or baffles,depth of liquid -level in relation to -et invert,structural integrity,evidence of leakage,etc -NatJI y r ba.'i GF"tTR'AP:1j I Q Depth;Helow Grade `' Material,of Construction: concrete_metal lFRP_Other, ; (explwwn) 7 7 Dimensions: Scum Thickness: Distance from top of scum to top of.outlet tee or baffle: Comments: (recommendation for,pumping„condition of iniet_and outle(tees;or ba>Iles,,depth`'of,liquid level'in relatron to outlet invert, Lmctural uttegnity :evidence,of leakage.etc.) ._ + TIGHT OR HOLDING TANK: t Depth Below Grade: Material of Construction:_concrete_metal_FRP_Other(explain) Dimensions: Capacity; gallons Design Flow: gallons/day Alarm Level: Comments: (condition of inlet tee, condition of alann and float switches,etc.) DISTRIBUTION BOX: ✓ , Depth of liquid level above outlet invert: 4/1J J Comments: (no istribution is equal, vide e dif solids carryover, evidence of 1 ge i to or out f box,etc.) w PUMP CHAMBER. E I-T . t.'Pump"`is in working order: 9 ---- -Comments:(note condition•of pump chamber;condition of pumps and appurtenances,etc.) -S : "SUBSURFACE SEWAGE DISPOSACSYS-I -Mr1NS'PECTION FORM PART.C ` SYSTEM INFORMATION(continued) SOIL ABSORPTION,,SYSTEM(SAS):_ (Locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive. ..: methods) If not determined to be present,explain: Type; f 1 `t'Leaching pits;nu*r:_ Leaching chambers, number: Leaching galleries,number. a. `Leaching trenches;number,length: Leaching`tields,number,dimensions: '::Overflow cesspool,number Comme :(note condition of soil,tl signs of ydraulic failure level of pon 'ng,'condi 'on of v getation," .) - "tt �. . CESSPOOLS: Number and configuration:' Depth-top of liquid to inlet invert:-, f Depth of solids layer: Depth of scum layer: `y Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool.must be pumped as part of inspection) Comments:(note condition of soilk,signs of hydraulic failure, level of ponding,condition;of vegetauon;o etc.) PRIVY.` Materials of construction: Dimensions: Depth of Solids: Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation, etc.) -6- r SUBSURFACE SEWAGE DISPOSAL SYSTEM.INSPECTION FORM PART C SYSTEM NFORMATION (conlinued) SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks. Locate all wells within 100 Feet. l t m DEPTH TO GROUNDWATER: ' Depth to groundwater: Z Feet Meth of Determination or Approxirna 'on: Q r ,s v yl } -7- P TOWN OF BARNSTABLE 1.6CATION !7-- G SEWAGE # VILLAGE Z-U- �•�Lt ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.5tVZdGG177�90AJ 7—, SEPTIC TANK CAPACITY 1StJD 4EACHING FACILITY:(type) /�jT`S �� (size) NO. OF BEDROOMS RIVATE WEL R PUBLIC WATER BUILDER OR OWNER oeS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No i iv No.. 7/=A`/*`.;2_ 4 ,; ,� wqjo ......... THE COMMONWEALTH OF MAS SACHUSETTS 4-4--10 BOAR® OF HEALTH TOWN OF BARNSTABLE -Appiiration for Biiipoiial Workii Tomtriirtion Vamit plicatiori'1s hereby made for a Prmit'to moons r t-( 7. jr ) an Individual Sewage Disposal Sy em at-CAPES TRAIL (BRKSHIRETRAIL) 31 ......................................... -Add ess or Lot Owner Address W a ......installer Address Type of Building Size Lot_44, 897 Sq. feet aDwelling—No. of Bedrooms...........................................Expansion Attic ( X) Garbage Grinder (N9 Other—T e of Building RES.