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HomeMy WebLinkAbout0185 CAPES TRAIL - Health 185 CAPES 7RAIL, Id. BARNS 7 A13LC _ A= 0.88-007 w o ,u F ry� A e O 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail ". Property Address Brian Hibbard ••n Owner Owner's Name information is c required for every West Barnstable Ma 02668 9-25-15 page. Cityrrown State Zip Code Date of Inspection P t:•� Inspection results must be submitted on this form. Inspection forms may not be altered iA any way.Please see completeness checklist at the end of the form. Important:When A. General Information form filling out for 514 on the computer, use only the tab 1. Inspector key to move your cursor-do not David J.Bumie use the return Name of Inspector key. David J. Burnie LLC„ � Company Name 3 Perry's Way Company Address E. Harwich Ma 02645 Cityrrown State Zip Code 774-216-1440 SI 386 Telephone Number License Number B. Certification 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 16.340 of Title 5(310 CHAR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 9-25-15 spector's Sign ure Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. ""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. /o vs t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System 1 of, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is required for every West Barnstable Ma 02668 9-25-15 pe", Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: The system is a 1500 gallon septic tank,distibution box and 4 leaching gallies with 4'of stone on the sides and 2'on the ends. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not .determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): tUM•W13 Title 5 OfficM kmpectlon Forth:&bDurfaca Sewage Mposdl System•Pape 2 or 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner owner's Name formation is required for every West Barnstable Ma 02668 9-25-15 re page. Cityrrown State Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumpstalarms not operational. System will pass with Board of Health approval if pumpstalarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): } I ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 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 CHAR 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 t5ins•3M 3 Title 5 offidal lotion Form:SLbaurte Sewage Disposal System•Page 3 of 17 Commonwealf of Massachusetts o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner owner's Name information is West Barnstable Ma 02668 9-25-15 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fall unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other. 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 Y2 day flow t5ins•3H 3 Title 5 Offidal trq)ection Form:Substufee Sewaoe Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owners Name information is requiredWest Barnstable Ma 02668 9-25-15 e. for every Cityrrown Page. State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes N the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,0009pd. ❑ ® 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 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. 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 a ❑ 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. t5ins•3h 3 Title 5 OftW kmpection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is West Barnstable Ma 02668 9-25-15 required for every page. Cityrrown state Zip Code Date of Inspection C. Checklist 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? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® ❑ 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: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 622 gpd per DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms). plan on file. t5lns-3113 Title 5 Official hipection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is required for every West Barnstable Ma 02668 9-25-15 page. Cayrrown State Zip Code Date of Inspection D. System Information Description: 1500 gallon septic tank, distribution box and 4 H2O leaching galleys. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): well water Detail: well water. Sump pump? ❑ Yes ® No ent Last date of occupancy: Date Commerciallindustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 OrBdal Inspection form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is West Barnstable Ma 02668 9-25-15 required for every page. cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Per Owner July 2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Offldal Inspection Form:Subsurface Sewage Disposal System.Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is West Barnstable Ma 02668 9-25-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known)and source of information: Plan date Revised 8-30-95 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 12"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: Well. 100+per plan feet Comments(on condition of joints, venting,evidence of leakage, etc.): Normal as to what we could view. Septic Tank(locate on site plan): 12" Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) Tank at normal level, inlet outlet tees are in position.Outlet tee has fifter.The filter should be cleaned every year. The filter was cleaned by homeowner at time of inspection. If tank is metal, list age: rears 1s age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins•3/13 Title 6 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form WWMN Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner owner's Name information is required for every West Barnstable Ma 02668 9-25-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 36 Plus, if any 0 inches Scum thickness Distance from top of scum to top of outlet tee or baffle 0 inches Distance from bottom of scum to bottom of outlet tee or baffle 16 inches How were dimensions determined? Tape and estimate Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank in good condition, Should be service every year. The measuerments are 0 because the tank had been serviced in July. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3113 Title 5 Official Inspedon Forth:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is required for every West Barnstable Ma 02668 9-25-15 page. Cityrrown State Zip Code Bate of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): All at normal working level. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•W 3 Title 5 Official Inspection Form:Subsurtece Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form UVSubsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is required for every West Barnstable Ma 02668 9-25-15 page. cityrrown state Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert None Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Normal level. Pump Chamber(locate on site plan): Pumps in working order. ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Located. very deep. Used steel tape to measure standing water estimated to be 4 to 6 inches. t5ins•3113 Title 6 official inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is West Barnstable Ma 02668 9-25-15 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 4 per plan. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): None. 4 to 6 inches standing water in leaching. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-W 3 Tito 5 Of cid trrspeetion Form Subsurface Sewage Disposal System-Page 13 of 17 �± Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owners Name required information is West Barnstable Ma 02668 9-25-15 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins-3113 Title 6 of iclal Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Comm Ith of Massachuseft onw� Title 5 Official Inspection Form Subsurface SeMrage Doposal System Form-Wfor Voluntary Assessments 185 Capes trail PMWVAdd1M Brian Hibbard Owner Owner's Dame kdany own is West Barnstable Ma 02668 9-25-15 MOO= stags Zip code Date of aravedior+ D. System Information (cost.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system,including ties to r permanent reference landmarks or benchmarks. Locate all welts within 100 feet Locate c vrdW supply enters the budding.Check one of the boxes below:ketch in the area below ® drawing attached separately -1 7' lie- \,;�t o d 1;046�I Yn � � Y 4k na o Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail --- Pmperty Address Brian Hibbard Owner Owner's Name information is West Barnstable Ma 02668 9-25-15 required for every Page• c4rrown state Zip Code Date of inspection D. System Information (cunt.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells 19, Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record Revised 8-30-95 If checked,date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Plan on file . Revised 8-30-95 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Test hole plan on file,revised 8-30-15....The bottom of the leaching is at elevation 91.70 the bottom of the test hole was at elevation 86.00 allowing for a minimum seperation of 5.70' Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 16 of 17 c ✓ Commonwealth of Massachusetts UIVTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 185 Capes Trail Property Address Brian Hibbard Owner Owner's Name information is West Barnstable Ma 02668 9-25-15 required for every page. Cityrrown State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION ^ &J SEWAGE# VILLAGE U� A ' '- t-® � ASSESSOR'S MAP & LOTA & ,� NSTALLER'S NAME&PHONE NO. / G� SEPTIC TANK CAPACITY C� } LEAC>IING FACILITY: (type) ?` (size) ,7�,NNO.}OF BEDROOMS BUILDER OR OWNER 43PERMrrDATE: �D /!� �75COMPLIANCE DATE: /.Z" Separation Distance Between the: r Maximum Adjusted Groundwater Table and Bottom of Leaching Facilityd 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 `i i N q V7 THE COMMONWEALTH, OF MASSACHUSETTS �j BOARD OF H E A LT I-I �►� -�- - 9 y P �. rt Blur �� TOWN OF BARNSTABLE Appfiration for Divpu!itt1 Wurk,i Tomitrurtiuu jirruuit 4 Application is hereby made for a Permit to Construct O or Repair ( ) an Individual Sewage Disposal System at: ................ .......------ ....._:__.... Location- Address or Lot No. ......................2.1 _..�.lh' ' '1-'' ................................................. 538 BRAN----� =---- :._l N_N.l� ..b d..........---Owner Address ------.....-••. : . ... .-------------------•------•-____•. ............................................... .. .......... Installer Address Q Type of Building Size Lot___y 3.,4 37.......Sq. feet U Dwelling—No. of Bedrooms.._--- W J_-- . --------- - Attic ( ) Garbage Grinder ( ) Other—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures ---------------------------- W Design Flow..............5S ...................... per person per day. Total daily flow.........Y------------------------------gallons. WSeptic Tank—Liquid capacity 50__-gallons Length----- .... Width..G.--------- Diameter---------------- Depth___y r x Disposal Trench—No. __QN0. ...... Width-----$----------- Total Length-----20 ...... Total leaching area_6!.t_(�/D_sq_4t, Seepage Pit No.......:..........:... Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) �4 G�.�Ltd� R S 1.4 Percolation Test Results Performed by._.:fi�01"t._.�..._M............................................ Test Pit No. 1-__r..30._..minutes per inch Depth of Test Pit.................... Depth to ground water-----/�1_0 _._.. L=. Test Pit No. 2......_.Z..-minutes per inch Depth of Test Pit---nl$....... Depth to ground water-.--_ � ._... --------------------------- -----------------------•- -------------•--------------.-----•---- ----•--------------•-•----- O Description of Soil ..1 0"Z�F" �'( 'p... _S�� SDIL...... ..---- *.L---- 36� TO v't 5Lt1 .. .':_" r- .............................................................` ' c$.� i A^� Clfr? cS�Na U W --------------------------------------------------------------------•---••-•---------------------------------------------------- --•-•-•-•------•--••----...----•••-•---•--•--------•----•-•---...--•-•- 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 Environ Ma ode —The undersigned further agrees not to place the system in operation until a Certificate of Compli ce has n issu t -y oard of health. Signed �� ' A lication A roved B �..4.. .........................................---------------------------- PP PP Y �� ( Dace Application Disapproved for the following reafonf: ........................ ......... .................... -------------------------------------------------- .. ....... .......... . ................... . ............ ............. ............. ................... 17Y.... Dare Permit No. ......7.Y....------ -------------- Issued .......1Q... .��-:....... ......... < FEE 1.6z5 � THE COMMONWEALTH OF MASSACHUSETTS BOARD O�\ HEALTH TOWN OF BARNSTABLE Ap.pliration for Di-npoiittl Workri Tontitrnrtion rrrmit ?- Application is hereby made for a Permit to Construct or Repair ( ) an Individual Sewage Disposal System at: 'Nk—_ I c6- S— .....LOT I� CAPE-5 T '41-� ( Y3 !LNJ - - Location-Address or Lot No. Brit!�ti_..H_i' �' -' ------------------------------------------------ 53 M 'N ....... Owner Address a --------------------- .__�..`f' A < .--• --------------------•------------- Installer Address UType of Building Size Lot.... .3,4 371____..Sq. feet .� -- w�fiN �E Dwelling—No. of Bedrooms--- --- --_ _--_---_--_-Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons-_-----_------_----_------- Showers ( ) — Cafeteria dOther fixtures ----------------------------------------------------------- -••-•----••--•-------------.---------------------------•------•-----•-------------------- ` W Design Flow--------------r�s---_-_--_-______.___--gallons per person per day. Total daily flow...-....y.Y6.-.-.-_._._.-.._.-____--..gallons. WSeptic Tank—Liquid capacity60P...gallons Length----�L,_--_-_ Width_.G-_-------- Diameter................ Depth...y :E;T:F x Disposal Trench—No. -------- Width.....g............ Total Length.....20....... Total leaching area.62Z_&/Dsq_4+, 3 Seepage Pit No...................... Diameter-_--------_------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by._.Vi_0H_4,-.._MCL:eL_'4N P C• �5 a --••----•a-•-------•-- Date. Test Pit No. 1----1-30....minutes per inch Depth of Test Pit--------------- Depth to ground water------Aj.0 ..... Li, Test Pit No. 2.....`7--._minutes per inch Depth of Test Pit-..22_--1------ Depth to ground water----- IVUtiL'---. .......................... ----------------------•-•--....._---•-_..........--------................................... D Description of Soil#.t_._.0.-:`-- �r-- _.S96SOI I ------ S1 7` ---W. ..------ ..(.---- vv �Q1-t �� ��8� �A�v `'(.._l o,! ...................................V9 /Jn� MF� �i0�0 W 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 Environm tallCode—The undersigned further agrees not to place the system in operation until a Certificate of Compiia�nce�hasben issued tthe board of health. ...... � . Signed ... --:;-:f .�,G.�'..-.-......... ......... - .......-...-.:-...-. Dare Application Approved BY --------- ,- .. ..c =�� c'�-- -�'.-.-��. ..".. - ........................................................................... Dare Application Disapproved for the following reasons- ----------------- ----------------------------- ---------------------------------------------------.--..---- ... ..................................................................... ........ .............................. - - - .........-................. ------------------------------------ Permit No. ........7.5 --- -----1.7j-.-.7.......... Issued ---------�1�� -f<- �� - Dare ----------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate of TIImpliance THIS To CERTIFY, That the Individual Sewage Disposal System constructed ( `) or Repaired ( ) byC --------------------------------------------------------_........... - ---...y-�-�.n---------------.-.---------------....-....---------------------------------- at ......./. ) _/� _ z r�4....--'�1 W'.--�s-----------Insrau /^Q--(.......x...`" --------------------------- ----------------------------------- has been installed in accordacce with the provisions of TITLE 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No- .._.,J� ........I--7_5 7�1.- dated ------4%;�..-.../1.-_��. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........f- ...'... ... �o^±..... - .------ ---------- Inspector. --^ l� THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH qq 77� TOWN OF BARNSTABLE `� No._.(..��'...1.1...., FEE..l.................. �i�poottl ork� �on�tr�s#ion �rrmit Permission is hereby granted--------_-- ------------------------------------------------------------------------------------------•- to Construct (� or Repair ( ) an Individual Sevt>age Dis oral System at No.