-_..-______ No. of persons............................ Showers a YP g ---------------•- ---------------P ( ) — Cafeteria ( ) d Other fixtures . - 64) W Design Flow....... XXX______55 _ allOns per person per day. Total daily flow.....330................... gallons. WSeptic Tank—Liquid capacit .:.gallons Length._1.0------- Width-_6........_ Diameter--.XX------- Depth 6_1..._.._... x Disposal Trench—No_ __ __Parrieter _______ Width.................... Total Length.................... Total leaching area...26.6_..._.__sq. ft. Seepage Pit No. . 12--------- Depth below inlet---6•.-----•---.. Total leaching area.---••-•-----••--.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~-' Percolation Test Results Performed by-UPPER CAPE_ENGINEERING Date. 10/3/91 Test Pit No. 1.........2.....minutes per inch Depth of Test Pit...... 8......... Depth to ground water _NONE 0-4 44 Test Pit No. 2................minutes per inch Depth of.Test Pit---................ Depth to ground water........................ Ri •-------------------- ----•-•------•-•----•-•---•-----•----•------•-•-••--•---------.......------.................................... 0 Des cri tion of Soil_....... TOP/SUBSOIL 3 ' -12' CONSOLIDATED FINE SAND- --------------------------------------------------------- x W TH FINES, 12-14'CONSOLIDATED FINE SAND WITH CORBELLS/FINES .....-•-•-• ------•---------•---------------------------------------------------•--------------••--•---------------------•-•-•---•----•--••••---•---•-----••••-•••-•-.............------•---------•- W 14' -18' MEDIUM SAND x ---•---•••----------------------------------•••••-•••-••-----••••--••-----------------------••----------------•-----------------------•----••--------••--•••-•----•---•-•---•--••-----•---------•-----•- 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 until a Certificate of Compliance s b en iss�.boardealth. Signed jvi� Date Application Approved By ................. - .. ------f - � Date Application Disapproved for the.9 lowing reasons- -------------------------------------------------------------- ......................................................................................................................................................................I......................................... �} Dace PermitNo. . --------------_----------- Issued .............................................................. No ols W q 14 ......7/ THE COMMONWEALTH OF MASSACHUSETTS_ TS BOARD OF HEALTH •' TOWN OF BARNSTABLE Appliration for Disposal lgorkg 6tuilrnrtion ratuff Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: � XX ................-CAPES TRAIL....BERKSHIRE....TRAI... ----•--•--•-•-----...LOT... 1--------•------•-------------------------------------------- Location.Address or Lot No: ROSS BUILDING . . . • -......---•-••••••.....-•----•---•---------•---• -----•---•••------------------•--------•-•---.._._...---------........------------.............._. Owner Address W Installer Address d Type of Building Size Lot__44______,__________897..........Sq feet Dwelling—No. of Bedrooms............................................Expansion Attic ( X) Garbage Grinder (N9 aOther—Type of Building ______RES_............ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures ------------ AQ-------------------------------------------------------------------•-----•------------------------------------------------•-- W Design Flow.......Y ®X 55 allons per person per day. Total daily flow.._.-33.. elons. WSeptic Tank—Liquid capacit}r�'®fl�gallons Length_-10.._..... Widt j 6.. ___._.. Diameter-__ X De th xDisposal Trench—No___ __ _________ Width.................... Total Length.......- Total leaching area___? 6____.:.aq. ft. 3iameSeepage Pit No.- 12 6 ter. Depth below inlet Total leaching area.. •. .'. sq. ft; z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by-U.PPER CAPE ENGINEERING"-" IO/3/91 ------------•-•-------------•------•---•------•-•--•• Date . -............................. - Test Pit No. l---------_......minutes per inch Depth of Test Pit-------.8..__.... Depth to ground water....NONE 4q Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ O� Descri tion of Soil........0-3' TOP/SUBSOIL 3'-12' CONSOLIDATED FINE SAND- x WNW FINES, 12-14'CONSOLIDATE5 FINE SAND WITH CORBELLS/FINES W 14'-18' MEDIUM SAND ------------------------------------------------------------------------------------------------•-----------------------------------------------------------------•---------------------...--------••-- 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 TITLE 5 of the State Environmental Code—The undersigned further-agrees not to place the system in operation until a Certificate of Compliances4ben issued/6y¢tthe board of health. f Signed I Date Application Approved BY - .�L �" ` ........................................... ...... Date Application Disapproved for the fo lowing J reasons- ------------------------------------------------------------------------------------------ :.:------------- ------- ------------------------------------------------------------------------------------- ---....---.....--------...----..... . ----- --- Permit No. ........ —'-----_-------------------- Issued .............:. '....- -........Dat .-e Date THE COMMONWEALTH OF MASSACHUSETTS _ :i BOARD OF HEALTH TOWN OF BARNSTABLE Certif rate of CZomplianee THIS IS TO CERTIFY, Jha. the-,Individual Sewage Disposal System constructed ( X ) or Repaired ( ) by----------------------------------------------------- �'�o - ? ......... Q4� "7 ` .---. ....-- -------------- ------...... -- ----- -------------.......... ..-- Installer x at ----------LOT 31 CAPES SRAIL (BERKSHIRE TRAIL SUBDIVISION) --- ------------------------------------------- ----------------.....-------....-------------------------..-------------------- ------------------------- ----- has been installed in accordance with the provisions of TITLE 5 f The State Environmental Code as described in 4N the application for Disposal Works Construction Permit No. ...�1 :....t,/�1 .. ............ dated ................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONS R ED AS A GUARANTE.1 THAT THE SYSTEM WILL FUNCTION SATISFACT R DATE --------------------------/.. ... .. ---........ Inspector ------ .................................................--......... ......................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Ropoa1 Worhp Tonstrudiatt Pgrutit, l�rUL i C©,� i Permission ' hereby granted................... ........---........-------•--.....•--•.................... to Construct an ndivl al SeK>a a Disposal System at No...G4_'T.. --------------------------A L (IBERKSHIRE TRAIL SUBDIVISION)-------•-- Street // as shown on the application for isposal Works Construction e No._ 1'` � ated.................. .................. =— ---- -•----------- ---` ---------- DATE. -• .•, .............................. Board of Health FORM 36508 HOBBS 6 WARREN,INC.,PUBLISHERS a Department of Environmental Management/Division of Water Resources y< WATER WELL COMPLETION REPORT WELL 1_05illhTl eN GEOGRAPHIC DESCRIPTION A effjq�hss �,, — � S E W of G � (feet) (circle) City/Town Well own p� (road) Aress O 1 Q N E W Of (mi.in tenths) (circle)) Board of Health permit: yes ❑ no ❑ intersect. w Ie ,✓ (road) WELL USE WELL DATA Domestic Public❑ Industrial ❑ Total well depth ft. Monitoring❑ Other Depth to bedrock_ ft. Method drilled R Water-bearing rock/unconsolidated terial: Date Description ate drille _ Water-bearing zones- CASING L 0 11 From�To Type Length.�ft. Dia(.I.D.) in.. 2) From To 3) From To Length into bedrock ft. V Gravel pack w�IJ�� ilia. Protective well seal: Screen:1 7 ia. Grout_❑. Other Slot**_length .from _ tQ& PUMP TEST Static water level below land surface ft. ` Date Drawdowrf ft. after pumping I r. _miA.at 4(146 gpm Howmeasured &Recovery ft. after—hr. min. : o LOG of FORMATIONS COMMENTS Materials From To 0 bU av a D Dr:ll.IA,-"-PY Mass. egi tration t O Fir 4 Address City/Town —lqd i rp 7' f rw- - ilo � D D � Signature of supervising,registered well driller Please Print firmly BOARD .0, HEALTH.;COPY, .�11TIii�i Sititltt1111[tr11(ijiT!!1"SiSttitrSl!?ttrrtrtritt9itnrtrtSTn....ttft..........trS�tttttSttttitttetrtrtttrntttrtm... ... ....rtnrttrttrrrr ttrrrrr tt iii tt K nri tt p rrn Tti r r r r rnr rntr ...:..:.r ,...,...t......... .,:. T ENVIR®TECH LABORATORIES r Mass. Cert.#:MA063 = 449 Route 130 Sandwich,MA 02563 • (508) 888-6460 = r ZZ z-. CLIENT: Dick'Schrader LOCATION: Lot 31 Capes Trail ~' ADDRESS: _ Berkshire Trails, W. Barnstable. c MA COLLECTED BY: L. Wile SAMPLE DATE: 9-23-91 TIME: DATE RECEIVED:9-23-91 SAMPLE ID: Z390 =- �- 160/37 JOB #: WELL DEPTH: RESULTS OF ANALYSIS: Parameter Units Recommended limit Result c:. Coliform bacteria/100 ml (MF Method) 0 0 z = pH pH units 6.0-8.5 6.43 ' — _ c Conductance umhos/cm 500 344 -3 Sodium mg/L 20.0 e 54.8 x e: Nitrate-N mg/L 10.0 2.90 Iron mg/L 0.3 0.40 :a Manganese mg/L 0.05 0.08 �_ En Hardness mg/L as CaCO 3 500 30.4 :x �= Sulfate mg/L 250 16.2 Potassium mg/L 20.0 0.7 == Alkalinity mg/L 200 _ 11.4 _ Chloride mg/L 250 x R: 87.5 E Turbidity NTU 5.0 9.5 Color APC units 15.0 5.0 Background bacteria 340 _3 A COMMENT: Sodium level is not a health hazard, but if on a low sodium diet, _ consult physician before drinking. Iron and manganese are not health = hazards, but may cause taste, odor and staining problems. EPA Method E 6t01/602aa ug/L Below Reporting Limit '= . YES Nv ' SV1eA�ElW'9613�k& OR DRINKING PURPOSES FOR PARAMETERS ESTED. ❑ 7 (' �., DATE '�ifilil!lull!!tilt!illllilllllliiiiilliiiilliiiilllU!liillllillllllllUUl!llililltlliiitiiiilillLiiii►1il11lliiii;illiiiiiliiiliilliiiil►lli!!!!Ill►iiii'i