- �_.�' �. R �n �tn.Q 1 :-.... - r C . • ------ �J --- ---- -•-• -- : ...................................................... Strcet (��-. q 7,�-�I as shown on the application for Disposal Works Construction Permit No.--J:_/__/ ,_--_-. Dated-,......................................... /� . ' A--- ------ �ir_ • _- ------ Board of Health .......................... FORM 3630E HOBBS&WARREN-INC.,PUBLISHERS T 1 ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 . Sandwich, MA 02563 (508)888-6460 . 1-800-339-6460 FAX(508) 888-6446 CLIENT: Brian Hibbard LOCATION: Lot 19 ADDRESS: Cape's Trail W. Barnstable, M SAMPLE DATE: 9-27-95 COLLECTED BY: L. Wile & Son DATE RECEIVED: 9-27-95 TIME: N/A LAB I.D. #: E9-369 JOB TYPE: New Well SAMPLE I.D. #: E9-369 WELL SPECS. : 165' 4" PVC 10 G.P.M. RESULTS OF ANALYSIS: Parameters Units Recommended Result Limit Coliform bacteria/100ml (MF Method) 0 0 PH pH units 6.0-8.5 7.38 Conductance umhos/cm 500 438 Sodium mg/L 28.0 73.2 Nitrate-N mg/L 10.0 0.63 Iron mg/L 0.3 0.14 Manganese mg/L 0.05 0.009 Hardness mg/L as CaCO3 500 28.3 Sulfate mg/L 250 7.2 Potassium mg/L 20.0 1.4 Alkalinity mg/L 200 83.0 Chloride mg/L 250 85.0 Turbidity NTU 5.0 3.8 Color APC units 15.0 IT 1.0 Volatile Organics See attached report. EPA Method 524 ug/L None detected. COMMENTS: Sodium level is not a health hazard, but if on a low sodium diet consult physician before drinking. Yes No WATER IS SUITABLE FOR DRINKING PURPO S FOR P ETERS TESTED. XXX Date�� C� Ro ald J. ari IT = Less Than Laboratory Director LAPUCK LABORATORMS, INC. 50 Hunt Street t rrsr�w�r► ,Al,":NALY!7S Watef2own, . 02172 BAD; �: I()I,Oi;Y (617) 923-0300 WATER.t1A;:ll:'YSI3 SPECIFICATION TESTING REPORT 14AB NO. 53479 October 09 , 1.995 Mr,. Ron Saari Date Received : 1.0/02/95 ENVIROTECII LABORATORIES, ZNC, Matrix W,i n1d ng-water 449 Route 130 Detection Limit.: 0 . 5 ug/L Sandwich, MA 02563 Anal.ysi.s Date : 10/03/95 Sample I.D.- A i.bbar•d -- V_ol:.a1„i..1e=_.nxLL�aric -- EPA Metbod ..#524_-i.n nnb_.Lufi/..1j. :SIJI�' �tJr,SIII,T Benzene ND 1. , 2 Diah1oropropane ND Bromobenzene ND 1. , 3 Dichloropr.opane ND Bromochl.oromethane ND 2 , 2-Dichlor.opropa.nr NI) Bromodichl.oromethune ND 1 , 1 --Di r.hl o.roprope-ne ND Bromoform ND cis-1 , 3-Di.chl.oropr.opene ND Bromomethane ND tracts-1 , 3-D1.0h0.o:rop.ropene ND n-Butyl Benzene ND Ethyl.beri Yrlci ND Sec--Butyl. Benzene ND Pexach.l or-obut.adi c-ne ND T(,.rt:-13t,tyl. Benzene NI) Isopr-opylbenzene ND Carbon Tetrachloride ND p-Isopropyltol.mil:'lo ND Chlorobenzcne ND Methyl Chloride ND Chl.oroethane ND Naphthalene ND Chloroform ND n Pmpylbenzene NJ) Chloromethane ND Styrene ND 2-Chl.or.otol uene ND 1 , 1 , 1 , 2--tet..rsic;h.l o.r.oet.hane ND 4-Chlor.otol uene ND 1 , 1 , 2 , 2-t et:r nohl.oroethane ND 1. , 2-di.I->r. omo-3-chloropropa.ne NJ) Tetrachloroet.hene ND D,ibromomethrane NJ) Toluene ND 102-Di.chlorobenzene ND 1 , 20-Tr:ic.hlorobenzene ND 1 , 3-Dichl.orobenienr ND 1 , 2 , 4--T.ri.chlorobenzene ND 1. ,4-W oh:lorobenzene NI) 1 , 1 , 1 Tri.c:h.l o roe thane ND Dibromochlor. omt't:hane ND 1. , 1 , 2 Trich1or.oet;harle ND 1 ,2 Di.bromoethane (EDI3) ND Tri.ch.l orof luoromet harlc ND Diohlorodifl.uoromnthanc ND Tt ,ichloroethene ND 1 , 1. Dich.l.oroetht>yle NJ) 1 , 2 , 3-Triahl.oropropane ND 1 , 2 Dichl.oroet:hane (I,DC) ND 1 , 2 , 4-Tr-.,imvt.hylbenzene ND 1 , 1 Dichl..oroothylene ND 1 , 3 , 5-Tri.methylbenzene ND Lis 1 , 2 Diuhior.oethyirl^,e ND_ Vinyl Chloride ND Trans 1 , 2 Dichloror.thylene ND Total Xyl.one ND Recoverie,s--of Internal-, .Standards & Su .ragfAtes�_ 6 Fluorobenzene 97 1-1-Bromuf luorobenzene 97 1. , 2--J),i.t:h1orobenzerjn-d4 gE Consulting do Testing Services � cs I+ont:Pnnrosa, J.aho..ratory Manager for over 20 Years... Tbis report is mulared utn,a the condition that It Is not be Ito reprWmed wholly or In part for edvartising or other lwrmes over our sigtsture or in 0011nocti0n Wllh uur name without spceial pennlssitut In Writing.Total liability is limitod tct the invoiced amount.The tumults listed refer only to tasted samplem and/or applicable parameters. r ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich,MA 02563 y (508)888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Brian Hibbard LOCATION: Lot 19 ADDRESS: Cape's Trail W. Barnstable, M SAMPLE DATE: 9-27-95 COLLECTED BY: L. Wile & Son DATE RECEIVED: 9-27-95 TIME: N/A -_ _ LAB..E.D.. #:. E9-369 JOB TYPE: New Well SAMPLE I.D. #: E9-369 WELL SPECS.: 165' 4" PVC 10 G.P.M. RESULTS OF ANALYSIS: Parameters Units Recommended Result Limit Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 7.38 Conductance umhos/cm 500 438 Sodium mg/L 28.0 73.2 Nitrate-N mg/L 10.0 0.63 Iron mg/L 0.3 0.14 Manganese mg/L 0.05 0.009 Hardness mg/L as CaCO3 500 28.3 Sulfate mg/L 250 7.2 Potassium mg/L 20.0 1.4 Alkalinity mg/L 200 83.0 Chloride mg/L 250 85.0 Turbidity NTU 5.0 3.8 Color APC units 15.0 LT 1.0 COMMENTS: Sodium level is not a health hazard, but if on a low sodium diet, consult a physician before drinking. Yes No WATER IS SUITABLE FOR DRINKING PURPOSES FOR PAFhAMETERS TESTED. XXX Datel 'Ron ld J. lari LT = Less Than Laboratoryirector y.sa ,arm �. --Department of Environmental Management/Division of Water Resources I V1, S f WATER WELL COMPLETION REPORT K,63 WELL LO TION ` GEOGRAPHIC DESCRIPTION Address R R/A & /� i d*5Q120 i I(A4i 19 CAP.)' s VA A- 3o N S E W of )feet) (circle) i f City/Townh-/� &t&"_5tARikZ 1 (^ill pe 5 Well owner /Q 41kk (road) Address N S E of (mi.in tenths/ /^ (circle) Board of Health permit: yes ❑ no ❑ intersect. w/L ONT (road) WELL USE WELL DATA Domestic [Public❑ Industrial ❑ Total well depth J ft. Monitoring❑ Other Depth to bedrock Water-bearing rock/uncon lidated material: Method dri Date.drilled / i Description SAZ I-- CAS Ihirl' Water-bearing zones: TYPe 1) From To 2) From To Length ft. Dia(I.D.) in.. 3) From To i Length into bedrock., ft. Gravel pack well: dia. Protective well seal: II Screen: dia. Grout-[] OtherSl6t** � length-S—frorr>ldd tome,. PUMP TEST Static water level below land surface :740 ft. Date 9jJ Drawdown ft. after pumping Y hr. 3 r'J min.at /O gpm How measured p Recovery ft. after hr.