liiiiiiiitiltlliiiiiliiiiiiii►iliiiiliiiiiiiiliiiiiilitiiliiiuiiiitiii��`° GR©LINOWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: Z-390 Lab ID: 2000-01 Project: Schrader QC Batch: VGA-848 Client: Envirotech Laboratories Sampled: 09-23-91 Cont/Prsv: 4Oml VOA Vial/NaHSO4 Cool Received: 09-24-91 Matrix: Aqueous Analyzed: 09-25-91 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 1 Vinyl Chloride BRL I Bromomethane BRL 5 Chloroethane BRL 1 Trichlorofluoromethane BRL 1 1, 1-Dichloroethene BRL 1 Methylene Chloride BRL I trans-1,2-Dichloroethene BRL 1 1, 1-Dichloroethane BRL I cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1, 1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL I 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL I 2-Chloroethylvinyl Ether BRL 1 trans-1,3-Dichloropropene BRL 1 Toluene BRL 1 cis-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 - Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL I Ethylbenzene BRL 1 m*Xylene * BRL 1 o-pylene * BRL 1 Bromoform BRL I 1, 1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 . 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS Bromochloromethane 30 31 103 % 83 - 117 Fluorobenzene 30 30 , 100 % 87 - 113 BRL = Below Reporting Limit. * Non-target compound. "Trace" indicates probable presence below listed Reporting Limit. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. J 36, Appendix A (1986). r / TOWN OF BARNSTABLE 'I',OCATION /a-7 64P—aJ ra<< SEWAGE #aC�3 ' VYV VILLAGE wf74S/r ASSESSOR'S MAP&LOT 097-0 3 INSTALLER'S NAME&PHONE NO. N6i7�/�vf �a1�rr.�/ice y1y'8�2 C SEPTIC TANK CAPACITY /f71YJ Ga LEACHING FACILITY: (type) O/ P, (size) NO.OF BEDROOMS ' BUILDER O WNER t z rn�e q PERMTTDATE: cl�`�COMPLIANCE DATE: / 5 03 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet-of leaching facility) Feet Furnished by 01 6 �� !mod✓c t L/VG cej fp is /�� J No.-- ---- - ---- = Fee `-'------------- BOARD OF HEALTH TOWN OF BARNSTABL, E 2ppli ationi orVell Con6truet ion permit App 'c ion is hereby made fora a it to �onsj�ut ( , Alter ( ), or Repair ( )an individual Well at: __ Location — Addres Assessors Map and Parcel - - cc, (' -------------------------- Owner D Address--- ------- -------------------------- & ------—--------—----------------------------------------------- Installer — Driller Address Type of Building Dwelling-&j-CV-�------- l=Ny11__-- Other - Type of Building ------------------ No. of Persons----------------------------------------------------- Type of Well--y l �/__Ir�------Q - --------------------- Capacity--------------------------- - ; Purpose of Well - Q_ - ------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board He th Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unti Certificate of mp iance�h s been issued by the Board of Health. / Sign —- - - - -- g -----{ � ----( --- Application Approved By-- 1/�V - -- ------- --------------- of — — — date — Application Disapproved for the following reasons:—-----------------------------------------------------------------_-__-----_--__------ ---------------- -------------------------- ------ -------==-------------------------------------------------------------------------------------- I date � . Permit No.