—min. , I 0 LOG of FORMATIONS COMMENTS in Materials - Front To oU l /( / Driller O Mass. R gist/ration' :/ gp Firm l r ANf� OQ Address -d S *Pd ;r;�q 490 M City/Town Si nature of supervising re istered wet!drdler Please print firmly ROARfI`::OF ..HFAI TH `COPY.,. ,. No.-------- ---------- Fee -- -/------- BOARD OF HEALTH TOWN OF BARNSTABLE Application-*rIve1C Co 5tructionpermit Ap lication is hereby made for a permit to Construct Alter ( ), or Repair ( )an individual Well at: e ` ------C A ' - -'�� �- 1-� -- -- - -- ----- -- ------ -- Loc Lion — Address Assessors Map and Farcel �ner Address 1_ /' '! - _ -- ---------------------- -------------------------------------------------------------------—---------------------- Installer Driller Address Type of Building Dwelling----------------------------------------------------------------- Other - Type of Building -------- No. of �r Type of Well—y------4-�-L---- .- -— -— Capacity---------------------- —— — - - --— --- Purpose of Well--------------- 1;�- ---- -- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation until a Certificate .of Compliance has been issued by the Board of Health. Si ne -- - --—-- ----_ ate Application Approved By -- a -- — 1V 5 date _ Application Disapproved for the following reasons:-------------------------------------_____________—_______—_________ ----------- ------------ --- ------------------- -------------------------------- ------- --- ----- ---------------------------- date Permit No. -- �-- -----_-- Issued-------- date BOARD OF HEALTH TOWN OF BARNSTABLE C ertif irate ®f Com'iance THIS S //T.O,, CEERRTIFY, That the Indivind I Well Constructed ( ), Altered ( ), or Repaired ( ) YAl�Yns----er ----------------------------------- at-- — --- —-- J ��� Installer/' ,. ! �4t�-�--1- - -=�-���'-��------14�'� --�--------------- --- has been installed in accordance with the provisions of the Town of Barnstable BQar4i.Qfr Health Private Well Protection Regulation as described in the application for Well Construction Permit No. -Dated------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------———-- — - ----- Inspector--- - —--------------------------- ---- r .- . „..+.i�'u<::F,'iwr.+.r •c" "".`M'�rX�. .r....h.. -..,,� .n �,'3 r.�.Ti�j,' ` :�Y t .•..`i,J .,i i r r - y.��. � a• .� w�ld'e-.*�1'.,� �.sM *�'. �.�, ��; y.�;,,,��,rt..;+�y;�,—r3-.7�, k•�a,,ri `*,*'.ui �'s�t1"- .,, �6 'k No. -- �, ----- d .. . ee °� I F - 4 - -\ BOARD OF WEALTH TOWN `OF BARNS.TARLE' 1 .� ApplicationArlVell �tCon�tructioriVermit Ap hcation is hereby made for a permit to Construct Alter ( ), or*Repair ( )an individual Well at: - �-- ----CAP - fl l�- -�- -= - ---�---- -- ------- ------- Loc tion — Address Assessors Map and Parcel } l v -1A1310u — Owner Address SvK----_ —------ -----------—— —— — — —— — — i Installer Driller Address Type of Building Dwelling-------------------------------------------------------------- i Other - Type of Building —- - ------ No. of Persons-----=________________________—___—________ --- - Type of Well— f- `�- --= - - Capacity--------------------- Purpose of Well---------------voh — — — -- r c Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The t Town of Barnstable Board of Health Private Well.Protection Regulation = The undersigned further agrees not to place the well in operation until Certificate .of Compliance has been issued by the Board of Health. Signe - -- — = ------ - - dat ---- -- - e 07 `. !'r Application Approved By- - -5 � --- � - date — Application Disapproved for the following reasons:— ° --t--- -- — -- - - ___ --- --- — --- --------- h date, I I! Permit No. Issued--- -- ¢ qPJ --- — -- date BOARD OF HEALTH ! t f r TOWN OF BARNSTABLE :w Certificate Of Compliance THIS IS TO CE TIFY, That the Individual Well.Constructed ( ), Altered ( ), or Repaired ( , ) t —A- --------------�' s - - - -- Installer ��2- at- --� --- — ----�----------- -has been installed in accordance with the provisions of the Town of Barnstable B=ated vate Well Protection' ,l 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-------------------------------------------- ------------------------ BOARD OF HEALTH TOWN OF BARNSTABLE- well Co0truct ion Permit Permission hereby grante --------------------------=------------------------------- to Const uct t(� ), Alter ( ), or Repair ( ) an Individual Well at: Street as sho on the aDvficatpok for. Well Construction Permit ------- ..r - Dated--- -� -�- "� - - A- - - —- - -- --- --------- Board of Healt ` DATE— -- NO. - -- -- - ---- Fee--` =5------------- BOARD OF HEALTH TOWN OF BARNSTABLE ApplirationforlVerr Con6trurtionpermit A plicatiodtis`hereby made for a pe it to Construct ( ), Alter ( ), or Repair ( )an individual Well at: fi_ -- ,� --- � ---------------------------------- ocat on — ddress Assessors Map and Parcel — --- -- -- --------------------------------------------------------------------------------------- Owner Address —--------------------------------— _—_ -------- ----------------- Installer — Driller Address Type of Building Dwelling------------------------------------------------------- Other - Type of Building-------------------------------- -- No. of Persons----------1 1----------------------------------------- Type of Well-41g -- i�-d -------------------- Capacity---------- - Purpose of Well--—-- -------------— - Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unt' a Certificate of Compliance has been issued by the Board of Health. Signe — - — —-- _ _ _ ----- date A lication Approved B date Application Disapproved for the following reasons:----------------__—__________________—__________--_ ___�______________ ------------------------- -- date . .I Permit No.-- -- - ------- ---- Issued--------------___—_ ---_-- —� — - -- date `BOARD OF HEALTH TOWN OF BARNSTABLE Certifirate ®f �omriante THIS IS T CE TIFY, That the Individual Well Constructed (� Altered ( ), or Repaired ( ) c`�''----------------------------------------------------------------------------------------- ----- - - -- b a- - Z Y Insta t9 r - - at -- --- --`�'�— -- ------ --- - - ------- has been installed in accordance with the provisions of the Town of Barnstable Boa d Health rivate Well Protection Regulation as described in the application for Well Construction Permit No. r--- - `-Dated-------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE - --- ----- --- -- Inspector— -- - - --- —— - - -- --- - J1 No.---- ------= - ---- .w. Fee- BOARD OF HEALTH TOWN OF BARNSTABLE AppritationibrIvell Construction'vermit Applicatiodisthereby made for a permit to Construct ( ), Alter ( ), or Repair ( )an individual Well at: - '- �� ------------------------------------------------------------------------------------------ ocation — ' ddress Assessors Map and Parcel �7- I�61 Rl�� n✓7 - -- I 1-------------------- --------------------------------------------------------------------------------------------------- Owner Address --------------------------------------------------------- Installer — Driller Address Type of Building Dwelling------------------------------------------------------------------- Other - Type of Building- - --- -- -- No. of Persons------------------------------------------------------- `- /r Typeof Well��M ----------Y-----gPk- - Capacity----------------------------------------------------------------------------------- Purposeof Well----------------------------------------------------------- Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation unt' a Certificate of Compliance has been issued by the Board of Health. C/LttiCJ ------------------------------------- Sign d-- ------------------------------------------------------------------------- date Application Approved B ��r"�_ IN` -- - - -------------- ------------------ PP PP Y- -- -- date Application Disapproved for the following reasons:--------------------------------------------------------------------------------------------------------------- ---------------------------------------- ----- ---------------------------------------------------------------------------------------------------------------------------------------- date PermitNo.--� �g- - - -- -------------- — Issued------------------------------------------------------------------------------- date �— �— BOARD OF HEALTH TOWN OF BARNSTABLE Certificate Of Compliance THIS IS T VCETIFY, That the Individual Well Constructed (V), Altered ( ), or Repairedby---- --)E- --- ------------------------------------------------------------------------ Inst 1'er 1 p /► at !gill--- - - ----=------------------------- ----------------------------------------------------------- hasbeen installed in accordance with the provisions of the Town of Barnstable Boa,dclf Healt ,Private Well Protection G1Regulation as described in the application for Well Construction Permit No. -- ---Dated---------------------------- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE------------------------------------------------------------------------------------ Inspector----------------------------------------------------------------------------------- BOARD OF HEALTH TOWN OF BARNSTABLE 1 Vell Con!5truction joermit PermissionIs hereby grante,----'_4,,----------- ----------------------------------------------------------------------------------------------------- to Construct (Alter ( ), or Repa�i ) any Individual Well a(,: No. ------------------ - �0= -�__C _Pg�� ----------(, ^AV-------------------------------------------------------------------------- Street as shown onghey plicationrfor a Well Construction Permit J1 ! � `�7 '--------------- D eed- --------------------- --- 7 hy " ------------- !� No.- — - -- - ::- a Board of Health, DATE------------------------------------------------------------------------------------- — — ..� ii%. . _ - . . . * . r . - . ` % . __ _ . .... - .. _ _ _ .- -,. ..ffi* :�...,,.', - - - �\,N0M ., -.. .. r., ..:.... . r. , :,;-.� -..I� .....,.-..- � 9 .... ..:. _..:. - _ -.... ..... .... ... i ,:.-. , _� . : ....r_._.:... - _ .. ,, _ —. 1. ., ..- , - .. - a r.. .. - .r - - — _ -- S. . ..,.. . ,cl.. .. ._. . . _. 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O ...._.- .._..... r. - .. .. . i. , ..:::.K. .. r. % _ .. ., :. 1. : aiy: 6 _.— ' I .. - .L ,,'-- .,..,.��,i� - --L . ..L L 'r . -.r-, , U.L-r NLD_I. EYER: ..a ...„ .. , .,, ... .... . .....' .. .. .. .. . .. :L:; - -:::... �. Qq , ,.2 . _ :., ........ 