—- -- F ----- Issued-----------------=------------------------------------------------------------------- ------------------ -------------------- date BOARD-OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO/CERTIFY, T t the Individual Wel Cons ucted ( ), Altered ( ), or Repaired b 4_S�l��S/ -- �'✓� — ram- ---------------------- Y- ------------------------------------------------------------ JInstaller at------------------- - - - ---------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of1-70-0bated ealth,Private Well Protection C/ Regulation as described in the application for Well Construction Permit No. - --- - --- -� -- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. , DATE------------------------------ ---- Inspector ------ -------------------------------------------------------------------- �,. No.-- -------r-r----:-- Fee -- ------------- BOARD OF HEALTH TOWN OF BARNSTABLE 0[pprication-forlVell Con5tructionOermit App is 'ion is hereby made for a e it to onstiu t ( ), Alter ( ), or Repair ( )an individual Well at: "-- � -: --�'- ' sue`- - -------------------------------- - --- --- -Parcel -------------------------------- �j Location — Addres / n Assessors Ma and Pazcel -- � — -- — - ---------- —— —— —----—--------- ------------------- — —---------------------- --------- ------------ Owner Address ----------& -------------------------------------------------------------------------------------------------- Installer — Driller Address Type of Building Dwelling CYO�--------- � - Other - Type of Building --------- No. of Persons------------------------------------------------------- Typeof Well-q- ---Y___ ----------------- Capacity------------------------------------------------------------------------------- Purpose of Well----V4.2�1 �---------------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of He lth Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unti J1.1 Certificate o �mpliance h s been issued by the Board of Health. - ------�°�' ° ---- Sign d -—- -- '=` - ------ $ d to Application Approved By- _ - - - - - ----------- ---- -------------------- - r �. date Application Disapproved for the following reasons:----------------------------------------------------------------------------------------- ------------- - -- ------------------------- ---------------------------------------------------------------------------------------------------------------------------- — date j "" ---------------- Issued----- - ------ - ----- Permit No. --;-----------, -- --------------------------------------- i - ---------------------------- date + BOARD OF HEALTH TOWN OF BARNSTABLE Certificate ®f Compliance THIS IS TO CERTIFY, T qt the Indivi ual W-11 Constructed ( ), Altered ( ), or Repaired ( ) bY-------`-`( _—- � -� 0�--- ------------------------------------------------------------------------------------- Installer at---------------------- ------------ --------------------------------------------------------------------------------------- has been installed in accordance with the provisions of the Town of Barnstable Board of ealth rivate Well Protection Regulation as described in the application for Well