1., .. ....: .. - _ - ion B _: .. :: ..... , ,. -, -... .. :. :: k r. _ L. Pro es a uitdm �D s 5 ¢ i e1 S Su _ _.x - y,, APOn Bo 53 ` "::.. Yarmouth'MA-02Gli4 .. .r _. .. .. ,.... :.: .,. .. .._ .- - .wf _. t. .. -... .._...... Q rW. .... _. _.. _ _.-.:_ ... ..... .. ........ .-., .. ... .._ .... ... ... .. _ ... .. ..+-- .... .... - ri ..:.: ...a, ,. ._ ._ .. - .. ..-. ... ... :-.-. , . .. ,W Y394;5296 _, ,. <- : 1-- __ < , :'. . . , - - ^_ Of z R Ant.g ! l , i III 1 � �✓t+!l' (»��� �� ��' r, i � ,y y`.� -N I E. 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YarmOouth:S' 32 6 So- Two PRA I 2664 5 39 i _ 1 7=-- Ol10 t , OL ol �j ,1Q j ` " 461 M 14 Lill of a 10 ---- : �1 ") 711 I � - M 00 D -__ pr; CO 44) � k 0 ti09 c r a p_ r — 3 I s A,S7 - /17 1,41 1 N ASSESSORS MAP: 88 _ PARCEL: NOT ASSIGNED CURRENT ZONING: RF PROPOSED TEMPORARY BUILDING SETBACKS: TURN-AROUND c F: 34Y S: 15, R: 15' US ��sr. FLOOD ZONE: C EDGE OF DIRT ROAD (AS SHOWN ON FLOOD MAPTH-1 PANEL # 250001 0015 C _ _ - - 99 A & 0 HORIZON REVISED 8-19-85) too _ lot - - 100. 2 B HORIZON LOAMY SAND PROPOSED WELL 103 - - / 2.5Y 618 104.0 LOCATION MAP (155' TO PROPOSED — LOT 19 AREA LEACHING ARIA) ��� ► l l � Cl HORIZON � SILT LOAM 43,639 f S.F. 103 I I I r f ��� 2.5Y 614 kPEI 102 (1.0 f A.C.) I . 1 I I I ?'� s (BANDS OF SAND) & LOAMY SAND) 101 120" 96.0 $$N t ► I 104 �,pI,I O E H��g A ►► 1 I I i ` ` ` \ `\` 12: 99. 8 100 N 1 pIS �H I14G r ► 1 106 �� yi � � foo. o 15GpL lot , � �` 102, � � i I ` _ - - - - - _ i i f `• _� 103104 . 106. - 07 108\ T109 H-2to Ito 5_ 103 � •�\ � mac'' �� `.� �g� � � i los T /5 ,` 1 R&S T �_100' 1 1 102 103 104 105 106 107 E.109 5� 1 108 I ► I 10 / I BENCHMARK AT WOODEN STAKE BENCHMARK AT 9�Ite 4( / ELEV.= 1112 - L CONC. BOUND `b 10 , KEY: ELRV= 107.4 / EXISTING CONTOUR: 109 PROPOSED CONTOUR: ••... •'..''''..''•''''' EXISTING SPOT ELEVATION: 25.5 11 ',- - - - - - - f f o PROPOSED SPOT ELEVATION: 25 TEST HOLE: * fit UTILITY POLE: --- CMAREST-McLELLAN ENGINEERING FENCE LINE: SCHOOL STREET P.O. BOX 463 \ HYDRANT: -6 KST DENNIS, MASSACHUSETTS 02670 RETAINING WALL: T R Ti'F'• f'1 - S MAP: 88 N ASSESSOR TEST HOLE LOGS NOTES: PARCEL: NOT ASSIGNED (P#: 8534 & 8551) 1. VERTICAL DATUM: ASSUMED FROM QUAD (NGVD +\-) ENGINEER: THOMAS McLELLAN P.E. 2. MUNICAPAL WATER IS NOT AVAILABLE. CURRENT ZONING: RF PROPOSED TEMPORARY 3.SCHEDULE 40 - 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. BUILDING SETBACKS: TURN-AROUND WITNESS. EDWARD BARRY 4. ALL PRECAST:UNITS TO CONFORM WITH AASHTD H-10 & H-20 F: 30' S. 15 15 R: DATE: 7-20-95 / 8-10-95 / 8-29-95 LOADING SPECIFICATIONS. CED LOCUS .�e-S _ PERCOLATION RATE: < 2. 4, & > 30 MIN/IN 5.PIPE PITCH = 114" PER FOOT, (UNLESS NOTED OTHERWISE). C EDGE OF DIRT ROAD t�._.. .,.,,. 6. FIRST 2' OF PIPE OUT OF D-BOX TO BE SET LEVEL 4 FLOOD ZONE. ` TH-2 TH-6 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE (AS SHOWN ON FLOOD MAP TH-1 105.0 105.0 USE OF A GARBAGE DISPOSAL. v PANEL # 250001 0015 C A & 0 HORIZON FLEV A &0 HORIZON ELEV A & 0 HORIZON ELEV 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE REVISED 8-19-85 100 _ - 99 '1" 7" 12" STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL > lot- - f 00. 2 B HORIZON B HORIZON B HORIZON HEALTH REGULATIONS. , LOAMY SAND SANDY LOAM LOAMY SAND �.w. .- ��'- 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR PROPOSED WELL 103 - J 2.5Y 6/8 f04.0 25" 2.5Y 6/6 103S 36", 2.5Y 6/8 102.0 TO CONSTRUCTION. LOCATION MAP (155' To PROPOSED J LEACHING AREA) � - J J J C1 HORIZON C1 HORIZON C1 HORIZON 10. D-BOX TO BE HATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. LOT 19 AREA , C MED-FINE SAND SANDY LOAM SILT LOAM 11. PROPOSED WELL AND SEPTIC SYSTEM LOCATIONS ARE IN ACCORDANCE 43,639 ± S.F. , 1 fit 1 �A 2.5Y 6/4 PERC 66" 2.5Y 7 4 99.5 108' 2.5Y 7/3 96.0 WITH MASTER PLAN, PREPARED BY DOWN CAPE ENGINEERING. 1.0 A.C. 103 L� F- C2 HORIZON PERC ( } f02 . , _, I I s (BANDS OF SAND) (> 30) •< - J 1 1 ! j FINELOAMY SAND 4 INIIN) C2 HORIZON ► / 1 t ` ♦ ` \ & LOAMY SAND) 76" 2.5Y / ( M MEDIUM SAND 101 l J r i C3 HORIZON 98.7 2.5Y 7/3 PERC J r 120" 96.0 F..- 1 1 t ' , ` ♦ c�'6; 120" 1 SILT LOAM 95.0 z8" (< 2 MIN/IN) g8N r J t 104 r ► � � ` � z c� a A J r 1 r r ` \ ` ♦ \ � 12; 99. 8 t NO GROUNDWATER ENCOUNTERED AT ANY TEST,HOLE 86.0 DI$T IN6 i r t i f06- ♦` - - 100 TH-4: LOAMY SAND TO A DEPTH OF IT 1J CH J ♦ ♦ - - 100. 0 �1 LEA J ♦ ♦ ♦ _ _ _ TH-5: SILTY CLAY LOAM TO 12' Ej,1, '102, ♦ , / _ 103 i i / ♦ _ 105104` �>k SEPTIC SYSTEM .DESIGN \ _ - bo76' � , FLOW ESTIMATE: (3 BEDROOMS WITH DEN) 108 4 BEDROOMS AT 110 GAL/DAY/BEDROOM 440 GAL/DAY zz 109 ` TH-2 �`s� ♦ ', , , SEPTIC TANK: DECK _ _ 4' 40 GAL/DAY x 2 DAYS = .$$Q GAL 102 USE 1500 GALLON SEPTIC TANK PROPOSED ,r '�D,e , 4 BEDROOM r T �i�,Q`r�"d • : � LEACHING AREA: DWELLING 30' 1103 _ USE 4 LEACHING GALLEYS WITH 2' OF STONE TH-3► TH-1 Off, -lO�, , , 36' t �'� :'O ALL AROUND -(20' x 8' x 3.3 DEEP) 20 AREA: SIDE PROPOSED DWELLING ' \ , ` / ' � � ` �:.: .•' .: � � + 82x3.3 = 185 (2.5} � ► � -. / ♦ . • ( � = 462 GAL/DAY BOTTOM .A]�EA:_20' a• 8'_ =.16Q SF _ (1,0) = _1S0_ GAL/DAY t ► 1 , , - _ ?�", ` \ . ♦ ; \ 1 = 622 GAL ► , ► , � ^ , �. .•,. .,. .. f o3 TOTAL CAPACITYDAY/ - SEPTIC SYSTEM SECT ION ► - CO N Tl-�5 1 ► 6' ♦ ♦ f 05 _ - ' �d ♦ --lot- - COVERS WITHIN`12" OF 106.0 1 �� ` : ♦ ` ` ` � - - - - t ` L 1Oz FINISHED GRADE 2" PEASTONE '� ♦ I ` . . _ _ - OF34" - 1 2 '1 ". , \ ` ` � ` ♦ ` � - - - - - - - - � ` `• . ` 1os � TOP OF FOUNDATION 2' / / ♦ ` - _ - WASHED STONE ► 1 ` ♦ ` - - - - - - 0'` ` ` -104 ELEV = 95.7 1 I ♦ ♦ g0 � . 1 l . ♦ - ♦ 10 102.66 ELEV. D-BOX ,t, ► ♦ - _ _ _ - _ \ 150)0 GAL 101.98 4 91.7 c�� I I ♦ \ ♦ ♦ ELEV. SEPTIC TANK 102.15 (6" OF ELEV. �-� ELEV. ; �' I , ' ♦ 107 p : ELEV. STONE 21 20' $ 1103.0 TEE SIZES. E --- - I � � � ♦ \ p 9 r UNDER) 10s !