Construction Permit No. -1, --- Dated------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE--------------------------------------------------------------------------------------- Inspector----- F----------------------------------------------------------------------- i BOARD OF HEALTH TOWN OF BARNSTABLE Yell Con6tructioni3ermit No.uo--- �---------- FeJ------------- Permission is hereby grante ,-� -�=-�-- � - --t�-fi►------�---`'(/ to Construct ( r ( ), epair ( ) an diva j� Well ati,( ' Street as shown t? a applic do for a Well Construction Permit l / - -- -- - Dated ---"- (�... --- - _------------ ---------- -- ------�='�1!�� Board of Heal DATE--------------I---- e1q, — ----------------------=------------ J L� 2"LAYER OF A07V ��� 29 GRADE MIN T CONCRETE CO VE STONE ABOVE LEACHING PIT R.S 7 �-- EL=55 4' 3=DUMV 40 P.V.C.DVT / PIPE' -1�PER 1T BOX P.TICH PRECAST LEACHING VERT MUS�v Ss Tr IT OR S7YIN� 8 e 8;8 S 8:8: INNVERT I q o B'QUIVALENT 51_4 a EL.= SQ, n. :- o c 2' ALL AROUND MTTRT— o : 6 ti i VA /4" �� WASHED STCINE EL.=_ �L_ EL.=�50_. 5 p o� 1044- 5 ' o --g' DIA. LEACH PIT 5 10' DL4 - -- -- - - - --—- -- --- -- --- - --- -- - - -- -- , BOTTOM OF TEST HOLE EL--- 40 r 57 EM DESIGN DATA. NUMBER OF BEDROOMS GARBAGE DISPOSAL NO TOTAL ESTIMATED FLOW —,s3a� —_ GPD ( _ L GAL./BR DA Y x 3 BR.) SEPTIC TANK CAPACITY 330a 5=495 GAL OG USE 1000 GAL TANK LEACHING AREA REQUIREMENTS r1 BOTTOM AREA _1,R_ I I IDA Y . 1------ LEACHING CAPACITY ( BOTTOM & SIDEWALL) 548 GAL. INDI TEST HOLE 1 .BOTTOM �7-X10X6 = 188S.F. (4 70 GAL�DA Y) - SIDE 97' X102 :-4 = 78S.F (78 GAL`DAY) EL.= 57. 94 -- RESERVE LEACHING CAPACITY 548-330=220 GAL IDAY 0-3'O" TOP/SUF�SOIL 01-3; "H C011�SOLIDATED FINE REMOVE ALL IMPERVIOUS MATERIALS W-R SAND WI?'H FINES 10' ALL AROUND AND REPLACE YYITH CLEAN CO URSE SAND BEL0 W INVERT o EXISTING CONMVJ?S_----------- XX 3'D =12, o° PROPOSED CON7bUl?S. .— —•_ ' c c CONSOLIDATED FINE 12-14 •- SAND WITH CORB.EIJS/IINES 0 14-18' °° MED. SAND o . M W TER ENCOUNTERED PROJECT LOCATION CAPES TRAIL S. NONE RF OOD ZONE' 7C''. . W BARNSTABLE AN REF.: 462134 ��OF — PAUL �cyG� APPLICANT. — — — A. ROSS BUILDING COMPANY MEAITMF-W ell N0.32098 >� STERo�JQ,� - --- —— - ------ AL l{N FM SHALL L. BE CAPABLE YANKE'E SURVEY CONSULTANTS D n Rn V 9jq Jc f,14 On T T'PJP YJQ h a� TOP OF FMUNDAIYON 0 coy GROUND EL._ 5 i /4OR SCHEDULE 40 12:lIAX PITCH 1/4" PER FT P Y.C. PIPE INY"T 110A . 4 EVERT 7 APPRO VED- -soARD Off' HEALTH _ 1O, SEPTIC DATE r A G O ENT l r PRO IL= BOX SEWAGE DID PO S VACANT 40F ,�s NOT TO W ALL �LE`V�4IION� • t IN TREE O- _ �. -,., E�=\ - - -- RE RL'NCE I g /�_--' --. �� IN TREE' T.R At LOT �30 � , s° VACANT ` ° o .Sp f ,io // / / / / ,► YELL WITNESS.tD BY: _DOl TOWN OF-B. jjt S2ABLLr PERFORMED UPPER CAP_ F E'NGIM 56 ' NOTE.• LOCATION PERCOLATION RATE - ••�.,; �$ — - _ OF WELL -- �`• ` LOT - BY MAST,RPLAN �1 _ - & BY .FIEld) NOTES ` l_ ---- , • NN8 60 .r r•r � Ion, ` ` \\`N\ �`\� \�`__.. . 'N 9 'N l_ \ t ' LOT 32 VACANT GENERAL ' NOTES 1. THIS PLAN IS FOR INSTALLATION OF NEW SEPTIC SYSTEM . 7 ALL COMPONENTS 40 PVC "O 2- ALL PIPE 4" SCHEDULE' C. F .5"� OF yYlTHS7ANDING' H-10. r. Co c o r top s ._....___�_.:..._.. _,_. .. .�.��. __._ — _..______... _.._.____....• � ! � _._.._ — • _R�ivitiirL--�1=i4.�'ST".ir." �c/%.�:L. � 4 O f _ s 7� 77 V�_� �7' v ELI 2LA Y" OF IVP OF YVVIMAIYON RETE COMU COW 12 -27. GRADE AflN R7. GRADE,imv MNE ABOVE LEA CIMVC PIT . . . EL. GROUND �4 5 , ZABO VE S.T CONCRETE CO VMS! 7- --/-777 -z ., 1771 7 'EL 5 5 AX 7y OR CHMUIX 40 P.Va , 1pE PMH 114 PER 7. 4'-3r_JMULF 40 RVC VT PME Y BOX WR YT P=H,J14 P JNE FLOPr I LEACHNG c OR 'EirmT C2?usm 7-0 EQUrVALENT C . 0 2 ALL EL. /10c - Ob 0. AR 70 EL. 60 914 2 V 1 2" 0/ Lum STI WE EL '50.5 TA 0 01 op. 10, BOARD OF HEAL GALLONS PPRO VED TH -5 -10 �6 "DIA JUCH Pff 5' DA TY AGENT" . 10' op- -- 40' BOTTOM OF_TEST ROLE , '.EL-__��� nus STEM ' SEWAGE ,,, �'-DISPOSAL SY G7 D TA DESIGA ' 0 ',SCALE NOT NUMBER OF BEDROOMS ell L EVA TIONS 0 ALL �E GARBAGE DISPOSAL,.,,'. 4c D REFERENCE_RAI -SET D TOTAL ESTIMATED. FLOW E --54 00 4b L N TREE, T E. E 54.1 00 GALIBR� ��A Y -7 SEPTIC rA",:oApACjTY , -GAL' ' QXI.5�=495 3j USE GAL 'TA" 'AREk *REQUIREMENTS LoT,,,30, SO IL LEACHING VAC"T­ SJDEWALL AREA TEST;� P7816 BOTTOM S 11DAY AREA ..;Lj&_ ,'GAL1 op GAL 9 A .644� TE , 4b DA ----- - A CIMVG CARA CITY BOYTOM, TOM. , �rMOW BOT AL�DA Y) X- 1 . 4, -�Y8s. (78.-.,GAL\DAY) ;' F. 'o y. DONNA �Z. -',M 6RANDI TEST HOLE 02� ,�'WITNESSVD , B SIDE ' 57.94 'R EL TOWN- ESER VE LEA CHING CAPACITY 548�.PERFORMED PY , -E *0 J70P .1NERRING EP—PER �CAPE M 'I�SUBSOIL EMALS fiV_R _R Mo E VELt'�.W NT70M MAT CONSOLIDATED,— AAD ;.REPLACE.:'W=' CLEAN 6 PERCOLA TION RA TE. SS LE I"? M1*/�� -1 Fo FINE 10' ALL COtMSE SAND BELOW'EaTRT -:LOCAY70N_ FINES, 6 TF NO ,��OF 1ELL' low :BY MA STERPLAN R,19STMG, C40NM URS TW�! BY117ELD NO LO PROPOS -IOU co-m 3'0'�- 7 CONSOLMA TED 0 _0_; -SAND JUTH : 0 0 Af go ED. �S"D ------ ' '00 10 -TO ML "ENCOUN RED, L 0 CA 179N. CAPES TAIT 'L OT 32 , w BARNSTABLE .RES. ZOjVE- RF FL ACANT : 0O.D. ZONE- PLAN; REP , 462134 'A PFEIC. PAUL 'ROSS BUILDING COMPANY NERAL NO A. GE TES MERITHEW No.32098 s VANKEE. SURVEY CONSULTANTS�7. ALL SANITAR Y,3 COMPONENTS OF THE FS. E&f 5 H� ,A L L BE CA TA EL E I,- THIS .PLAN IS FOR PVSTALLATION OF NEIV.SEP77C SY�TMV .�' :P.O. . ,BOX,265,�:143 �ROUTE 149 RTTHST4XQ= H-10; LOADLIW,':,UNLASS -,TUEY_ARE 'UNDER .�MARSTOAS J01L.S: A. . 2.. ALL'P1PE 4" SCAED= 40:PVC '� OR R=1N,10',-OF,DRTVE5`.-OR PARAING AREA.'� H 70 OADflVG� FAX -5553 L508) -0055 508) 420 4,28 SH4 L L BE USED U10ER, OR WITHIN'7.10': OF:LRIVES OR PARAYNG. , Al OP,.SEPTIC STEM -3. THIS,,PLAN 13 FOR INSTALLA RE P R, UNLESS NOTED. f��M '91261PI ANO ,NOT TO, BE USED FOR. SUR VEYYNG OR ZONING URPOSES- SCALY -40' HALL 8. ANY MASONRY 'UAM ,,USED CO VERS,TO GRADE S BE MO RIARED V PLA CE. TERMLS SHALL CONFORM: TO D.E P. ALL IFORKMANSHIP 'AAD MA SAAD '�REGULATIONS. 9. NO ETERMINA TO W RVLE TION'BAS -BEENAVADE AS T0,,C0MPLJANCE` ,,W=, =9 .5�AND TIM 2V .OKI� EV REV DE D REG&YAT10NS_. WE? PLICANT L5 TO A _OKS P70R TRE­SUBSURFACE �DSPOS, L , E JfA GE EDE OR ZONflVG - OBT HIN AIN,SUCH DETEWTNAYTONFROM APPROPRIATE AUTHORITY ALL to �TO 07T VER PO SANITARY U=, SHALL BE BROUGHT, IMSJMD GRADE., SHEET �127 OF F 11 1 $ ` r WR ZONE 'FROM YPETLAArDS , I OF, 10. SEPTIC NOT ,1N,A P,50 90069 .REY"N EssENTma!�, THE OR , vEGETA 1ED _oETLANDs. DPG : ' 6.­E.HSTXG "D FRVAL GRADE.5 S :S AIESS,NOTED BY-FINAL �COATOURS , ", U E I 0�)_, EA 0 00 OC -9 4 OC