►� ,IpZ E1,EV. INLET 6"' UP, 13" DOWN 4 LEACHING GALLEYS 4' x 4' x 3.3' WITH ` 10a pl $ll' OUTLET: 6" UP, 14" DOWN 95.0 ( ) \ �Z� ��( ELEV. 2' OF STONE (20' x 8' x 3.3' DEEP) \ ti5d 4ps$ (H-20) _ - p .• _ I I I ` _ _ _ _ Yg I I I 1 k ► BENCHMARK AT .� \ WOODEN STAKE SITE AND SEWAGE PLAN BENCHMARK AT l�,t�, ELEV= 1112 APPROVED BY: DATE: CONC. BOUND 10 KEY: ELEV.= 107.4 EXISTING CONTOUR: LOCATION CLOT' ........................:..... TRAIL PROPOSED o LET 19 CAPES TR I 109 EXISTING SPOT ELEVATION. 25.5 WEST BARNST ABLE, MA 1 110 PROPOSED SPOT ELEVATION. 25 TEST HOLE: E 3' �'. , �{ ,., PREPARED FOR- UTILITY POLE: -0- FENCE LINE: BARD DEMAREST--McLELLAN ENGINEERING BRI AN HI B 24 SCHOOL STREET P.O. BOX 463 HYDRANT: -� �"r: a ., :; H z�►'Y` �. !fir l t � �,� �--•�---.__�- -•- SCALE: 1" _ 30' DATE: 7 26-95 WEST DENNIS, MASSACHUSETTS 02670 RETAINING WALL: S, REV: 8-30-95 :4 TREE: REFERENCE: LAND COURT CASE 40599B 076 Df4Fs DM # 95- ( ) THOMAS McLELLAN, P.E. JGHN Z. DEMAREST JR., P.L.S. i i N ASSESSORS 'MAP. - 88 .PARCEL: NOT ASSIGNED _ TEST HOLE LOGS NOTES: P : 8534 & 8551 ( # ) 1. VERTICAL DATUM: ASSUMEb FROM QUAD (NGVD +L) P RF ENGINEER. THOMAS McLELL:AN, P.E. 2.`MUNICA AL WATER�S OTVAILABLE.. N A CURRENT ZONING. PROPOSED TEMPORARY S. SCHEDULE 40 -4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. BUILDING SETBACKS: TURN-AROUND WITNESS: EDWARD BARRY 4. ALL PRECAST UNITS TO CONFORM WITH AA.S'HTO H-fO & H-20 DATE: 7--20-95 8-10-95 8-29-95 � F. 30' S. 15, R. �5 � � LOADING SPECIFICATIONS. LOCUS ED' S'T PERCOLATION RATE: < 2 4 & > 30 MIN IN 5. PIPE.PITCH 1 4" PER FOOT UNLESS NOTED OTHERWISE). EDGE of DIRT ROAD FLOOD ZONE: C n 6. FIRST 2' OF PIPE OUT OF D-BOX'TO BE SET LEVEL. 4 TH-1 TH-2 TH-6 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE (AS SHOWN ON FLOOD MAP 105.0 105D USE OF A GARBAGE DISPOSAL. 250001 0015 C. � 8. L CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE kr PANEL.# - - - - 99 4„ A d• 0 HORIZON -, ELEV, A dt 0 HORIZON ELEV 12„ A & O HORIZON ELEV AL ST V REVISED 8-19-85) 10o _ STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL �'r o - f 00. 2 B HORIZON B HORIZON Ate, t� lot- - -. B HORIZON S HEALTH.REGULATIONS. LOAMY SAND LOAMY SAND AND' LO'� 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR PROPOSED WILL 103 - - ! 2.5Y 618 25" 2.5Y 616 103.9 36" 2,5Y 618 102.0 TO CONSTRUCTION. LOCATION MAP (155' TO PROPOSED _ 04.0 ' ! Cl HORIZON Cl HORIZON 10. D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. LOT 19 AREA LEACHING AREA) ClC1 HORIZON C YED-FINE SAND SANDY LOAM SILT LOAM � 11. PROPOSED WELL AND SEPTIC SYSTEM LOCATIONS ARE IN ACCORDANCE 4(1.0 t S.F. , ► ► 1 �A ,2.5Y 614 P�ERc 66 C22_5 7 4 99 5 108' 2 5Y T s 9s o WITH MASTER PLAN, PREPARED BY DOWN'CAPE ENGINEERING. (1.0 f A.C.) 102 03 , I ► ?' �S BANDS OF SAND > 30 C2 HORIZON I'E RC i ' %►� \ �Q �g LOAMY SAND)) ( ) FINE LOAMY SAND (4 MIN/IN) C2 HORIZON ! , ► . ` f� 7,5- 2.5Y 613 MEDIUM SAND lotr t 98.7 2.5Y 7/3 PERC ! ► � � � 120" 96.0 $EN C3 HORIZON mo 120- SILT LOAM 95.0 (t 2 MIN/IN) � 6' 228"! ► ► 104 ! ! . � \ 1 pI c% B p , ! 1 ► ! ` `\\ \ 12; 99. 8 NO GROUNDWATER ENCOUNTERED,AT ANY TEST HOLE 86.0 STAI't IpG i ! i i fOs� `� ; 100 TH-4: LOAMY SAND TO A DEPTH OF 1T 15 D Ac 101 l ` � - - - - =_ TH-S: SILTY CLAY LOAM TO 12' - - - - _ _ i 103 _� DESIGN 104\ • \ �k _ SEPTIC SYSTEM 105 _ 1 G;'. 0 ) %07, , , ` _ FLOW ESTIMATE. (3 BEDROOMS WITH DEN - 1os w BEDROOMS AT '110 GAL/DAY/BEDROOM 440 GAL/DAY 22• 1os , , TH 1 s . 1$ / - , / SEPTIC TANK: •.•-2 j_•._ - - .-•• � .� / DECK 74' - 8 / � 440 GAL/DAY x 2 DAYS = 880 GAL Ito h 105 0 / C TANK D SEPTIC N 1 oz CALL ON / USE 9 U 0 S D/ OPO E ` _ 9C r ► \ 4'' PR x 'pO,o / / / 4 BEDROOM \ ► ► � ��n��s�� \ ` J LEACHING AREA: DWELLING so' 1103 USE 4 LEACHING GALLEYS WITH 2' OF STONE TH TH-3 / -1 die 36 ► / , ALL AROUND (29 x 8' x 3.3' DEEPS oe , ' \ : PROPOSED DWELLING \ •: .� ` SIDE AREA. (20 + 8)2 x 3.3 = 185 (2.5) 462 GAL/DAY / s . 111z BOTTOM-AREA. 20' x 8 -- 160 SF- (1.0) 16,0 GAL/DAY r / / , - '` \• : �:` ' \ ` TOTAL CAPACITY= 622 GAL DAY TH-4 T t,/5 /\ t , \ 's �ti� \ `1 oo_ 1 SEPTIC SYS TEM SECTION \ \ �1cd ♦ ` � t t 105, \ \ ` ` \ -1Of 102 COVERS WITHIN 12" of _ _ - \ \ 106.0 FINISHED GRADE 2" PEASTONE . \ , TOP OF FOUNDATION 2 OF 3/4' - 1 1/2" ` _ _ WASHED STONE` _ _ - - - - - ELEV � 95.7 _ p0 � -104 4 o c o0 \ „ 102.41 0 1 0s ELEV. 102.66 1500 GAL D-BOX 101.98 4' 91.7 ELEV. - - - - \ SEPTIC TANK 102.15 (6" �I' ELEV. H ELEV. �� r I - - \ \ \ 107 ELEV. STONE 2 Sp 103.0 TEE SIZES: s UNDER) 20' ELEV. INLET: i6" UP, 13" DOWN 95.0 , 109 91,`'S ,, 4 LEACHING GALLEYS (4 x 4 x 3.3') WITH \ / fos 1�. �� OUTLET: 6" UP, 14 DOWN ELEV. 2' OF STONE (20' x 8' x 30 DEEP) H-20 ( ) - - - off. ► BENCHMARK AT SITE AND SEWAGE PLAN WOODEN STAKE ' BENCHMARK AT ��, �/ ELEV.- mz APPROVED BY: DATE: CONC. BOUND 0 10 KEY: ELEV.- 107.4 / EXISTING CONTOUR: LOCATION.' OSED CONTOUR: ........ .... . .� CAPES TRAIL PROP - f � LOT 19 A 109 .,. EXISTING SPOT ELEVATION: 25.5 - - - - 110 SPOT ELEVATION: 25 _ - ;; r �.`, ,E', PROPOSED P E [� WEST BARNSTABL MA � r. � t ^. r r f i TEST H 1 • - ttt PREPARED FOR: UTILITY P -0- �- ,�� � ._..:�,•, � -: --f . c�-;: FENCE LINE. : .. BRIAN HIBBARD DEMAREST-MCLELLAN ENGINEERING - �l: -�- � � �v. `�� _ ;.� • w . � 24 SCHOOL STREET P,O. BOX 463 HYDRANT SCALE: 1n 30' DATE: 7 26-95 WEST DENNIS, MASSACHUSETTS 02670 RETAINING WALL: ® , } REFERENCE:. LAND COURT .CASE 40599E REV: 8-30-95 TREE: [THOMAS McLELLAN, P.E. JOHN Z. DEMAREST JR., P.L.S.